WHO Cochrane Project: Systematic Reviews for GRADE Profiles for HIV Infected Children

Investigator: George Rutherford, MD
Sponsor: World Health Organization (WHO)

Location(s): United States


In early 2009, the World Health Organization (WHO) commissioned GRADE Evidence Profiles from the Cochrane HIV/AIDS Group as the evidence base for updating two WHO guidelines: one on antiretroviral therapy for HIV infection in adults and adolescents, and the other on antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. These two WHO guidelines have now been published, with GRADE Evidence Profiles included from 11 Cochrane Reviews.

The WHO guidance on antiretroviral therapy for HIV infection in adults and adolescents was previously updated in 2006, but with new evidence emerging on when to initiate antiretroviral therapy, optimal antiretroviral therapy regimens, management of HIV co-infection, and management of antiretroviral therapy failure, a new update was needed. Similarly in the field of mother-to-child transmission of HIV, since the last update of the guidelines in 2006, new evidence had become available on antiretroviral drugs for treating pregnant and breastfeeding women, the optimal time to initiate antiretroviral therapy, and safe feeding practices for HIV-exposed infants.

The WHO requested ‘rapid advice’ from the Cochrane HIV/AIDS Group, and in accordance with the WHO Handbook for Guideline Development, required Evidence Profiles using the GRADE approach.3 The process required extensive communication between the Cochrane HIV/AIDS Group and WHO, and involved formulation of clinical questions and agreement on outcomes. Author teams were assembled to address these clinical questions, and in March 2009 work began on the 10 new systematic reviews and one update for both sets of guidelines. By September 2009 the Cochrane HIV/AIDS Group presented WHO with the findings from the systematic reviews and the GRADE Evidence Profiles. Following consensus meetings at WHO, involving experts and stakeholders from around the world, and with presentations from the Cochrane HIV/AIDS Group, the WHO released its ‘rapid advice’ preliminary guidance in November 2009. Final versions of the two new guidelines were published in July 2010.