Primary care guidelines for the management of persons infected with human immunodeficiency virus: Recommendations of the HIV Medicine Association of the Infectious Diseases Society of America

It has been >20 years since the first case of AIDS was identified. There has been a significant and dramatic change in the management of HIV infection since the introduction of potent antiretroviral therapy in 1996. There has also been a significant decrease in morbidity and mortality among persons living with HIV infection resulting from improved access to care, prophylaxis against opportunistic infections, and antiretroviral therapy. A working group of clinical scientists was chosen by the HIV Medicine Association of the Infectious Diseases Society of America (IDSA) to develop guidelines addressing the primary care of persons infected with HIV. The purpose of these guidelines is to assist health care providers in the primary care management of persons infected with HIV, including a description of baseline laboratory screening and adherence issues. Given the improved survival among people living with HIV infection, it is imperative that all persons in the United States be managed according to standard practices appropriate for the individual's age and sex regardless of HIV status. In addition, HIV-infected persons require more extensive screening and examinations than do those without HIV infection. There are increasing reports of complications associated with antiretroviral therapy that may require additional and more frequenting monitoring. These guidelines discuss the following topics: (1) transmission of HIV infection; (2) HIV diagnosis; (3) risk screening; (4) management, with special sections concerning women and children; and (5) adherence. It is not our intent to duplicate the extensive guidelines endorsed by the United States Public Health Service, the Department of Health and Human Services, the Centers for Disease Control and Prevention (CDC), IDSA, or other accredited programs. We have referred to these guidelines where applicable, so that this document may also serve as a "guide to the guidelines" (table 1). As with previously published IDSA guidelines, we have graded our recommendations accordingly (table 2).