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These are general recommendations for clinicians who are not HIV specialists. We encourage you to call the NIH Medical Consultation Services at 1-866-887-2842 or the National HIV/AIDS Clinical Consultation Center at 1-800-933-3413 to consult with HIV experts. Visit www.aahivm.org or www.hivma.org for updates to this document.

1) First priority is to treat active infections. Most HIV patients will respond to treatment with antibiotics just like non-HIV patients.
2) Find out the patient's last CD4 (T cell) count, if possible. The most frequent infections by CD4 count are:

3) If it is a choice between getting antiretroviral medications and getting prophylaxis for opportunistic infections (OI) for patients on HAART, get the antiretrovirals first to avoid treatment interruptions. Such interruptions can lead to the development of drug-resistant virus. However, if drug supply in the general community is not an issue, make every attempt to continue all medications for OI prophylaxis and antiretrovirals. If medications are interrupted, make sure to restart all antiretrovirals and OI prophylaxis medications. For patients not on HAART and CD4 <200, SMX/TMP is the preferred prophylaxis. Recommendations for antiretroviral therapy are available at http://www.aidsinfo.nih.gov/guidelines.

4) If patients cannot obtain their medications, make sure that they stop all antiretroviral drugs, rather than continuing on only one or two.

5) Once continued access to antiretroviral therapy is enssured, patients should have their OI prophylaxis continued. Federal guidelines on the prevention and treatment of OI are available at http://www.aidsinfo.nih.gov/guidelines.

6) People with HIV should get tetanus shots, just like everyone else.

7) Live virus vaccines should be used with caution in people with HIV. However, people with CD4 (T cell) counts over 350 should do fine and have a normal response. Use clinical judgment--preventing epidemics remains a priority, even with people with HIV.

Basic Medication Information

• An easy-to-read chart of AIDS drugs with photos is available at www.aidsmeds.com/lessons/drugchart.htm.
• Certain medications are heat sensitive and are best kept refrigerated. Ritonavir (Norvir) and Lopinavir/Ritonavir (Kaletra) should maintain potency at room temperature (77F), Ritonavir for 30 days, and Lopinavir/Ritonavir for 60 days. Saquinavir (Fortovase) soft gel can be out of refrigeration for 90 days. Tipranavir can be at room temperature for 60 days. Exposure to extreme heat and/or sunlight can greatly diminish potency, necessitating replacement (be aware of this in places that still have no power or air conditioning).

Important Drug Interactions to Consider

Pregnant Women: For pregnant patients be sure to consult fact sheets about appropriate antiretroviral medications. Recommendations on antiretroviral treatment for pregnant women and interventions to reduce perinatal HIV transmission are available at http://aidsinfo.nih.gov/guidelines. An easy-to-read chart of acceptable medications for pregnant women is available at http://www.aidsmeds.com/lessons/Pregnancy8a.htm.

Treatment for Possible Exposure to HIV Infection: Prophylactic antiretrovirals should be administered if at all possible in occupational and non-occupational exposures. The current recommendations for healthcare worker occupational exposure are out of date. Use the same protocols for occupational as for non-occupational exposures. New recommendations for occupational exposures are due to be released in MMWR in late September. Consultation on PEP is available from the National PEPline at 1-888-HIV-4911.

Rapid HIV Testing: If possible, do rapid HIV testing. People will need proof of their HIV status to obtain help from HIV service providers.

Locating HIV Providers and Clinics: For a list of HIV clinics, go to www.aahivm.org or www.hivma.org and click on the Hurricane Katrina links. HIVMA and AAHIVM members accepting patients also are available from our Websites or by calling 1-888-844-4372 (HIVMA) or 1-866-241-9601 (AAHIVM).

Patients Enrolled in Clinical Trials: Patients enrolled in clinical trials should contact the trial sponsor to obtain experimental study drugs. Some contacts are: AIDS Clinical Trials Group - 301-628-3000; Bristol Myers Squibb - 800-272-4878; Community Programs for Clinical Research on AIDS - 1-301-628-3000; GlaxoSmithKline - 1-888-825-5249; TIBOTEC - 1-609-730-7500. For others, call the NIH consultation number at 1-866-887-2842 or the main number for the pharmaceutical company involved.

The American Academy of HIV Medicine and HIV Medicine Association collectively represent more than 3,500 HIV medical providers throughout the United States More resources are available on our Websites at http://www.aahivm.org and http://www.hivma.org.