New primary care guidance released on HIV care

The HIV Medical Association of the Infectious Diseases Society of America has released updated guidance on HIV in primary care.

The guidance was developed by an expert panel and updates the organization's previous guidance from 2020. It includes an expanded section devoted to patient-centered optimization of HIV care, covering use of tools such as multidisciplinary care teams, telehealth, and street medicine. New sections address immunizations, cancer screening, and sexually transmitted infections (STIs). The section on metabolic diseases now addresses statin use in people with HIV, screening for comorbidities, and management.

Regarding patient-centered care, all persons with HIV should be provided with timely access to routine and urgent medical care via a patient-centered approach, beginning with rapid antiretroviral therapy (ART) if feasible, the guidance said. Among other recommendations, the guidance stated that longitudinal low-barrier models, such as extended or nontraditional business hours, walk-in acute or primary care, telehealth, and alternate care venues, including street medicine, should be incorporated as feasible.

One recommendation for STIs said that all patients should be screened for gonorrhea, chlamydia, and syphilis upon entry into care. People who have receptive vaginal sex should be screened for trichomonas using vaginal or cervical nucleic acid amplification testing (NAAT), and screening for gonorrhea and chlamydia should be by NAAT at all sites of sexual contact (oral, anal, urethral/urine, and vaginal/neovaginal), the guidance said, noting that self-collected NAAT swabs may be used if done correctly.

Regarding statin therapy, it is recommended for primary prevention of cardiovascular disease in people with HIV who are ages 40 to 75 years, regardless of lipid levels and risk for atherosclerotic cardiovascular disease. The recommendation is strongest for those whose 10-year cardiovascular disease risk is 5% or higher, the guidance said. For people with HIV who are younger than age 40 years, evidence is insufficient to recommend for or against statin therapy for primary prevention of cardiovascular disease, the guidance said, adding that decisions in this age group should be individualized and should take risk factors for the general population and for people with HIV into account.

The guidance also includes a section on children with HIV and updated sections on COVID-19 as well as care for adolescents, persons of childbearing potential, and transgender and gender-diverse populations. It was published Oct. 12 by Clinical Infectious Diseases.