Beyond Italian guidelines in the management of HIV-positive patient

Although AIDS/HIV infection and related deaths have significantly decreased in Italy in recent years, new problems have made it more challenging to manage the disease. To overcome the new hurdles, the Italian National Plan of Interventions against HIV and AIDS was recently issued by the National Health Authorities, and the Italian Guidelines (GL) for diagnosis, therapy and management of HIV-1 infection were subsequently drafted by the Italian Society of Infectious and Tropical Diseases (SIMIT). Although the GLs provide clear recommendations, they are open to personal interpretation depending on the experience and/or background of individual healthcare professionals. To minimize the interpretative variability, eight residential meetings were organized in Italy in 2019 to promote a multidisciplinary approach and discuss specific HIV-associated conditions, such as cardiovascular or neuro-psychological comorbidities, advanced stage of infection, and high CD4 cell counts. To undertake this educational program, the GLs were simplified into key steps by creating ad hoc decisional algorithms, and an innovative multimedia technology was used during the meetings to collect and summarize individual opinions up to the final statements. For HIV patients with cardiovascular diseases, "CV risk factor identification" and "change of patients' lifestyle" were the most commonly shared approaches by all healthcare professionals, regardless of individual attitudes. Among HIV individuals with neurocognitive and psychological comorbidities, "more neurocognitive tests", "better customization of antiretroviral therapy (ART)", and "assessment of psychological symptoms" were the most frequently identified options to carry out. Advanced HIV infection and low CD4 cell count being a particularly serious condition burdened by high mortality, almost all specialists oriented their opinion toward a prompt and scrupulous clinical evaluation to be performed just before and immediately after the start of ART. Finally, the most pursued recommendations in patients with acute HIV infection and high CD4 cell count were the achievement of a "prompt diagnosis" and "start of well-shaped ART", as the most appropriate means to keep the viral load as low as possible. Undoubtedly, despite negligible discrepancies in individual interpretation among specialists, this nationwide educational program was able to capture local differences, but to guarantee at the same time a constant alignment of individual specialists towards the Italian clinical practice GLs. Different priorities in the daily management of the four HIV-1 subpopulations highlighted during the meetings reflect the presence of different regional health policies nationwide, in turn generating different healthcare offers. This program offered state-of-the-art management of four widely represented subpopulations of HIV-1 patients.