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Last Updated: 7/7/2015  

Human Immunodeficiency Virus Disease

  • Offer pre-exposure prophylaxis to persons at ongoing high risk for HIV transmission.

  • Encourage universal risk-reduction behaviors.

  • Offer postexposure prophylaxis after both occupational and nonoccupational exposures to HIV with cART for 4 weeks.

  • See table Drug Treatment for HIV Infection.

  • Screen all patients age 13 to 64 years for HIV as part of routine clinical care.

  • Screen all pregnant women.

  • Repeat HIV testing at least annually in high-risk individuals.

  • Test for HIV infection using the fourth-generation combination immunoassay HIV test, which tests for HIV-1 and HIV-2 antibodies in addition to the p24 antigen in HIV-1. A positive test result should be followed by an HIV-1/HIV-2 antibody differentiation immunoassay to confirm positive initial test results and identify the type of chronic infection.

    • If fourth-generation testing is not available, test for chronic infection using a third-generation immunoassay for HIV-1 and HIV-2 as the initial test, or HIV ELISA or EIA and, if the result is positive, confirm with Western blot.

  • Use direct virologic testing with serial immunoassay or ELISA testing when acute HIV infection is suspected.

  • Assess both viral load and CD4 count in asymptomatic patients with newly diagnosed HIV infection identified through screening to obtain important prognostic information and for monitoring responses to therapy. Check other lab studies to establish a baseline and look for comorbid conditions.

  • Assess for acute HIV infection using direct virologic testing if a febrile illness occurs within several weeks of a potential exposure.

  • Offer ART to all HIV-positive individuals, and add prophylactic antimicrobial agents when the CD4 count declines to <200 cells/mm3.

  • Choose regimens of three agents on the basis of proven potency, safety of coadministration, and individualized factors related to convenience and potential adverse events, with the goal of suppressing viral load.

  • Consider regimens containing tenofovir/emtricitabine or abacavir/lamivudine to be preferred for most patients as initial therapy.

  • Provide prophylaxis against opportunistic infections on the basis of the level of immunosuppression and other clinical factors, including previous opportunistic infections, history of latent TB, and exposure to endemic mycoses.

DOI: 10.7326/d132
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Author(s) and Disclosures:
J. Michael Kilby, MD is a speaker for Roche, GlaxoSmithKline, Bristol Myers Squibb, received honorarium from Roche, GlaxoSmithKline, Bristol Myers Squibb, received grants from several of these companies. Rachel Chasan, MD has nothing to disclose. Jonathan Hand, MD has nothing to disclose.

One or more of the present or past ACP Smart Medicine physician editors worked on this module and had nothing to disclose: Davoren Chick, MD, FACP; Deborah Korenstein, MD, FACP; Marjorie Lazoff, MD, FACP; Richard Lynn, MD, FACP.

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