Prevention: • Much work remains to be done, particularly regarding methods initiated and controlled by women, as well as prevention of transmission between serodiscordant couples. Further work is needed to evaluate sexual transmission prevention strategies among men who have sex with men. • These studies highlight the importance of continuing to recommend condomu seasaproven HIV prevention strategy. • Further research on optimal vaccination regimens, immune responses to vaccination, and the safety and efficacy of vaccinations in specific target populations is still needed. Testing: • Routine point of care testing can markedly increase screening rates. • Attention to issues of stigma and clear communication about results are important for both patients and providers. • Provider perceptions must be addressed, including concerns about inadequate time and legal ramifications. Initiation of Treatment: The studies presented both favor earlier treatment in the 350-500 cells/mm3 range and possibly above. The combined data have led to a change in DHHS Guidelines28: • As before, ART should be initiated if the CD4 count is less than 350 cells/mm3 or in cases of pregnancy, HIV-associated nephropathy, and hepatitis B virus (HBV) coinfection when treatment of HBV is indicated. • Now, the expert panel recommends starting therapy between 350-500 cells/mm3 and is divided on therapy at CD4 counts above 500 cells/mm3 with 50% in favor and 50% viewing it as optional. • It is important to note that most patients are diagnosed with a CD4 under 350 cells/mm3. Increased adoption of routine testing may identify those with HIVat earlier CD4 counts.
ASJC Scopus subject areas
- Internal Medicine