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
...Diagnosis a...
...e 1. Initial Assessment—History—P...
...le 2. Initial Assessment—Review of...
A comprehensive present and past medical h...
...atients who have no documentation of their HIV s...
CD4 Cell C...
...ell count with percentage should be obtained u...
...surement of the CD8 cell count and...
...Plasma HIV...
...ve HIV RNA (viral load) level shou...
...HIV Resi...
...drug-resistant virus can be transmitted...
...y is deferred, repeat testing at the t...
...ing is also indicated for patients who are ex...
...persons failing to respond to integrase strand...
...Corec...
...should be performed if the use of a CCR5 a...
...Laboratory Te...
...Compl...
...plete blood cell count with differ...
...Glucose-6-Phosp...
...r glucose-6-phosphate dehydrogenase (G...
...Fasting Lip...
...iretroviral drugs, HIV infection itse...
...HLA B*5701 Scre...
...ng should be performed before initiating abacav...
...ts who are positive for the HLA B*5701 haplotype...
Urina...
...nalysis should be performed and baseline calcul...
...s and calculated creatinine cleara...
...Tuberculosis...
...initiation of care, HIV-infected patients withou...
...e with positive test results should be treat...
...testing is recommended in patients with ad...
...ected patients who are close contacts of persons...
...Serologic T...
...nfected patients should be tested for prior...
...sma-seronegative adults, representing 7...
...Viral Hepatitis...
...cted patients should be screened for evid...
...who are susceptible to infection should be vac...
...b testing should be repeated 1-2 months after...
...ld be recommended for nonimmune sexual pa...
...are negative for HBsAg and HBsAb but positive fo...
...patients should be screened for hepatitis...
HCV RNA testing should be ordered on all those wit...
...ected women should be tested for HBV...
...vaccination is recommended for all...
...vaccination is recommended for all susc...
...ine may be considered for all other nonimmune pa...
...Screeni...
...s at lower risk of cytomegalovirus (CMV) infection...
...nts who are susceptible to varicella zoster...
...rimary vaccination may be considered in HIV-i...
...ected children ages 1-8 years with CD4...
...s should be screened for syphilis upon...
...lumbar puncture should always be performe...
...lumbar puncture should be performed in patie...
...Screening for Oth...
...uld be screened for trichomoniasis, and all women...
...women should be screened for gonorrhea and chl...
...esting in 3 months is indicated in m...
...be screened for all of these conditio...
Ce...
...en should have a cervical Pap smear performed upo...
...ypical squamous cells (both ASC-US [...
Screening...
...d men and women with human papillomavirus (HPV)...
...n is recommended for all females ages 9-26...
...Serum Testostero...
...ing serum testosterone level testing is reco...
...ining testosterone levels in women in...
...Ot...
...ing for cryptococcal infection with serum cry...
...Chest Radio...
...t radiograph should be obtained in...
Patient Management
...Patient Management...
...Routine Health Care Maintenance in the...
...e Immunizations for HIV-Infected Adults...
Behavioral Intervention
...Behavioral...
...ssages regarding risk reduction should be pr...
...red messages are critical for patients who repor...
Schedule of Care Evaluation for HIV-Infected Patients
...Schedule of Ca...
...generally monitored every 3-4 months in un...
...nts should be monitored both to assess the...
CD4 cell counts should generally be monito...
...ning and tuberculosis screening tests sho...
...for pneumococcal infection, (SR, H)21881...
...nfluenza, (SR, H)2...
...icella, (SR, M)21881...
...s A (SR, H)21881...
...d B (SR, H)21...
Special Considerations for Women and the Prevention of Mother-to-Child Transmission
...Special Consideration...
...Contraceptio...
All HIV-infected women of childbearing age...
...mography should be performed annually in women...
...ages 40-49 years, providers should...
...Menopau...
...lacement therapy, particularly if prolonge...
...ement therapy may be considered in wome...
...Mo...
...infection of their fetus, pregnant women sh...
...ts exposed to HIV in utero should receive antir...
...posed infants should have virologic tes...
...Special Conside...
-infected infants should undergo HIV resis...
...use of the rapid progression of disea...
...rst year of life, initiation of th...
...ll counts and viral loads should be monitored...
...cinations should be administered according to...
...infants and children should be managed by a speci...
...Spec...
...cents require an individual and developmental appr...
...infected with HIV should have a coordinated...
Metabolic...
...sting blood glucose and/or hemoglobin A...
...ng lipid levels should be obtained...
...ine bone densitometry (dual-energy...
...Optimizing Patie...
...HIV-infected patients should be provided tim...
...V care sites should make every effort to pr...
...care sites should utilize a multidisciplinary mo...
...patients should be evaluated for depression a...