Login
Drugs & Diseases
News & CME
E-Learning
MENU
About MIMS Treatment Guidelines
+
Anxiety Overview
Symptoms
Treatment
Patient Education
+
Arrhythmias Overview
Symptoms
Treatment
Patient Education
+
Asthma Overview
Symptoms
Treatment
Patient Education
+
Attention-Deficit/Hyperactivity Disorder (ADHD) Overview
Symptoms
Treatment
Patient Education
+
Bipolar Disorder Overview
Symptoms
Treatment
+
Breast Cancer Overview
Symptoms
Treatment
+
Bronchitis - Chronic in Acute Exacerbation Overview
Symptoms
Treatment
Patient Education
+
Bronchitis - Uncomplicated Acute Overview
Symptoms
Treatment
Patient Education
+
Chlamydia Overview
Symptoms
Treatment
Patient Education
+
Chronic Obstructive Pulmonary Disease Overview
Symptoms
Treatment
Patient Education
+
Dengue Overview
Symptoms
Treatment
Patient Education
+
Depression Overview
Symptoms
Treatment
Patient Education
+
Diabetes Mellitus Overview
Symptoms
Treatment
Patient Education
+
Dyslipidemia Overview
Symptoms
Treatment
Patient Education
+
Dyspepsia Overview
Symptoms
Treatment
Patient Education
+
Endometriosis Overview
Symptoms
Treatment
+
Gastroesophageal Reflux Disease (GERD) Overview
Symptoms
Treatment
Patient Education
+
Gout Overview
Symptoms
Treatment
Patient Education
+
Hepatitis Overview
Symptoms
Treatment
Patient Education
-
HIV Overview
Symptoms
Treatment
+
Hypertension Overview
Symptoms
Treatment
Patient Education
+
Infective Endocarditis Overview
Symptoms
Treatment
+
Insomnia Overview
Symptoms
Treatment
Patient Education
+
Lung Cancer Overview
Symptoms
Treatment
+
Measles Overview
Symptoms
Treatment
+
Melanoma Overview
Symptoms
Treatment
Patient Education
+
Neuropathic Pain Overview
Symptoms
Treatment
+
Parkinson's Disease Overview
Symptoms
Treatment
+
Rheumatoid Arthritis Overview
Symptoms
Treatment
Patient Education
+
Scabies Overview
Symptoms
Treatment
Patient Education
+
Schizophrenia Overview
Symptoms
Treatment
+
Vertigo Overview
Symptoms
Treatment
Patient Education
Symptoms
Â
Treatment Guidelines
/
HIV Overview
/
Symptoms
MIMS treatment guidelines
About MIMS Treatment Guidelines
Anxiety Overview
Symptoms
Treatment
Patient Education
Arrhythmias Overview
Symptoms
Treatment
Patient Education
Asthma Overview
Symptoms
Treatment
Patient Education
Attention-Deficit/Hyperactivity Disorder (ADHD) Overview
Symptoms
Treatment
Patient Education
Bipolar Disorder Overview
Symptoms
Treatment
Breast Cancer Overview
Symptoms
Treatment
Bronchitis - Chronic in Acute Exacerbation Overview
Symptoms
Treatment
Patient Education
Bronchitis - Uncomplicated Acute Overview
Symptoms
Treatment
Patient Education
Chlamydia Overview
Symptoms
Treatment
Patient Education
Chronic Obstructive Pulmonary Disease Overview
Symptoms
Treatment
Patient Education
Dengue Overview
Symptoms
Treatment
Patient Education
Depression Overview
Symptoms
Treatment
Patient Education
Diabetes Mellitus Overview
Symptoms
Treatment
Patient Education
Dyslipidemia Overview
Symptoms
Treatment
Patient Education
Dyspepsia Overview
Symptoms
Treatment
Patient Education
Endometriosis Overview
Symptoms
Treatment
Gastroesophageal Reflux Disease (GERD) Overview
Symptoms
Treatment
Patient Education
Gout Overview
Symptoms
Treatment
Patient Education
Hepatitis Overview
Symptoms
Treatment
Patient Education
HIV Overview
Symptoms
Treatment
Hypertension Overview
Symptoms
Treatment
Patient Education
Infective Endocarditis Overview
Symptoms
Treatment
Insomnia Overview
Symptoms
Treatment
Patient Education
Lung Cancer Overview
Symptoms
Treatment
Measles Overview
Symptoms
Treatment
Melanoma Overview
Symptoms
Treatment
Patient Education
Neuropathic Pain Overview
Symptoms
Treatment
Parkinson's Disease Overview
Symptoms
Treatment
Rheumatoid Arthritis Overview
Symptoms
Treatment
Patient Education
Scabies Overview
Symptoms
Treatment
Patient Education
Schizophrenia Overview
Symptoms
Treatment
Vertigo Overview
Symptoms
Treatment
Patient Education
Symptoms
Test For HIV
Pretest Counselling & Informed Consent
Risk assessment & education focused on prevention should be done prior to & after receiving test results
The following information should be provided by health care providers when recommending HIV testing & counselling:
Reasons why HIV testing & counselling is being offered & their benefits & potential risks (eg discrimination, abandonment)
Services that are available, including ART, in either an HIV-positive or an HIV-negative test result
That the patient has a right to decline the test & that result will be treated w/ confidentiality; patient’s decision to decline should be noted in the medical record
In critically ill or unconscious patients where informed consent is not possible, permission should be sought from the patient’s next-of-kin, guardian or other caregiver; in the absence of such person, the health care provider should act according to the best interest of the patient
In case of an HIV-positive test result, disclosure to other persons who may be at risk of exposure to HIV should be encouraged
An opportunity for the patient to ask the health care provider questions
HIV Test
Choice of HIV test depends on various factors such as cost & availability of equipments or test kits, lab expertise, availability of staff, number of samples to be tested, collection & transport of samples, convenience, setting where testing will be performed, ability of the patients to come back for the results
Testing strategies are either done as:
Parallel testing: Recommended when using whole blood as samples; 2 tests are simultaneously done using assays based on different antigens; concordantly negative or positive results are reported as true negatives or positives, respectively
Serial testing: If the HIV antibody test is negative, it is reported as “negative”; if test result is positive, the specimen undergoes a second test using an antigen different from the first; a second positive result is considered a true positive
In low-prevalence setting where false positive results are likely, a third confirmatory test may be done
Recommended due to its cheaper cost; a second test is only required for reactive initial test results
Rapid HIV tests
Eg OraQuick Rapid HIV-1/2 Antibody Test, Reveal G3 Rapid HIV-1 Antibody Test, Uni-Gold Recombigen HIV Test, Clearview HIV 1/2 Stat Pack, Clearview Complete HIV 1/2, Multispot HIV-1/HIV-2 Rapid Test
May either be done as serial or parallel testing
Provide accurate results w/in a much shorter time compared w/ traditional enzyme-linked immunosorbent assays (ELISA)
Advantages include visibility of the test & quick turn-around, testing can occur outside lab settings, does not require specialized equipment; however, trained lab supervisors are required to supervise & assure quality control
ELISA
Are almost always serial in nature
Preferred method when large numbers of tests need to be performed (allows large numbers of samples to be tested efficiently at one time)
Disadvantages include longer time to assemble enough samples to make a test run, longer reporting time of the results (half day), precluding outpatients receiving the test result at the same visit, requires certified lab staff to manage the test procedure, report results & maintain equipment
Reactive ELISA or rapid test must be followed by a Western blot
Negative ELISA or rapid test or a reactive ELISA or rapid test w/ negative or indeterminate Western blot should be followed by a virologic test (ie p24 antigen or HIV RNA assay); a positive virologic test in this case, is consistent w/ acute HIV infection
If an acute HIV infection is diagnosed by a positive virologic test & preceded by a negative HIV antibody test, a confirmatory HIV antibody test should be performed over the next 3 months to confirm seroconversion
Post-Test Counseling
All individuals undergoing HIV testing should be counselled when their results are given, regardless of the test result
HIV-positive patients
Clearly inform the patient of the test result & allow him/her the time to consider it
Ensure that the patient understands the result & allow questions to be asked
Provide emotional support & crisis management
Discuss any immediate concerns & determine available & acceptable social network to offer support
Discuss treatment & follow-up services available, including care & support services, prevention of mother-to-child transmission
Provide information on prevention of HIV transmission (including provision of male & female condoms & guidance on their use) & relevant health preventive measures (eg good nutrition)
Notification, counselling & referral for HIV testing of partners & children
HIV-negative patients
Explanation of the test result, including information on the window period for the appearance of HIV antibodies & a recommendation to re-test in case of a recent exposure
Educate on methods of prevention of HIV transmission
Provision of male & female condoms & guidance on their use
Start ART to uninfected partner for prevention
Top
Evaluation
History and Physical Examination
Signs, symptoms & lab findings of acute HIV infection w/ recent (w/in 2-6 weeks) high risk of exposure to HIV may include (but are not limited to):
Fever
Skin rash
Headache
Diarrhea
Myalgia, arthralgia
Lymphadenopathy
Oral ulcers
Leucopenia, thrombocytopenia
Elevated transaminase level
High-risk exposures include sexual contact w/ an HIV-infected person or w/ an individual at risk for HIV, sharing of injection drug use paraphernalia, contact w/ potentially infectious blood w/ mucous membranes or breaks in the skin
Laboratory Tests
HIV Antibody Testing
Done if no prior documentation is available or if HIV RNA is below the assay’s limit for detection
Plasma HIV RNA (viral load)
Most important indicator of initial or sustained response to ART
Should be measured in all HIV-infected patients upon start of care & therapy then on a regular basis thereafter
Pre-treatment viral load level is taken into consideration in selecting initial ARV regimen
Due to poorer responses in patients w/ high baseline viral load
Optimal viral suppression is generally defined as a viral load persistently below the level of detection (<20-75 copies/mL), depending on the assay used
Viral suppression is generally achieved in 12-24 weeks, provided patient is adherent to their ART regimen & does not develop resistance to the prescribed drugs
Early detection of virological failure allows better preservation of the efficacy of second-line regimens
In settings where resources are limited, measurement of plasma viral load is not required prior to initiation of ART
Measurement is done:
After initiation of therapy because virologic failure w/in 2-4 weeks but not later than 8 weeks after treatment initiation or modification
Repeat viral load measurement at 4-8 weeks interval until the level falls below the assay's limit of detection
In virologically suppressed patients in whom ART was modified because of drug toxicity or for regimen simplification, measurement should be performed w/in 4-8 weeks after changing the therapy
Viral load test is repeated every 3-4 months or as clinically indicated in patients who are on stable & suppressive ARV regimen. It may be extended up to 6 months if the viral load was suppressed for >2 years & if the clinical & immunologic status are stable
Frequency of monitoring in patients w/ suboptimal response to ART will depend on the adherence & availability of other treatment options
CD4 T-cell count
Serves as a major indicator of immune function
One of the key factors in deciding whether to start ART & prophylaxis for opportunistic infections
Strongest predictor of subsequent disease progression & survival
An adequate CD4 response for most patients on ART is defined as an increase in CD4 count in the range of 50-150 cells/mm
3
per year except in patients w/ a low starting CD4 count & in those w/ an advanced age who may show a blunted increase despite virologic suppression
Should be monitored every 3-4 months to determine when to initiate ART in untreated patients, evaluate immunologic response to ART & to determine the need for initiation or discontinuation of prophylaxis for opportunistic infections
In patients w/ consistently suppressed viral loads, CD4 count may be monitored every 6-12 months, unless there are changes in the clinical status of the patient
3-6 months intervals was recommended in patients who fail to maintain viral suppression on ART & those who were already on ART for 2 years
CBC, transaminase levels, BUN, creatinine, hepatitis A, B & C serologies, urinalysis
Fasting blood sugar & lipid levels
HIV drug resistance testing should be done upon entry into care, regardless of whether ART will be started immediately or deferred
Genotypic testing is the preferred resistance testing to guide the selection of initial regimen in ART-naive patients
Helps in the selection of alternative regimens in patients who fail to achieve viral suppression
Is also performed when managing suboptimal viral load reduction
Should be done while the patient is taking ART regimen or w/in 4 weeks of treatment discontinuation
HLA-B *5701 screening
Recommended prior to initiating Abacavir-containing regimen to reduce the risk of hypersensitivity reaction
Pregnancy test: If patient will be started on Efavirenz
Coreceptor tropism assays are used whenever a CCR5 inhibitor (eg Maraviroc) is being considered
Also considered if patients exhibit virologic failure on Maraviroc or any CCR5 inhibitor
Other tests include tests for sexually transmitted infections & tests for determining risk of opportunistic infections
Clinical Staging of HIV Disease in Adults & Adolescents
HIV disease staging and classification systems are critical tools for providing clinicians and patients with important information about HIV disease stage and clinical management. Two major classification systems currently are in use: The U.S. Centers for Disease Control and Prevention (CDC) classification system and the World Health Organization (WHO) Clinical Staging and Disease Classification System
Assessment used where HIV infection has been confirmed by HIV antibody testing & serves to guide decisions on when to initiate ART
Clinical stage 1:
Asymptomatic, persistent generalized lymphadenopathy
Clinical stage 2:
Unexplained moderate weight loss (approx <10% of estimated or actual body wt), recurrent oral sores, angular cheilitis, pruritic papular lesions, seborrheic dermatitis, recurrent respiratory tract infections (eg tonsillitis, pharyngitis, otitis media, sinusitis), fungal nail infections, herpes zoster
Clinical stage 3:
Unexplained severe weight loss (>10% of estimated or measured body wt), unexplained persistent fever (intermittent or constant) lasting for >1 month, unexplained diarrhea lasting for >1 month, unexplained neutropenia (< 0.5 x 10
9
/L), anemia (<8 g/dL), &/or chronic thrombocytopenia (<50 x 10
9
/L), oral hairy leukoplakia, persistent oral candidiasis, acute necrotizing stomatitis, gingivitis or periodontitis, pulmonary tuberculosis, severe bacterial infection (i.e pneumonia, empyema, meningitis, pyomyositis, bone & joint infection, bacteremia, severe pelvic inflammatory disease)
Clinical stage 4:
HIV wasting syndrome, recurrent bacterial pneumonia, extrapulmonary tuberculosis, cytomegalovirus disease, Kaposi’s sarcoma, disseminated mycosis, recurrent septicemia, disseminated nontuberculous mycobacterial infection, lymphoma, progressive multifocal leukoencephalopathy, HIV encephalopathy, pneumocytis jirovecii, chronic herpes simplex (urolabial, genital, anorectal of >1mm or visceral at any site), esophageal candidiasis (trachea, bronchi & lungs), CNS toxoplasmosis, extrapulmonary cryptococcosis, including meningitis, chronic cryptosporidiosis, chronic isosporiasis, disseminated mycosis (histoplasmosis, coccidiomycosis) recurrent septicaemia (including nontyphoidal Salmonella), lymphoma (cerebral or B cell non-Hodgkin), invasive cervical carcinoma, atypical disseminated leishmaniasis and symptomatic HIV-associated nephropathy or HIV-associated cardiomyopathy
Top
â—€HIV Overview
HIV Treatmentâ–¶