Primary Care Guidelines for the Management of Persons Infected with Human Immunodeficiency Virus: 2009 Update by the HIV Medicine Association of the Infectious Diseases Society of America

Abstract

Evidence-based guidelines for the management of persons infected with human immunodeficiency virus (HIV) were prepared by an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America. These updated guidelines replace those published in 2004. The guidelines are intended for use by health care providers who care for HIV-infected patients or patients who may be at risk for acquiring HIV infection. Since 2004, new antiretroviral drugs and classes have become available, and the prognosis of persons with HIV infection continues to improve. However, with fewer complications and increased survival, HIV-infected persons are increasingly developing common health problems that also affect the general population. Some of these conditions may be related to HIV infection itself and its treatment. HIV-infected persons should be managed and monitored for all relevant age- and gender-specific health problems. New information based on publications from the period 2003-2008 has been incorporated into this document.

The prevalence of comorbidities among people living with HIV in Brent: a diverse London Borough

“…29,30 There is also a clear need to tailor care provision for people with HIV to reduce mortality and morbidity risks by preventing comorbidities; through encouragement of lifestyle changes, screening, 29 education about comorbidity risks 15 and widening knowledge about self-management in those with multiple long-term conditions. 31 Practitioners need to be more aware of the risk of comorbidities in people with HIV, in particular depression, 32 hepatitis and tuberculosis, 33 and the safety implications of interactions between HIV and other medications. 34 Treating comorbidities early may be beneficial, for example, the early treatment of HCV in PLWHA may improve clinical outcomes 35 and treating mental health issues may improve adherence to ART.…”

Lymphopenia and Treatment-Related Infectious Complications in ANCA-Associated Vasculitis

“…Newer therapies, such as rituximab, precisely target this cell (36). However, clinicians should specifically monitor this variable, and the presence of severe lymphopenia must alert the clinicians to its risk and entail appropriate actions: (1) to taper corticosteroids as proposed by current guidelines because this can easily be forgotten (37), (2) to measure CD4 lymphocyte cell count in order to establish the risk of opportunistic infections and start prophylaxis accordingly (35), (3) to reevaluate other risk factors of infection and reinforce preventive measures (hand washing, avoidance of viral contact), and (4) to suspect infections early and institute prompt treatment. Prevention of infectious complications should always be weighed against the need to control disease activity.…”

Comorbidity-Related Treatment Outcomes among HIV-Infected Adults in the Bronx, NY

“…Six treatment outcomes were assessed, including both processand disease-related measures. Process-related measures were: (1) proportion of medical visits with documented blood pressure, (2) whether LDL-cholesterol (LDL-C) was checked yearly and within 6 months of starting new cART, 10 and (3) frequency of hemoglobin A1c measurements. Disease-related measures were: (1) proportion of blood pressure measurements at goal as defined by the 7th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7); 11 (2) proportion of LDL-C measurements at goal as defined by the 3rd Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP ATPIII); 12 and (3) proportion of hemoglobin A1c values G7% as recommended by the American Diabetes Association (ADA).…”