Clinical Management of HIV Disease - moh.gov.jm

CLINICAL MANAGEMENT OF HIV DISEASE Guidelines for Medical Practitioners 2017

JAMAICA

CLINICAL MANAGEMENT OF HIV DISEASE

Guidelines for Medical Practitioners

2017

CLINICAL MANAGEMENT OF HIV DISEASE Guidelines for Medical Practitioners 2017

MOH-DOC-6000-5

CLINICAL MANAGEMENT OF HIV DISEASE

Guidelines for Medical Practitioners

Ministry of Health Jamaica

January, 2017

_______________________

DR. NICOLA SKYERS DIRECTOR, HIV/STI/TB UNIT HPPD

_______________________

DR. BEVERLY WRIGHT DIRECTOR HEALTH PROMOTION AND PROTECTION DIVISION(ACT'G)

__________________________

DR. WINSTON DE LA HAYE CHIEF MEDICAL OFFICER MINISTRY OF HEALTH (ACT'G)

CLINICAL MANAGEMENT OF HIV DISEASE Guidelines for Medical Practitioners 2017

TABLE OF CONTENTS

Acknowledgements Glossary of Terms Foreword by HST Director

Introduction Promotion of Optimal Health Positive Health, Dignity and Prevention HIV Testing, Counselling and Psychological support

- HIV Testing: Pre and Post-test counselling - Counselling and Psychological support Linkage and Retention in care Oral health Initial evaluation of the HIV infected patient History Physical Examination Laboratory Investigations Packages of Care Clinical Management and Monitoring 1. Acute HIV Infection 2. Management Prior to Antiretroviral Therapy commencement 3. Adherence 4. Antiretroviral Therapy Commencement When to Start What to Start When to Switch Recommended second line ARVs

v vi viii

1 4 4

9 10 11 13 15 - 20 16-18 19 20 21-22 23 - 66 24 25 26

28 29 30 31

CLINICAL MANAGEMENT OF HIV DISEASE Guidelines for Medical Practitioners 2017

5. Antiretroviral Therapy Maintenance

Stable Patients

32

Unstable Patients

34

Characteristics of Antiretroviral Agents

36

6. Primary prophylaxis for Opportunistic Infections 7. Treatment Guidelines for opportunistic and other common infections

Timing of antiretroviral therapy with acute opportunistic infections Immune Reconstitution Inflammatory Syndrome Specific treatments 8. Treatment Guidelines for AIDS-defining Illnesses Management of Special Populations HIV and Women - Contraception in HIV HIV and Key populations - Specific prevention techniques HIV and Ageing HIV and Chronic Diseases - Cardiovascular disease and dyslipidemia - Insulin Resistance and Diabetes Co-Infections - Hepatitis B - Tuberculosis - Sexually Transmitted Infections HIV Drug Resistance Third Line Antiretroviral Therapy Post-Exposure Prophylaxis Occupational Exposure Non-occupational exposure

40 42 - 48

42 42 43 - 48 49 - 50 51 - 58 51 52 53 55 57 59-64 59-63 64 66 - 69 65 66 68 70 - 73 74 76 - 84 77 82

CLINICAL MANAGEMENT OF HIV DISEASE Guidelines for Medical Practitioners 2017

. Other considerations Pre-Exposure prophylaxis Voluntary Medical Male Circumcision Appendices

1. CDC HIV classification system 2. WHO HIV classification 3. ART adjustments for renal and hepatic disease 4. Desensitization with Trimethoprim/Sulfamethoxazole 5. General principles of Positive Health Dignity And Prevention 6. Reporting algorithm 7. Rapid testing algorithm 8. HIV confidential reporting form 9. Post Exposure Prophylaxis (PEP) reporting forms 10. Antiretroviral Drug Interactions with Hormone replacement therapy 11. HIV Drug Resistance request forms 12. MOH Drug Monitoring Form 13. ARV Sensitivity Confirmation Form 14. ARV Request Form Bibliography

85- 89 86 88

91 94 96 97 98 100 101 102 104 108 109 114 117 118 119

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