Clinical Overview of HIV Disease
Section 9: Routine Health Care Maintenance in HIV Infection
All individuals, whether on ART or not, will have other health care needs,
some related to HIV infection and some not. Individuals with HIV infection must
be considered to be at risk for other blood-borne pathogens and sexually
transmitted infections. All HIV-infected individuals should be screened for
viral hepatitis A, B, and C, and immunized (against A and/or B) or treated as
appropriate. Routine screening for syphilis, chlamydia, gonorrhea, and other
sexually transmitted diseases should be done according to the individual's risk
behavior. Age- and gender-appropriate cancer screening should also be done in
HIV-infected individuals, with special recommendations for increased screening
for cervical and anal dysplasia associated with human papillomavirus (HPV)
disease.( 300-302 ) Annual screening for tuberculosis with purified protein
derivative (PPD) testing is indicated, particularly in high incidence areas.
Hyperlipidemia, glucose intolerance, and insulin resistance are common
consequences of antiretroviral therapy.( 324-326 ) With indications of potential
increases in cardiac events among HIV-infected individuals, careful attention
should be paid to modifiable cardiac risk factors.( 327 ) Routine monitoring of
fasting lipid panels, particularly among patients on antiretrovirals, and lipid
management that follows the guidelines of the National Cholesterol Education
Program (NCEP) is recommended.( 328 )
Routine immunizations for HIV-infected individuals should follow standard
guidelines with a few exceptions. Oral polio vaccine and smallpox vaccine are
contraindicated in HIV-infected individuals and in those with whom they have
significant contact. The risks of other live vaccines such as measles, mumps,
and rubella must be weighed against the potential benefits of vaccination. Data
on varicella vaccination in HIV-infected adults are lacking. Pneumococcal
vaccination is recommended every 5 years for those with HIV infection, as is
annual influenza vaccine. Vaccination may be more effective in individuals with
relatively intact immune systems (CD4 count >200 cells/µL), and for individuals
beginning ART, may be delayed until such a goal is reached.
Discussions of sexual health should involve education to reduce risk of
transmitting HIV to uninfected partners, as well as preventing other sexually
transmitted diseases. Contraceptive options and issues of family planning should
be addressed regularly with individuals of reproductive potential.
Other routine health measures such as blood pressure determination, depression
and domestic violence screening, smoking cessation interventions, drug and
alcohol counseling, and dental and ophthalmologic evaluation should be used with
HIV-infected individuals, just as with HIV-uninfected individuals.
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