Can we trust the guidelines? Comparison between the data presented and the recommendations of the International Antiviral Society-USA Panel

INTRODUCTION: Clinicians often do not have the time and possibilities to read all scientific evidence necessary to maintain high quality patient care. They rely on guidelines made by experts to help them in their daily work. METHODS: We compared the 2012 recommendations and the arguments of the IAS-USA Panel with the data referenced and presented with the original data of the studies. Special topic was the timing of antiretroviral therapy. Only studies included in the guideline text were analyzed. RESULTS: There is a large discrepancy between the data and the recommendations concerning early antiviral therapy. The studies are either not designed to answer this question or the data is not sufficient to support the arguments. The authors highlight benefits without mention of side effects or other problems. Neither in transmission rates, nor mortality, AIDS events, co-morbidities (hepatitis B and C excluded) or decreasing the risk of malignancy, the data presented support early therapy. CONCLUSIONS: A large discrepancy between the underlining data and the recommendation made by the IAS-USA Panel exists concerning early antiviral therapy.