HIV and AIDS information for health professionals

 The Positive Speakers’ Bureau (managed by Positive Women) developed a free online course to provide accessible, accurate and up-to-date information on HIV prevention, treatment and stigma.

• HIV Essentials Online Course

HIVinfo has a large number of articles on most aspects of HIV.

• HIVinfo

•  The AIDS Epidemiology Group-Te Hunga Aroturuki Mate ārai Kore (AEG) is responsible for national surveillance of AIDS and HIV infection in New Zealand. 

• AEG’s Epidemiological Surveillance annual newsletters

 These pages provide surveillance information from around the world:

• WHO
• United Nations AIDS
• Australian Kirby Institute
• HIV/AIDS Surveillance in Europe
• Public Health England
• Secretariat of the Pacific Community

 Testing should be part of ‘normal’ medical practice, similar to testing for other treatable conditions, but without any relaxation of the need for consent and confidentiality.

• Ministry of Health recommendations for HIV testing of adults in healthcare settings

 The guidelines on HIV testing produced by the US Centers for Disease Control and Prevention provide a comprehensive, evidence-based summary of best practice with regard to HIV counselling, testing and referral.

• Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings

 The Burnett Foundation Aotearoa has a lot of information on how to get a test and how often as well as information on how the process works in New Zealand.

• Burnett Foundation Aotearoa – all about testing

 HIV PrEP is a daily oral tablet that, when taken as prescribed, can reduce new infections as part of a combination prevention strategy.

• Burnett Foundation Aotearoa – Information on PrEP

 Occupational exposures should be considered urgent medical concerns to ensure timely post-exposure management and administration of PEP.

• U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis

 Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) provides guidance on Post-Exposure Prophylaxis after Non-Occupational and Occupational Exposure to HIV.

• Post-Exposure Prophylaxis after Non-Occupational and Occupational Exposure to HIV

The Centers for Disease Control and Prevention provide guidelines on Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV.

• Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV

 Antiretroviral therapy has progressed rapidly over the past decade and has achieved remarkable reductions in HIV-related mortality in most developed countries with ready access to drugs.

 The pace of change is so great that treatment guidelines require frequent revision.

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV

Information on indications for the antiretroviral medications is available on the Medsafe website.

 These websites provide up-to-date information on drug resistance testing:

•  Stanford Drug Resistance Database
  This research-oriented site offers software that allows uploading of a sequence text file to a drug resistance interpretation algorithm.
• Victorian Infectious Disease Reference Laboratory
  The HIV Characterisation Laboratory has both diagnostic and research and development roles.

 To become a prescriber of ARTs or PrEP, the clinician must apply to the Ministry of Health, specifying whether they intend to prescribe both or either type of medicine.

• Applying to become a prescriber of antiretroviral agents (ART) or pre-exposure prophylaxis (PrEP)

 HIV testing is offered as part of pregnancy blood tests.

• HIV testing in pregnancy

 The following two guidelines are very similar, with the first being from the British HIV Association and the second from the United States Public Health Service task force.

British HIV Association: Management of HIV infection in pregnant women 2018 (2020 interim review)

The British guidelines cover areas such as discordant couples and psychological issues and have ‘levels of evidence’.

The United States guidelines are a complete review of antiretroviral therapy in pregnant HIV infected women as well as mode of delivery.

Both cover issues for the neonate. Reading at least one of these is essential for the medical professional directly involved in the care of an HIV-infected pregnant woman.

• Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States

 The general principles of therapy in HIV-infected adults, adolescents and children are similar but there are many unique aspects that are covered in these specific paediatric references:

•  Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection.
• Guidelines for the Prevention and Treatment of Opportunistic Infections Among HIV-Exposed and HIV-Infected Children.
• The American Academy of Pediatrics has written a number of statements on specific issues around HIV in children which are available from the Pediatric AIDS website.

Injecting drug use accounts for approximately 10% of HIV infections globally and 30% of those outside of Africa.

Harm reduction, including needle/syringe programmes, is an evidence-based approach to HIV prevention, treatment and care for people who inject drug and is strongly supported by WHO and other UN agencies.

Needle and syringe exchange programmes exist in pharmacies and community groups throughout New Zealand.

A list of outlets is available from: New Zealand Needle Exchange Programme website.

The US Government Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents address opportunistic infections.

They are endorsed by numerous organisations and disseminated widely, providing a new standard of care for HIV-infected people.

• Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents

 The Sanford Guide to Antimicrobial Therapy is intended for bedside clinical management decisions.

• Sanford Guide to Antimicrobial Therapy 2020, 50th edition

These HIV specialists can be contacted by medical and health care professionals for advice on the management of HIV infected individuals.

This also includes the management of HIV infected women in pregnancy and the prevention of mother-to-child transmission of HIV.

• Dr Lesley Voss, Paediatrician: Phone 09 379 7440
• Dr Mark Thomas, Consultant Physician in Infectious Diseases: Phone 09 379 7440