The family physician's role in HIV care

- Jennifer Middleton, MD, MPH

I read my AFP cover to cover most of the time, but I hesitated before reading this issue's "What Is New in HIV Infection?" I don't work in an area of the country with a high prevalence of HIV, and I admit to thinking that HIV care largely belongs with infectious disease (ID) specialists, not family doctors.

At least, that's what I thought before I read the article. I learned that the new fourth-generation assay for HIV turns results around in hours, that preexposure prophylaxis ("PrEP") is an option for high-risk individuals, and that early treatment for newly diagnosed HIV can help prevent the spread of HIV.

The new fourth-generation assay tests for both HIV antibodies and the p24 antigen. It's more expensive than third-generation tests (which my health system currently uses) but yields faster results; high-risk individuals can be retested three weeks later instead of six months later. Family physicians can advocate for their patients by encouraging their labs and health systems to adopt this improved test.

PrEP is another opportunity for family physicians. Using guidelines in this article, we can counsel on risk reduction behaviors, routinely check for STDs and pregnancy, test for HIV every three months, and prescribe emtricitabine/tenofovir (Truvada) to our patients at high risk of contracting HIV. Primary care is the right arena for prescribing PrEP; after all, we know our patients well, and we're in the perfect position within our Patient-Centered Medical Home practices to follow these patients.

Immediate treatment for newly diagnosed HIV has been standard for a while, but the article nicely summarizes the most up-to-date treatment guidelines. Given the complexity of these regimens, here I absolutely would partner with my ID colleagues. We family doctors, though, can still streamline the referral process for our patients and, perhaps, even get them started on HIV treatment while they await their first ID appointment; for patients in more remote areas, this timely care could make a big difference both to them and the community.

There's an AFP By Topic on HIV/AIDS if you'd like to read more.

Does this article change how you will prevent, test, and care for HIV in your practice?