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U.S. Department of Health and Human Services
HIV

HIV Treatment

The Indian Health Service (IHS) remains committed to agency-wide strategic initiatives, including the National Sexually Transmitted Infection (STI) Initiative and the National Chronic Liver Disease Initiative. Many resources are available and were developed in collaboration with the IHS National Pharmacy & Therapeutics Committee (NPTC), IHS Chief Clinical Consultant in Infectious Disease, and the IHS HIV/HCV/STI Branch to address the public health challenges affecting Indian Country. NPTC has taken a proactive approach to accessing effective therapeutics and offering clincial information for treating HIV. Through the IHS National Core Formulary, they have added a variety of pharmaceuticals, as well as clinical briefing documents targeting providers and pharmacy staff. For additional recommendations, please refer to NPTC for Clinical guidance.

Background

Human Immunodeficiency Virus (HIV) is a preventable and treatable infection that is managed at IHS facilities across the United States. Due to modern advancements in diagnosis and care, HIV has become a chronic disease that can be managed by primary care providers. Within the IHS network, many resources are available to assist providers in helping to bring an end to the HIV epidemic in the United States.

Diagnosis

HIV is diagnosed with a screening HIV antigen/antibody test and confirmed with an HIV-1/HIV-2 differentiation assay and HIV viral load. Throughout IHS, universal HIV screening is recommended for all people aged 18 and above at least once in a lifetime, regardless of any underlying risk factors. People at risk for acquiring HIV can be screened more frequently based on the degree of risk. For the basics of HIV testing, screening, and diagnosis, view the CDC's Clinical Testing Guidance for HIV for Providers. Exit Disclaimer: You Are Leaving www.ihs.gov 

Treatment

HIV Treatment should be initiated as soon as possible (ideally same day) after confirmation of diagnosis, with a reflex test after a positive antigen/antibody screening. Treatment is started regardless of the level of HIV viremia (viral load) and CD4 count. The single-tablet regimen Tenofovir/Emtricitabine/Bictegravir is a first line therapy according to clinical guidelines and is the combination treatment that is most frequently used at IHS. Initiating treatment early is perhaps the best way to stop HIV transmission in the communities we serve, as individuals taking antiretroviral therapy (ART) have a rapid decline in viral load after initiation and ultimately will achieve an undetectable viral load within several weeks. An undetectable viral load makes HIV infection essentially untransmittable. This concept considers using Treatment as Prevention, also known as Undetectable = Untransmittable, or U=U.

Visit Clinicalinfo.HIV.gov's HIV treatment guidelines Exit Disclaimer: You Are Leaving www.ihs.gov , updated every 6-12 months, from the Department of Health and Human Services (HHS). The following guideline sections are important for initiation of ART: 1.Baseline Evaluation, 2.Laboratory Testing, 3.Initiation of Antiretroviral Therapy, and 4.What to Start.

Monitoring

People living with HIV need to be monitored to assess adherence to medications, evaluate the effectiveness of therapy, and to avoid adverse events and complications. Guidance for HIV treatment monitoring is described in the HHS guidelines within the Laboratory Test section, under Table 3, Laboratory Testing Schedule for Monitoring People With HIV Before and After Initiation of Antiretroviral Therapy: HIV Monitoring Exit Disclaimer: You Are Leaving www.ihs.gov 

HIV Primary Care

HIV is a chronic condition that can be treated at most IHS facilities by a primary care provider. If complications are prevented with primary care, patients can do so well with modern therapy that a long-life expectancy is essentially a given. Infectious disease specialists are available for consultations whenever needed. It is essential in HIV primary care to address comorbidities and prevent opportunistic infections, monitor for neoplasms such as cervical and anal squamous cell carcinoma, screen for sexually transmitted infections, and monitor for diabetes and cardiovascular disease. Screening, immunizations, and preventive therapy are the keys to success in HIV primary care. HIV Primary Care guidelines Exit Disclaimer: You Are Leaving www.ihs.gov  from the Infectious Disease Society of America cover the basics in a concise but comprehensive fashion.

Preventing and Treating Opportunistic Infections

Patients diagnosed with HIV, especially in the advanced stages of immunosuppression, are at risk for developing opportunistic infections. These infections can be diagnosed, treated, and prevented by IHS providers using these opportunistic infections guidelines Exit Disclaimer: You Are Leaving www.ihs.gov  from HIV.gov.

Diagnosing, Treating and Preventing Sexually Transmitted Infections

Patients diagnosed with HIV are at risk for sexually transmitted infections. These infections are easily treated and prevented in IHS facilities. The CDC STI Treatment Guidelines Exit Disclaimer: You Are Leaving www.ihs.gov  are a valuable resource for managing STIs.

Sexually Transmitted Infections

Read guidelines to prevent certain significant STIs using Doxycycline Post-Exposure Prophylaxis (DoxyPEP). Visit the CDC MMWR Doxyccycline Guidelines Exit Disclaimer: You Are Leaving www.ihs.gov  recommendations and Reports page for more information.

Treating HIV in Pregnancy

Special guidance is offered for the care of pregnant women. There are special considerations in selecting antiretroviral therapy and monitoring and preventing transmission at the time of delivery. Read Perinatal treatment guidelines Exit Disclaimer: You Are Leaving www.ihs.gov  from HIV.gov for a comphrehensive reference source.

HIV Prevention

The IHS emphasizes that treating HIV in the individual patient prevents transmission to others who are not living with HIV. This concept is called Treatment as Prevention. A linked concept is U = U (Undetectable equals Untransmittable), which means that people with HIV who achieve and maintain an undetectable viral load—the amount of HIV in the blood—by taking antiretroviral therapy (ART) daily as prescribed cannot sexually transmit the virus to others. Finally, both HIV Pre-exposure Prophylaxis (or PrEP) Exit Disclaimer: You Are Leaving www.ihs.gov  and HIV Post-Exposure Prophylaxis (PEP) Exit Disclaimer: You Are Leaving www.ihs.gov  are available across IHS for individuals not living with HIV.

Additional Resources

IHS HIV Clinical Questions? Contact Us