Contemporary recommendations for primary care management of patients with HIV infection

The morbidity and mortality associated with HIV infection has decreased significantly in the current era of antiretroviral therapy, with HIV-infected individuals now anticipating a normal life expectancy in developed countries. HIV has transformed from a disease of certain death into a chronic condition that can be managed medically. Reflecting this change, the Infectious Disease Society of America (IDSA) recently released an update on the management of HIV with a new emphasis on primary care and enhanced screening for comorbid conditions. For individuals with well-controlled HIV infection, the frequency of viral load and CD4 cell count monitoringcan is reduced from every 3-4 months to every 6-12 months. Increased attention is devoted to immunizations with new recommendations for HPV vaccination in males and an updated pneumococcal vaccination schedule. There is also an enhanced section on sexually transmitted diseases including annual screening for trichomoniasisin women, yearly screening for gonorrhea and chlamydia in at risk individuals, and anal cytologic screening in certain risk groups. This article reviews the 2013IDSA guidelines, highlights significant changes from prior IDSA guidelines, and contrasts these recommendations with other United States screening guidelines.