NEW YORK (Reuters Health) – Newly updated guidelines for managing persons infected with HIV recommend that all patients undergo genotypic resistance testing even if there are no immediate plans to initiate antiretroviral therapy.

“Because drug-resistant virus can be transmitted from one person to another, all patients should be assessed for transmitted drug resistance with an HIV genotype test upon initiation of care,” the guidelines state. “If therapy is deferred, repeat testing at the time of antiretroviral therapy initiation should be considered because of the potential for superinfection.”

The new guidelines, an update of recommendations issued in 2004, were prepared by an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America. The guidelines are based on research published from 2003 to 2008.

Lead guideline author Dr. Judith A. Aberg, from Bellevue Hospital Center, New York, and colleagues report their recommendations in the September 1st issue of Clinical Infectious Diseases.

“The guidelines,” the authors note, “are intended for use by healthcare providers who care for HIV-infected patients or patients who may be at risk for acquiring HIV infection.”

Some of the other new recommendations in the guidelines include:
–Varicella zoster virus-negative patients or those without a chickenpox or shingles history should be given VZV immune globulin as soon as possible after exposure to a person with chickenpox of shingles.
–To reduce the risk of an allergic reaction, HLA-B*5701 testing should be done in candidates for abacavir therapy. Test-positive patients should not receive the drug.
–Because of an increased risk of HIV-associated nephropathy, baseline urinalysis and creatinine clearance testing should be considered, particularly in black patients.
–Clinicians should put greater emphasis on adherence to the full HIV care plan, rather than focus solely on adherence to medications.
–Patient management should include monitoring for all relevant age- and gender-specific health problems.

To optimize patient adherence, the authors advise that, if possible, HIV care sites should provide care that is linguistically and culturally appropriate and competent. Each patient should have a primary provider, and patients should be evaluated for depression and substance abuse. If present, a management plan to address these problems should be implemented.

Reference:
Clin Infect Dis 2009;49:651-681.