Provider Resources

Development of HIV disease encompasses the acquisition of Human Immunodeficiency Virus (HIV) infection leading to a patient to become HIV-seropositive or asymptomatic infection. Patients may remain with chronic infection and mostly asymptomatic for several years.

Subsequent emergence of symptomatic HIV infection with clinical signs and symptoms leads to HIV disease and without antiretroviral treatment to the development of Advanced HIV, formerly known as Acquired Immunodeficiency Syndrome (AIDS).

Advanced HIV is defined as the depletion of CD4 T cell counts below 200 cells/µL and/or the presence of Advanced HIV defining illnesses.

Related resources:

• CDC: Recommended Laboratory HIV Testing Algorithm for Serum or Plasma Specimens
• NIH: Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents
• NIH: Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection
• NIH: Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents
• NIH: Guidance for Non-HIV-Specialized Providers Caring for HIV-Infected Residents Displaced from Disaster Areas

Antiretroviral agents interact with many other commonly prescribed medications and several alternative or complementary therapies. These interactions can lead to either sub- or supra-therapeutic levels of the interacting drugs which can lead to virologic failure, drug toxicity, and ineffective treatment for other comorbidities. Some drug interactions can be life threatening.

Related resources:

• HIV Drug Interactions from the University of Liverpool

PEP relates to the clinical and medical management of HIV negative patients who have been exposed to body fluids or other biological material from people with known or suspected HIV infection with consequent risk for transmission of HIV.

The current management guidelines following exposure of body fluids or other biological material from people with HIV infection include assessment of the risk, necessary testing, appropriate use of antiretroviral therapy, and clinical follow up for persons exposed to HIV infected material.

Related resources:

• US Public Health Service: Guidelines for the Management of Occupational Exposures to HIV and Recommendations for PEP, 2013
• New York State DOH: Updated HIV Prophylaxis Following Occupational Exposure Clinical Guideline

HIV nPEP is a preventive treatment strategy that may reduce, but not eliminate, the possibility of becoming infected with HIV among individuals who have experienced high risk exposures such as:

• Unprotected vaginal or anal sex with a partner known to be (or possibly) HIV positive
• Sharing injecting drug use equipment
• Sexual assault

nPEP involves taking antiretroviral medications as soon as possible after exposure.

Related resources:

• CDC: Guidelines for PEP After Sexual, IDU, or Other Non-occupational Exposure to HIV—United States, 2016
• MDHHS: Guidance on Non-Occupational Post Exposure Prophylaxis, June 2015

PrEP represents the clinical management recommendations for patients who are HIV negative but are at high risk for acquiring HIV infection and will likely benefit from prophylaxis with antiretroviral agents.

The guidelines provide the approach to assessing patients at high risk for HIV acquisition, antiretroviral therapy, clinical monitoring and strategies to reduce HIV acquisition.

Related resources:

• CDC: Pre-Exposure Prophylaxis for the Prevention of HIV Infections in the United States
  • Clinical Practice Guideline
  • Clinical Providers’ Supplement
• CDC: PrEP Fast Facts
• MDHHS: Directory of Michigan PrEP Providers
• PRESCRIBE PEP: Post-Exposure Prophylaxis FAQs for the Health Care Professional

The prevention of mother-to-child transmission of HIV infection (HIV-infected mother to unborn child) during the perinatal period is key to preventing and possibly eliminating pediatric HIV disease. First and third trimester HIV testing should be provided to all pregnant women.

The guidelines discuss preconception counseling and care of HIV positive women, initiation of antiretroviral therapy in HIV positive pregnant women, antepartum care during the pregnancy, intrapartum care at delivery, and postpartum care of both the mother and HIV-exposed neonate.

Related resources:

• NIH: Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States
• Call the HIV and Hepatitis C Consult Service at 313-575-0332 or reach out here if it is not urgent.
• MDHHS Maternal/Perinatal Screening Guidelines