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HIV Primary Care

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7 Coinfection and Comorbidity Laboratory Tests Tuberculosis Screening Î Upon initiation of care, HIV-infected patients without a history of tuberculosis or a prior positive tuberculosis screening test result should be tested for Mycobacterium tuberculosis infection by either a tuberculin skin test (TST) or by an interferon-γ release assay (IGRA) (SR-H). Those with positive test results should be treated for latent M tuberculosis infection after acute tuberculosis has been excluded (SR-H). Î Repeat testing is recommended in patients with advanced HIV disease who initially had negative TST or IGRA results but subsequently experienced an increase in the CD4 cell count to >200/μL on ART and who may thus have developed sufficient immunocompetence to mount a positive reaction (SR-H). Î HIV-infected patients who are close contacts of persons with infectious tuberculosis should be treated for latent M tuberculosis infection regardless of their TST or IGRA results, age, or prior courses of tuberculosis treatment. Active tuberculosis should be excluded first (SR-H). Serologic Testing for Toxoplasma gondii Î All HIV-infected patients should be tested for prior exposure to T gondii by measuring anti-Toxoplasma immunoglobulin G (IgG) upon initiation of care (SR-M). Î Toxoplasma-seronegative adults, representing 70%-90% of the US population, should be counseled on how to avoid new infection (WR-M). Viral Hepatitis Screening and Vaccination Recommendations Î HIV-infected patients should be screened for evidence of hepatitis B virus (HBV) infection upon initiation of care by detection of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), and antibody to hepatitis B total core antigen (anti-HBc; also abbreviated as HBcAb) (SR-H), and those who are susceptible to infection should be vaccinated against HBV (SR-H). HBsAb testing should be repeated 1-2 months after the third vaccine is given, or at the next scheduled visit after the third vaccine is given, to assess for immunogenicity. A second series of vaccination is recommended for those whose HBsAb levels are negative or <10 IU/mL after the primary vaccine series (SR-H). Î Vaccination should be recommended for nonimmune sexual partners of patients who are positive for HBsAg (SR-H).

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