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
...agnosis
...OPTIMIZING CARE ENGAGEMENT, MEDICATION ADHERENC...
...ll persons with HIV should be provided timely acc...
...IV care sites should make every effort to pr...
...should implement programs incorporating evidence-...
...s should utilize a multidisciplina...
...TIAL EVALUATION AND IMMEDIATE FOLLOW-UP FOR...
...ensive present and past medical histo...
...Tests for All Persons With HIV...
...ing Patients who have no documentation of...
...Cell Counts and Percentage...
...ount with percentage should be obtained upon initi...
...Measurement of the CD8 cell count and th...
...a HIV RNA Levels A quantitative HIV RNA...
...IV Resistance Testing
...ients should be assessed for transmitte...
...stance testing should be obtained f...
...ication of ART, resistance testing, including for...
...mitted integrase strand transfer inhibitor (...
...ted Tests in Selected Patients...
...Tropism AssayTropism testing should be pe...
...B*5701...
...B*5701 testing should be performed befor...
...ts who are positive for the HLA B*5701 haplotype...
...Tests to Assess Safety and General Health...
...lood count with differential white b...
...tiretroviral drugs, HIV infection itself, and ho...
...ng for Coinfections...
...or Sexually Transmitted Infections (S...
...ons with HIV should be screened for...
...rsons having receptive vaginal sex should be...
...yphili...
All patients should be screened for syphilis up...
...ure should always be performed for patients...
...ture should be performed in patients who exper...
...atent Tuberculosis (TB)...
...tion of care, persons with HIV without a his...
...Persons with HIV who are close con...
...itis A, B, and C
...with HIV should be screened for evidence of hep...
...s with HIV should be screened for evidence...
...ersons with HIV should be screened for H...
...ants born to persons with HBV- and/...
...rsons who are not immune to HAV and HB...
...Persons who are not immune to HAV a...
Measles, Mumps, and Rube...
...with HIV born in 1957 or after should be t...
...ine should be given to protect against measles,...
...Zoster VirusSerologic screening for varicel...
Tests That May Be Performed Under Ce...
...t RadiographyA baseline chest radiograph sh...
...ervical Cancer Screening...
...rsons with a uterus who...
...ersons with a uterus who are >30 ye...
...h atypical squamous cells of unknown significan...
Following hysterectomy for benign d...
...ScreeningPersons with a history of receptive...
...Phosphate DehydrogenaseScreening for glucose-6...
...ncy TestingAll persons of childbearing poten...
Serum Testosterone Leve...
...m testosterone levels are recommended in adult...
...ng testosterone levels in women at base...
Tests NOT Recommended for General Screeni...
...for HSV, CMV IgG, Toxoplasma IgG, and b...
...ting for serum cryptococcal antigen ma...
III. ROUTINE HEALTHCARE MAINTENANC...
HIV-Specific Monitoring Following the Initia...
...tion of ART, HIV RNA should be rechecked after 2â...
...should be monitored to determine the need...
...for Mental Health and Substance Use Issues...
...ning for substance use should be done at...
...or depression using validated screening tool...
...Vaccination for Infectious Disease...
...g for Chlamydia, Gonorrhea, Trichomoniasis...
...g for syphilis, chlamydia, and gonorrhea in asympt...
...sons having vaginal sex should be screened for tr...
Tailored messages are critical for pat...
...ccination for Other Infectious Diseases...
...rm tuberculosis screening annually in...
...peat testing is recommended in patients with...
...for pneumococcal infection, influenza, teta...
...atic persons with CD4 >200 cells/m...
...atitis A and B (HAV, HBV)...
...are susceptible to infection should be vacc...
...n should be recommended for nonimmu...
...nts who are negative for HBsAg and HBsAb b...
...accination for HAV is recommended for all nonimmun...
...pillomavirusPersons between 9–26 ye...
...icella Zoster Virus...
...Patients who are susceptible to VZV (those who...
...Varicella primary vaccination may b...
...ant zoster vaccine, two dose series, should be g...
...ing for and Prevention of Cancer...
...ll patients who smoke should be str...
...ning for prostate, breast, lung, and colon can...
...eening mammography is recommended for persons a...
...Persons with HIV between 21–29 years of...
...rsons >30 years of age, cervical Pap tests shoul...
...screening: Periodic anal cytology b...
...ing for hepatocellular carcinoma every 6...
...er Healthcare Maintenance
...Complete blood count and chemistry panels should...
...is should be monitored annually among...
...ns with HIV should be asked about t...
...ducation should be provided at every visit...
...ns with HIV should have semi-annual o...
...TABOLIC AND OTHER NONCOMMUNICABLE...
...should be obtained prior to, and within 1–3 m...
Random or fasting blood glucose (FBG) and hemoglob...
...seline bone densitometry (DXA) screening...
...eplacement therapy for cisgender me...
...DERATIONS FOR CISGENDER WOMEN AND TRANSGEND...
...aception and Preconception C...
...and Preconception CareAll persons with HIV who ar...
...revention of Perinatal Transmi...
...perinatal transmission, all pregnant persons w...
...Infants exposed to HIV in utero should be managed...
...eedingIn the US, persons with HIV sho...
.... SPECIAL CONSIDERATIONS FOR CHILDR...
...d with HIV should undergo HIV resis...
...ldren with HIV should initiate ART, regardless of...
...cell counts and HIV RNA should be mo...
Childhood vaccinations should be administered ac...
...hildren with HIV should be managed by a special...
...SPECIAL CONSIDERATIONS FOR ADOLESCENT...
...with HIV require an individual and developmental a...
...cents with HIV should have a coordina...
...cinations should be administered acco...
...ONSIDERATIONS FOR TRANSGENDER AND GENDER DIVERSE...
...r and gender diverse persons with HIV...
...forms, medical records, and other docum...
...ansgender persons should be offered medi...
...reening should be conducted based on...
...1. Initial Assessment: History of t...
.... Other Medical and Surgical HistoryHaving trouble...
...Assessment — Review of Systems and Ph...
...Recommended Initial Laboratory Scre...
Treatment
Treatme...
...5. Routine Healthcare Maintenance for People W...
...le 6. Effect of Protease Inhibitors and No...
Gender Identity
...ender Identit...
...ble 7. Terminology Associated with Gender Iden...
...rinciples of Care of Transgender and Gender Dive...