New guidelines for the care of HIV-positive patients have been issued by the Infectious Diseases Society of America (IDSA). They are published in the online edition of Clinical Infectious Diseases.
They replace the previous 2004 guidelines, and many of the changes in the new guidelines are already recommended in the various guidelines of the British HIV Association.
The IDSA care guidelines are distinct from the HIV treatment guidelines of the US Department of Health and Human Services, but should be read in conjunction with them.
In summary, the following changes have been made in the new care guidelines:
- Genotypic resistance testing – all patients should have such a test at the time of their HIV diagnosis.
- Syphilis – cerebrospinal investigations should be considered for patients with neurological or ocular symptoms, tertiary syphilis or treatment failure.
- HLA-B*5701 testing should be performed on all patients before treatment with abacavir is initiated. Patients whose tests are positive should not take abacavir.
- Kidney function – baseline creatinine clearance should be assessed before treatment with tenofovir or indinavir is started. This is especially important for black patients.
- Tropism testing should be performed before starting treatment with a CCR5 inhibitor.
- Hormone replacement therapy is only recommended for women with severe menopausal symptoms, and then treatment should be for a limited time period at the lowest effective dose.
- The importance of adherence should be emphasised.
The complete guidelines can be downloaded for free from the website of Clinical Infectious Diseases.