Medico

IDSA GUIDELINES

Primary Care Guidelines for the Management
of Persons Infected with Human Immunodeficiency
Virus: Recommendations of the HIV Medicine
Association of the Infectious Diseases Society
of America
Judith A. Aberg,1 Joel E. Gallant,2 Jean Anderson,2 James M. Oleske,3 Howard Libman,4 Judith S. Currier,6
Valerie E. Stone,5 and Jonathan E. Kaplan7
1

New York University, NewYork; 2Johns Hopkins University, Baltimore, Maryland; 3University of Medicine and Dentistry of New Jersey, Newark;
Beth Israel Deaconess Medical Center and 5Massachusetts General Hospital, Boston; 6University of California at Los Angeles, Los Angeles;
and 7Centers for Disease Control and Prevention, Atlanta, Georgia

4

EXECUTIVE SUMMARY
It has been 120 years since the first case of AIDS wasidentified. There has been a significant and dramatic
change in the management of HIV infection since the
introduction of potent antiretroviral therapy in 1996.
There has also been a significant decrease in morbidity
and mortality among persons living with HIV infection
resulting from improved access to care, prophylaxis
against opportunistic infections, and antiretroviral therapy. A workinggroup of clinical scientists was chosen
by the HIV Medicine Association of the Infectious Diseases Society of America (IDSA) to develop guidelines
addressing the primary care of persons infected with
HIV. The purpose of these guidelines is to assist health
care providers in the primary care management of persons infected with HIV, including a description of baseline laboratory screening andadherence issues. Given
the improved survival among people living with HIV
infection, it is imperative that all persons in the United
States be managed according to standard practices ap-

Received 3 June 2004; accepted 3 June 2004; electronically published 11 August
2004.
These guidelines were developed and issued on behalf of the Infectious
Diseases Society of America.
Reprints orcorrespondence: Dr. Judith A. Aberg, AIDS Clinical Trials Unit,
Bellevue Hospital Center, New York University, Bellevue C and D Bldg., Rm. 558,
New York, NY 10016 (judith.aberg@med.nyu.edu).
Clinical Infectious Diseases 2004; 39:609–29
2004 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2004/3905-0001$15.00

propriate for the individual’s age and sex regardless of
HIVstatus. In addition, HIV-infected persons require
more extensive screening and examinations than do
those without HIV infection. There are increasing reports of complications associated with antiretroviral
therapy that may require additional and more frequenting monitoring.
These guidelines discuss the following topics: (1)
transmission of HIV infection; (2) HIV diagnosis; (3)
riskscreening; (4) management, with special sections
concerning women and children; and (5) adherence. It
is not our intent to duplicate the extensive guidelines
endorsed by the United States Public Health Service,
the Department of Health and Human Services, the
Centers for Disease Control and Prevention (CDC),
IDSA, or other accredited programs. We have referred
to these guidelines where applicable,so that this document may also serve as a “guide to the guidelines”
(table 1). As with previously published IDSA guidelines,
we have graded our recommendations accordingly (table 2).
TRANSMISSION OF HIV
The modes of transmission of HIV—sexual contact,
exposure to infected blood through sharing of injection
drug use paraphernalia or receipt of contaminated
blood products, and perinataltransmission—were clarified relatively early in the AIDS epidemic. In the United
States, their relative importance over time is reflected
Primary Care Guidelines for HIV • CID 2004:39 (1 September) • 609

Table 1.

Guidelines from various sources regarding aspects of care of HIV-infected persons.

Topic

Title

URL

Issuing agency

Reference

HIV testing and counseling

Revised...