PRACTICE GUIDELINES

More than 75% of practice guidelines issued by the Agency for Healthcare Research and Quality (AHRQ; formerly the Agency for Health Care Policy and Research) that are still in use are outdated, according to an article in the September 26, 2001, issue of JAMA. In general, most guidelines should be updated roughly every 3 years, concluded the authors, led by Paul G. Shekelle, MD, PhD, of the RAND Health Division, Santa Monica, CA.

At the request of AHRQ and with its assistance, Dr. Shekelle's team assessed the validity of 17 AHRQ practice guidelines developed between 1990 and 1996 on a variety of topics. They surveyed the people who developed the guidelines and searched the literature for new information on the topics. Of the 17 guidelines, 7 required a major update based on new evidence and expert judgement. Six of the documents needed a minor update, 3 were thought to still be valid, and no conclusion could be drawn for 1.

Survival analysis indicated that about half the guidelines were outdated in 5.8 years (95% confidence interval [CI], 5.0-6.6 years). The point at which no more than 90% of the guidelines were still valid was 3.6 years (95% CI, 2.6-4.6 years). The authors concluded that guidelines should be reassessed for validity every 3 years; however, the number of years may need to be adjusted up or down, depending on a priori expectation of how quickly a field is advancing.

SKIN ABNORMALITIES AND HIV

Skin abnormalities are common among women who are infected with HIV and are more common among women with advanced disease, characterized by fewer CD4 cells or a higher viral load, according to a study published in the May 2001 Journal of the American Academy of Dermatology. The researchers analyzed baseline data from the Women's Interagency HIV Study, a prospective study of the natural history of women in the U.S. who are infected with HIV or at risk for infection. A total of 2,018 HIV-infected women and 557 uninfected women were included in the analysis. HIV-infected women were more likely to report skin abnormalities than uninfected women (63% vs 44%) and were more likely to be diagnosed with more than 2 skin problems (6% vs 2%). Folliculitis, seborrheic dermatitis, herpes zoster, and onychomycosis were more common among HIV-infected women.

HIV-infected women who had CD4 counts less than 50 or high viral loads (100,000 to 499,999 and greater than 499,999 copies of virus per ml of blood) were nearly twice or were twice as likely to have skin abnormalities (odds ratio 1.68, 1.77, and 2.15, respectively). Other predictors of skin abnormalities included black race (odds ratio 1.38) and injection drug use (odds ratio 2.74).