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
...s and Assessment...
...tial Assessment—History—Present and PastHaving...
...2. Initial Assessment—Review of Systems and...
...mprehensive present and past medical history...
...se Tests: Serological Assays for HIV...
...tients who have no documentation of t...
...ell Counts and Percentag...
...ount with percentage should be obtained upon initi...
...ent of the CD8 cell count and the ratio of CD4 c...
...lasma HIV RNA...
...antitative HIV RNA (viral load) level s...
...V Resistance Testing...
...cause drug-resistant virus can be transmitted from...
...is deferred, repeat testing at the time of antire...
...nce testing is also indicated for patients...
...sons failing to respond to integrase strand trans...
...ptor Tropism Assay
...ropism testing should be performed if the use of...
...aboratory Test...
...lood Cell Count and Chemistry Pan...
...te blood cell count with differential white blo...
...Phosphate Dehydrogenase...
...creening for glucose-6-phosphate dehydro...
...ting Lipid Profil...
...antiretroviral drugs, HIV infection itse...
...B*5701 Screening
...5701 testing should be performed befor...
...ents who are positive for the HLA B*5701 haplotyp...
...d Calculated Creatinine Clearan...
...baseline urinalysis should be perform...
Urinalysis and calculated creatinine clearance ass...
...fection and Comorbidity Laboratory Tests...
Tuberculosis Screening
...tiation of care, HIV-infected patie...
...h positive test results should be trea...
...ing is recommended in patients with...
...ted patients who are close contacts...
...Testing for Toxoplasma gondii...
...l HIV-infected patients should be tested for p...
...asma-seronegative adults, represen...
...Screening and Vaccination Recommendations...
HIV-infected patients should be screened f...
...are susceptible to infection should be vaccin...
...g should be repeated 1-2 months after th...
...uld be recommended for nonimmune se...
...ents who are negative for HBsAg and HBsAb but...
HIV-infected patients should be scree...
...CV RNA testing should be ordered on all th...
...nd/or HCV-infected women should be tested for HB...
...accination is recommended for all susceptible me...
...ccination is recommended for all susceptible...
...s A vaccine may be considered for a...
...creening and Vaccination Recommendati...
...at lower risk of cytomegalovirus (CMV) infection...
...ents who are susceptible to varicella zoster v...
...ella primary vaccination may be consid...
and in HIV-infected children ages 1...
...ng for Syphilis...
...l patients should be screened for syphili...
...puncture should always be performed for p...
...lumbar puncture should be performed...
...r Other Sexually Transmitted Dise...
...be screened for trichomoniasis, and...
...and women should be screened for gonorr...
...in 3 months is indicated in men and women...
...ld be screened for all of these cond...
...ancer Screening and Prevention...
HIV-infected women should have a cervical P...
...atypical squamous cells (both ASC-U...
...r Anal Human Papillomavirus...
...nfected men and women with human papi...
...cination is recommended for all females ages 9-26...
...um Testosterone Leve...
...ing serum testosterone level testing is r...
...testosterone levels in women in nonresearch setti...
...her Laboratory Tests
...tine testing for cryptococcal infect...
...Radiology
...ine chest radiograph should be obtained...
Patient Management
...nt Management...
...ine Health Care Maintenance in the HIV-Infec...
...ble 4. Routine Immunizations for HIV...
Behavioral Intervention
...avioral Interven...
...ages regarding risk reduction should be provided...
...ailored messages are critical for patients who...
Schedule of Care Evaluation for HIV-Infected Patients
...of Care Evaluation for HIV-Infected...
...dult...
...ad is generally monitored every 3-4...
CD4 cell counts should be monitored both to...
...cell counts should generally be monit...
...and tuberculosis screening tests should be r...
...s for pneumococcal infection, (SR, H)218...
...nfluenza, (SR, H)21881
...icella, (SR, M)21881...
...itis A (SR, H)21...
...d B (SR, H)218...
Special Considerations for Women and the Prevention of Mother-to-Child Transmission
...Considerations for Women and the Preven...
...ption and Preconception Car...
...ll HIV-infected women of childbearing age...
Breast Cancer Screen...
...ould be performed annually in women age >50...
...-49 years, providers should perform indiv...
...enopau...
...ent therapy, particularly if prolo...
...replacement therapy may be considered in...
Mother-to-Child Tra...
...nt infection of their fetus, pregna...
...ts exposed to HIV in utero should receive...
...k exposed infants should have virologic testing...
...Considerations for Children...
...ed infants should undergo HIV resista...
...the rapid progression of disease, should initiate...
...fter the first year of life, initiation of...
...D4 cell counts and viral loads should be monit...
...inations should be administered according...
HIV-infected infants and children should be...
...siderations for Adolescents...
...lescents require an individual and dev...
...ected with HIV should have a coordinated, deli...
...rbidities Associated With HIV and AR...
...od glucose and/or hemoglobin A1c meas...
...sting lipid levels should be obtai...
...ne densitometry (dual-energy x-ray absorptiometry,...
...izing Patient Adherence to HIV Care...
...HIV-infected patients should be provided ti...
...e sites should make every effort to provide...
...should utilize a multidisciplinary model but iden...
...ll patients should be evaluated for depressi...