Federal HIV guidelines updated, reconciled among agencies

Federal agencies and nongovernmental organizations have reconciled and expanded recommendations for preventing the spread of HIV.

The Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), and the National Institutes of Health (NIH) collaborated with several nongovernmental organizations to update and expand their 2003 recommendations to prevent HIV transmission.

HIV experts from the CDC and HRSA consolidated long-standing recommendations into a report, released by the CDC online on Dec. 11. It updates and expands recommendations on the 4 topics covered by the 2003 recommendations, including screening for behaviors that could transmit HIV, screening and treating sexually transmitted diseases, services for sex partners and those who share needles, and referral to other medical and social services.

The report also includes recommendations on 7 topics that were not described in detail in the 2003 recommendations, including access to and retention in care, use of and adherence to antiretroviral treatment (ART), and perinatal issues. The report does not provide comprehensive guidance on all prevention and care services for persons with HIV, the experts noted. It does not address comprehensive primary care; the prevention, diagnosis, and treatment of common co-infections such as hepatitis or sexually transmitted diseases; or most opportunistic infections.

Some specific recommendations included informing all people with HIV, regardless of their CD4 cell count, about the role of effective ART; offering ART regimens recommended by the U.S. Department of Health and Human Services; and supporting high adherence to ART. Others included:

• using biomedical factors, such as HIV viral load and recently diagnosed STDs, along with HIV risk behaviors to assess a person's risk of HIV transmission,
• supporting safer sexual and drug-use behaviors,
• supporting people with HIV in selectively disclosing that they have HIV and notifying partners of possible exposure while minimizing negative consequences,
• expediting partner services to people with acute HIV infection or high viral load who are most infectious,
• informing patients about the availability of preexposure prophylaxis (PrEP) or nonoccupational postexposure prophylaxis (nPEP) for HIV-uninfected partners, and
• screening people with HIV with the most sensitive STD tests, including tests using rectal and oropharyngeal specimens from gay, bisexual, and other men who have sex with men, and treating infected persons with the most effective STD treatment, as recommended by the latest CDC guidance.