Hiv Infection Among Neonates Infants And Children
Diagnosis of HIV infection in a pregnant woman indicates the need for evaluating and managing the HIV-exposed neonate and considering whether the womans other children, if any, might be infected. Detailed recommendations regarding diagnosis and management of HIV infection among neonates and children of mothers with HIV are beyond the scope of these guidelines but are available at . Exposed neonates and children with HIV infection should be referred to physicians with expertise in neonatal and pediatric HIV management.
Sti Screening Of Persons With Hiv Infection In Hiv Care Settings
At the initial HIV care visit, providers should screen all sexually active persons for syphilis, gonorrhea, and chlamydia, and perform screening for these infections at least annually during the course of HIV care . Specific testing includes syphilis serology and NAAT for N. gonorrhoeae and C. trachomatis at the anatomic site of exposure. Women should also be screened for trichomoniasis at the initial visit and annually thereafter. Women should be screened for cervical cancer precursor lesions per existing guidelines .
More frequent screening for syphilis, gonorrhea, and chlamydia should be tailored to individual risk and the local prevalence of specific STIs. Certain STIs can be asymptomatic their diagnosis might prompt referral for partner services, might identify sexual and needle-sharing partners who can benefit from early diagnosis and treatment of HIV, and might prompt reengagement in care or HIV prevention services . More detailed information on screening, testing, and treatment is provided in pathogen-specific sections of this report.
Targeted Versus Routinely Recommended Hiv Ctr
Providers in all settings should ideally recommend CTR to all clients on a routine basis to ensure that all clients who could benefit from CTR receive these services. However, resources might be insufficient to permit this practice. Therefore, these guidelines contain recommendations aimed at ensuring that as many persons as possible who are HIV-infected or at risk for HIV who do not know their HIV status have access to testing, prevention counseling, and referrals.
Routinely Recommending CTR to All Clients Versus Targeting CTR to Selected Clients
Studies have documented that, in settings serving clients at increased behavioral and clinical risk for HIV infection, targeting HIV testing based on reported risk factors will miss many HIV-infected clients . However, in low prevalence settings, where most clients have minimal risk, targeting clients for HIV testing based on risk screening might be more feasible for identifying small numbers of HIV-infected persons . Providers should consider three factors in determining whether to recommend HIV CTR to all clients or to target only selected clients.
Using Prevalence Data to Establish Service Priorities
Because of the availability of antiretroviral therapy to reduce the risk for perinatal HIV transmission, all pregnant women should be recommended HIV testing regardless of setting prevalence or behavioral or clinical risk .
Determining Individual HIV Risk Through Risk Screening**
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Vital Features Of Counseling:
Patients Who Should Be Tested
Because of the changing demographics of the HIV/AIDS epidemic, the CDC19 recently updated HIV testing recommendations. The CDC now recommends that physicians offer HIV testing as part of routine health care to all patients in high-prevalence settings , all patients with risk factors for HIV infection in low-prevalence settings, and patients who request HIV testing.
Counseling for the prevention of HIV infection is encouraged, and the CDC19 also is promoting simplified testing procedures. Requirements for preventive counseling should not be a barrier to HIV testing. The CDC recommends routine HIV testing in all pregnant women regardless of risk and screening of infants if their mothers have not been tested. The CDC is developing guidelines for the use of rapid HIV tests during labor and delivery, or postpartum if the mothers did not undergo prenatal testing. In addition, all persons with an acute or nonacute occupational exposure to HIV should be tested.19 Symptoms of HIV infection can vary in presentation and severity. However, primary HIV infection generally presents within two to four weeks after transmission as an acute influenza-like or mononucleosis-like illness in about 70 percent of newly infected patients.20,21 Any sexually active or needle-sharing patient presenting with such symptoms should be tested for HIV. Antibody tests may be negative or indeterminate during early infection, but a very high viral load establishes the diagnosis.21
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Primary Care Guidance For Persons With Human Immunodeficiency Virus: 2020 Update By The Hiv Medicine Association Of The Infectious Diseases Society Of America
Clinical Infectious Diseases, Volume 73, Issue 11, 1 December 2021, Pages e3572e3605, : 6 November 2020 Correction Issued 8 December 2021
Melanie A. Thompson, Michael A. Horberg, Allison L. Agwu, Jonathan A. Colasanti, Mamta K. Jain, William R. Short, Tulika Singh, and Judith A. Aberg
Perinatal Hiv Prevention For Transgender And Gender Diverse People Assigned Female Sex At Birth
- This section provides an overview about the Panels recommendations regarding perinatal HIV prevention and treatment of HIV in pregnancy for transgender and gender diverse people assigned female sex at birth.
- The Panel has determined that, in most cases, it is appropriate to extrapolate its recommendations based on data in presumed cisgender women to all people assigned female sex at birth, including transgender and gender diverse people, with modification when indicated .
- Patient-centered HIV and perinatal services should be provided using gender-affirming and shared decision-making approaches and models of care that address the unique and varied needs of transgender and gender diverse people and reduce barriers to ongoing engagement in care that can affect adherence to ARV therapy and the likelihood of viral suppression during prepregnancy, antepartum, and postpartum periods .
- Health care providers should assess reproductive and parenting intentions and support access to appropriate contraception and perinatal HIV prevention services for transgender and gender diverse people .
- Some transgender and gender diverse patients may experience the onset or worsening of gender dysphoria and associated symptomssuch as depressionduring prepregnancy, antepartum, and postpartum periods health care providers should regularly assess patients comfort with their care and provide referrals for mental health or other support services as needed .
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Institution Of Opportunistic Infection Prevention
Table 52,6,7,25,27 lists the CDCs recommended prophylaxis guidelines and their indications. The most important prophylaxis is for P. jiroveci pneumonia, because the incidence rate approaches 80 percent in the absence of prophylaxis at CD4+ cell count levels below 200 cells per mm3, and its preventability is above 90 percent. Even pending the results of baseline T-lymphocyte cell counts and viral load, the presence of oral thrush or herpes ulcers for more than four weeks indicates sufficient immunodeficiency to warrant P. jiroveci pneumonia prophylaxis, which may save the patient an unnecessary bout with the most common opportunistic infection related to HIV.
Partner Notification And Case Reporting
The goals of partner notification and HIV testing are to interrupt the cycle of repeated HIV exposure and to detect other cases of HIV infection to facilitate entry into medical care. Providers need to be familiar with local public health statutes concerning partner notification and patient confidentiality, because these vary among states. When providing testing of contacts, attention must be paid to the likely timing of potential exposures because seroconversion typically occurs subsequent to the initial period of acute infection viremia. Thus, during the first three months after HIV exposure, early detection may require testing of HIV RNA levels confirmed by repeat serologic testing.4,6,7,9,23
The reporting of cases of HIV or AIDS is an important public health requirement, especially because in most states these figures determine the distribution of federal Ryan White AIDS CARE Act funds or Medicaid funds for the care of uninsured patients.9,24 Information regarding requirements and procedures for reporting cases of HIV or AIDS can be obtained through local public health departments.
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Pregnant People With Hiv Who Are Currently Receiving Antiretroviral Therapy
- Although no data exist on the use of two-drug oral ARV regimens during pregnancy , the component drugs are recommended for use in pregnancy. The Panel recommends that pregnant persons who present to care on DTG/3TC or DTG/RPV and have successfully maintained viral suppression can continue the two-drug regimen with more frequent viral load monitoring, every 1 to 2 months throughout pregnancy .
- For people with HIV who have achieved virologic suppression and become pregnant while receiving ARV drugs with insufficient data about their use in pregnancysuch as bictegravir or doravirineclinicians should consider whether to continue or change the regimen, because a regimen change carries a risk for viral rebound at the time of the switch. If a decision is made with the patient to continue the same regimen, viral load should be monitored more frequently .
- Because data about the use of long-acting injectable CAB and RPV during pregnancy are extremely limited, the Panel recommends that pregnant persons who present to care on this regimen should be switched to a Preferred or Alternative three-drug ARV regimen recommended for use in pregnancy .
How Can You Help Someone Who Has Been Newly Diagnosed With Hiv
There are many things that you can do to help a friend or loved one who has been recently diagnosed with HIV:
If you are the sexual partner of someone who has been diagnosed with HIV, you should also get tested so that you know your own HIV status. If you test negative, talk to your healthcare provider about PrEP , taking HIV medicine daily to prevent HIV infection. PrEP is recommended for people at high risk of HIV infection, including those who are in a long-term relationship with a partner who has HIV. If you test positive, get connected to HIV treatment and care as soon as possible.
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Prepregnancy Counseling And Care For Persons Of Childbearing Age With Hiv
- This section has been retitled in alignment with the transition from preconception care to prepregnancy care by the American College of Obstetricians and Gynecologists.
- Prepregnancy counseling and care has been updated to include vaccination to SARS-CoV-2 and considerations for the care of gender diverse and transgender individuals.
Who Publishes New Guidelines On Hiv Hepatitis And Stis For Key Populations
Today, WHO published new Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations. The guidelines are officially launched at the AIDS 2022 Conference in Montreal, Canada, in a satellite session entitled: Launching new WHO guidelines for key populations: Focus for impact.
The guidelines outline a public health response to HIV, viral hepatitis and sexually transmitted infections for 5 key populations .
WHO promotes an evidence and rights based approach to addressing these health issues which puts key populations at the centre of the response. Key populations must be prioritized, in every setting and this means as outlined in these new guidelines, planning to reach them first with prevention, testing and treatment as well as prioritizing key populations in funding programmes, said Erika Castellanos, Director of programmes at GATE , who was the co-chair of the WHO Guidelines Development Group.
Particularly for key populations, social, legal, structural and other contextual factors both increase vulnerability to HIV, viral hepatitis and STIs and obstruct access to health and other essential services. These guidelines highlight the critical importance of addressing structural barriers in all settings as a priority.
A summary of the guidelines is provided in the policy brief.
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Tests For Noninfectious Comorbidities
There are many laboratory abnormalities commonly seen in patients with HIV,7,8 including: anemia thrombocytopenia leukopenia and lymphopenia hypergammaglobulinemia hypoalbuminemia transaminitis and proteinuria . Patients who are diagnosed later in the course of their infection may also have complications related to HIV that may be initially detected through routine chemistry evaluations .
Patients with HIV also have typical health care needs beyond conditions related to HIV.7,8 These include the need for routine, age-appropriate health-maintenance screening for cardiovascular health and for cancer . In addition, as patients with HIV age they may become afflicted with obesity, hypertension, insulin resistance, diabetes, hyperlipidemia, or atherosclerotic disease. Any of these may be a consequence of the antiretroviral therapies or of aging itself. Thus, extra preventive focus at baseline is increasingly important for these patients.
Sti And Hiv Infection Risk Assessment
Primary prevention of STIs includes assessment of behavioral risk and biologic risk . As part of the clinical encounter, health care providers should routinely obtain sexual histories from their patients and address risk reduction as indicated in this report. Guidance for obtaining a sexual history is available at the Division of STD Prevention resource page and in the curriculum provided by the National Network of STD Clinical Prevention Training Centers . Effective interviewing and counseling skills, characterized by respect, compassion, and a nonjudgmental attitude toward all patients, are essential to obtaining a thorough sexual history and delivering effective prevention messages. Effective techniques for facilitating rapport with patients include using open-ended questions understandable, nonjudgmental language and normalizing language . The Five Ps approach to obtaining a sexual history is one strategy for eliciting information about the key areas of interest . In addition, health care professionals can consider assessing sexual history by asking patients such questions as, Do you have any questions or concerns about your sexual health? Additional information about gaining cultural competency when working with certain populations is available in sections of these guidelines related to these populations.
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Importance Of Counseling And Psychosocial Aspects Of Hiv Infection
– 4 min read
Apart from the effects it has on your physical health, HIV infection can create significant fear and anxiety. To know how counseling will be helpful, read the article.
Counseling an individual with HIV infection is important because HIV infection is lifelong. An individual can avoid acquiring HIV infection or transmitting it to others by changing their own behavior. The diagnosis of HIV infection in an apparently healthy individual can create a lot of mental pressure and anxiety. It can hamper his or her psychology and worsen the illness, especially in view of the fear of future perspective, misunderstanding and discrimination provoked by the HIV epidemic.
The purpose of counseling is to create awareness and prepare a person to both the seropositive and seronegative status. Also, to address the issues of anxiety, denial, anger and guilt, which a person is expected to go through on knowing the seropositive status.
What If A Friend Tells You That They Have Hiv
More than a million people in the United States are living with HIV, so you may know someone who has the virus. If your friend, family member, or co-worker has been HIV-positive for some time and has just told you, heres how you can be supportive:
- Acknowledge. If someone has disclosed their HIV status to you, thank them for trusting you with their private health information.
- Ask. If appropriate, ask if theres anything that you can do to help them. One reason they may have chosen to disclose their status to you is that they need an ally or advocate, or they may need help with a particular issue or challenge. Some people are public with this information other people keep it very private. Ask whether other people know this information, and how private they are about their HIV status.
- Reassure. Let the person know, through your words or actions, that their HIV status does not change your relationship and that you will keep this information private if they want you to.
- Learn. Educate yourself about HIV. Today, lots of people living with HIV are on ART and have the virus under control. Others are at different stages of treatment and care. Dont make assumptions and look to your friend for guidance.
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Counselling Patients And Partners Together
- This should only take place with the patient’s explicit consent, but it may be important for the following reasons:
- Adjustments to sexual behaviour and other lifestyle issues can be discussed and explained clearly to both.
- If the patient’s partner is HIV negative particular care and attention must be paid to emotional and sexual consequences in the relationship.
- Misconceptions about HIV transmission can be addressed and information on safer sex given.
- The partner’s and the patient’s psychological responses to the diagnoses or result, such as anxiety or depression, can be explained and placed in a manageable perspective
- There may be particular issues for couples who have children or who are hoping to have children or where the woman is pregnant.
Partners and family members sometimes have greater difficulty in coming to terms with the knowledge of HIV infection than the patients do themselves. Individual counselling support is often required to manage this, particularly role changes within the relationship, and other adjustment issues that may lead to difficulties. This is part of a holistic approach to the patient’s overall health care.
Men Who Have Sex With Men
The prevalence of AIDS is highest in men who have sex with men. The number of AIDS cases is increasing in this group, especially in younger men. Preventive efforts that produced attitudinal and behavior changes in older men have not necessarily led to reduced risk in younger men. Some younger men may be taking more risks because of a perception that HIV is a treatable chronic disease.26
Homophobia continues to complicate preventive efforts. Men in a heterosexual relationship who also are engaging in sex with other men may not identify themselves as bisexual or homosexual. The combination of racism and homophobia can create additional challenges to creating culturally sensitive programs for the prevention of HIV infection in the black and Hispanic communities.27
Many men who have sex with men believe that oral sex is safe. However, one study28 in San Francisco found that about 8 percent of a group of men with primary HIV infection likely became infected through oral sex.
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