eMedicine Specialties > Emergency Medicine > Infectious Diseases

HIV, Early Recognition and Rapid Testing: Treatment & Medication

Author: Jeff Dubin, MD, Medical Director, Emergency Department, Washington Hospital Center, Assistant Professor, Department of Emergency Medicine, Georgetown University School of Medicine
Contributor Information and Disclosures

Updated: Apr 7, 2009

Treatment

Prehospital Care

  • Outreach programs can provide rapid HIV testing in the community.
  • Counseling and testing can be completed anywhere.
  • These programs provide an opportunity to identify high-risk patients who otherwise would not seek outpatient testing.

Emergency Department Care

Care in the ED consists of the following:

  • Routine HIV screening of asymptomatic patients and outpatient referral for confirmatory testing and care
  • Identification of acute HIV infection with possible ED diagnosis and/or referral for further diagnostics and treatment
  • Confirmation of diagnosis of HIV in patients with AIDS defining illness, previously not known to be seropositive

Consultations

Infectious disease consultants are invaluable to those caring for HIV-infected patients. Formal consultation in the ED rarely is necessary, but phone discussion regarding management can be very helpful.

Some recommend initiating antiretroviral therapy in the ED for patients with confirmed acute HIV infection. However, this is controversial given adverse effects of HIV medications and lack of immediate clinical benefits, so infectious disease consultation is recommended before prescribing these medications.

Medication

The goals of pharmacotherapy are to inhibit viral replication and to reduce morbidity and death. Limited data are available on the clinical benefits of initiating pharmacotherapy for patients with acute HIV infection. A number of studies, including HIV genotype analysis, must be performed before antiretroviral therapy is initiated. For these reasons, beginning antiretroviral therapy at an emergency department visit is never necessary. Outpatient followup with a provider experienced in antiretroviral therapy should be provided.

For further information on therapy, see HIV Infection, Antiretroviral Therapy.

More on HIV, Early Recognition and Rapid Testing

Overview: HIV, Early Recognition and Rapid Testing
Differential Diagnoses & Workup: HIV, Early Recognition and Rapid Testing
Treatment & Medication: HIV, Early Recognition and Rapid Testing
Follow-up: HIV, Early Recognition and Rapid Testing
Multimedia: HIV, Early Recognition and Rapid Testing
References
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References

  1. CDC HIV/AIDS Science facts: CDC releases revised HIV testing recommendations in healthcare settings. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hiv/topics/testing/resources/factsheets/pdf/healthcare.pdf. Accessed December 1, 2008.

  2. Greenwald JL, Burstein GR, Pincus J, Branson B. A rapid review of rapid HIV antibody tests. Curr Infect Dis Rep. Mar 2006;8(2):125-31. [Medline].

  3. HIV infection: detection, counseling, and referral. Sexually transmitted diseases treatment guidelines 2006. National Guideline Clearinghouse. Available at http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=9674&nbr=5183. Accessed March 25, 2009.

  4. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. National Guideline Clearinghouse. Available at http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=9799&nbr=5246. Accessed March 25, 2009.

  5. Centers for Disease Control and Prevention. HIV/AIDS Statistics and Surveillance. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hiv/topics/surveillance/incidence.htm. Accessed December 3, 2008.

  6. HIV and AIDS estimates and data, 2007 and 2001. 2008 Report on the Global AIDS Epidemic. Available at http://data.unaids.org/pub/GlobalReport/2008/jc1510_2008_global_report_pp211_234_en.pdf. Accessed April 7, 2009.

  7. World Health Organization. Global Summary of the AIDS Epidemic, 2007. Available at http://www.who.int/hiv/data/2008_global_summary_AIDS_ep.png. Accessed April 7, 2009.

  8. Joint United Nations Programme on HIV/AIDS (UNAIDS). 2008 Report on the global AIDS epidemic - Executive summary. Available at http://data.unaids.org/pub/GlobalReport/2008/JC1511_GR08_ExecutiveSummary_en.pdf. Accessed April 7, 2009.

  9. Branson B. Rapid HIV testing: 2005 update. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hiv/topics/testing/resources/slidesets/pdf/USCA_Branson.pdf. Accessed December 1, 2008.

  10. Department of Health and Human Services. November 3, 2008; 1-139. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. AIDSinfo. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed December 1, 2008, pages 38, 70-72; tables 8,11, appendix B Table 1a.

  11. FDA-approved rapid HIV antibody screening tests. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hiv/topics/testing/rapid/rt-comparison.htm. Accessed December 1, 2008.

  12. Greene WC. The molecular biology of human immunodeficiency virus type 1 infection. N Engl J Med. Jan 31 1991;324(5):308-17. [Medline].

  13. Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. Aug 6 2008;300(5):520-9. [Medline].

  14. Kahn JO, Walker BD. Acute human immunodeficiency virus type 1 infection. N Engl J Med. Jul 2 1998;339(1):33-9. [Medline].

  15. Stebbing J, Gazzard B, Douek DC. Where does HIV live?. N Engl J Med. Apr 29 2004;350(18):1872-80. [Medline].

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Further Reading

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Keywords

HIV infection, HIV, AIDS, rapid testing, rapid HIV testing, HIV treatment, HIV symptoms, HIV causes, STD, sexually transmitted disease, human immunodeficiency virus, acquired immune deficiency syndrome, highly active antiretroviral therapy, HAART, Lentivirus, retroviruses, HIV-related illnesses, Pneumocystis jiroveci pneumonia, P jiroveci pneumonia, PCP, cryptococcal meningitis, tuberculosis, TB, cytomegalovirus retinitis, CMV retinitis, CNS toxoplasmosis, central nervous system toxoplasmosis, toxoplasmosis, HIV-associated malignancies, oral candidiasis, acute retroviral syndrome

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Contributor Information and Disclosures

Author

Jeff Dubin, MD, Medical Director, Emergency Department, Washington Hospital Center, Assistant Professor, Department of Emergency Medicine, Georgetown University School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine
Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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