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
...agnosis and Assess...
...able 1. Initial Assessment—History...
...2. Initial Assessment—Review of Systems and Phy...
...ve present and past medical history, physical...
...Tests: Serological Assays for HIV...
...nts who have no documentation of t...
...Counts and Percentage...
...t with percentage should be obtained upon...
...of the CD8 cell count and the ratio of CD4 ce...
...ma HIV RNA Lev...
...antitative HIV RNA (viral load) level should...
...IV Resistance Testing...
...ause drug-resistant virus can be transmitted from...
...therapy is deferred, repeat testin...
...sting is also indicated for patients who ar...
...iling to respond to integrase strand transfer in...
...ptor Tropism Assay...
...opism testing should be performed if...
...ratory Tests...
...plete Blood Cell Count and Chemistry Pan...
...te blood cell count with differentia...
...hosphate Dehydrogenase...
...for glucose-6-phosphate dehydrogenase (G6PD) def...
...ng Lipid Profile
...ny antiretroviral drugs, HIV infection itself, and...
...B*5701 Screening...
...5701 testing should be performed befor...
...are positive for the HLA B*5701 haplot...
...d Calculated Creatinine Clearanc...
...urinalysis should be performed and baseline c...
...calculated creatinine clearance assay...
...nfection and Comorbidity Laboratory Tests...
...losis Screening...
...ion of care, HIV-infected patients withou...
...e with positive test results should b...
...s recommended in patients with advance...
...d patients who are close contacts of persons with...
...sting for Toxoplasma gondii...
...V-infected patients should be tested f...
...eronegative adults, representing 70...
...ral Hepatitis Screening and Vaccination Recommen...
...atients should be screened for evidence of hepatit...
...d those who are susceptible to infection...
...hould be repeated 1-2 months after the...
...ation should be recommended for nonimm...
...e negative for HBsAg and HBsAb but positive for...
...tients should be screened for hepatitis C...
...testing should be ordered on all those with a po...
...d/or HCV-infected women should be test...
...vaccination is recommended for al...
...patitis A vaccination is recommended for all susce...
...epatitis A vaccine may be considered for...
...Vaccination Recommendations for Herpes Viru...
...er risk of cytomegalovirus (CMV) infection (eg,...
...ts who are susceptible to varicella z...
...lla primary vaccination may be considere...
...infected children ages 1-8 years with CD4 cel...
...eening for Syphi...
...ll patients should be screened for sy...
...puncture should always be performed for patient...
...ture should be performed in patients who e...
...Other Sexually Transmitted Diseases...
...l women should be screened for trichomoniasis, a...
...men should be screened for gonorrhea and chlamyd...
...3 months is indicated in men and women found to be...
...s should be screened for all of these c...
...Cancer Screening and Prevent...
...V-infected women should have a cervical Pap...
...omen with atypical squamous cells (b...
...ing for Anal Human Papillomavi...
...infected men and women with human papillomavirus (...
...vaccination is recommended for all females ages...
...um Testosterone Leve...
...serum testosterone level testing is reco...
...ng testosterone levels in women in nonresearch...
...er Laboratory Tests
...for cryptococcal infection with serum cryptococc...
...est Radiolog...
...e chest radiograph should be obtained in a...
Patient Management
...t Management...
...ine Health Care Maintenance in the HIV-Infe...
Table 4. Routine Immunizations for HIV-Infected Ad...
Behavioral Intervention
...oral Intervention...
...neral messages regarding risk reduction...
...essages are critical for patients wh...
Schedule of Care Evaluation for HIV-Infected Patients
...Evaluation for HIV-Infected Patients...
...dult...
...d is generally monitored every 3-4 month...
...cell counts should be monitored both to...
...should generally be monitored every 3-4 months. F...
...ing and tuberculosis screening tests sh...
...for pneumococcal infection, (SR, H)21881...
...uenza, (SR, H)21881...
...ella, (SR, M)21881...
hepatitis A (SR, H)2188...
...B (SR, H)21881...
Special Considerations for Women and the Prevention of Mother-to-Child Transmission
...onsiderations for Women and the Preve...
Contraception and Preconception Care
...infected women of childbearing age should be...
Breast Cancer Screening
...hould be performed annually in women age >50 years...
...es 40-49 years, providers should perform individu...
...enopau...
...ormone replacement therapy, particularly if prolon...
...placement therapy may be considered in...
...r-to-Child Transmission...
To prevent infection of their fetus, pregnant w...
...nts exposed to HIV in utero should rec...
...-risk exposed infants should have virolo...
...onsiderations for Children...
...d infants should undergo HIV resistance te...
...because of the rapid progression of disease, shou...
...the first year of life, initiation...
...l counts and viral loads should be moni...
...vaccinations should be administer...
...nfants and children should be mana...
...siderations for Adolescents...
...dolescents require an individual and deve...
...scents infected with HIV should have a coo...
...abolic Comorbidities Associated With HIV and ART...
...glucose and/or hemoglobin A1c measure...
...ipid levels should be obtained prior to...
Baseline bone densitometry (dual-energy x-ray abso...
...timizing Patient Adherence to HIV Care...
...d patients should be provided timely...
...e sites should make every effort to prov...
...should utilize a multidisciplinary model but...
...l patients should be evaluated for...