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
Diagno...
...RE ENGAGEMENT, MEDICATION ADHERENC...
All persons with HIV should be provided t...
...should make every effort to provid...
...should implement programs incorporating evi...
...sites should utilize a multidisciplinary m...
...IAL EVALUATION AND IMMEDIATE FOLLOW-UP F...
...omprehensive present and past medical histo...
...ic Tests for All Persons With HIV...
...eening Patients who have no documentati...
...unts and Percentages...
...l count with percentage should be obt...
...Measurement of the CD8 cell count and the...
...NA Levels A quantitative HIV RN...
...esistance Testing...
Patients should be assessed for transmi...
...sting should be obtained for patients re-e...
...ication of ART, resistance testing, i...
...integrase strand transfer inhibitor (I...
...d Tests in Selected Patients...
...eptor Tropism AssayTropism testing sh...
...B*5701
...A-B*5701 testing should be performed...
...who are positive for the HLA B*5701...
...ry Tests to Assess Safety and General...
...lood count with differential white blo...
...se many antiretroviral drugs, HIV i...
...g for Coinfections...
...ing for Sexually Transmitted Infectio...
...Persons with HIV should be screened fo...
...ons having receptive vaginal sex should...
...yphili...
...ould be screened for syphilis upon initiatio...
...cture should always be performed for patients w...
...umbar puncture should be performed in patients wh...
Latent Tuberculosis (T...
...itiation of care, persons with HIV without a h...
...ns with HIV who are close contacts of persons...
...epatitis A, B, and C...
...Persons with HIV should be screened for evide...
...rsons with HIV should be screened for eviden...
...rsons with HIV should be screened for HCV anti...
...to persons with HBV- and/or HCV should be test...
...Persons who are not immune to HAV and HB...
...who are not immune to HAV and HBV should b...
...s, Mumps, and Rubella...
...ith HIV born in 1957 or after should be te...
...cine should be given to protect agai...
...cella Zoster VirusSerologic screening for varic...
...at May Be Performed Under Certain Circumstances...
...diographyA baseline chest radiograph...
...ical Cancer Screening...
...with a uterus who are...
...ns with a uterus who are >30 years old sh...
...with atypical squamous cells of unknown signifi...
...Following hysterectomy for benign disease,...
...reeningPersons with a history of rece...
...sphate DehydrogenaseScreening for glucose-6-...
...ngAll persons of childbearing potential sh...
...tosterone Level...
...Morning serum testosterone levels are recommend...
Obtaining testosterone levels in women at base...
...OT Recommended for General Screening Purposes...
...ting for HSV, CMV IgG, Toxoplasma IgG, and bi...
...um cryptococcal antigen may be consid...
...ROUTINE HEALTHCARE MAINTENANCE CONSIDERATION...
...nitoring Following the Initial Assessment...
...ation of ART, HIV RNA should be rechecked a...
...count should be monitored to determine t...
...ental Health and Substance Use Issues...
...creening for substance use should b...
...ning for depression using validated screen...
...Vaccination for Infectious Diseases
...hlamydia, Gonorrhea, Trichomoniasis...
...reening for syphilis, chlamydia, and gonorrhea...
...All persons having vaginal sex should be scree...
...ed messages are critical for patients who r...
...and Vaccination for Other Infectious...
...uberculosis screening annually in persons at...
...g is recommended in patients with advanced HI...
...for pneumococcal infection, influenza, tetanus...
...ic persons with CD4 >200 cells/mm3 who are tr...
...epatitis A and B (HAV, HB...
...hose who are susceptible to infection should be...
...on should be recommended for nonimmune sexual...
...atients who are negative for HBsAg and HBsAb bu...
...tion for HAV is recommended for all nonimmune i...
...n papillomavirusPersons between 9–26 y...
...ricella Zoster Virus
...Patients who are susceptible to VZV (those w...
...a primary vaccination may be considered in VZV-s...
...zoster vaccine, two dose series, should be giv...
...eening for and Prevention of Cance...
...tients who smoke should be strongly...
...creening for prostate, breast, lung, and co...
...screening mammography is recommended for p...
...ersons with HIV between 21–29 years of age...
...ons >30 years of age, cervical Pap tests...
...nal cancer screening: Periodic anal cytolog...
...r hepatocellular carcinoma every 6 months by ultr...
...lthcare Maintenance...
...od count and chemistry panels shoul...
...hould be monitored annually among those a...
All persons with HIV should be ask...
...ient education should be provided at...
...ns with HIV should have semi-annual...
...BOLIC AND OTHER NONCOMMUNICABLE COMORBIDITIE...
...s should be obtained prior to, and within 1–3 m...
...m or fasting blood glucose (FBG) and hemo...
...densitometry (DXA) screening for o...
...erone replacement therapy for cisgender men should...
...SIDERATIONS FOR CISGENDER WOMEN AND TRANSGEN...
...n and Preconception Care
...eption and Preconception CareAll persons wi...
...f Perinatal Transmission...
...revent perinatal transmission, all...
...ts exposed to HIV in utero should be mana...
...dingIn the US, persons with HIV should avoid brea...
...CONSIDERATIONS FOR CHILDREN
...diagnosed with HIV should undergo HI...
...ren with HIV should initiate ART, regardless of...
...D4 cell counts and HIV RNA should be monitore...
...ccinations should be administered according to ACI...
...fants and children with HIV should be managed b...
...CONSIDERATIONS FOR ADOLESCENT...
...s with HIV require an individual and developmental...
...h HIV should have a coordinated, d...
...ns should be administered according to AC...
...DERATIONS FOR TRANSGENDER AND GENDER...
...nsgender and gender diverse persons with HI...
...dical records, and other documentatio...
...r persons should be offered medical and/or surg...
...eening should be conducted based on guidelines f...
...al Assessment: History of the Present Illness...
...edical and Surgical HistoryHaving trouble v...
.... Initial Assessment — Review of Systems and...
...mmended Initial Laboratory Screening and Other St...
Treatment
...atment...
...Healthcare Maintenance for People With...
...6. Effect of Protease Inhibitors and Nonnucleosid...
Gender Identity
...der Identity
Table 7. Terminology Associated wi...
...ciples of Care of Transgender and Gend...