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• W4200597964 abstract "The year 2021 marks the 40th anniversary of the first case of Pneumocystis carinii pneumonia (PCP), Kaposi’s sarcoma (KS), and the associated diagnosis of acquired immunodeficiency syndrome (AIDS) appearing in Centers for Disease Control and Prevention (CDC) reporting.1HIV.govA timeline of HIV and AIDS.https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timelineDate accessed: November 15, 2021Google Scholar Since 1981, great strides have been made to isolate, manage, and prevent transmission of the causative agent commonly known as the human immunodeficiency virus (HIV). During these past 4 decades, HIV has gone from a quickly debilitating and lethal disease to a chronic manageable condition. Nurse practitioners (NPs) across all practice settings must be well versed in the medication regimens for prevention of the transmission of HIV, as well as treatment of existing HIV infection and common opportunistic infections experienced by people living with HIV (PLWH). Furthermore, NPs must be aware of potential contraindications and interactions when prescribing for persons currently managed on antiretroviral therapy (ART). This special edition aims to provide necessary information for NPs in a wide range of practice environments to allow them to become better acquainted with the therapeutic regimens, historical context, and clinical implications of caring for PLWH. Historically, the introduction of antiretroviral therapy (ART) was pivotal in the global battle against HIV.1HIV.govA timeline of HIV and AIDS.https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timelineDate accessed: November 15, 2021Google Scholar Early generations of ART offered a glimmer of hope in managing a disease in which the only outcome was death. However, these initial generations were often intolerable, caused adverse effects, and required high pill burden and frequency. PLWH and their health care providers were faced with deciding whether the risks of the uncontrolled disease outweighed the adverse effects of the medication intended to save their lives. To make management even more complicated, limited options for alternative regimens were available if a person experienced treatment failure or developed resistance due to a lack of adherence. Fortunately, ongoing advances have vastly improved the safety profile, durability, tolerability, pill burden, and frequency of regimens associated with HIV management.1HIV.govA timeline of HIV and AIDS.https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timelineDate accessed: November 15, 2021Google Scholar A person newly diagnosed with HIV in 2021 has several treatment options that include coformulation of 2 to 3 drug-class regimens in simple 1 or 2 pills daily, compared with the multiple times per day, multiple-pill regimens of the past. The evolution of ART has shifted HIV from a terminal disease to one that is chronic in nature. The chronicity of the disease now means that PLWH are living longer, healthier lives. The increased longevity and quality of life among this group also means that PLWH are being seen more frequently in primary care settings compared with earlier years of managing the virus, which occurred primarily in acute care settings and HIV specialty clinics. The increasing presence of PLWH in primary care settings means that primary care providers must be more knowledgeable in the management of other comorbidities in the presence of HIV as it relates to potential drug–drug interactions. When managing cardiovascular disease, diabetes, or depression along with HIV, polypharmacy and frailty must now be considered. The average PLWH is likely to be seen in the primary care setting at a minimum of 3 decades, with the most common age for HIV infection being between 19 and 35 years.2Centers for Disease Control and PreventionHIV in the United States and dependent areas.https://www.cdc.gov/hiv/statistics/overview/ataglance.htmlDate accessed: November 15, 2021Google Scholar Additionally, advances in research and the efficaciousness of clinical interventions have aided in the transition in HIV goal-setting from virologic suppression to preventing HIV acquisition. The approval of 2 medications by the US Food and Drug Administration for preexposure prophylaxis (PrEP) has also been a game-changer.2Centers for Disease Control and PreventionHIV in the United States and dependent areas.https://www.cdc.gov/hiv/statistics/overview/ataglance.htmlDate accessed: November 15, 2021Google Scholar PrEP allows those at the highest risk the option of being on a regimen to prevent them from HIV acquisition. With these medications being the first of their kind, access, use, and adherence to PrEP comes with its own set of challenges. For primary care providers, the need to understand HIV screening recommendations, PrEP initiation strategies, and ongoing monitoring are necessary components to a robust evidence-based practice environment. As with much of health care, access to information, effective screening, prevention, and treatment for HIV is not evenly distributed among populations. For communities of color, HIV continues to carry a heavy community burden. According to 2019 CDC data, new diagnoses of HIV are disproportionately seen in Black/African American and Hispanic/Latinx persons, with Black/African Americans comprising 42% and Hispanic/Latinx persons 29% of new diagnoses.2Centers for Disease Control and PreventionHIV in the United States and dependent areas.https://www.cdc.gov/hiv/statistics/overview/ataglance.htmlDate accessed: November 15, 2021Google Scholar These issues of disproportionality and inequity must be acknowledged and addressed on the local, state, and national levels by policymakers and health care providers alike. Although this special issue focuses on PLWH in the United States, it is important to note that HIV continues to be a global concern, with more than two-thirds of PLWH residing in the World Health Organization African Region.3World Health OrganizationNewsroom fact sheets HIV-AIDS.https://www.who.int/news-room/fact-sheets/detail/hiv-aidsDate accessed: November 15, 2021Google Scholar Disruptions in HIV services in Africa brought on by COVID-19 are of grave concern, as the number of new infections is increasing. As we have seen with the pandemic, infectious diseases cannot be contained by borders. Without concerted, ongoing effort, increased transmission of HIV will continue. This issue contains articles that will provide NPs with direction and insight on the management of HIV. Topics addressed span from preventing HIV acquisition to evaluating frailty in adults living with HIV. As you read this special edition, we hope that you will find information and tools to use as you interact with your patients. Perhaps more important, as NPs, we hope you will recognize the clarion call to recommit to equitable, safe, evidence-based care for all patients." @default.
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• W4200597964 date "2021-12-01" @default.
• W4200597964 modified "2023-09-28" @default.
• W4200597964 title "Forty Years of HIV Care: Optimism and Challenges" @default.
• W4200597964 doi "https://doi.org/10.1016/j.nurpra.2021.11.015" @default.
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