Clinical Manual for Management of the HIV-Infected ... - myCME.com

3–10 | Clinical Manual for Management of the HIV-Infected Adult/2006
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could transmit resistant virus to a partner or, if they
are pregnant, to an infant.
Patients should know that HIV medications do not
prevent transmission of infection to others. Safer-sex
recommendations must be followed and other highrisk
activities (eg, needle sharing) must be carefully
avoided to keep from spreading the virus to others
(see chapter Preventing HIV Transmission/Prevention
with Positives for more information).
Experts recommend using latex barriers during sex
(safer sex) and not sharing needles or other drugusing
equipment, even with other HIV-infected
persons. Patients should know that if their virus
develops resistance to some ARVs and they pass that
virus on to another person, HIV medications may
not be effective in that person. If a patient’s partner
happens to have a drug-resistant strain of HIV, it is
possible for the patient to become infected with a
resistant virus in addition to the one he or she has
already, and this may limit treatment options.
Hepatitis C, hepatitis B, and other sexually
transmitted infections such as syphilis and gonorrhea
can be transmitted between partners who both have
HIV.
If ARVs must be discontinued, it is usually best
to stop all ARVs at once. The exception to this
recommendation may be NNRTI-containing
regimens; in this case, the NRTIs should be
continued for about 1 week after discontinuation
of the NNRTI, if possible. Even carefully managed
interruptions can cause drug resistance mutations.
Again, this will limit future treatment options, and
should be avoided if possible.
Discuss contingencies in the event that the client is
unable to take ARVs for a day or more (eg, illness,
severe adverse effects, hospitalization, or other
unexpected circumstances).
References
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Centers for Disease Control and Prevention.
Updated U.S. Public Health Service Guidelines for
the Management of Occupational Exposures to HIV
and Recommendations for Postexposure Prophylaxis.
MMWR Recomm Rep. 2005 Sep 30; 54(RR09); 1-
24. Available online at aidsinfo.nih.gov/Guidelines/
GuidelineDetail.aspx?GuidelineID=10. Accessed
May 19, 2006.
Centers for Disease Control and Prevention. Public
Health Service Task Force Recommendations for Use
of Antiretroviral Drugs in Pregnant HIV-1-Infected
Women for Maternal Health and Interventions to
Reduce Perinatal HIV-1 Transmission in the United
States. October 12, 2006. Available online at
http://aidsinfo.gov/Guidelines/GuidelineDetail.
aspx?GuidelineID=9. Accessed July 8, 2007.
Coffey S. Options for Once-Daily Dosing of
Antiretrovirals. Accessed May 19, 2006.
Kojic E, Carpenter C. Initiating Antiretroviral
Therapy. In: Peiperl L, Coffey S, Volberding PA, eds.
HIV InSite Knowledge Base [textbook online];
San Francisco: UCSF Center for HIV Information;
2006. Accessed February 7, 2006.
Hirsch M. Highly Active Antiretroviral Therapy in
2005: Recent Data for Clinical Practice. Accessed
February 7, 2006.
New York AIDS Institute. Criteria for the Clinical
Care of Adults with HIV Infection: Antiretroviral
Therapy; revised June 2005. Accessed February 7,
2006.
U.S. Department of Health and Human Services.
Antiretroviral Postexposure Prophylaxis After Sexual,
Injection-Drug Use, or Other Nonoccupational Exposure
to HIV in the United States. MMWR Recomm
Rep. 2005 Jan 21;54(RR02);1-20. Available online
at aidsinfo.nih.gov/Guidelines/GuidelineDetail.
aspx?GuidelineID=11. Accessed May 19, 2006.
U.S. Department of Health and Human Services.
Guidelines for the Use of Antiretroviral Agents in HIV-
1-Infected Adults and Adolescents. October 10, 2006.
Available online at aidsinfo.nih.gov/Guidelines/
GuidelineDetail.aspx?GuidelineID=7. Accessed July
7, 2007.
World Health Organization. Progress on Global Access
to Antiretroviral Therapy: An Update on “3 X 5”; June
2005. Accessed February 7, 2006.