HIV

IDSA Releases New HIV Primary Care Guidelines

The HIV Medicine Association of the Infection Diseases Society of America has released new guidance for the treatment of individuals with human immunodeficiency virus (HIV) in primary care.

“To receive optimal medical care and achieve desired outcomes, persons with HIV must be consistently engaged in care and able to access uninterrupted treatment, including antiretroviral therapy (ART). Comprehensive evidence-based HIV primary care guidance is, therefore, more important than ever,” the authors wrote.

The guidance was based upon an expert panel literature review of evidence available since the release of the last guideline (2013) up through December 2019.

Among the recommendations:

  • Individuals with HIV should have timely access to routine and urgent primary care.
  • Comprehensive medical history, including HIV-related information, should be obtained for all patients when starting care.
  • HIV RNA should be checked after 2 to 4 weeks and no later than 8 weeks after initiation of ART, and every 4 to 8 weeks until viral suppression.
  • Screening for substance use should be conducted at every health care encounter.
  • Lipid levels should be obtained before starting ART and within 1 to 3 months of starting ART.
  • Patients with childbearing potential should be asked about their plans regarding pregnancy upon initiation of care.
  • Infants should undergo HIV resistance testing before starting ART.
  • All children with HIV should initiate ART regardless of CD4 cell count/percentage, HIV RNA level, or symptoms.
  • Transgender and gender-diverse individuals with HIV should have access to gender-affirming, nondiscriminatory, nonstigmatizing care.

“As the population ages and noncommunicable diseases arise, providing comprehensive healthcare for persons with HIV becomes increasingly complex, including management of multiple comorbidities and the associated challenges of polypharmacy, while not neglecting HIV-related health concerns. Clinicians must address issues specific to persons of childbearing potential, including care during preconception and pregnancy, and to children, adolescents, and transgender and gender-diverse individuals.”

—Michael Potts

Reference:

Thompson MA, Horberg MA, Agwu AL, et al. Primary care guidance for persons with human immunodeficiency virus: 2020 update by the HIV Medicine Association of the Infectious Diseases Society of America. November 6, 2020.  Clin Infect Dis. https://doi.org/10.1093/cid/ciaa1391