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
...Dia...
...l Assessment—History—Present and PastH...
...itial Assessment—Review of Systems and Physical...
...present and past medical history, phys...
...ho have no documentation of their HIV serostatus...
...CD4 Cell Coun...
...l count with percentage should be...
...the CD8 cell count and the ratio of CD4 ce...
...ive HIV RNA (viral load) level should be...
...HIV Resistance Tes...
...e drug-resistant virus can be transmitte...
...ferred, repeat testing at the time of antiretrovir...
...testing is also indicated for patients...
...ersons failing to respond to integrase strand t...
...Coreceptor Tr...
...pism testing should be performed if the use of a C...
...Laboratory Tests...
...Complete Blood...
...blood cell count with differential white blo...
...Glucose-6-P...
...or glucose-6-phosphate dehydrogenase...
...Fasting Lipi...
...any antiretroviral drugs, HIV infe...
...HLA...
...LA-B*5701 testing should be performed befor...
...e positive for the HLA B*5701 haplo...
...Urinalysis...
...e urinalysis should be performed and baseline c...
...calculated creatinine clearance ass...
...Coinfection an...
...Tuberculosis Screen...
...initiation of care, HIV-infected pa...
...th positive test results should be treated for...
...testing is recommended in patients with advance...
...tients who are close contacts of persons with in...
...Ser...
...cted patients should be tested for...
...negative adults, representing 70%-90% of...
...Viral Hepa...
...V-infected patients should be screened for ev...
...re susceptible to infection should be...
...should be repeated 1-2 months after the third vac...
...hould be recommended for nonimmune sexual partne...
...ents who are negative for HBsAg an...
...ted patients should be screened for hepatitis...
...ng should be ordered on all those with a posi...
...CV-infected women should be tested for HBV and...
...accination is recommended for all suscep...
...titis A vaccination is recommended for...
...ine may be considered for all other nonimmune...
...Screening and...
...ower risk of cytomegalovirus (CMV) infecti...
...atients who are susceptible to varicella zoster...
...ary vaccination may be considered in HIV-infect...
...d in HIV-infected children ages 1-8 years w...
...Screenin...
...should be screened for syphilis upon...
...cture should always be performed for patient...
...ar puncture should be performed in patie...
...Scree...
...women should be screened for trichomoniasis,...
...nd women should be screened for gonorrhea and c...
...g in 3 months is indicated in men and w...
...ents should be screened for all of t...
...Cerv...
...d women should have a cervical Pap smea...
...n with atypical squamous cells (both ASC-US [atypi...
...Screening f...
...cted men and women with human papillomavi...
...n is recommended for all females ages 9...
...Serum Testosterone...
...estosterone level testing is recommended in ad...
...osterone levels in women in nonresearch...
...Other Laboratory Tests...
...sting for cryptococcal infection with...
...Chest Radiol...
...st radiograph should be obtained in all...
Patient Management
...Patien...
...tine Health Care Maintenance in the...
...e 4. Routine Immunizations for HIV-In...
Behavioral Intervention
...Behavioral Inter...
...es regarding risk reduction should be provi...
...ges are critical for patients who r...
Schedule of Care Evaluation for HIV-Infected Patients
...Schedule of Care Ev...
...Adults...
...oad is generally monitored every 3-4 months in...
...should be monitored both to assess the urgenc...
...cell counts should generally be monitored...
...creening and tuberculosis screening tests should b...
Vaccinations for pneumococcal infect...
...za, (SR, H)21881...
...ella, (SR, M)21881...
...titis A (SR, H)21881
...(SR, H)21881...
Special Considerations for Women and the Prevention of Mother-to-Child Transmission
...Spec...
...Contraception and P...
...ll HIV-infected women of childbearin...
...Breast Cancer Screeni...
...y should be performed annually in women...
In women ages 40-49 years, providers should...
...Menop...
...replacement therapy, particularly if...
Hormone replacement therapy may be considere...
Mothe...
...nt infection of their fetus, pregnant w...
...nts exposed to HIV in utero should rec...
...igh-risk exposed infants should have virologic...
...Special...
...nfants should undergo HIV resistance testing (S...
...ause of the rapid progression of disease, sho...
...year of life, initiation of therapy in HIV-infe...
...cell counts and viral loads should be monitored...
...hood vaccinations should be administered a...
...infants and children should be managed by a spec...
...Special Considerati...
...olescents require an individual an...
...olescents infected with HIV should have...
...Metabolic Co...
...d glucose and/or hemoglobin A1c meas...
...pid levels should be obtained prior to and within...
...line bone densitometry (dual-energy...
...Optimiz...
...patients should be provided timely access to ro...
...s should make every effort to provide care i...
...sites should utilize a multidisciplina...
...ients should be evaluated for depression an...