Surveillance – in New Zealand
- The AIDS Epidemiology Group-Te Hunga Aroturuki Mate ārai Kore (AEG) is responsible for national surveillance of AIDS and HIV infection in New Zealand.
Surveillance – international
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.
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.
Pre-exposure prophylaxis (PrEP)
HIV PrEP is a daily oral tablet that, when taken as prescribed, can reduce new infections as part of a combination prevention strategy.
Post-exposure prophylaxis (PEP)
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.
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 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.
Information on indications for the antiretroviral medications is available on the Medsafe website.
Drug resistance testing
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.
How to become a prescriber of antiretroviral agents (ARTs) or pre-exposure prophylaxis (PrEP)
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.
HIV in pregnancy and perinatal HIV
HIV testing is offered as part of pregnancy blood tests.
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.
HIV in children
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.
HIV in injecting drug users
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.
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.