New HIV Guideline Updates, Expands Prevention Recommendations

Larry Hand

December 17, 2014

A new guideline containing updated and new recommendations on preventing HIV transmission is available for clinical providers, nonclinical providers, and health department staff members.

The Centers for Disease Control and Prevention (CDC) published the comprehensive guideline, "Recommendations for HIV Prevention With Adults and Adolescents With HIV in the United States, 2014," on December 12, along with a summary for clinical providers. Summaries also are available for nonclinical providers and health department staff members.

"Several factors have prompted this update: the context and method of HIV prevention, care, and treatment is changing in the US due to recent advances in biomedical, behavioral, and structural prevention strategies, changes in public and private sector healthcare delivery, and new national HIV prevention strategies," Kathleen Irwin, MD, MPH, a medical epidemiologist in CDC's Division of HIV/AIDS Prevention, and a primary author of the guideline, told Medscape Medical News through a spokesperson.

"For example," she said, "early initiation of antiretroviral therapy (ART) has been shown to improve health, suppress viral load, and reduce the risk of transmitting HIV to others. Moreover, offering HIV treatment shortly after diagnosis can also hasten the use of other biomedical, behavioral, and structural interventions that can reduce the risk of transmitting HIV to others."

The new guideline updates and expands four recommendations covered in the previous guideline issued in 2003:

  • behavioral screening for possible HIV transmission,

  • sexually transmitted disease screening and treatment,

  • HIV partner services, and

  • referral for medical and social services.

The new guideline adds seven topics:

  1. individual, social, structural, ethical, legal, and programmatic factors influencing HIV transmission and use of services;

  2. medical care linkage and retention;

  3. ART;

  4. methods to sustain ART adherence;

  5. reproductive healthcare for men and women;

  6. pregnancy-related services; and

  7. methods to monitor, evaluate, and improve quality of HIV prevention and care and programs for HIV-infected individuals.

The 2003 guideline provided recommendations to healthcare providers who treated persons with HIV, but the new guideline expands recommendations to clinical and nonclinical providers and health department staff members who provide population-level prevention and care services.

The CDC's partners in developing the guideline were the Health Resources and Services Administration, the National Institutes of Health, and five nongovernmental organizations: the American Academy of HIV Medicine, the Association of Nurses in AIDS Care, the International Association of Providers of AIDS Care, the National Minority AIDS Council, and the Urban Coalition for HIV/AIDS Prevention Services.

Although effective interventions exist today, Dr Irwin said, "unfortunately, many interventions for people with HIV have not been optimally coordinated, consolidated, and aligned with the latest scientific evidence. By offering this expanded set of interventions, providers, health departments, and HIV planning groups can enhance the health of people with HIV, prevent HIV transmission to their sex and drug-injection partners and children, as well as contribute to community well-being overall."

"Recommendations for HIV Prevention With Adults and Adolescents With HIV in the United States, 2014." CDC. Full text


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