RECOMMENDATIONS

Managing Acute HIV

  • Clinicians should recommend ART to all patients diagnosed with acute HIV infection. (A1)
  • Clinicians should inform patients about the increased risk of transmitting HIV during acute infection and for the 6 months following infection in patients who do not initiate ART. (A2)
  • As part of the initial management of patients diagnosed with acute HIV infection, clinicians should:
    • Consult with a care provider experienced in the treatment of acute HIV infection. (A3)
    • Obtain HIV genotypic resistance testing for the protease (A2), reverse transcriptase (A2), and integrase (B2) genes at the time of diagnosis.
  • Patients taking PEP: When acute HIV infection is diagnosed in an individual receiving PEP, ART should be continued pending consultation with an experienced HIV care provider. (A3)
  • Patients taking PrEP: Because the risk of drug-resistant mutations is higher in patients who acquire HIV while taking PrEP, clinicians should consult with an experienced HIV care provider and recommend a fully active ART regimen. (A3)
    • Clinicians who do not have access to experienced HIV care providers should call the Clinical Education Initiative (CEI) Line at 866-637-2342.

Initiating ART

  • When a patient agrees with the clinician’s recommendation to initiate ART during acute HIV infection:
    • The clinicians should implement treatment to suppress the patient’s plasma HIV RNA to below detectable levels. (A1)
    • Clinicians should perform baseline laboratory testing listed in Box 2: Baseline Laboratory Testing Checklist for all patients initiating ART immediately; ART can be started while awaiting laboratory test results. (A3)

Abbreviations: ART, antiretroviral therapy; PEP, post-exposure prophylaxis; PrEP, pre-exposure prophylaxis.

From: Diagnosis and Management of Acute HIV Infection

Cover of Diagnosis and Management of Acute HIV Infection
Diagnosis and Management of Acute HIV Infection [Internet].
Cowan EA, McGowan JP, Fine SM, et al.
Baltimore (MD): Johns Hopkins University; 2021 Jul.
Copyright © Johns Hopkins University Clinical Guidelines Program 2000-2024. The Clinical Guidelines Program, a collaborative effort of the NYSDOH AI and the Johns Hopkins University School of Medicine, Division of Infectious Diseases, encourages the use, reproduction, and distribution of original documents and related graphics from this program website accompanied by a full citation of source that includes: Author(s). Committee. Title. Date of publication. Full URL. Date accessed. Links to pages on this Clinical Guidelines Program website are also encouraged and may be created without seeking permission. Requests to adapt material, i.e., to change or alter in any way material from this website for inclusion in another publication, should be sent to aiguidelines@jhmi.edu. Please include detailed information about the intended use and desired adaptations.

This book is licensed under the terms of the Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY-NC-ND 3.0).

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.