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Executive Summary

Introduction

The Agency for Health Care Policy and Research (AHCPR) convened a multidisciplinary, private-sector panel of physicians, dentists, nurses, nurse practitioners, physician assistants, social workers, and medical consumers to create a guideline for the evaluation and management of early human immunodeficiency virus (HIV) infection. The panel limited its focus to early HIV infection because (a) recognition of early infection is becoming more common; (b) the prevalence of early HIV infection is increasing in proportion to later stages of infection; (c) medical intervention in the early stage of HIV infection may be most effective in delaying life-threatening symptoms; and (d) early patient education often facilitates increased patient involvement in treatment and better access to services and helps prevent further spread of the disease.

This guideline contains panel recommendations, made as a result of an exhaustive search and analysis of relevant literature, clinical experience, peer review, public testimony, and a feasibility review. The guideline, which seeks to serve primary care providers as well as those with HIV infection, consists of five parts: Clinical Practice Guideline, which contains detailed recommendations and is primarily aimed at health care providers; Guideline Report, which contains supporting technical materials; Quick Reference Guide for Clinicians, a summary of the key components of the Clinical Practice Guideline; HIV and Your Child, a pamphlet that provides information for parents and guardians of infected children; and Understanding HIV, a pamphlet that provides information for adolescents and adults with HIV infection and their families and friends.

The guideline is not a comprehensive guide to early HIV care. Rather, it provides detailed recommendations for: (a) counseling related to disclosure of HIV status; (b) medical evaluation and management of early HIV infection and selected conditions in adults, adolescents, infants, and children; and (c) case management. The guideline also suggests strategies for addressing challenges in providing and accessing appropriate and comprehensive early HIV care. Because advances in the management of HIV infection are occurring at a rapid pace, providers should seek frequent updates.

Recommendations were based whenever possible on published evidence. Where evidence was inadequate to form the basis for a recommendation, the panel relied on expert opinion and consensus. Each recommendation is followed by a rating that indicates the extent to which it is evidence based. To complement the text, eight algorithms

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