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
...iagnos...
...IZING CARE ENGAGEMENT, MEDICATION ADH...
...sons with HIV should be provided t...
...IV care sites should make every eff...
...V care sites should implement progr...
...sites should utilize a multidisciplinary m...
...L EVALUATION AND IMMEDIATE FOLLOW-UP FOR PERSO...
...rehensive present and past medical his...
...ic Tests for All Persons With HIV...
...Patients who have no documentation of...
...ell Counts and Percentages...
...ll count with percentage should be obt...
...Measurement of the CD8 cell count and t...
...HIV RNA Levels A quantitative HIV RNA (viral l...
HIV Resistance Testing...
...ould be assessed for transmitted dr...
...stance testing should be obtained for pat...
...guide modification of ART, resistance...
...ntegrase strand transfer inhibitor (INSTI)...
...d Tests in Selected Patients...
...Tropism AssayTropism testing should be per...
...A B*5701...
...sting should be performed before init...
Patients who are positive for the HLA B...
...ry Tests to Assess Safety and General Health...
...e blood count with differential white blood c...
...ntiretroviral drugs, HIV infection...
Screening for Coinfecti...
...r Sexually Transmitted Infections (STIs) —...
...HIV should be screened for gonorrhea and ch...
...All persons having receptive vagi...
...yphili...
...atients should be screened for syphi...
...puncture should always be performed for pati...
...lumbar puncture should be performed in pati...
...uberculosis (TB)...
...nitiation of care, persons with HIV without a...
...Persons with HIV who are close contacts o...
...itis A, B, and C
Persons with HIV should be screened fo...
...ns with HIV should be screened for evidence of...
...ns with HIV should be screened for...
...Infants born to persons with HBV-...
...Persons who are not immune to HAV an...
...Persons who are not immune to HA...
...umps, and Rubella...
...ersons with HIV born in 1957 or after...
...vaccine should be given to protect...
...a Zoster VirusSerologic screening for varicella z...
...y Be Performed Under Certain Circumstances...
...adiographyA baseline chest radiogra...
...ical Cancer Screening
...with a uterus who are
...th a uterus who are >30 years old sh...
...ersons with atypical squamous cells...
...ysterectomy for benign disease, rou...
...l Cancer ScreeningPersons with a h...
...phate DehydrogenaseScreening for gluco...
...egnancy TestingAll persons of childbear...
...Testosterone Level...
...ning serum testosterone levels are recomme...
...testosterone levels in women at baselin...
... NOT Recommended for General Screening Purpos...
...esting for HSV, CMV IgG, Toxoplasma IgG, and...
...esting for serum cryptococcal antigen may be co...
.... ROUTINE HEALTHCARE MAINTENANCE CONSIDERATIONS...
...itoring Following the Initial Assessm...
...ter initiation of ART, HIV RNA should be r...
...4 cell count should be monitored to determine t...
...for Mental Health and Substance U...
...ing for substance use should be do...
...ening for depression using validated...
...accination for Infectious Diseases...
...ning for Chlamydia, Gonorrhea, Trichomonias...
...r syphilis, chlamydia, and gonorrhea in asympt...
...s having vaginal sex should be screened for trich...
...d messages are critical for patients who r...
...nd Vaccination for Other Infectious Diseases...
...tuberculosis screening annually in per...
...peat testing is recommended in patients with adv...
...for pneumococcal infection, influenza, tet...
...Asymptomatic persons with CD4 >200 cells/mm3...
...atitis A and B (HAV, HB...
...re susceptible to infection should be vaccinated...
...on should be recommended for nonimmune sexual par...
...are negative for HBsAg and HBsAb but positive fo...
...ccination for HAV is recommended for...
...apillomavirusPersons between 9–26 years...
...ella Zoster Virus...
...who are susceptible to VZV (those who have not b...
...a primary vaccination may be consid...
...t zoster vaccine, two dose series, should be given...
...reening for and Prevention of Cancer
...ts who smoke should be strongly encouraged...
Screening for prostate, breast, lung, and colon...
...Biennial screening mammography is recommen...
...ons with HIV between 21–29 years of age shoul...
...persons >30 years of age, cervical Pap tests shoul...
...l cancer screening: Periodic anal cytology by an...
...for hepatocellular carcinoma every 6...
...er Healthcare Maintenance...
Complete blood count and chemistry p...
...alysis should be monitored annually among th...
...with HIV should be asked about their repro...
...Patient education should be provided at eve...
...sons with HIV should have semi-annual oral health...
...D OTHER NONCOMMUNICABLE COMORBIDIT...
...pid levels should be obtained prior to, and wit...
...dom or fasting blood glucose (FBG) and hemogl...
...e bone densitometry (DXA) screening for os...
...lacement therapy for cisgender men should...
.... SPECIAL CONSIDERATIONS FOR CISGENDER WO...
...n and Preconception Care...
Contraception and Preconception CareAll pe...
...Perinatal Transmission...
...To prevent perinatal transmission, all...
...xposed to HIV in utero should be managed acco...
...gIn the US, persons with HIV should avoid b...
VI. SPECIAL CONSIDERATIONS FOR CHILDREN...
...diagnosed with HIV should undergo HIV resista...
...ll children with HIV should initiat...
CD4 cell counts and HIV RNA should be mo...
...ations should be administered according to...
...ldren with HIV should be managed by a specialist w...
VII. SPECIAL CONSIDERATIONS FOR ADOLESCEN...
...with HIV require an individual and developmental...
...nts with HIV should have a coordinat...
...should be administered according to ACIP schedules...
...I. CONSIDERATIONS FOR TRANSGENDER...
...nd gender diverse persons with HIV should have ac...
...ntake forms, medical records, and other docu...
...ender persons should be offered medical a...
...er screening should be conducted based on g...
...nitial Assessment: History of the Prese...
...Other Medical and Surgical HistoryHaving...
...itial Assessment — Review of Systems and Physi...
Table 4. Recommended Initial Laboratory Screen...
Treatment
...atment
Table 5. Routine Healthcare Maintenance...
...ect of Protease Inhibitors and Nonnucleoside...
Gender Identity
...der Identity...
...ble 7. Terminology Associated with...
...8. Principles of Care of Transgender and Ge...