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...
...ARE ENGAGEMENT, MEDICATION ADHERENCE, AND VIRAL SU...
...with HIV should be provided timely acces...
...V care sites should make every effort...
...ites should implement programs incorporatin...
...sites should utilize a multidisciplinary model...
...LUATION AND IMMEDIATE FOLLOW-UP FOR PERSONS...
...ive present and past medical history...
...cific Tests for All Persons With...
...V Screening Patients who have no documenta...
...ell Counts and Percentag...
...A CD4 cell count with percentage should...
...ent of the CD8 cell count and the rat...
...lasma HIV RNA Levels A quantitative HIV RNA...
...stance Testing...
...ts should be assessed for transmitt...
Resistance testing should be obtained for pat...
...o guide modification of ART, resistance t...
...smitted integrase strand transfer in...
...elated Tests in Selected Patients
...ropism AssayTropism testing should...
...B*5701...
...1 testing should be performed before initia...
...Patients who are positive for the HL...
...sts to Assess Safety and General Health...
...d count with differential white bl...
...ecause many antiretroviral drugs, HIV infec...
...eening for Coinfect...
...for Sexually Transmitted Infections (S...
...with HIV should be screened for gonorrhea and c...
...ns having receptive vaginal sex should b...
...philis...
...ould be screened for syphilis upon initiation...
...umbar puncture should always be perfo...
...puncture should be performed in patien...
...atent Tuberculosis (TB)...
...initiation of care, persons with H...
...with HIV who are close contacts of persons...
...tis A, B, and C
...HIV should be screened for evidence of...
...ons with HIV should be screened for evid...
...ons with HIV should be screened for...
...rn to persons with HBV- and/or HCV should be tes...
...rsons who are not immune to HAV and HBV sh...
...re not immune to HAV and HBV should be imm...
...Mumps, and Rubella...
...ersons with HIV born in 1957 or after should...
...ine should be given to protect against...
...r VirusSerologic screening for vari...
...May Be Performed Under Certain Ci...
...phyA baseline chest radiograph should be obtain...
...ervical Cancer Scree...
...Persons with a uterus who are...
...ersons with a uterus who are >30 years old should...
Persons with atypical squamous cells of un...
...ysterectomy for benign disease, routin...
...ScreeningPersons with a history of...
...se-6-Phosphate DehydrogenaseScreen...
...ncy TestingAll persons of childbearing potential...
...estosterone Level...
...rning serum testosterone levels are...
...aining testosterone levels in women a...
... NOT Recommended for General Screeni...
...ng for HSV, CMV IgG, Toxoplasma IgG,...
...rum cryptococcal antigen may be considered in...
...ROUTINE HEALTHCARE MAINTENANCE CONSIDERATIONS FO...
...ecific Monitoring Following the Initial Ass...
...er initiation of ART, HIV RNA should be rechec...
...hould be monitored to determine the need f...
...r Mental Health and Substance Use Issues...
...bstance use should be done at all he...
...ning for depression using validated screening to...
...ng and Vaccination for Infectious Diseases...
...creening for Chlamydia, Gonorrhea, Trichomoniasi...
...for syphilis, chlamydia, and gonorrh...
...l persons having vaginal sex should...
...Tailored messages are critical for pa...
...d Vaccination for Other Infectious Diseases...
...erculosis screening annually in persons at...
...eat testing is recommended in patients...
...ns for pneumococcal infection, influenza, tet...
...c persons with CD4 >200 cells/mm3 who are...
...titis A and B (HAV, HB...
...se who are susceptible to infection shoul...
Vaccination should be recommended...
...Patients who are negative for HBsAg and HB...
...nation for HAV is recommended for all n...
...avirusPersons between 9–26 years of...
...a Zoster Virus...
...o are susceptible to VZV (those who hav...
...Varicella primary vaccination may...
...combinant zoster vaccine, two dose s...
...for and Prevention of Cancer...
All patients who smoke should be strong...
...ing for prostate, breast, lung, and colon c...
...l screening mammography is recommended f...
...ns with HIV between 21–29 years of age s...
...>30 years of age, cervical Pap tests should...
Anal cancer screening: Periodic...
...reening for hepatocellular carcinoma every 6 month...
...lthcare Maintenance...
...te blood count and chemistry panels should be...
...ysis should be monitored annually...
...ll persons with HIV should be asked ab...
...Patient education should be provided at...
...ith HIV should have semi-annual oral...
IV. METABOLIC AND OTHER NONCOMMUNICABLE COMOR...
...ls should be obtained prior to, and within...
...om or fasting blood glucose (FBG) and hemoglo...
...nsitometry (DXA) screening for osteoporosi...
...ne replacement therapy for cisgender men shou...
...DERATIONS FOR CISGENDER WOMEN AND TRANS...
...and Preconception Care
...d Preconception CareAll persons with...
Prevention of Perinatal Tra...
...event perinatal transmission, all...
...nfants exposed to HIV in utero should be ma...
...ngIn the US, persons with HIV shou...
...CONSIDERATIONS FOR CHILDREN...
...nfants diagnosed with HIV should und...
...children with HIV should initiate ART, regardles...
...D4 cell counts and HIV RNA should be monitored n...
...ldhood vaccinations should be admini...
...d children with HIV should be managed by a specia...
...I. SPECIAL CONSIDERATIONS FOR AD...
...nts with HIV require an individual a...
...scents with HIV should have a coordinated, delibe...
Vaccinations should be administered...
...IDERATIONS FOR TRANSGENDER AND GENDE...
...d gender diverse persons with HIV sho...
...rms, medical records, and other documentatio...
...ender persons should be offered medical and/o...
...reening should be conducted based on guide...
...ble 1. Initial Assessment: History of the...
...2. Other Medical and Surgical History...
...itial Assessment — Review of Systems and Physica...
...ble 4. Recommended Initial Laboratory Screeni...
Treatment
...atment...
...utine Healthcare Maintenance for People...
...fect of Protease Inhibitors and Nonnucleoside Rev...
Gender Identity
...r Identity
...e 7. Terminology Associated with Gender Id...
...8. Principles of Care of Transgen...