Primary Care Guidance for Persons with HIV
Key Points
Key Points
- This guidance from an expert panel of the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) updates the 2013 HIV primary care guidelines.
- These recommendations encompass the comprehensive care of persons with HIV, including comorbidity management
Diagnosis
...gnosis...
...OPTIMIZING CARE ENGAGEMENT, MEDICATION ADHERENCE,...
...rsons with HIV should be provided timely a...
...V care sites should make every effort to provi...
...should implement programs incorpor...
...sites should utilize a multidisciplinary...
...EVALUATION AND IMMEDIATE FOLLOW-UP...
...prehensive present and past medical history...
...IV-Specific Tests for All Per...
...Screening Patients who have no documentat...
...ounts and Percentages...
...D4 cell count with percentage should be obtaine...
...asurement of the CD8 cell count and...
...asma HIV RNA Levels A quantitative...
...Resistance Testing...
...should be assessed for transmitted drug re...
...esistance testing should be obtained for patients...
...dification of ART, resistance testi...
...f transmitted integrase strand transfer inhibi...
...Related Tests in Selected Patients...
...receptor Tropism AssayTropism testing shou...
HLA B*5701...
...esting should be performed before i...
...Patients who are positive for the HLA B*5701 hapl...
...aboratory Tests to Assess Safety and Gene...
...lood count with differential white blo...
...ecause many antiretroviral drugs, HIV in...
...ning for Coinfections...
...ng for Sexually Transmitted Infections (STIs...
...Persons with HIV should be screened for gonorrhe...
...persons having receptive vaginal sex should be...
Syphili...
All patients should be screened for syph...
...ture should always be performed for patients...
...r puncture should be performed in patients who...
...nt Tuberculosis (TB)...
Upon initiation of care, persons with HIV witho...
...rsons with HIV who are close contacts of per...
...epatitis A, B, and C
...rsons with HIV should be screened for evidence of...
...ersons with HIV should be screened for evid...
...th HIV should be screened for HCV antibody upon...
...born to persons with HBV- and/or H...
...s who are not immune to HAV and HBV shou...
...sons who are not immune to HAV and HBV should be i...
..., Mumps, and Rubella...
...sons with HIV born in 1957 or afte...
...should be given to protect against measles,...
...r VirusSerologic screening for varicella...
...hat May Be Performed Under Certain Circumstan...
...graphyA baseline chest radiograph shoul...
Cervical Cancer Screening
...sons with a uterus who...
...ns with a uterus who are >30 years old sho...
...ersons with atypical squamous cells...
...sterectomy for benign disease, routi...
...ncer ScreeningPersons with a history of re...
...6-Phosphate DehydrogenaseScreening for...
...regnancy TestingAll persons of childbearing...
...rum Testosterone Level
...testosterone levels are recommended...
...ning testosterone levels in women at b...
...s NOT Recommended for General Sc...
...tine testing for HSV, CMV IgG, Tox...
...r serum cryptococcal antigen may be considered in...
...ROUTINE HEALTHCARE MAINTENANCE CONSIDERAT...
HIV-Specific Monitoring Following the...
...of ART, HIV RNA should be recheck...
...t should be monitored to determine the need f...
...ental Health and Substance Use Issue...
...reening for substance use should be done at a...
...for depression using validated screening tools s...
...ing and Vaccination for Infectious Diseases...
...reening for Chlamydia, Gonorrhea, Tri...
...for syphilis, chlamydia, and gonorrhea in asympt...
All persons having vaginal sex should be scre...
...red messages are critical for patients who re...
...and Vaccination for Other Infectious Diseases...
...erculosis screening annually in persons...
...g is recommended in patients with advanced...
...Vaccinations for pneumococcal infection, in...
...symptomatic persons with CD4 >200 cells/mm3 who a...
...A and B (HAV, HBV)
...who are susceptible to infection should be vacc...
...tion should be recommended for nonimmu...
...atients who are negative for HBsAg and HBs...
...or HAV is recommended for all nonimmu...
...apillomavirusPersons between 9–26 years of age s...
...lla Zoster Virus...
...ts who are susceptible to VZV (those who have...
...lla primary vaccination may be cons...
...oster vaccine, two dose series, sh...
...for and Prevention of Cancer...
...tients who smoke should be strongly encouraged...
...g for prostate, breast, lung, and colon c...
...Biennial screening mammography is recommended f...
...ons with HIV between 21–29 years of age sh...
...r persons >30 years of age, cervical Pap te...
...ancer screening: Periodic anal cytology by a...
Screening for hepatocellular carcinom...
...Healthcare Maintenance...
Complete blood count and chemistry pan...
...lysis should be monitored annually among thos...
All persons with HIV should be ask...
...education should be provided at every vi...
...ll persons with HIV should have semi-annual o...
...ABOLIC AND OTHER NONCOMMUNICABLE COMORBIDITIES ASS...
...evels should be obtained prior to, a...
...asting blood glucose (FBG) and hemoglobin A1c...
...e bone densitometry (DXA) screening fo...
...one replacement therapy for cisgender men shou...
...DERATIONS FOR CISGENDER WOMEN AND TRANSGENDER MEN...
...raception and Preconception...
...and Preconception CareAll persons with HI...
...f Perinatal Transmission...
...prevent perinatal transmission, all pregnant p...
...Infants exposed to HIV in utero should be...
...ingIn the US, persons with HIV should avoid...
...IAL CONSIDERATIONS FOR CHILDREN...
...iagnosed with HIV should undergo HIV resistance te...
...children with HIV should initiate ART, regardl...
...ts and HIV RNA should be monitored no...
...ations should be administered according to ACIP...
Infants and children with HIV should...
...ONSIDERATIONS FOR ADOLESCENT...
...ts with HIV require an individual and develo...
...ts with HIV should have a coordina...
...accinations should be administered accord...
...ONSIDERATIONS FOR TRANSGENDER AND GENDER D...
...nder and gender diverse persons with HIV should...
...medical records, and other documenta...
...sons should be offered medical and/or s...
...er screening should be conducted based on guidelin...
...1. Initial Assessment: History of the Present I...
...ble 2. Other Medical and Surgical HistoryH...
...3. Initial Assessment — Review of System...
...ecommended Initial Laboratory Screen...
Treatment
...eatment
...5. Routine Healthcare Maintenance for...
...fect of Protease Inhibitors and Nonnucleoside...
Gender Identity
Gender Iden...
...e 7. Terminology Associated with Gende...
...ciples of Care of Transgender and Gender Di...