HIV and ID Observations

Over on the CID web site, they have the revised version of the “IDSA Primary Care Guidelines for the Management of Persons Infected with Human Immunodeficiency Virus”. It’s a great document, filled with useful references and a particularly strong table where to find other consensus guidelines (diabetes, hyperlipidemia, mental health, others).

My vote for what will be most commonly-cited part of the guidelines it Table 5 (Recommended Baseline Lab Tests) — though Table 9 (Vaccines) could be a close second.

Some potential areas of controversy:

• No recommendation for routine screening for osteoporosis
• No recommendation for routine anal pap smears in MSM
• LP for all patients with late-latent syphilis or syphilis of unknown duration

Regarding the bone density, I suspect this will will be recommended one day, though agree for now it’s premature.

However, I’m sure there are many who will be surprised that the anal paps are not routinely recommended.  Solid quote:

Anal cytologic screening (ie, anal Pap smears) in HIV infected women and MSM is not considered to be the standard of care at this time but is being performed in some health care centers. Additional studies of screening and treatment protocols for anal dysplasia are in progress to clarify this issue.

Seems that it is done uniformly at clinics that have enthusiasts, or zealots — plus a high-resolution anoscopy plus biopsy protocol.  (“If you’re at Disneyland, you go on the rides.”)   We don’t really know yet whether this screening prevents cancer.

For the LP issue — I know it’s in the STD Guidelines, but do you really LP all such cases in your HIV patients?