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Updated IDSA/HIVMA guidelines focus on primary, preventive care
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Because antiretroviral therapy has allowed patients with HIV to live longer, the Infectious Diseases Society of America and the HIV Medicine Association have updated their HIV care guidelines to highlight the importance of preventive care in this aging population.
“These guidelines urge physicians that are providing primary care to patients with HIV to deliver the total care that these patients need as they live longer,” Michael Horberg, MD, executive director of research at Mid-Atlantic Permanente Research Institute, and a co-author of the guidelines, told Infectious Disease News. “They need to be aware of the common age-related comorbidities and the necessary preventive screenings.”
According to the guidelines, published online in Clinical Infectious Diseases, patients with HIV are at increased risk for common health conditions, such as high cholesterol and triglycerides and high blood pressure, either because of the infection, ART or traditional risk factors such as smoking and unhealthy diets.
The guidelines recommend screening for diabetes, osteoporosis and colon cancer and also recommend vaccinations against pneumococcal infection, influenza, varicella and hepatitis A and B. There also are recommendations for STD screening, including annual screening for trichomoniasis in women and yearly screening for gonorrhea and chlamydia for those at risk.
Physicians also are urged to consistently discuss sexual history and risky behaviors with their patients to determine how patients are coping and if they have a sufficient support system. They encourage physicians also to screen for other mental health issues.
“In the beginning, we weren’t concerned with these things with our HIV patients because they had significant mortality in a short timeline,” Horberg said. “Post-ART, HIV is now a complex chronic condition and people are living long lives, with some surviving almost as long as an uninfected person. As a result, these patients need the preventive care that the aging population requires.”
Disclosure: Horberg reports no relevant financial disclosures.
Perspective
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Paul A. Volberding, MD
As antiretroviral treatment has improved and dramatically prolonged the lives of persons infected with HIV, clinicians must contend with an ever enlarging list of common conditions that are typical of an aging patient population. Some of these conditions are accentuated by HIV infection or its treatment, or are complicated by drug interactions. For all these reasons, it is very timely that these new primary care guidelines have been developed. They provide a central source of evidence-based guidance for the busy clinicians delivering front-line HIV care.
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