HIV Primary Care
Key Points
Key Points
HIV-infected persons should be managed and monitored for all relevant age- and sex-specific health problems.
Figure 1. Primary Care Management of HIV
Figure 2. HIV Testing Algorithm
Diagnosis and Assessment
...is and Assessment...
...Initial Assessment—History—Presen...
...able 2. Initial Assessment—Review of Systems a...
...mprehensive present and past medical history, phy...
...IV Disease Tests: Serological Assays for...
...s who have no documentation of their HI...
...Counts and Percentage...
...ell count with percentage should be...
...the CD8 cell count and the ratio of CD4 c...
...a HIV RNA Levels
A quantitative HIV RNA (viral load) level should b...
...V Resistance Testi...
...ecause drug-resistant virus can be transmitted f...
...f therapy is deferred, repeat testing at the...
...esistance testing is also indicated for pa...
...ling to respond to integrase strand transfer inhi...
...ceptor Tropism Assay...
...ng should be performed if the use of a CC...
...aboratory Tes...
...te Blood Cell Count and Chemistry Pa...
...ete blood cell count with differen...
...e-6-Phosphate Dehydrogena...
...for glucose-6-phosphate dehydrogenase (G6PD) de...
...sting Lipid Profil...
...use many antiretroviral drugs, HIV infec...
...5701 Screening...
...ting should be performed before initiating a...
...ts who are positive for the HLA B*5701...
Urinalysis and Calculated Creatinine Cleara...
...eline urinalysis should be performed a...
...alculated creatinine clearance assay should also...
...nfection and Comorbidity Laborat...
...ulosis Screening...
...itiation of care, HIV-infected patients without a...
...h positive test results should be treated...
...testing is recommended in patients with...
...patients who are close contacts of persons with...
...Testing for Toxoplasma gondii...
...HIV-infected patients should be tested...
Toxoplasma-seronegative adults, repr...
...itis Screening and Vaccination Recommendations...
...patients should be screened for evidence of h...
...re susceptible to infection should...
...hould be repeated 1-2 months after the th...
...uld be recommended for nonimmune sexual partn...
...nts who are negative for HBsAg and HBsAb but...
...ted patients should be screened fo...
...A testing should be ordered on all those...
...HCV-infected women should be tested for...
...ination is recommended for all susceptible men...
...itis A vaccination is recommended for al...
...A vaccine may be considered for all ot...
...reening and Vaccination Recommendations for...
...s at lower risk of cytomegalovirus (CMV) inf...
...ho are susceptible to varicella zoster virus (VZ...
...mary vaccination may be considered in HIV-infected...
...nd in HIV-infected children ages 1-8 years with...
...ening for Syphilis...
...s should be screened for syphilis upon...
...ture should always be performed for patients...
...ure should be performed in patients who ex...
...for Other Sexually Transmitted Diseases...
...ld be screened for trichomoniasis, and all wome...
...omen should be screened for gonorrhea...
...n 3 months is indicated in men and...
...ents should be screened for all of these conditi...
...Cancer Screening and Preventio...
...ected women should have a cervical P...
...pical squamous cells (both ASC-US [atypica...
...for Anal Human Papillomavirus...
...ected men and women with human papillomavirus...
...vaccination is recommended for all females...
...m Testosterone L...
Morning serum testosterone level test...
...ning testosterone levels in women in...
Other Laboratory Tests
...esting for cryptococcal infection with seru...
...est Radiology
...ine chest radiograph should be obta...
Patient Management
...atient Management...
...Routine Health Care Maintenance in the HIV-...
...ne Immunizations for HIV-Infected Adults...
Behavioral Intervention
...vioral Intervent...
...neral messages regarding risk reduction...
...sages are critical for patients who rep...
Schedule of Care Evaluation for HIV-Infected Patients
...chedule of Care Evaluation for HIV-Infected Patien...
...dults...
...oad is generally monitored every 3-4 months...
CD4 cell counts should be monitored both...
...cell counts should generally be monitored ev...
...and tuberculosis screening tests should...
...tions for pneumococcal infection, (SR, H)21881...
...luenza, (SR, H)21881...
...ella, (SR, M)21881...
...atitis A (SR, H)218...
...d B (SR, H)218...
Special Considerations for Women and the Prevention of Mother-to-Child Transmission
...ations for Women and the Prevention of Mothe...
Contraception and Preconce...
...fected women of childbearing age should be...
...ast Cancer Screening...
...uld be performed annually in women age >50 years...
...0-49 years, providers should perform individu...
Menopause
...eplacement therapy, particularly if prolonged, ha...
...ormone replacement therapy may be c...
...ther-to-Child Transmis...
...nt infection of their fetus, pregnant women...
...fants exposed to HIV in utero shou...
...-risk exposed infants should have viro...
...l Considerations for Children
...ed infants should undergo HIV resistance...
...of the rapid progression of diseas...
...year of life, initiation of therapy in HIV...
...and viral loads should be monitore...
...ations should be administered according to Adv...
...ted infants and children should be manage...
...Considerations for Adolescents...
...cted adolescents require an individual and de...
Adolescents infected with HIV should...
...morbidities Associated With HIV and ART...
...blood glucose and/or hemoglobin A1c measurem...
...d levels should be obtained prior t...
...one densitometry (dual-energy x-ray a...
...izing Patient Adherence to HIV Care...
...-infected patients should be provi...
...s should make every effort to provide care in a w...
...should utilize a multidisciplinary model bu...
...ts should be evaluated for depression and su...