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
...Diagnosis...
...I. OPTIMIZI...
...l persons with HIV should be provided timel...
...e sites should make every effort to pr...
...should implement programs incorporatin...
...should utilize a multidisciplinary model but ide...
...comprehensive present and past medical hist...
...HIV-S...
...IV Screening Patients who have no documentat...
...l Counts and Percentages...
...unt with percentage should be obtained up...
...easurement of the CD8 cell count and...
...ma HIV RNA Levels A quantitativ...
...IV Resistance Testing...
...should be assessed for transmitted drug resis...
...ce testing should be obtained for patients re-enga...
...dification of ART, resistance testing, inclu...
...integrase strand transfer inhibitor (INST...
HIV-...
...tor Tropism AssayTropism testing should be...
...LA B*5701
...B*5701 testing should be performed bef...
...Patients who are positive for the HLA B...
...Laboratory Tests...
...lete blood count with differential white blood cel...
...e many antiretroviral drugs, HIV infe...
...Screening for C...
...eening for Sexually Transmitted Infec...
...Persons with HIV should be screened for...
...All persons having receptive vaginal sex...
...philis...
...patients should be screened for syphilis upo...
...ncture should always be performed fo...
...cture should be performed in patients who exper...
...uberculosis (TB)...
...on of care, persons with HIV witho...
...with HIV who are close contacts of persons wi...
...epatitis A, B, and C...
...with HIV should be screened for evidence of...
...ns with HIV should be screened for evidenc...
...Persons with HIV should be screened f...
...s born to persons with HBV- and/or H...
Persons who are not immune to HAV...
...who are not immune to HAV and HBV...
...les, Mumps, and Rubella...
...ons with HIV born in 1957 or after should be tes...
...cine should be given to protect again...
...lla Zoster VirusSerologic screening f...
...raphyA baseline chest radiograph sh...
...al Cancer Screening...
Persons with a uterus who...
...with a uterus who are >30 years old shoul...
...with atypical squamous cells of unknown...
...ollowing hysterectomy for benign disease, rout...
...Cancer ScreeningPersons with a hist...
...cose-6-Phosphate DehydrogenaseScreening for glucos...
...TestingAll persons of childbearing potential...
...rum Testosterone Level
...serum testosterone levels are recommended in ad...
...Obtaining testosterone levels in women at...
...Tests NOT Recommend...
...outine testing for HSV, CMV IgG, Toxo...
...for serum cryptococcal antigen may be...
...III. ROUTINE...
HIV-Spe...
...n of ART, HIV RNA should be recheck...
...count should be monitored to determine the ne...
...Screening for Men...
...ng for substance use should be done at all he...
...r depression using validated scree...
...Screening and Vaccination...
...creening for Chlamydia, Gonorrhea, Trichomoniasis...
...ening for syphilis, chlamydia, and gonorr...
...s having vaginal sex should be screened for tric...
...messages are critical for patients who r...
...Vaccination for Other Infectious Disea...
...tuberculosis screening annually in persons at ri...
Repeat testing is recommended in p...
Vaccinations for pneumococcal i...
...tic persons with CD4 >200 cells/mm3 wh...
...A and B (HAV, HBV)...
...o are susceptible to infection should be vaccinat...
...ination should be recommended for non...
...who are negative for HBsAg and HBsAb but posi...
...Vaccination for HAV is recommended for all no...
...mavirusPersons between 9–26 years of age sho...
...ella Zoster Virus...
...Patients who are susceptible to VZV (th...
...ella primary vaccination may be considered in VZ...
...mbinant zoster vaccine, two dose series, should be...
Screening for and Prevention...
...l patients who smoke should be str...
...ening for prostate, breast, lung, and col...
...creening mammography is recommended for pers...
...HIV between 21–29 years of age should have a...
...persons >30 years of age, cervical Pap...
Anal cancer screening: Periodic anal cyt...
...ning for hepatocellular carcinoma every...
...ther Healthcare Maintenance...
...od count and chemistry panels should...
...alysis should be monitored annually among those...
...All persons with HIV should be asked abo...
...atient education should be provided...
...persons with HIV should have semi-...
...IV. METABOLIC AND OTHE...
...levels should be obtained prior to, and wit...
...fasting blood glucose (FBG) and hemoglobin A1c...
...ne bone densitometry (DXA) screenin...
Testosterone replacement therapy for...
...V. SPECIAL CONSIDERAT...
...Contraception...
...ption and Preconception CareAll persons with HIV...
...ion of Perinatal Transmission...
...perinatal transmission, all pregnant pe...
...fants exposed to HIV in utero shou...
...stfeedingIn the US, persons with HIV...
...VI. SPECI...
...s diagnosed with HIV should undergo HIV...
...children with HIV should initiate ART, re...
...ll counts and HIV RNA should be monitored no less...
...cinations should be administered acco...
...fants and children with HIV should be...
...VII. SPEC...
...with HIV require an individual and developmental...
...th HIV should have a coordinated, deliberate...
...s should be administered according to AC...
...VI...
...gender diverse persons with HIV should have...
...s, medical records, and other documentat...
...ansgender persons should be offered medical...
...r screening should be conducted based on guidel...
...ial Assessment: History of the Present...
Table 2. Other Medical and Surgical HistoryHaving...
...3. Initial Assessment — Review of Systems an...
...Recommended Initial Laboratory Screening and...
Treatment
...Treatme...
...outine Healthcare Maintenance for Peopl...
...ffect of Protease Inhibitors and Nonnucleoside...
Gender Identity
...Gender Identity...
...ble 7. Terminology Associated with Gender Ident...
...ciples of Care of Transgender and Ge...