What Are The Most Recent Updates To The Guidelines
At the time this article was written, the DHHS guidelines were most recently updated on .
Researchers are continuing to improve their understanding of how to best treat and manage HIV. The guidelines are updated periodically to include the latest research and expert opinions.
Heres an overview of the most recent changes included in the 2022 update.
Treatment: Sandra Ann Springer Md
Infectious disease and addiction medicine doctor Springer is focused on preventing and treating HIV and AIDS by preventing and treating substance use disorders, in particular opioid use disorder with medication treatment like buprenorphine and extended-release naltrexone. In her research program, InSTRIDE, she investigates how best to help people get treatmentsfor HIV and substance use disorders alikeand stick to them.
At the end of March, Springer launched a new study comparing two methods for doing this work: giving patients access to HIV prevention and treatment and SUD services on mobile health units and connecting them with patient navigators who link study participants to care at brick-and-mortar clinics.
Study participants have a history of opioid and or stimulant use, have or are at risk for acquiring HIV, and have recent involvement with the criminal justice system. Participants are randomized to treatment through the mobile health unit or to a patient navigator.
The primary outcome of the study is how long it takes patients to begin antiretroviral treatment, if they have HIV, or PrEP, if they are do not have HIV. The study will evaluate the full HIV/PrEP, HCV and OUD care cascades, including not just initiation of treatment but retention on treatment as well. Another important secondary outcome assessed in this study is the frequency of non-fatal and fatal overdoses, the number one cause of death for people released from jail or prison, Springer said.
Training Doctors At Sfgh
At the HIV clinic at SFGH’s Ward 86, consistently ranked the top program nationwide by U.S. News & World Report, patients receive the absolute best medical care, Gandhi said.
Yet even there it is difficult for UCSF medical students and residents to learn from the best and master the discipline. Since so much of student and resident time is spent in the hospital and since competing demands dominate their outpatient time, trainees simply are not seeing as many HIV/AIDS patients as they did early on in the epidemic.
As a medical resident, you dont see HIV patients in the outpatient setting for the most part, said Damon Francis, MD, who was a chief resident at SFGH before doing a one-year fellowship at the East Bay AIDS Center in Oakland, CA, to get his specialty training in HIV/AIDS medicine. His fellowship was funded by the HIV Medical Association.
A lack of training opportunities for motivated medical students and residents is exactly what Gandhi and her colleagues are addressing.
Our desire is to train more people on HIV medicine at this premiere HIV institution, she said. They have started programs to take doctors and train them extensively in HIV medicine for one year the amount of time, Gandhi estimates, it takes to be fully exposed to the many medications and drug combinations the modern HIV/AIDS doctor needs to know.
We are trying desperately to find money for this fellowship, Gandhi said, and we would welcome any suggestions with open arms.
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Who Is At Higher Risk And How You Can Reduce Your Risk Of Getting Hiv
Some populations are more affected by HIV than others. This is due to a mix of social and individual factors which affect a persons ability to avoid HIV infection and make decisions that keep them healthy.
Populations that are considered to be at a higher risk of getting HIV include:
- gay, bisexual and other men who have sex with men, including trans men
- African, Caribbean and Black communities including men and women from parts of Africa and the Caribbean where HIV is endemic
- Indigenous peoples
- people who inject drugs
- at-risk women , including trans women
You can reduce the risk of HIV transmission by:
- always using a condom when having sex
- not sharing needles or other drug using equipment
- using HIV medications
- Whether you have HIV or are at risk, HIV medications can reduce transmission of HIV if taken consistently and correctly.
Treatment: Frederick Altice Md
Today treating HIV is not difficult, according to Altice, an infectious disease doctor. The medications are simple and safe and people who receive it are doing well. Your patients who are stable can now be seen once a year, if even that, he said. The challenge now is overcoming the barriers, including substance use, homelessness, and incarceration, which prevent many people from accessing those treatments. As an implementation science researcher, I work at reducing or overcoming such barriers so that those at the margin of society will have parity in terms of access to treatment, he said.
About 30 years ago, in 1993, Altice developed one of the first mobile healthcare systems in the U.S. This 40-foot Community Health Care Van , a bus repurposed as a clinic, provides free HIV prevention and treatment services to people in areas of New Haven where the risk for HIV and other medical problems is high. The van has a waiting area, multiple exam rooms, and bilingual staff. It offers HIV treatment and prevention services as well as primary care, mental health care, and treatment for substance use disorders. It also serves as the hub for the New Haven Syringe Services Program, one of the largest harm reduction programs in the country.
Ive heard people say oh, you can’t go out into the street, you’re in a bad neighborhood. In reality, people in these neighborhoods feel respect when they can receive treatment on their own turf, Altice said.
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Is There A Permanent Aids
As yet, there is no permanent HIV cure. Antiretroviral treatment can effectively control HIV, prevent AIDS, and help people live a healthy life despite the infection. It can make the viral load undetectable but cant completely cure HIV.
Research is being conducted to find a definitive AIDS-HIV cure. There are two types of HIV cures being researched. One is a functional cure, which reduces the levels of HIV in the body. Antiretroviral therapy is a functional cure, but it needs to be taken throughout life.
Another cure is called a sterilizing cure, which can completely remove HIV from the body. A stem cell transplant is one such treatment. To date, only three patients are known to have been completely cured of HIV through a stem cell transplant. They are as follows:
Stem cell therapy showed promising results in these cases. However, transplants require surgery and can be risky for patients living with HIV.
How To Get Tested For Hiv
Although there is currently no cure for HIV/AIDS, Ontario offers a number of testing and treatment programs. These programs help people with HIV/AIDS live for many years after contracting the disease.
All doctors, nurse practitioners and midwives in Ontario can order HIV tests. There are three types of tests:
- standard HIV testing: a sample of your blood is taken and sent to a public health laboratory
- anonymous testing: the test is ordered for you and your results are provided using a code known only to you. Anonymous HIV testing is offered at 50 locations in communities across Ontario
- point of care testing: your blood is tested while you wait. If you test negative for HIV/AIDS, you will learn your results immediately. If you test reactive, your blood sample will be sent for standard testing
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Who Should Be On My Health Care Team
Finding a health care team that is knowledgeable about HIV care is an important step in managing your care and treatment. If you are able to choose your provider, you should look for someone who has a great deal of experience treating HIV. This matters because the more HIV experience your provider has, the more familiar he or she will be with the full range of treatment options that exist today, as well as the unique issues that can come up in HIV care over time.
Who is on your HIV health care team will depend on your health care needs and the way that the health care system, clinic, or office you will get your care from is set up. It should also be based on your preferences and what will work best for you. Dont get hung up on finding the perfect provider the first week after you are diagnosed. The most important thing you can do now for your health is to meet with an HIV provider who can order your first lab tests and start HIV treatment as soon as possible. Dont let the search for the perfect doctor slow you down on this. You can change doctors later if you need to.
In addition to your HIV health care provider, your health care team may include other health care providers, allied health care professionals, and social service providers who are experts in taking care of people living with HIV.
The types of professionals who may be involved in your HIV care include:
Health care providers
Allied health care professionals:
Social service providers:
Their Approach To Health Care
Find a person who shares your basic philosophy about health care. Don’t downplay the importance of this.
Do you want a doctor who will allow you to take an active part in decision-making? Or do you prefer a more traditional doctor-patient relationship, where the doctor takes the lead?
How aggressive do you want to be about treatment? Do you want someone who will encourage you to try new drugs or participate in research trials?
Are you interested in complementary care, such as homeopathy or vitamin therapies? Will the doctor support this?
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Research: Onyema Obguagu Mbbch
HIV treatment has advanced to the point where people with HIV can take pills only once a day or long-acting injectables to suppress the virus. Thats just been huge, said Ogbuagu. But taking a pill every day can be difficult. It can be exhaustinga phenomenon called pill fatigue. People facing mental illness, substance use disorders, unstable housing, and other barriers to treatment may be unable to take a pill every day. When people miss doses of their medications, HIV can develop resistance to the drugs. Multi-drug resistant strains can develop, such that even if you go back on some pills, they no longer work. Multi-drug resistance is also common in people who were infected with HIV from birth, according to Ogbuagu. To avoid the challenges of a daily pill, the next frontier with regards to the advancement of HIV therapeutics is long-acting therapies, Ogbuagu said.
We’ve accomplished two things with these results, Ogbuagu said. We showed that lenacapavir added to the failing regimen, two weeks in, can have an effect on the virus. And then in the next phase of the study, we showed that in combination with other antiretrovirals, it could achieve and maintain viral suppression in patients.
Ogbuagu and colleagues are also testing the drug in people who are just beginning HIV treatment and as a type of long-lasting PrEP.
Qualifications And Office Practice
Your doctor should be board certified in internal medicine with a subspecialty in infectious disease . If they specialize in HIV, even better. However, some doctors without all of these qualifications — internists, family physicians, osteopaths — do have experience treating people with HIV and take very good care of their patients. Ask how many patients with HIV or AIDS theyâve seen and whether they feel comfortable taking care of you.
Find out what the average wait time for an appointments is, and how long it typically takes to return phone calls.
Do they regularly work with specialists they can refer you to when you need it?
Check which insurance they accept. Will they wait for payment from the insurance company, or will you have to pay up front? Do they take Medicaid?
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Hiv: Why See A Specialist
Human immunodeficiency virus is a complex disease that affects everyone differently. Thats why all HIV patients should follow unique treatment plans tailored to their specific needs. But your primary care doctor may not have all the information you need to manage your HIV successfully.
Thats where specialists come in: a HIV specialist has the right skills and insight to help you stay in control of your HIV. Heres why:
Other Specialized Hiv Care
Casey House is a hospital providing both compassionate in-patient health care and community programming for people with HIV/AIDS.
Casey House provides:
- Day health care
- Community care and outreach
- help with finding supportive housing for people with HIV/AIDS
- programs that provide volunteer in-home hospice care
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Comparison Analysis Between Groups
One hundred seventy-one PCPs reported currently treating HIV patients, and 176 reported they did not. PCPs practicing HIV medicine were more likely than those not practicing HIV medicine to agree that PCPs should help with the HIV provider shortage and that PCPs are the best solution to the HIV provider shortage .
Comparison analysis between groups: PCPs who currently practice HIV medicine vs. PCPs who currently do not practice HIV medicine
Comparison analysis between groups: PCPs who currently practice HIV medicine vs. PCPs who currently do not practice HIV medicine
Articles On Hiv Medical Team
If you have human immunodeficiency virus , you need to take several medicines every day to help you stay healthy so you don’t develop AIDS. You also need regular checkups to manage the disease and take the best possible care of yourself.
Many different medical professionals provide care, comfort, and treatment for people with HIV. They offer services that range from primary health care to information about the disease and about nutrition. This is known as an “interdisciplinary care team.”
The specific providers you need will depend on your overall health and preferences. For help finding HIV/AIDS services, visit AIDS.gov.
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Looking After Your Mental Health
Your mental health and wellbeing are as important as your physical health.
Talking to staff at your clinic about how you feel about your health and treatment, and other aspects of living with HIV can be just as important as telling them about symptoms or side effects. They can often help, or refer you to other services that can.
Learn More About Hiv/aids Testing
To learn more:
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Finding An Hiv Specialist
HIV specialists can be found in most large cities. And HIV specialists often serve rural communities as well. Here are some ways that will help you find one:
- Contact large hospitals in your area, especially ones that are affiliated with a university. HIV specialists can usually be found in the infectious disease departments of those hospitals. Please note that not all infectious disease specialists are necessarily HIV specialists. When making the call, make sure you request an HIV specialist.
- Speak with the local HIV/AIDS service agencies in your area. They will have a list of local HIV specialists and, in most cases, will help you get connected with one of them.
- Word of mouth is a good source when looking for an HIV specialist. Listen to others who are living with HIV. They may be able to recommend a specialist.
How To Avoid Possible Drug Interactions On Art
Be sure to discuss all the drugs and supplements you’re taking with your doctor, because antiretroviral drugs can interact with a wide range of other medicines.
Certain drugs or supplements may compromise the efficacy of HIV medication. These include, but are not limited to:
- Acid-reducing agents and acid reflux medication, including antacids, proton pump inhibitors, and H2 antagonists
- Drugs and supplements that affect p-glycoprotein or the enzyme CYP3A4, such as St. John’s wort.
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Ongoing Research And Potential Hiv Cures
There is still no universal or permanent cure for HIV. But techniques like gene editing, immune cell modulation, and stem cell transplants are currently being studied to cure HIV. These methods focus on changing and boosting immune cells to fight the virus. Many researchers have also conducted HIV vaccine trials. But more research is required before it can be used to cure HIV.
In the meantime, doctors recommend patients test regularly for HIV to ensure that they dont have the virus. If youre HIV-positive, your doctor will ask you to start antiretroviral treatment immediately. For now, it is the best way to control HIV, prevent AIDS, and live a long and healthy life.
Drugs When Starting Treatment
- ART is recommended for all people with HIV to lower the chances of severe illness, death, and transmission.
- People with a new diagnosis of HIV should start ART as soon as possible.
- Genetic testing is recommended at the beginning of treatment to screen for potential drug resistance.
- Medical professionals should discuss future pregnancy plans with people who are able to become pregnant. A pregnancy test may be performed before starting HIV treatment.
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