2549. Variance Between Clinicians and Guidelines in Management of HIV/HCV Coinfection

Abstract

BackgroundClinicians often encounter patients requiring simultaneous treatment for both HIV and HCV. Although several resources help clinicians identify potential drug interactions, these resources do not account for other factors that should be considered when selecting HIV and HCV regimens, such as renal function, HLA-B*5701 status, and HCV genotype. We developed an online decision support tool based on HIV and HCV guideline recommendations. We report data comparing guideline recommendations with the initial treatment plans of clinicians using the tool.MethodsIn May 2018, American Association for the Study of Liver Diseases (AASLD)/IDSA and DHHS treatment recommendations were applied to 304 unique HIV/HCV coinfection case scenarios based on a simplified set of patient variables: current ART/HCV therapy, HIV and HCV genotypes, liver histology, renal function, HLA-B*5701 status. We then developed an online decision support tool that enables clinicians to specify a patient scenario using these variables. After clinicians select their currently intended HIV and HCV treatment from among the guideline-recommended first-line options, guideline recommendations for that specific patient case are shown, and clinicians are asked if this information changed their treatment plan.ResultsFrom August 2018 to March 2019, 505 participants (n = 303 ID/HIV, n = 68 hepatology/GI, n = 58 IM/FP/GP/addiction, n = 76 other; n = 229 North America, n = 118 Europe) entered 694 patient case scenarios in the HIV/HCV coinfection tool. In 36% of patient case scenarios (248/694), clinicians were unsure or were planning a treatment not recommended by guidelines. All treatment choices that were inconsistent with guidelines are shown in the table. Not all clinicians self-identified the impact of the tool, but in the subset of 174 patient case scenarios where they did, 47 identified their initial treatment plan as different from the guidelines. Of these, 32% (15/47) changed their treatment plan based on the recommendations, 40% (19/47) had barriers to implementing the recommendations, 23% (11/47) were still undecided, 4% (2/47) disagreed with the recommendations.ConclusionThis online treatment decision support tool shows substantial variability between clinicians’ treatment plans and HIV and HCV treatment guidelines for 36% of case scenarios. Disclosures All authors: No reported disclosures.