World AIDS Day is observed annually on December 1st, providing a global platform for individuals to come together in solidarity with those affected by HIV and to honor those who have succumbed to AIDS-related illnesses. Each year, World AIDS Day centers around a specific theme, with this year’s focus being on “Taking the Rights Path.” By emphasizing human rights and empowering communities to take action, we can work towards eradicating AIDS as a public health crisis by 2030.

In observance of World AIDS Day 2024, this Guidelines Spotlight will focus on the recently published guideline from the HIV Medicine Association (HIVMA) and the Infectious Diseases Society of America (IDSA). The guideline, Primary Care Guidance for Persons With Human Immunodeficiency Virus, offers updated recommendations for healthcare providers managing individuals living with HIV.

Please be aware that this summary does not cover all major points. For a comprehensive list of recommendations, please refer to the summary provided here or access the full text guideline located here. Let’s get started!

Key Takeaways
  • Prioritizing Routine Primary Care:
    • It is essential to seamlessly integrate HIV care into routine primary care, emphasizing the management of HIV as a chronic condition in conjunction with other comorbidities. 
    • Regular screenings for overall health, mental well-being, and social determinants of health are imperative for comprehensive care.
    • HIV care facilities should adopt a multidisciplinary team approach while designating a primary clinician with specialized experience in HIV for each patient. This approach fosters the establishment of enduring and trusting patient-clinician relationships, ensuring optimal long-term care outcomes.
    • The guideline highlights the importance of HIV-specific tests for individuals living with HIV. Some of the tests that are included are the HIV antigen/antibody screening test, a CD4 cell count, a quantitative HIV RNA level, and an assessment for transmitted drug resistance using a genotype assay for protease and reverse transcriptase mutations.

  • Optimizing HIV Treatment:
    • The guidelines strongly advocate for the utilization of antiretroviral therapy (ART) in order to achieve and maintain an undetectable viral load, thereby reducing the risk of transmission (undetectable = untransmittable or U=U) and enhancing long-term health outcomes. 
    • The sustained efficacy of ART hinges on the consistent suppression of viral replication. It is imperative for clinicians to underscore that viral suppression not only benefits the patient’s health but also serves to prevent the transmission of HIV to others.
    • One of the primary causes of treatment failure, particularly among patients initiating their first ART regimen, is suboptimal adherence to care or treatment protocols. Maintaining medication adherence is crucial for attaining and sustaining viral suppression with contemporary ART.
    • There is a continued emphasis on tailoring treatment regimens to individual patients, taking into account factors such as side effects, drug interactions, and patient preferences.

  • Addressing Mental Health:
    • Providers are encouraged to screen for and treat mental health issues such as depression and anxiety, which are common in people living with HIV. 
    • Screening for depression should be routinely performed on all adult patients, with the frequency of screenings determined by individual risk factors. Given the heightened susceptibility to depression in individuals with HIV, annual screenings are recommended.
    • Similarly, screening for anxiety should be conducted on all adult patients under the age of 65, with the frequency of screenings tailored to individual risk factors. Annual screenings are advised due to the increased risk of anxiety in this population.
    • Providing mental health support is essential for promoting adherence to antiretroviral therapy (ART) and enhancing overall quality of life for individuals living with HIV.

  • Preventive Care:
    • The 2024 update reinforces the importance of routine screenings for other infectious diseases (e.g., tuberculosis, sexually transmitted infections, hepatitis) and the provision of vaccines (e.g., flu, pneumococcal, HPV). 
    • In order to effectively address the health needs of individuals with HIV, preventive care should also focus on managing common comorbidities such as cardiovascular disease, kidney disease, and bone health.
    • All eligible individuals should receive vaccinations for diseases such as pneumococcus, influenza, HPV, VZV, tetanus-diphtheria-whooping cough, HAV, HBV, COVID-19, and meningococcus.

  • Women and Gender-Specific Care:
    • Special attention is recommended for women living with HIV, including reproductive health concerns, pregnancy care, and menopause management.
    • Gender-specific care for transgender and gender-diverse individuals is also emphasized and should be gender-affirming, nondiscriminatory, non stigmatizing, and culturally sensitive.

  • Telemedicine and Virtual Care:
    • The update highlights the importance of utilizing telemedicine for routine visits, adherence support, and remote monitoring, all of which contribute to improving patient care.
    • Healthcare providers and multidisciplinary teams are encouraged to incorporate both in-person and telemedicine visits into their patient monitoring protocols, especially during the initial months following the initiation of a new antiretroviral therapy (ART) regimen. This approach ensures that patients receive comprehensive and continuous care, leading to better treatment outcomes.

This guideline aims to provide a holistic approach to HIV care that goes beyond viral suppression, promoting overall well-being, mental health, and addressing structural barriers to healthcare.

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