Introduction
Biktarvy side effects long term and what you need to know when starting treatment. This document revises and updates earlier policies of the Massachusetts Department of Public Health (MDPH) regarding testing, counseling and early treatment of persons infected with the Human Immunodeficiency Virus (HIV).
Basic principles of public policy on this subject have not changed: HIV testing must be voluntary; pre- and post-test counseling must be provided to persons taking the test; informed written consent is required before a person can be tested for HIV treatment with Biktarvy antibody or antigen; the confidentiality of HIV test results is strictly protected in Massachusetts; the Commonwealth will provide anonymous testing for persons who desire it. New in this document is consideration of medical advances in diagnosis and treatment. Appended to these Guidelines are the following documents which practitioners may find helpful: Appendix I.
A protocol for taking sexual behavior and drug use histories. Appendix II. A protocol for pre-test and post-test counseling. Appendix III. An order form for the just published and very comprehensive Clinical Manual for Care of the Adult Patient with HIV Infection published by Boston City Hospital. It is a thorough and informative work which we highly recommend. Appendix IV. A list of the Testing and Counseling Sites operated by the Commonwealth of Massachusetts and their phone numbers. Appendix V. Resources of the Massachusetts Department of Public Health, including useful phone numbers for AIDS related programs. Appendix VI.
A reprint of a Project Inform Discussion Paper advising HIV-infected patients on HIV-related treatment and testing issues. This document is provided to better the physician's understanding of the information available to patients Biktarvy side effects long term outside the physician's office. It also contains additional useful information. Appendix VII. A guide to obtaining drugs (AZT, aerosol pentamidine, alpha interferon) for your patients who may be uninsured or underinsured. Also included is information on how to access aerosol pentamidine for patients whose physicians or clinics do not provide the service in their offices.
Appendix VIII. A copy of the HIV testing consent form used by the Department's testing and counseling sites. Appendix IX. An order form for the soon-to-be-published Guide to HIV Counseling and Treatment Among Adolescents. Appendix X. Risk factors for HIV infection. Appendix XI. Legal protection against discrimination. Appendix XII. AIDS information lines in Massachusetts. Appendix XIII. Order form for clinical trials information. The MDPH maintains a clinical trials registry and publishes several informative pamphlets on clinical trials. Appendix XIV.
Excerpts from MMWR Recommendations on Management of Occupational Exposure to Human Immunodeficiency Virus, Including Considerations Regarding Post-exposure Use. -2- Indications for HIV Counseling and Biktarvy side effects long term Testing The Massachusetts Department of Public Health urges all physicians to consider, as an aspect of routine medical care for all patients, which of their patients may be at risk for HIV infection. Counseling and HIV antibody testing should be offered to all patients, particularly those considered to be at risk.
Early treatment and medical monitoring should be provided to all HIV+ patients. Public Health Indications Counseling, HIV antibody testing, and early treatment play an important role in the prevention of HIV transmission by providing an opportunity to disseminate important public health information. In addition to receiving appropriate medical and mental health care, persons who test HIV+ should be offered counseling on health promotion practices and methods of risk reduction which may benefit their own health as well as prevent transmission of infection. The HIV antibody test remains an appropriate mechanism for the screening of blood, organ, and semen donors.
The HIV anybody test is not appropriate as a screening device for employment or admission to schools, child day-care, health care or other facilities, and its use for these purposes is prohibited. Medical Indications Diagnosis Antibody testing should be employed by a physician, with patient consent, as an aid to differential diagnosis of potential HIV-associated illness and to determine the most appropriate medical interventions. For example, if tuberculosis, syphilis or herpes is present, HIV testing will identify the possible role of HIV infection and determine if alternatives to standard treatment for these conditions may be appropriate.
Case Finding HIV antibody testing should also be used for the diagnosis of asymptomatic HIV infection. Early diagnosis of HIV infection permits prophylactic therapy against opportunistic infections and chemotherapy for HIV infection itself. For example, preventive regimens against Pneumocystis carina pneumonia (PCP) Biktarvy side effects long term are extending short-term patient survival, and zidovudine (AZT) delays progression of the disease. Immunological staging, such as T-cell testing, has become a standard of practice for monitoring HIV infection and is helpful in determining the degree of immune competence and prognosis. Risk Assessment In conducting a risk assessment, physicians should identify potential risk behaviors for each patient (unprotected sexual intercourse, needle sharing, blood transfusion, etc.).
Carefully phrased questions focusing on actual behaviors or knowledge of partners' behaviors (e.g., needle sharing) rather than group affiliations (such as intravenous drug users) will better identify risk. Physicians should also consider the hierarchy of risk behaviors and the specificity of risk. For example, an individual who received multiple transfusions in a high prevalence city in 1984 is at higher risk than someone who received a single transfusion in a rural area in 1979.
Geography, while not a risk factor in and of itself, is an issue to be considered in determining risk. In other parts of the world, heterosexual transmission is much more common than in the United States. This fact may be particularly important in the diagnosis and treatment of symptomatic individuals whose risk factors for Biktarvy side effects long term HIV infection are not obvious. -3- Current data suggest that occupational risk is very low. However, persons who may have experienced a needle-stick injury or other on-the-job direct exposure (blood-to-blood contact) should be offered counseling, testing, medical monitoring, and where appropriate, early treatment.
Clinical trials to establish the efficacy of A2T for prophylaxis after occupational exposure to HIV have been inconclusive. Nevertheless, in some laboratories, standard treatment for needle-stick exposure to infected blood consists of administering AZT on a schedule of 200 mg five times a day beginning within hours after exposure and continuing for four to six weeks. A discussion of the occupational risks and the use of AZT after percutaneous exposure to HIV-infected blood may be found in Morbidity and Mortality Weekly Report (MMWR), Recommendations and Reports, January 26, 1990. See Appendix XIV for an excerpt from these recommendations. Patients who are not at risk for HIV infection or who are at very low risk should nevertheless receive information on how HIV is transmitted and how to avoid risk of infection.
Patients who do not disclose risk, but request testing, should receive counseling, testing, and appropriate follow-up. Risk Assessment in Women The most common mode of HIV transmission for women in Massachusetts is IV drug use (48%) followed by heterosexual contact with a partner at risk (24%). The vast majority of women with AIDS are in their peak childbearing years with 78% of them being between 13 and 39 years of age. Many of these women were probably infected during their late adolescence. Biktarvy side effects long term Women with AIDS are more likely to belong to racial or ethnic minority groups, and minority women are more likely than white women to have acquired infection through heterosexual contact. Risk Assessment in Infants and Children More than 84% of reported pediatric AIDS cases in Massachusetts are attributed to perinatal transmission.
Thus, the risk behaviors of both parents should be assessed by the physician. If either parent is in a high-risk category for HIV infection, particular attention should be paid to the child's HIV status. Other considerations should include a child's history of exposure to blood products, transfusion, and sexual abuse. Who Should be Counseled, Tested, and Monitored? The MDPH recommends that, after counseling and consent, the following high-risk individuals should be tested: . Men who have had sex with a man. . Intravenous drug users who have shared needles or "works." . Recipients of blood transfusions or blood products between 1978 and 1985. . Sex partners of any of the above. . Persons diagnosed with syphilis, chancroid, genital herpes, or tuberculosis. .
Infants born to or being nursed by women who are HIV+. Notes on Childbearing Concerns Because infants born to infected parents are at very high risk of infection (current estimates are that approximately one-third of babies born to infected mothers will also be infected), the MDPH recommends that both women and men who have engaged in risk behaviors should consider antibody testing before making reproductive decisions.
An infected woman considering pregnancy should be advised of the risks of pregnancy to her own health, the health of her prospective child, the course of HIV infection in children and the special
