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Last Updated: 12/19/2014  

Human Immunodeficiency Virus Disease

Prevention
  • 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 non-occupational exposures to HIV with combination antiretroviral therapy for 4 weeks.

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

  • Repeat HIV testing annually in high-risk individuals.

Diagnosis
  • Assess for acute HIV infection if a febrile illness occurs within several weeks of a potential exposure.

  • Test for chronic HIV infection by testing for HIV using a third-generation immunoassay for HIV1 and HIV2 as the initial test.

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

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

Therapy
  • Offer antiretroviral therapy to all HIV-positive individuals, and add prophylactic antimicrobial agents when the CD4 count declines below 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 when initiating combination therapy, with the goal of suppressing viral load.

  • Consider regimens containing tenofovir/emtricitabine 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

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.
Authors 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. Shirish Huprikar, MD has nothing to disclose.

The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, FACP, Editor.

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