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Updated HIV Guidelines Emphasise Primary Care Need of Patients

NEW YORK -- August 17, 2009 -- The HIV Medicine Association (HIVMA) and the Infectious Diseases Society of America (IDSA) have updated their evidence-based guidelines to help providers manage the care of those living with HIV.

The guidelines appear in the September 1 issue of the journal Clinical Infectious Diseases.

"While improvements in antiretroviral therapy have improved the prognosis for many HIV patients, data from recent studies suggest those living with HIV are at higher risk for developing common health problems, such as heart disease, diabetes or cancer," said lead author Judith A. Aberg, MD, Department of Medicine, Division of Infectious Diseases & Immunology, New York University School of Medicine, New York, New York.

"Now more than ever, it's imperative that HIV care providers be aware of the primary care needs of their patients, and that includes routine screening for these kinds of conditions."

Developed by an expert panel, the updated, evidence-based guidelines outline recommended screening tests for common health problems in the context of HIV infection. Information about recommended immunisations, along with dose and regimen details, is provided as well.

Last updated in 2004, the guidelines also emphasise the importance of patients adhering to a comprehensive program of care rather than focusing solely on a medication regimen.

"For people living with HIV, it's not just about adherence to medication, it's also about adherence to care," said Dr. Aberg. "These patients must have access to a range of services to help them stay engaged in their medical care and should receive the regular monitoring and medical attention this chronic infection demands."

Specific Guideline Changes

· There is an expanded list of diagnostic HIV tests.
· All patients with HIV should have a genotypic resistance test performed at baseline regardless of whether antiretroviral therapy will be initiated.
· Patients who are seronegative for varicella zoster virus (VZV) or who do not give a history of chickenpox or shingles should receive postexposure prophylaxis with VZV immune globulin (VariZIG) as soon as possible (within 96 h) after exposure to a person with chickenpox or shingles.
· Varicella primary vaccination may be considered for HIV-infected VZV-seronegative persons aged older than 8 years with CD4 cell counts >200 cells/mm3 and in HIV-infected children aged 1 to 8 years with CD4 cell percentages 15%.
· Among patients with syphilis, cerebrospinal (CSF) examination should be performed for persons with neurologic or ocular signs or symptoms, active tertiary syphilis, and syphilis treatment failure. CSF examination is also recommended for patients with late-latent syphilis, including those with syphilis of unknown duration.
· HLA-B*5701 testing should be performed prior to initiating abacavir therapy to reduce the risk of a hypersensitivity reaction. Patients who are positive for the HLA B*5701 haplotype should not be treated with abacavir.
· Baseline urinalysis and calculated creatinine clearance should be considered, especially in black patients, because of an increased risk of HIV-associated nephropathy.
· Urinalysis and calculated creatinine clearance should also be performed prior to initiating treatment with drugs such as tenofovir or indinavir, which have the potential for nephrotoxicity.
· Tropism testing should be performed before initiation of treatment with a CCR5-antagonist antiretroviral drug.
· For women aged 40 to 49 years, providers should periodically perform individualised assessment of risk for breast cancer and inform the patient of the potential benefits and risks of screening mammography.
· Emphasis should be placed on the importance of adherence to care rather than focusing solely on adherence to medications.

SOURCE: HIV Medicine Association

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