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Health Maintenance Recommendations for PWH

Table of Contents

  • Vaccine Recommendations
    • Flu vaccine
    • Hepatitis A
    • Hepislav-B
      Hepatitis B
    • Human Papilloma Virus
    • Meningococcus
    • Diphtheria & Tetanus (Td)
    • Varicella Zoster recombinant vaccine
    • Pneumococcus
  • Screening Recommendations
    • Breast Cancer
    • Lung Cancer
    • Colorectal Cancer
    • Cervical Cancer
    • Anal Cancer
    • Abdominal Aortic Aneurysm
    • Hepatitis C
    • Osteoporosis (DEXA Scan)
    • Dyslipidemia
    • Diabetes Mellitus (Hemoglobin A1C)

Editors

  • Kassem Bourgi, MD
  • Stephen Raffanti, MD, MPH

Flu Vaccine

  • Who: All PWH
  • Frequency: Annually
  • Comments: Use high-dose inactivated vaccine for age: 65+ years.

Hepatitis A

  • Who: MSM, PWID, Persons with liver disease (including HBV and HCV)
  • Frequency: 2 doses: 0 and 6 months
  • Comments: Consider vaccination for all PLWH.

Hepislav-B
Hepatitis B

  • Who: Non-immune patients (1)
  • Frequency: 2 doses: one month apart
  • Comments: Recheck serology at least 4 weeks after last dose. If surface AB levels are not protective: repeat vaccine series.

Human Papilloma Virus

  • Who: PWH, both genders, age: 13 – 45 years
  • Frequency: 3 doses: 0, 1 and 6 months

Meningococcus

  • Who: All PWH
  • Frequency: 2 doses: Menveo or Menactra at least 8 – 12 weeks apart, booster in 5 years
  • Comments: Does not cover meningococcus serotype B (outbreaks, asplenics).

Diphtheria & Tetanus (Td)

  • Who: All PWH
  • Frequency: 1 dose every 10 years
  • Comments: One-time substitution of Td with TdaP (acellular pertussis).

Varicella Zoster recombinant vaccine

  • Who: Age > 50 Years & CD4 > 200 cells/mm3
  • Frequency: 2 doses: 2 – 6 months apart
  • Comments: Limited evidence on efficacy and safety but likely better than live vaccine.

Pneumococcus

  • Who: All PWH
  • Frequency: 2 doses: PCV13 followed by PPSV23 at least 8 weeks apart. PPSV23 boosters in 5 years & at age 65 years.
  • Comments: Consider deferring PPSV23 until CD4 > 200 cells/mm3. If PPSV23 given first, give PCV13 after 12 months.
  1. Hepatitis B non-immune patients include: HBsAg/Ab(-) HBcAB(-) & HBsAg/Ab(-) HBcAB(+)HBVPCR(-)
  2. Recombinant Zoster Vaccine (Shingrix) is not currently recommended by Advisory Committee on Immunization Practices (ACIP) for PWH.
    Abbreviations: PLWH: Persons Living with HIV; MSM: Men Who Have Sex with Men; PWID: Persons Who Inject Drugs; HBV: Hepatitis B Virus; HCV:
    Hepatitis C Virus; AB: Antibody; PCV13: Prevnar 13; PPSV23: Pneumovax; HBsAg/Ab: Hepatitis B surface antigen &antibody; HBcAB: Hepatitis B core antibody
  3. Abbreviations: PLWH: Persons Living with HIV; MSM: Men Who Have Sex with Men; PWID: Persons Who Inject Drugs; HBV: Hepatitis B Virus; HCV: Hepatitis C Virus; AB: Antibody; PCV13: Prevnar 13; PPSV23: Pneumovax; HBsAg/Ab: Hepatitis B surface antigen &antibody; HBcAB: Hepatitis B core antibody

Breast Cancer

  • Who: Women age ≥ 40 years
  • Frequency: Annually

Lung Cancer

  • Who: PWH age 55 – 80 with 30 pack-year smoking history
  • Frequency: One-time screening with lowdose CT Lung
  • Comments: Applicable if quit smoking < 15 years ago.

Colorectal Cancer

  • Who: All PWH age≥ 50 years
  • Frequency: Colonoscopy every 10 years if normal
  • Comments: Consider earlier screening for patients with strong family history & patients with IBD.

Cervical Cancer

  • Who: Women 21 – 65 years
  • Frequency: Pap Smear with HPV testing: At initiation of care, repeat in 6 months & annually thereafter
  • Comments: Not required after hysterectomy unless done for cancerous or precancerous disease.

Anal Cancer

  • Who: PWH, of both genders, age≥ 25 years, who engage in receptive anal intercourse
  • Frequency: Pap Smear with HPV testing. Screening data is lacking
  • Comments: Screen only if highresolution anoscopy + biopsy & ablative treatments are available.

Abdominal Aortic Aneurysm

  • Who: Men age 65 – 75 years who ever smoked
  • Frequency: One-time Abdominal Ultrasound screening
  • Comments: Not required if patient has recent abdominal CT scan without evidence of aortic aneurysm.

Hepatitis C

  • Who: All PWH
  • Frequency: HCV Antibody on initiation of care and then annually

Osteoporosis (DEXA Scan)

  • Who: PLWH, both genders, age: ≥ 50 years or ≥ 40 years with FRAX score ≥ 10%
  • Frequency: HCV Antibody on initiation of care and then annually
  • Comments: For women: start at age 50 or 10 years after menopause.

Dyslipidemia

  • Who: All PWH
  • Frequency: Baseline, within 1-3 months from starting new regimen then annually.
  • Comments: Consider TG treatment for levels ≥ 1,000 mg/dL & statin if ASCVD ≥ 7.5%.

Diabetes Mellitus (Hemoglobin A1C)

  • Who: All PWH
  • Frequency: Baseline, within 1-3 months from starting new regimen then annually.
  • Comments: Consider starting diabetes treatment at Hemoglobin A1C ≥ 7 – 7.5%.

4. Abbreviations: PLWH: Persons Living with HIV; HPV: Human Papilloma Virus; IBD: Inflammatory Bowel Disease; TG: Triglycerides; HCV: Hepatitis C
5. FRAX Risk Assessment Tool: https://www.sheffield.ac.uk/FRAX/tool.aspx?country=9,
6. ASCVD (Atherosclerotic Cardiovascular Disease) Risk Assessment Tool: http://www.cvriskcalculator.com/