Diagnosis

• Negative test on 4th generation (antibody/antigen) test at 4/52 post-exposure highly likely to exclude infection. Consider further test at 8.52 post-exposure if high-risk. 

Management

• Test & treat e.g. Biktarvy (Bictegravir [integrase], emtricitabine (NNRTI), tenofovir (NNRTI) 

Vaccines

• The vaccination advice for HIV-positive adults is complex, and whilst some live vaccines are permitted, BCG is contraindicated.

• The yellow fever vaccine is a live vaccine. HIV-positive adults with CD4 cell counts <200 cells/μL must not be given live vaccines due to a potential risk of vaccine-associated disease. Vaccination should be postponed until the CD4 cell count has improved with antiretroviral therapy (ART). Since 2004, inactivated polio vaccines (IPV) replaced the oral polio vaccine (OPV) in all UK routine vaccine schedules. The vaccine is given to adults in combination with tetanus and diphtheria toxoid (Td/IPV). 

• In general, HIV-positive persons aged <60 years and with CD4 cell counts >200 cells/μL who are due to travel to countries can also be offered travel vaccinations with live vaccines. They should however be advised that the levels and duration of vaccine-induced protection might be reduced relative to HIV-negative individuals. The importance of additional measures of protection (e.g. hand washing, against insect bites, food hygiene) should be emphasised.

• Vaccinations for influenza (annually), hepatitis B (if non-immune), HPV (age and gender criteria) and pneumococcus are all recommended.

• Hep A (for MSM). 

• Resource: BHIVA. British HIV Association Guidelines on the Use of Vaccines in HIV-positive Adults 2015.

Screening and health promotion

• Annual cervical smears (increased risk of HPV-related disease)

• Women aged 25–64 are recommended to have annual cervical cytology testing

• Men and women aged 40 years and above are recommended to have annual lipids and HbA1c

• Men and women aged 50 years and above should have a three-yearly FRAX score

Breastfeeding & HIV:

• not recommended in the UK. Cabergoline to suppress lactation. . BHIVA guidelines for the management of HIV in pregnancy and postpartum 2018 (BHIVA)

Resources

• HIV infection and AIDS (CKS), HIV/AIDS (WHO fact sheet), HIV (NHS Choices) (Terence Higgins Trust)​

• NHSCSP. Colposcopy and Programme Management (3rd ed.). 2016