2013 Edition

2013 Edition November 2013 U.S. Department of Health and Human Services Health Resources and Services Administration A Guide to the Clinical Care of Women with HIV – 2013 Edition The publication was produced for the U.S. Department of Health and Human Services, Health Resources and Services Administration by GEARS, Inc. under contract number HHSH25020110029C, by Management Solutions Consulting Group, Inc. under contract number HHSH250201000028C, and by Impact Marketing + Communications under contract number HHSH250200900041C. This publication lists non-Federal resources in order to provide additional information to consumers. The views and content in these resources have not been formally approved by the U.S. Department of Health and Human Services (HHS) or the Health Resources and Services Administration (HRSA). Listing these resources is not an endorsement by HHS or HRSA. A Guide to the Clinical Care of Women with HIV – 2013 Edition is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication; however, the photographs and images may be copyrighted and permission may be required to reproduce them. Images include tables, charts, and graphs. Suggested Citation: U.S. Department of Health and Human Services, Health Resources and Services A Guide to the Clinical Care of Women with HIV – 2013 Edition. Rockville, Maryland: U.S. Department of Health and Human Services, 2013. U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau i A Guide to the Clinical Care of Women with HIV – 2013 Edition U.S. Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau Parklawn Building, Room 7-05 5600 Fishers Lane Rockville, Maryland 20857 ii U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau A Guide to the Clinical Care of Women with HIV – 2013 Edition Table of Contents Preface ........................................................................................................iv Introduction ..................................................................................................v Contributing Authors ..................................................................................vi Abbreviations and Acronyms ...........................................................................................................................ix 1. Epidemiology and Natural History of HIV Infection in Women ......................1 Ruth M. Greenblatt, MD 2. Approach to the Patient .................................................................................................................................19 Jean R. Anderson, MD 3. Prevention of HIV Infection .......................................................................................................................37 Jared M. Baeten, MD, PhD, and Connie Celum, MD, MPH 4. Primary Medical Care .......................................................................................................................................73 Judith Feinberg, MD 5. Adherence to HIV Treatment and Retention in Care ..............................................133 Laura Armas-Kolostroubis, MD, and Laura Cheever, MD, ScM 6. Gynecologic Problems .................................................................................................................................151 Jean R. Anderson, MD Color Plates ....................................................................................................................................................................... 215 7. Preconception Care and Contraception ..................................................................................227 Erika Aaron, CRNP, MSN, and Jean R. Anderson, MD 8. HIV and Pregnancy .........................................................................................................................................263 Jean R. Anderson, MD 9. Psychosocial Issues, Mental Health, and Substance Abuse .........................339 Julie Barrosso, PhD, ANP, APRN, BC, FAAN 10. Adolescents ........................................................................................................................................................... 377 Donna Futterman, MD, and Anita Radix, MD, MPH 11. Palliative and Supportive Care .....................................................................................................397 Jessica S. Merlin, MD, MBA, and Rodney Tucker, MD, MMM 12. Occupational Exposure and Postexposure Management ............................425 Mina Matin, MD, and Ronald H. Goldschmidt, MD 13. Pharmacologic Considerations in HIV-Infected Pregnant Patients....443 Paul Pham, PharmD, and Patricia Barditch-Crovo, MD 14. Quality Management ................................................................................................................................515 Lori DeLorenzo, RN, MSN and Robin Bidwell, RNC, BSN, CCRC 15. Resources ................................................................................................................................................................. 531 Lori DeLorenzo, RN, MSN, and Skyler Sharp, RN, BSN 16. International Perspectives ....................................................................................................................547 Stacie C. Stender, MSN, MSc ID, FNP-BC, and Kelley Curran Index ......................................................................................................................................................................................... 569 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau iii A Guide to the Clinical Care of Women with HIV – 2013 Edition Preface Recommendations change rapidly in HIV care, so the care provider is cautioned that this edition is dated November 2013. For the most current and continually updated HIV/AIDS treatment guidelines, contact AIDSinfo at: http://www.aidsinfo.nih.gov This Guide contains information relating to general principles of medical care that should not be construed as specific instructions for individual patients. Some of the information may cite the use of a particular drug in a dosage, for an indication, or in a manner other than recommended by the FDA. Therefore, the manufacturer’s package inserts should be consulted for complete prescribing information. U.S. Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau Parklawn Building, Room 7-05 5600 Fishers Lane Rockville, Maryland 20857 http://www.hab.hrsa.gov iv U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau A Guide to the Clinical Care of Women with HIV – 2013 Edition Introduction HIV/AIDS clinical care has improved dramatically over the past two decades as new and effective medications have become available. Over that same period, our understanding of how best to use antiretrovirals and deliver primary care to persons living with HIV/AIDS has deepened as well. Positive change on such a massive scale, however, brings with it new demands on clinicians. Along with innovations in HIV drug therapies, HIV/AIDS care has become more complex than ever before due to increasing comorbidities that are attributable to HIV treatment and the aging of the HIV-infected population in the United States. Patient needs also have expanded across a broad spectrum of medical, psychological, behavioral, and social needs. Notably, significant numbers of infected individuals are identified and enter care late in the course of their HIV disease. Combined with the specific challenges faced by women with HIV infection, clinicians are confronted with complex care challenges. A Guide to the Clinical Care of Women with HIV is a comprehensive clinical manual that addresses primary care needs unique to women living with HIV infection. The book’s target audiences are clinicians who provide primary care to women and those seeking a more in-depth understanding of how to care for women with HIV/AIDS. The 2013 edition of the guide, which was first published in 2001, has been updated, and chapters have been added on quality management and psychosocial, mental health, and substance abuse issues. A manual devoted specifically to the care of women with HIV is important. Because women are often challenged by social isolation, poverty, discrimination, and lack of access to quality health care, they tend to be diagnosed later and to have poorer health status than men. They must often contend with vulnerability related to reproductive and gender issues and domestic violence. Finally, women living with HIV are usually relied upon to meet the care needs of children and other family members, many of whom are also HIV infected. By presenting best practices in the clinical management of women with HIV/ AIDS disease, the Guide can help us continue the remarkable advances in HIV/ AIDS care that have made the Ryan White HIV/AIDS Program a model for health care delivery for our nation and for the world. Laura Cheever, MD, ScM Associate Administrator HIV/AIDS Bureau U.S. Department of Health and Human Services Health Resources and Services Administration U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau v A Guide to the Clinical Care of Women with HIV – 2013 Edition Editor Jean R. Anderson, MD Contributing Authors Erika

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