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.
Subscribe to access the complete flowchart to guide your clinical decision making.
|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|
Subscribe for full access to all Tables and Figures.
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)
Subscribe to get the full list of 85 references and see how the authors distilled all of the evidence into a concise, clinically relevant, practical resource.
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
Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this month!
In This Episode
Have questions or comments on the podcast? Write us at firstname.lastname@example.org
Dr. Ashoo is a practicing emergency physician, board-certified in emergency medicine and clinical informatics. Join him as he takes you through the July 2021 issue of Emergency Medicine Practice: Managing the HIV-Infected Adult Patient in the Emergency Department (Infectious Disease CME, Pharmacology CME and HIV CME)
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 31, 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
Date of Original Release: July 1, 2021. Date of most recent review: June 10, 2021. Termination date: July 1, 2024.
Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME.
Credit Designation: EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
ACEP Accreditation: Emergency Medicine Practice is approved by the American College of Emergency Physicians for 48 hours of ACEP Category I credit per annual subscription.
AAFP Accreditation: This Enduring Material activity, Emergency Medicine Practice, has been reviewed and is acceptable for credit by the American Academy of Family Physicians. Term of approval begins 07/01/2020. Term of approval is for one year from this date. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Approved for 4 AAFP Prescribed credits.
AOA Accreditation: Emergency Medicine Practice is eligible for 4 Category 2-A or 2-B credit hours per issue by the American Osteopathic Association.
Specialty CME: 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.
Needs Assessment: The need for this educational activity was determined by a survey of medical staff, including the editorial board of this publication; review of morbidity and mortality data from the CDC, AHA, NCHS, and ACEP; and evaluation of prior activities for emergency physicians.
Target Audience: This enduring material is designed for emergency medicine physicians, physician assistants, nurse practitioners, and residents.
Goals: Upon completion of this activity, you should be able to: (1) demonstrate medical decision-making based on the strongest clinical evidence; (2) cost-effectively diagnose and treat the most critical presentations; and (3) describe the most common medicolegal pitfalls for each topic covered.
Discussion of Investigational Information: As part of the journal, faculty may be presenting investigational information about pharmaceutical products that is outside Food and Drug Administration–approved labeling. Information presented as part of this activity is intended solely as continuing medical education and is not intended to promote off-label use of any pharmaceutical product.
Faculty Disclosures: It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. In compliance with all ACCME Essentials, Standards, and Guidelines, all faculty for this CME activity were asked to complete a full disclosure statement. The information received is as follows: Dr. Egan, Dr. Jagoda, Dr. Merchant, Dr. Mishler, Dr. Toscano, and their related parties report no significant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation. Dr. Sani reported research support from Gilead Sciences; prior to completion of this writing, Dr. Sani has divested herself of this relationship. This relationship has also been mitigated via peer review. Dr. Faragon reported honoraria for papers, lectures, or teaching from Gilead Sciences, Merck, and Janssen; prior to completion of this writing, Dr. Faragon has divested himself of these relationships. These relationships have also been mitigated via peer review.
Commercial Support: This issue of Emergency Medicine Practice did not receive any commercial support.
Earning Credit: Go online to www.ebmedicine.net/CME and click on the title of the test you wish to take.When completed, a CME certificate will be emailed to you.
Hardware/Software Requirements: You will need a Macintosh or PC to access the online archived articles and CME testing.
Additional Policies: For additional policies, including our statement of conflict of interest, source of funding, statement of informed consent, and statement of human and animal rights, visit www.ebmedicine.net/policies.