HIV Primary Care

Last updated March 14, 2022

Key Points

Key Points

The prognosis of persons with HIV-infected persons are increasingly developing common health problems that also affect the general population. Some of these conditions may be related to HIV infection itself or its treatment.

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 and Assessment...

...l Assessment—History—Present a...


...nitial Assessment—Review of Systems and Physi...


...comprehensive present and past medical...


...HIV Disease Tests...

...s who have no documentation of their HIV s...


...CD4 Cell Cou...

...t with percentage should be obtained...

...asurement of the CD8 cell count and the rati...


...Plasma HIV RNA...

...uantitative HIV RNA (viral load) level sho...


...HIV Resistance...

...e drug-resistant virus can be transmitted fr...

...deferred, repeat testing at the time of antiret...

...testing is also indicated for patients who are ex...

...failing to respond to integrase strand t...


...Cor...

...ropism testing should be performed if the u...


...Laborator...

...Complete Blood...

...complete blood cell count with differentia...

...Gluc...

...ng for glucose-6-phosphate dehydrog...

...Fasting Lipid Pr...

...iretroviral drugs, HIV infection itself, and host...

...HLA B*570...

...testing should be performed before initiati...

...are positive for the HLA B*5701 ha...

...Uri...

...rinalysis should be performed and ba...

...alculated creatinine clearance assay should al...


...Coinfectio...

...ation of care, HIV-infected patients without a hi...

...sitive test results should be treated for lat...

...sting is recommended in patients wit...

...V-infected patients who are close contacts of per...

...Serologic Test...

...ll HIV-infected patients should be te...

...asma-seronegative adults, represent...

...Viral Hepatit...

...patients should be screened for evid...

...those who are susceptible to infection sho...

HBsAb testing should be repeated 1...

...should be recommended for nonimmune sexual...

...ho are negative for HBsAg and HBsAb but positive...

...-infected patients should be screened for hepatit...

...esting should be ordered on all those...

...HCV-infected women should be tested fo...

...vaccination is recommended for all suscepti...

...is A vaccination is recommended for all sus...

...ccine may be considered for all other nonimmune...

...Screening a...

...at lower risk of cytomegalovirus (...

...nts who are susceptible to varicella zoster v...

...ricella primary vaccination may be considered in...

...IV-infected children ages 1-8 years with CD4...

...Screening for Syphili...

...should be screened for syphilis upon initiation...

...ure should always be performed for patients with a...

...puncture should be performed in patie...

...Screening f...

...ld be screened for trichomoniasis, and a...

...should be screened for gonorrhea and chla...

...months is indicated in men and women found to...

...ts should be screened for all of these conditions...

...Cervical C...

...-infected women should have a cervic...

...atypical squamous cells (both ASC-US [at...

...Scre...

...V-infected men and women with human papillomaviru...

...accination is recommended for all females ages...

...Serum Testosterone Le...

...stosterone level testing is recommended...

...ining testosterone levels in women i...

...Other Laboratory...

...testing for cryptococcal infection with...

...Chest Radio...

...chest radiograph should be obtained in al...


Patient Management

...Patient Manage...

Table 3. Routine Health Care Mainte...


...outine Immunizations for HIV-Infected...


Behavioral Intervention

...Behavioral Interve...

...sages regarding risk reduction should be provi...


...ailored messages are critical for patien...


Schedule of Care Evaluation for HIV-Infected Patients

...Schedul...

...generally monitored every 3-4 months in untreated...

...ell counts should be monitored both to assess t...

...D4 cell counts should generally be monitored every...

...screening and tuberculosis screening tests...

...ons for pneumococcal infection, (SR, H...

...luenza, (SR, H)21881...

...ella, (SR, M)21881...

hepatitis A (SR, H)2...

...d B (SR, H)21881...


Special Considerations for Women and the Prevention of Mother-to-Child Transmission

...Special C...

Contracepti...

...cted women of childbearing age should be asked...


...Breast Cancer Screenin...

...should be performed annually in women age >50 yea...

...s 40-49 years, providers should perf...


...cement therapy, particularly if prolonged, has...

...eplacement therapy may be considered in women who...


...Mother-to-Chi...

...infection of their fetus, pregnant wo...

...d to HIV in utero should receive antire...

High-risk exposed infants should have...


Special Co...

...ts should undergo HIV resistance test...

...ecause of the rapid progression of...

...first year of life, initiation of th...

...ell counts and viral loads should b...

...d vaccinations should be administered accor...

...-infected infants and children should be mana...


...Special Consid...

...ted adolescents require an individua...

...fected with HIV should have a coordinated, de...


...Metabolic Como...

...blood glucose and/or hemoglobin A1c measurements s...

...id levels should be obtained prior...

...seline bone densitometry (dual-energy...


...Optimizing Pat...

...patients should be provided timely access to rou...

...es should make every effort to provide care in...

HIV care sites should utilize a multidiscipli...

...atients should be evaluated for depress...