Primary Care Guidance for Persons with HIV

Publication Date: November 5, 2020

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...

...CARE ENGAGEMENT, MEDICATION ADHERENCE, AND VIRAL...

...ll persons with HIV should be provided timely...

...ites should make every effort to provide care...

...are sites should implement programs in...

...re sites should utilize a multidisciplina...


...INITIAL EVALUATION AND IMMEDIATE FOLLO...

...e present and past medical history...

...Specific Tests for All Persons With HIV...

...Patients who have no documentation of the...

...ll Counts and Percentage...

...count with percentage should be obtained upon init...

Measurement of the CD8 cell cou...

...evels A quantitative HIV RNA (viral load) level...

...stance Testing...

...s should be assessed for transmitted...

...ing should be obtained for patients re-engaging in...

...dification of ART, resistance testing, inc...

...mitted integrase strand transfer inhibitor (INS...

...V-Related Tests in Selected P...

...pism AssayTropism testing should be...

...B*5701...

...esting should be performed before initiating ab...

...who are positive for the HLA B*5701 haplotype...

...ts to Assess Safety and General Health...

...complete blood count with differential white blo...

...se many antiretroviral drugs, HIV infection...

...ing for Coinfections...

Screening for Sexually Transmitted Infect...

...s with HIV should be screened for gonorrhea and...

...rsons having receptive vaginal sex should be scr...

...philis

...should be screened for syphilis upon...

A lumbar puncture should always be perf...

...e should be performed in patients who experi...

...uberculosis (TB)...

...tiation of care, persons with HIV without a hist...

...h HIV who are close contacts of persons wi...

...itis A, B, and C...

...sons with HIV should be screened for eviden...

...th HIV should be screened for evidence of i...

...sons with HIV should be screened for HCV ant...

...Infants born to persons with HBV- and/or HC...

...who are not immune to HAV and HBV should...

...are not immune to HAV and HBV should be immuniz...

...umps, and Rubella...

...persons with HIV born in 1957 or after should be...

...should be given to protect against...

...ricella Zoster VirusSerologic screen...

...That May Be Performed Under Certain...

...adiographyA baseline chest radiograph should be...

...al Cancer Screening...

...s with a uterus who are...

...ons with a uterus who are >30 years old sho...

...ith atypical squamous cells of unknown signifi...

...Following hysterectomy for benign disease, routi...

...eningPersons with a history of receptive anal inte...

...osphate DehydrogenaseScreening for glu...

...ancy TestingAll persons of childbea...

...tosterone Level...

...orning serum testosterone levels are recommended...

...g testosterone levels in women at baseline in...

... NOT Recommended for General Screening Pu...

...ting for HSV, CMV IgG, Toxoplasma IgG,...

...ting for serum cryptococcal antige...


III. ROUTINE HEALTHCARE MAINTENANCE CONSIDE...

...Monitoring Following the Initial Assessment...

...initiation of ART, HIV RNA should be reche...

...cell count should be monitored to d...

...Mental Health and Substance Use Issu...

...ening for substance use should be don...

...creening for depression using validated scre...

...ning and Vaccination for Infectious Diseas...

...ning for Chlamydia, Gonorrhea, Tricho...

...reening for syphilis, chlamydia, and gonorrhea...

...persons having vaginal sex should be screene...

...ilored messages are critical for patien...

...and Vaccination for Other Infectious Di...

...culosis screening annually in persons at risk...

...ting is recommended in patients wi...

...ons for pneumococcal infection, inf...

...c persons with CD4 >200 cells/mm3 who are trav...

...patitis A and B (HAV, HBV)...

...e who are susceptible to infection...

...ination should be recommended for nonim...

...s who are negative for HBsAg and HBsAb but positiv...

...ion for HAV is recommended for all...

...mavirusPersons between 9–26 years o...

...aricella Zoster Vi...

...ho are susceptible to VZV (those who have not been...

Varicella primary vaccination may...

...combinant zoster vaccine, two dose series,...

...ning for and Prevention of Can...

...All patients who smoke should be strongly encoura...

...ening for prostate, breast, lung, and colon...

...reening mammography is recommended...

...with HIV between 21–29 years of a...

...sons >30 years of age, cervical Pa...

...creening: Periodic anal cytology by anal...

...Screening for hepatocellular carcinoma every...

...er Healthcare Maintenanc...

...d count and chemistry panels should be monitor...

...Urinalysis should be monitored annually...

...ll persons with HIV should be asked a...

...atient education should be provide...

...All persons with HIV should have sem...


...METABOLIC AND OTHER NONCOMMUNICABLE CO...

...vels should be obtained prior to, and within 1...

Random or fasting blood glucose (FBG) and...

...seline bone densitometry (DXA) screening for ost...

...lacement therapy for cisgender men should be...


...CONSIDERATIONS FOR CISGENDER WOMEN AND TRANS...

...traception and Preconception Care...

...nd Preconception CareAll persons with HIV w...

...ntion of Perinatal Transmission...

...perinatal transmission, all pregnant persons...

...xposed to HIV in utero should be mana...

...ingIn the US, persons with HIV shoul...


.... SPECIAL CONSIDERATIONS FOR CHILDREN...

...fants diagnosed with HIV should under...

...with HIV should initiate ART, regardless...

...D4 cell counts and HIV RNA should be moni...

...accinations should be administered...

...nfants and children with HIV should be man...


VII. SPECIAL CONSIDERATIONS FOR ADOLESCE...

...s with HIV require an individual and devel...

...dolescents with HIV should have a coo...

...ons should be administered according to ACIP sched...


VIII. CONSIDERATIONS FOR TRANSGEND...

...and gender diverse persons with HIV should ha...

...s, medical records, and other documentation shou...

...ersons should be offered medical and/or surgi...

...ncer screening should be conducted ba...


...tial Assessment: History of the Present Illnes...


...able 2. Other Medical and Surgical HistoryHavin...


...l Assessment — Review of Systems and P...


...e 4. Recommended Initial Laboratory Scre...


Treatment

...reatment...

...ine Healthcare Maintenance for People...


...ble 6. Effect of Protease Inhibito...


Gender Identity

Gender Ident...

...ology Associated with Gender Identity and Hormon...


...le 8. Principles of Care of Transgender and Ge...