Updated Guidelines by the HIV Medicine Association


Updated Guidelines by the HIV Medicine Association

The HIV Medicine Association of the Infectious Diseases Society of America (IDSA) updated its 2009 guidelines regarding needed primary care interventions, including preventive measures, for persons with HIV infection.
 

These guidelines aim to educate HIV specialists regarding primary care issues and primary care physicians regarding HIV care recommendations.

  • Persons with HIV infection should be treated and monitored for complications of HIV infection and its treatment, as well as for age- and sex-specific health problems experienced by the general population.

  • Culturally and linguistically competent care is essential to successfully engage and retain patients in care.

  • Diabetes, osteoporosis, and colon cancer screenings are recommended.

  • Before and within 1 to 3 months after antiretroviral therapy (ART) is started, patients should undergo testing for fasting blood glucose and/or hemoglobin A1c (HbA1c) levels, as well as fasting lipid levels.

  • Patients with diabetes mellitus should have HbA1c monitoring every 6 months, with a target of less than 7%.

  • Patients with abnormal lipid levels should be treated according to the National Cholesterol Education Program Guidelines.

  • Postmenopausal women and men 50 years or older should undergo baseline bone densitometry screening for osteoporosis.

  • Vaccination against pneumococcal infection, influenza, varicella, and hepatitis A and B is recommended according to established guidelines.

  • Cardiovascular disease, high cholesterol levels, and high triglyceride levels are more prevalent among HIV-infected persons because of the infection itself, ART, and/or traditional risk factors.

  • Control of other cardiovascular risk factors should include smoking cessation, dietary counseling, and monitoring and management of lipid levels.

  • Clinicians should be aware of drug interactions between specific antiretroviral agents and statins.

  • For menopausal women, routine use of hormone replacement therapy, particularly if prolonged, is not currently recommended.

  • However, hormone replacement therapy may be considered in women with severe menopausal symptoms, but only for a limited period and at the lowest effective doses.

  • Updated Guidelines by the HIV Medicine AssociationWomen 50 years or older should receive an annual mammogram.

  • Women between 40 and 49 years old should have individualized assessment of risk for breast cancer and counseling regarding the potential benefits and risks of screening mammography.

  • Nonjudgmental discussion and counseling regarding current and past sexual history, illicit drug use, and other high-risk behaviors are indicated.

  • Clinicians should evaluate how well their patients are coping with the stresses of HIV infection and connect them with appropriate support systems.

  • All patients should be evaluated for depression and substance abuse, which are highly prevalent among HIV-infected persons.

  • A management plan to address depression and substance abuse, if present, should be developed and implemented in collaboration with appropriate providers.

Changes since the 2009 guidelines include the following:

  • Updated Guidelines by the HIV Medicine AssociationBlood monitoring for HIV levels in well-controlled patients should occur every 6 to 12 months; previous recommendation was for every 3 to 4 months.

  • Grading of recommendations based on either strong or weak and the quality of the evidence as high, moderate, low, or very low.

  • Recommendations on initial assessment and immediate follow-up are expanded and include user-friendly tables.

  • Recommendations for long-term complications are now omitted.

  • A new section on metabolic co-morbidities replaces separate guidelines on dyslipidemia.

  • Detailed representation of  sexually transmitted diseases section and table.

  • Annual trichomoniasis screening is recommended for women.

  • Annual screenings for gonorrhea and chlamydia are recommended for all who may be at risk.

 

For detailed Insight, visit http://cid.oxfordjournals.org

A preventive quadrivalent HPV vaccine is now available and routinely recommended in a 3-dose schedule for all females aged 926 years.


 

Dated  03 December 2013

 

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