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Primary care of the HIV-infected adult

Todd M Pollack, MD
Howard Libman, MD, FACP
Section Editor
John G Bartlett, MD
Deputy Editor
Allyson Bloom, MD


Over the past two decades, antiretroviral therapy (ART) has radically altered the natural history of HIV infection [1]. Opportunistic diseases have become less common, and mortality has declined such that most treated HIV-infected patients now have a near normal life expectancy [2,3]. More than 50 percent of deaths in HIV-infected patients receiving ART are now related to conditions other than AIDS [4]. HIV infection appears to increase the risk of non-AIDS-related cardiovascular disease, renal disease, liver disease, and malignancies [5]. In addition, a variety of long-term complications associated with ART have been described.

The emergence of non-AIDS-related conditions highlights the important role of the primary care physician. Based on experience from other chronic medical conditions, general practitioners are well suited to oversee and coordinate a multidisciplinary approach to HIV care. One survey of 102 internal medicine physicians and 75 infectious disease specialists found that generalists with extensive experience in HIV management provided high-quality care to these complex patients [6]. In the United States, there will be a future need for increased involvement of primary practitioners in HIV care given the growing prevalence of persons living with HIV [7].

The role of the primary physician in the care of the HIV-infected adult will be discussed here, with particular attention to clinical monitoring and health care maintenance. The initial evaluation of the HIV-infected adult is addressed elsewhere. (See "Initial evaluation of the HIV-infected adult".)


In the United States, the HIV Medicine Association of the Infectious Diseases Society of America has published guidelines on the primary care of HIV-infected individuals, which were last updated in 2013 [8]. The recommendations provided in this topic are generally consistent with these guidelines.

Links to recommendations by other expert groups, including the European AIDS Clinical Society [9], can be found in the society guideline links topic. (See 'Society guideline links' below.)

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Literature review current through: Nov 2017. | This topic last updated: Jun 12, 2017.
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