Primary Care Guidelines for HIV-Infected Patients Get First Overhaul in 4 Years

Executive Editor

The HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America has released an update to its primary care guidelines for the care of HIV-infected patients, the first such update since 2009. The revised guidelines appear in the Jan. 1, 2014 issue of Clinical Infectious Diseases.

The importance of primary care in HIV has steadily increased in the U.S. -- in addition to other areas of the world where comprehensive access to HIV treatment and quality health care can be assured -- as HIV infection continues to evolve into a chronic illness to be managed alongside other aspects of patient care. The latest incarnation of the HIVMA primary care guidelines marks the second update since their creation in 2004 and their first update four years ago.

Noteworthy changes to the guidelines include:

  • A more comprehensive exploration of recommendations and considerations when performing an initial evaluation and follow-up for a new patient with HIV. (The HIV testing and diagnosis guidelines that had been in the previous edition of the guidelines were removed.)
  • Expanded recommendations regarding screening for sexually transmitted diseases, including chlamydia, gonorrhea, human papillomavirus and trichomoniasis (in women).
  • Reorganized content intended to provide more streamlined access to recommendations, with evidence summaries for each recommendation separated and shifted to another section of the document.

Beyond those overarching changes, the document itself remains structurally similar to previous versions, with specific recommendations adjusted to account for new research developments between 2009 and 2013.

As much as anything, the updated HIVMA guidelines provide a hub for health care providers seeking information regarding the optimal approach to primary care for those with HIV. A number of organizations, including the U.S. Department of Health and Human Services, New York State Department of Health AIDS Institute and U.S. Centers for Disease Control and Prevention, produce or endorse separate documents containing various guidelines relevant to the primary care of HIV-infected patients. "This document may also serve as a 'guide to the guidelines,'" write the authors of the HIVMA guidelines.

The updated HIVMA guidelines arrive at an important juncture in the evolution of HIV care, particularly in the U.S. The "routinization" of HIV patient management (particularly as routine HIV screening becomes more widely adopted across a range of health care settings) has triggered a significant amount of discussion in recent years over the extent to which primary care should be integrated with traditional HIV care -- and the extent to which primary care providers should take on the mantle of HIV patient care. While these guidelines do not address that issue directly, their existence provides an additional information resource for HIV specialists as well as primary care providers who may be the main pathway through which HIV-infected Americans receive their health care.

Myles Helfand is the editorial director of and

Follow Myles on Twitter: @MylesatTheBody.