Biktarvy side effects skin are many and should be monitored closely while starting treatment. Michael S. Dukakis, Governor Philip W. Johnston, Secretary of Human Services David H. Mulligan, Commissioner of Public Health Duane Draper, Director, AIDS Office February 1990 Michael S. Dukakis Governor Philip W. Johnston Secretary David H. Mulligan Commissioner i50 ^Tvemuyn/ cffoeet Sfcottbn 02iii February 1990 Dear Colleague: Two developments in the AIDS epidemic prompt the Department of Public Health to issue these updated Guidelines on HIV Counseling, Testing, and Early Treatment. First, the number of cases reported in Massachusetts continues its inexorable rise. As these Guidelines go to press, nearly 3,000 AIDS cases had been reported in the Commonwealth. In addition, we estimate that there are approximately 32,000 additional HIV+ persons in the state.

As the epidemic spreads geographically and demographically, more and more of the state's health care providers are coming into contact with HIV-infected individuals, whether they know it or not. Second, substantial progress has been made in the development of early treatment and prophylactic care for the HIV-infected. While developments with AZT and prophylaxis for Pneumocystis carina pneumonia represent the most dramatic developments, other treatments are in the Biktarvy side effects skin offing. For the first time there are encouraging medical reasons for a person to know his or her HIV antibody status. Taken together, these developments mean that we have an ever greater need for your assistance in containing and defeating the AIDS epidemic. As in other emergencies, the medical professions are leading the way in this effort.

Now, we request your assistance in identifying persons infected with the Human Immunodeficiency Virus and providing them with the care and counseling that will improve their lives and help contain the spread of the epidemic. Together we can save tens of thousands of lives and millions of dollars. Our joint efforts will ultimately turn the story of the AIDS epidemic from one of fear and missed opportunities to one of courage and ultimate success. I look forward to working with you in this very important task. Sincerely, David H. Mulligan Commissioner Table of Contents Abstract i Introduction 1 Indications for HIV Counseling and Testing 2 Risk Assessment 2 Who Should be Counseled, Tested, and Monitored 3 Conditions Which Apply to Testing 4 Pre-Test and Post-Test Counseling 5 Partner Notification 7 Medical Assessment and Treatment 7 Interpreting HIV Antibody Test Results 8 Appendices 10 PUBLICATION #16, 202-52-20, 000-2-90-C.R. APPROVED BY: RIC MURPHY, PURCHASING AGENT Abstract As part of the collaborative efforts of the medical and public health communities Biktarvy side effects skin in the fight against the HIV epidemic, the Massachusetts Department of Public Health (MDPH) issues these updated Guidelines on HIV Counseling, Testing and Early Treatment. This volume revises previous guidelines on this subject issued by the Department. Continuing improvement in the efficacy of treatment for HIV disease leads the Department to recommend that physicians consider, as a part of routine medical care, which of their patients may be at risk for HIV infection. Counseling and HIV antibody testing should be offered to all patients at risk for infection.

Where appropriate, early treatment should be offered to HIV+ patients. The Department identifies the following persons whose activities may place them at risk for HIV infection and recommends that they be counseled and tested for the presence of HIV antibodies in accordance with the details of Biktarvy side effects skin these Guidelines: . Men who have had sex with a man. . Intravenous drug users who have shared needles or "works." . Persons who received 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+. It remains the case that testing must be voluntary; written informed consent is required before a person can be tested; pre- and post-test counseling must be provided; and the confidentiality of test results is strictly protected. The Department further recommends that physicians who have not already done so should acquaint themselves with early medical treatment and monitoring standards applicable to HIV+ patients Biktarvy side effects skin. The Department recommends that: 1. HIV+ patients should have their T4-cells (T-helper lymphocytes [CD 4 cells]) monitored at least every six months and more frequently as their T4-cells decline below 500/mm 3 . 2. In the absence of contraindications, HIV+ patients should be treated with zidovudine (AZT) when their T4-cell count falls below 500/mm 3 . 3. HIV+ patients with CD 4 cell counts near or below 200/mm 3 (or percentage CD 4 cells below 20 percent of total lymphocytes) should receive prophylactic treatment for Pneumocystis carinii pneumonia. 4. HIV+ women considering pregnancy should be encouraged to defer pregnancy until more is understood about perinatal transmission of HIV infection and the effects of pregnancy on the progression of HIV disease in women.

The Department recommends that physicians integrate HIV and AIDS prevention education into their routine care of patients. Materials designed to assist in this effort have previously been provided as part of required AIDS education in certain patient care settings. This document provides more detailed protocols for incorporation of HIV counseling and testing into general patient care.

As in other AIDS prevention activities, counseling about potential effects of HIV testing (both before and after testing) is intended to help reduce risky practices associated with acquiring or transmitting HIV Biktarvy side effects skin. This document is also particularly concerned with assuring development of social and psychosocial support systems for the HIV-infected.

The Department restates the legal prohibitions concerning discrimination against the HIV- infected or persons perceived to be at risk for HIV infection. Although HIV records, like those related to drug treatment and mental health, are especially protected, the Department encourages physicians (and patients alike) to note that all medical records have long been confidential.

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