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
...I. OPTIMIZING CAR...
...ll persons with HIV should be provided timely ac...
...IV care sites should make every effort to...
...s should implement programs incorporating evidenc...
...ites should utilize a multidisciplinary model...
...II. INITI...
...present and past medical history including HIV-r...
...HIV-Specifi...
...ng Patients who have no documenta...
...unts and Percentages...
A CD4 cell count with percentage...
...Measurement of the CD8 cell count and t...
...V RNA Levels A quantitative HIV RNA (viral...
...stance Testing...
...atients should be assessed for transmitted d...
...tance testing should be obtained for patient...
...odification of ART, resistance tes...
...transmitted integrase strand transf...
...HIV-Related...
...or Tropism AssayTropism testing should be perfor...
...B*5701...
...LA-B*5701 testing should be performed befo...
...atients who are positive for the HLA B*5701 hapl...
...Laboratory T...
...od count with differential white blood cell count,...
...use many antiretroviral drugs, HIV infecti...
Sc...
...ening for Sexually Transmitted Infections (...
...ns with HIV should be screened for...
...ersons having receptive vaginal sex should be scre...
Syphilis
...should be screened for syphilis up...
...ncture should always be performed for patie...
...lumbar puncture should be performed in patients w...
...t Tuberculosis (TB)...
...n initiation of care, persons with HIV without a...
...ons with HIV who are close contacts of p...
Hepatitis A, B, and C...
...h HIV should be screened for evidence of hepa...
Persons with HIV should be screen...
...ns with HIV should be screened for HCV antibod...
...rn to persons with HBV- and/or HCV should...
...ns who are not immune to HAV and HBV sh...
...rsons who are not immune to HAV and HBV shoul...
...easles, Mumps, and Rube...
...ons with HIV born in 1957 or after...
...cine should be given to protect against...
...VirusSerologic screening for varicella zo...
...Tests That May Be...
...phyA baseline chest radiograph shou...
...ervical Cancer Screening...
...s with a uterus who are...
...a uterus who are >30 years old should have...
...with atypical squamous cells of unknown sign...
...hysterectomy for benign disease, rout...
...l Cancer ScreeningPersons with a hist...
...Phosphate DehydrogenaseScreening for gluc...
...ncy TestingAll persons of childbear...
...m Testosterone Leve...
...m testosterone levels are recommended in adult cis...
...stosterone levels in women at base...
...Tests NOT Rec...
...testing for HSV, CMV IgG, Toxoplasma IgG, and bi...
...r serum cryptococcal antigen may be conside...
...III. ROUTI...
...HIV-Specifi...
...of ART, HIV RNA should be rechecked...
...4 cell count should be monitored to deter...
...Screeni...
...creening for substance use should be...
...reening for depression using validated screening...
...Screening and Vac...
...ing for Chlamydia, Gonorrhea, Tric...
...reening for syphilis, chlamydia, and gonor...
...ons having vaginal sex should be screened for tr...
...Tailored messages are critical for...
...reening and Vaccination for Other Infectious Disea...
...Perform tuberculosis screening annually i...
...epeat testing is recommended in patients with adv...
...ions for pneumococcal infection, influenza,...
...ymptomatic persons with CD4 >200 cell...
...is A and B (HAV, HBV)...
...ose who are susceptible to infection shou...
...tion should be recommended for nonimmune...
...Patients who are negative for HBsAg and HBsAb b...
...tion for HAV is recommended for all nonimmune in...
...lomavirusPersons between 9–26 years of age shou...
...aricella Zoster Vir...
...who are susceptible to VZV (those who have no...
...Varicella primary vaccination may be co...
...Recombinant zoster vaccine, two dose...
...g for and Prevention of Cancer...
...ients who smoke should be strongly encourag...
...r prostate, breast, lung, and colo...
...nnial screening mammography is recommended for per...
...s with HIV between 21–29 years of age should h...
...For persons >30 years of age, cervical...
...nal cancer screening: Periodic anal c...
...eening for hepatocellular carcinoma every 6 m...
...Healthcare Maintenance...
...Complete blood count and chemistry p...
...ysis should be monitored annually...
...ns with HIV should be asked about their...
...education should be provided at ev...
...All persons with HIV should have semi-annual oral...
...IV. METABOLIC AND OTHER...
...should be obtained prior to, and within 1–3 mon...
...ting blood glucose (FBG) and hemoglobi...
...e densitometry (DXA) screening for osteoporosis s...
...estosterone replacement therapy for ci...
...V. SPECIAL CON...
Contracepti...
...ontraception and Preconception CareAll persons wi...
...on of Perinatal Transmission...
...prevent perinatal transmission, all pregna...
...xposed to HIV in utero should be managed accord...
...the US, persons with HIV should avoid...
...VI. SPECI...
...s diagnosed with HIV should undergo HIV resistan...
...th HIV should initiate ART, regardless of...
CD4 cell counts and HIV RNA should be moni...
...hood vaccinations should be administered accor...
...nd children with HIV should be mana...
...VI...
...lescents with HIV require an individual an...
...nts with HIV should have a coordinated,...
...ons should be administered according to ACIP sched...
VIII...
...gender and gender diverse persons with...
..., medical records, and other documentati...
...ansgender persons should be offered medical and/o...
...er screening should be conducted based on gui...
Table 1. Initial Assessment: History...
...2. Other Medical and Surgical History...
...e 3. Initial Assessment — Review of Syste...
...able 4. Recommended Initial Laborat...
Treatment
...Treatme...
...ine Healthcare Maintenance for People With HI...
...Effect of Protease Inhibitors and Nonnuc...
Gender Identity
...Gender Ide...
...le 7. Terminology Associated with Gender Ident...
...ples of Care of Transgender and Ge...