antiretroviral%20therapy%20for%20hiv-infected%20adults
ANTIRETROVIRAL THERAPY FOR HIV-INFECTED ADULTS
Antiretroviral therapy is recommended for all HIV-infected individuals regardless of CD4 count to decrease morbidity and mortality associated with HIV infection.
Goals of antiretroviral treatment are suppression of viral load for maximum possible duration, restore & preserve immunologic function, reduce HIV-related morbidity & mortality and prevent HIV transmission.
Urgent initiation of antiretroviral treatment is recommended in the following individuals: pregnant women, patients w/ HIV with coinfections (HBV, HCV, active tuberculosis), AIDS-defining illness, HIV-associated nephropathy, low CD4 counts, acute opportunistic infections and HIV HBV with evidence of chronic liver disease.

Introduction

  • Human immunodeficiency virus (HIV) testing should be offered to all persons requesting HIV testing for any reason
  • HIV screening/testing and counselling should be voluntary and undertaken only with the patient’s knowledge and understanding that HIV test is being planned
    • Persons at high risk for HIV should be screened for HIV at least yearly
    • The “5 Cs” must be observed - informed consent, counselling, confidentiality, correct test results and linkage to care
    • General informed consent for medical care should be enough to cover consent for HIV testing
    • If a patient declines an HIV test, this decision should be documented in the medical record
  • HIV screening should be part of the routine panel of prenatal screening tests for all pregnant women
    • Allows HIV-infected women and their infants to benefit from timely and appropriate interventions (ART medications, scheduled cesarean delivery, etc)
  • In all types of HIV epidemics, health care providers must recommend HIV testing and counselling as part of standard care to individuals who present to health facilities with signs, symptoms or medical conditions that indicate a probable HIV infection
  • Types of HIV epidemics:
    • Low-level epidemic is when HIV may have existed for many years but has never spread to significant levels in any sub-population; recorded infection is largely confined to high-risk individuals [eg drug injectors, sex workers, men having sex with other men (MSM)]; HIV prevalence has not consistently exceeded 5% in any sub-population
    • Concentrated HIV epidemics is when HIV has spread rapidly in a defined sub-population but is not well established in the general population; HIV prevalence is consistently >5% in at least one sub-population but is <1% in pregnant women in urban areas
    • Generalized HIV epidemic is when HIV is firmly established in the general population; HIV prevalence is consistently >1% in pregnant women
  • In places with low-level and concentrated epidemics, HIV testing and counselling should not be recommended to all persons attending health facilities
    • In such settings, priority is to recommend HIV testing and counselling to all patients who present with signs and symptoms suggestive of an underlying HIV infection and to children who have been exposed perinatally to HIV
  • In generalized epidemics, HIV testing and counselling should be recommended to all individuals seen in all health facilities
    • HIV testing should be part of the normal standard of care provided to patients, regardless of the presence or absence of symptoms, or the reason for patient’s visit to the health facility
  • Regardless of type of epidemic setting, HIV testing and counselling are recommended to the following:
    • Patients of all age groups who present with signs and symptoms or medical conditions that could indicate HIV infection, including tuberculosis (TB)
    • HIV-exposed children or children born to HIV-positive women
    • Malnourished children in generalized epidemics who are not responding to appropriate nutritional therapy
    • Men who desire circumcision as an HIV prevention intervention
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