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Guidelines for HIV/AIDS Diagnosis and Treatment
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Guidelines for HIV/AIDS Diagnosis and Treatment

Christina Mattina
These guidelines provide an overview of the current recommendations surrounding HIV/AIDS diagnosis, treatment, and complications.
COMPLICATIONS
Opportunistic Infections
Due to their reduced immune system function, individuals with HIV are more susceptible to opportunistic infections (OIs), which are the leading cause of morbidity and mortality among this population.11 According to the National Institutes of Health guidelines on OIs, “the widespread use of potent ART has had the most profound influence on reducing OI-related mortality in HIV-infected persons.”11 These and other guidelines identify several strategies for OI prevention, including immunizations, OI prophylaxis, and exposure avoidance.

Immunizations
The following vaccinations are recommended to reduce the risk of preventable infections in all individuals with HIV: influenza; tetanus/diphtheria/pertussis; human papillomavirus (female or male); pneumococcal polysaccharide; pneumococcal 13-valent conjugate; and hepatitis B. The meningococcal and hepatitis A vaccines are recommended when certain risk factors are present, such as living in a dormitory for meningococcal or chronic liver disease for hepatitis A. Live vaccines (varicella, zoster, measles/mumps/rubella) are contraindicated for use in patients with severe immunosuppression, defined as a CD4 count of <200 cells/µL.7,11

Prophylaxis
Prophylaxis is used to prevent either a first episode or a recurrence of an OI. Guidelines recommend the initiation of prophylaxis against 3 main OIs when CD4 count falls below a certain threshold: Pneumocystis pneumonia (<200 cells/µL), Toxoplasma gondii encephalitis (<100 cells/µL), and Mycobacterium avium complex disease (<50 cells/µL).7,11 Several other recommendations are in place for the indication of prophylaxis depending on the presence of various risk factors. For instance, patients with latent Mycobacterium tuberculosis infection should receive prophylaxis to prevent tuberculosis. Prophylaxis is encouraged in endemic regions for Histoplasma capsulatum, coccidioidomycosis, malaria, and penicilliosis.

Exposure Prevention
In the course of daily life, patients will inevitably encounter potential sources of infection, but the risk of contracting an illness can at least partially be mitigated through careful exposure prevention. Each of the exposure types listed below is followed by some of the pertinent risk reduction strategies for HIV patients.7,11
  • Sexual exposures: using condoms, frequent testing for sexually transmitted diseases, avoiding risky sexual practices
  • Injection-drug-use exposures: substance abuse counseling and treatment, safer injection practices like one-time use of equipment, syringe-exchange programs, sterile preparation of drugs, safe disposal
  • Environmental and occupational exposures: frequent handwashing for parents or childcare providers, gloves and hand hygiene for contact with animals, avoiding contact with young farm animals or soil
  • Pet-related exposures: avoiding stray animals, wearing gloves or not handling animal feces, not allowing animals to lick patient’s open cuts, avoiding cleaning cat litter boxes whenever possible, avoiding contacts with reptiles and exotic pets
  • Food- and water-related exposures: safe food preparation including thorough cooking of meat, washing produce, avoiding food cross-contamination, avoiding potentially contaminated water sources
  • Travel-related exposures: researching risks in intended destinations, avoiding potentially contaminated food and tap water, special attention to good hygiene, receiving any indicated vaccines
  • Bloodborne exposures: following infection control procedures for tattoos or piercings, receiving CMV antibody-negative or leukocyte-reduced blood transfusions
  • Respiratory and bodily exposures: avoid people with tuberculosis, chickenpox, shingles, etc.
References
1. Centers for Disease Control and Prevention. About HIV/AIDS. CDC website. http://www.cdc.gov/hiv/basics/whatishiv.html. Published November 30, 2016. Accessed December 7, 2016.
2. Rom WN, Markowitz SB. Environmental and Occupational Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.
3. UN AIDS. Fact sheet November 2016. UN AIDS website. http://www.unaids.org/en/resources/fact-sheet. Published November 2016. Accessed December 7, 2016.
4. World Health Organization. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations – 2016 update. WHO website. http://apps.who.int/iris/bitstream/10665/246200/1/9789241511124-eng.pdf?ua=1. Published July 2016. Accessed January 3, 2017.
5. WHO issues new guidance on HIV self-testing ahead of World AIDS Day [news release]. Geneva, Switzerland: World Health Organization; November 29, 2016. http://www.who.int/mediacentre/news/releases/2016/world-aids-day/en/. Accessed January 3, 2017.
6. Centers for Disease Control and Prevention, Association of Public Health Laboratories. Laboratory testing for the diagnosis of HIV infection: updates recommendations. CDC website. https://stacks.cdc.gov/view/cdc/23447. Published June 27, 2014. Accessed January 3, 2017.
7. Health and Human Services, Health Resources and Services Administration. Guide for HIV/AIDS clinical care – 2014 edition. HHS website. http://hab.hrsa.gov/clinical-quality-management/clinical-care-guidelines-and-resources. Published April 2014. Accessed January 5, 2017.
8. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. NIH website. https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf. Published July 14, 2016. Accessed January 5, 2017.
9. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2nd ed. WHO website. http://apps.who.int/iris/bitstream/10665/208825/1/9789241549684_eng.pdf?ua=1. Published June 2016. Accessed January 5, 2017.
10. Centers for Disease Control and Prevention. Complete listing of medication adherence evidence-based behavioral interventions. CDC website. https://www.cdc.gov/hiv/research/interventionresearch/compendium/ma/complete.html. Published November 16, 2016. Accessed January 5, 2017.
11. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. NIH website. https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Published November 10, 2016. Accessed January 6, 2017.

 
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