As highly active antiretroviral therapies have advanced, HIV patients who are treatment-adherent can achieve undetectable viral loads, virtual elimination of opportunistic infection, improved quality of life, and normal life expectancy. This issue focuses on emergency department management of HIV patients both with successful disease suppression from long-term therapy as well as the patient with low CD4 counts in the context of lack of engagement with care, nonadherence, or undiagnosed disease. Optimal emergency department management of patients with HIV also includes identifying and treating undiagnosed patients, helping to re-establish care for those who have been lost to followup, and preventing new HIV infections with pre-exposure and postexposure prophylaxis.
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|United States Department of Health and Human Services||HIV treatment, PEP, PrEP, OI management, drug interactions|
|University of California, San Francisco||HIV treatment, drug interactions|
|University of Liverpool||HIV drug interactions|
|New York State Department of Health AIDS Institute||HIV treatment, PEP, PrEP|
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Following are the most informative references cited in this paper, as determined by the authors.
1. * U.S. Centers for Disease Control and Prevention. “CDC Fact Sheet: Vital Signs, 2019.” Accessed June 10, 2021. (CDC data report)
2. * U.S. Centers for Disease Control and Prevention.“HIV in the United States and Dependent Areas.” Accessed June 10, 2021. (CDC statistics)
5. * U.S. Centers for Disease Control and Prevention.“PEP (Post-Exposure Prophylaxis).” Accessed June 10, 2021. (CDC information page)
7. * U.S. Department of Health and Human Services.“US Statistics and Fast Facts.” Accessed June 10, 2021. (Data report)
9. * U.S. Preventive Services Task Force.“Final Recommendation Statement: Human Immunodeficiency Virus (HIV) Infection: Screening. U.S. Preventive Services Task Force.” Accessed June 10, 2021. (Guidelines)
10. American College of Emergency Physicians.“Policy Compendium.” 2021; Accessed June 10, 2021. (ACEP policies)
17. * Saag MS, Gandhi RT, Hoy JF, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2020 recommendations of the International Antiviral Society-USA panel. JAMA. 2020;324(16):1651-1669. (Guidelines) DOI: 10.1001/jama.2020.17025
18. * U.S. Department of Health and Human Services.“Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV.” Accessed June 10, 2021. (Guidelines)
25. * Dominguez KL, Smith DK, Vasavi T, et al.“Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV—United States, 2016.” Accessed June 10, 2021. (Practice guideline)
28. * U.S. Centers for Disease Control and Prevention.“Interim Statement Regarding Potential Fetal Harm from Exposure to Dolutegravir – Implications for HIV Post-exposure rophylaxis (PEP).” Accessed June 10, 2021. (CDC statement)
29. * U.S. Centers for Disease Control and Prevention.“Preexposure Prophylaxis for the Prevention of HIV Infection in the United States—2017 Update: A Clinical Practice Guideline.” Accessed June 10, 2021. (CDC guidelines)
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Keywords: HIV, AIDS, HAART, retroviral, antiretroviral, CD4, NRTI, PEP, PrEP, seroconversion, COPD, thromboembolism, MSM, opportunistic infection, OI, ABC, FTC 3TC, TAF, TDF, DOR, EFV, RPV, ATZ, DRV, BIC, DTG, EVG, RAL, NRTI, NNRTI, protease, integrase, hepatitis, pregnancy, renal, nephrolithiasis, diarrhea, rash
Fereshteh Sani, MD; John J. Faragon, PharmD; Daniel J. Egan, MD
Andy Jagoda, MD, FACEP; Roland C. Merchant, MD, MPH, ScD
July 1, 2021
July 1, 2024
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME, 4 Pharmacology CME and 4 HIV CME credits