Content area
Full Text
One-half of the estimated 1.1 million people in the United States with HIV infection are not receiving antiretroviral therapy (ART) or are receiving ART that is not sufficiently effective to achieve key clinical outcomes. Key outcomes include preventing clinical progression to advanced HIV disease, allowing near-normal life expectancy, and reducing transmission risk (i.e., treatment as prevention).1–8 HIV disproportionately affects people of color and people with limited access to continuous, comprehensive health care.9,10 Family physicians are uniquely positioned to diagnose HIV early and ensure long-term quality care for patients.
WHAT'S NEW ON THIS TOPIC
HIV Infection in Adults
Nearly one-half of the estimated 1.1 million people with HIV infection in the United States are not receiving antiretroviral therapy or are receiving antiretroviral therapy that is not sufficiently effective to achieve the key clinical outcomes.
Approximately 38% of new transmissions are from people with HIV who do not know their HIV status.
Clinicians should identify and address potential barriers to treatment and adherence, including concerns for unintended disclosure of HIV status, housing and food instability, transportation challenges or conflicting priorities, and lack of patient readiness or motivation.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| All people 15 to 65 years of age should be screened for HIV at least once; all people who are pregnant should be screened for HIV.12 | A | U.S. Preventive Services Task Force recommendations based on systematic review of high-quality patient-oriented evidence |
| Combination antiretroviral therapy should be initiated as soon as possible after HIV diagnosis.4,20 | C | Department of Health and Human Services guidelines based on epidemiologic and modeling studies; consensus guidelines from the International Antiviral Society–USA Panel |
| Combination antiretroviral therapy with durable viral load suppression is recommended for people with HIV to reduce the risk of sexual transmission to seronegative partners.4–8,20 | C | Department of Health and Human Services guidelines based on randomized controlled trials of serodiscordant couples; consensus guidelines from the International Antiviral Society-USA Panel |
| If the CD4 count is less than 200 cells per μL (0.20 × 109 per L), prophylaxis against Pneumocystis jiroveci should be initiated.23 | C | Department of Health and Human Services guidelines based on retrospective studies |
| If the CD4 count is less than 100 cells per μL (0.10 × 109... |