DOHMH recommendations for treating at-risk patients
In a medical health alert issued Feb. 11, 2005, the New York City Department of Health and Mental Hygiene (DOHMH) issued these recommendations for providers in New York City, where it’s believed a three-drug class resistant HIV (3DHR HIV) strain may become more prevalent:
1. Consider acute retroviral syndrome in patients who may have risk factors for recent HIV infection. Acute retroviral syndrome is a flu-like illness which may include fever, lymphadenopathy, pharyngitis, rash, myalgias, diarrhea, headache, nausea, vomiting, hepatosplenomegaly, weight loss, thrush, and neurologic symptoms lasting 1-2 weeks, generally within 1-2 months of risk behavior. Obtain thorough risk factor history and, for all people who have such a history and symptoms consistent with acute retroviral syndrome, test for HIV infection both by serology and tests for HIV nucleic acid (e.g., HIV-1 RNA PCR or bDNA).
2. Test for drug resistance in all people with newly diagnosed HIV. Genotypic assays detect resistance-conferring mutations. Phenotypic assays directly measure resistance of the patient’s HIV strain to specific individual drugs. If you suspect a patient has been infected with 3DCR HIV, report the case immediately to the DOHMH’s Bureau of HIV/AIDS Prevention and Control at (212) 442-3388.
3. Drug-resistance testing also should be obtained, along with a careful assessment of patient adherence, in all cases of clinical deterioration, incomplete viral suppression, or virologic failure. Use results of resistance testing to guide treatment.
4. Ensure adherence in patients receiving antiretroviral treatment to prevent further development and spread of drug-resistant HIV. Adherence improves with simpler regimens, housing support, mental health services, and drug and alcohol treatment.
5. Obtain, or refer to the DOHMH to obtain, partner names and contact information from all who test HIV+. Notify partners and recommend or obtain HIV testing; for HIV antibody-negative people with symptoms of acute seroconversion, additional testing for HIV nucleic acid (e.g., HIV-1 RNA PCR or bDNA) is indicated. Those with primary HIV infection have enhanced transmission efficiency due to their high viral loads. Partner notification results in prompt diagnosis of HIV and reduces spread of HIV; HIV+ people who are aware of their status are more likely to reduce risky behavior. Call DOHMH’s Contact Notification Assistance Program (212) 693-1419 for help with partner notification. For more information, go to www.nyc.gov/html/doh/pdf/chi/chi23-7.pdf.