BC-CfE Guidelines

BC-CfE Therapeutic Guidelines

The BC HIV/AIDS Therapeutic Guidelines are part of the BC-CfE’s ongoing commitment to bringing forward the most current information regarding the treatment of HIV/AIDS

The Therapeutic Guidelines are available for download. Please select from the following list:

Primary Care

There has been a significant decrease in the morbidity and mortality of HIV-positive individuals in the province of British Columbia since the introduction of potent antiretroviral treatment in 1996. At present, there are approximately 13,000 HIV-positive individuals in the province, of which approximately only 5,400 are receiving antiretrovirals.

In response to the need to expand the treatment of HIV-positive individuals and requests from the larger community of primary care providers, the British Columbia Centre for Excellence in HIV/AIDS (BC-CfE) has developed guidelines to support care and treatment programs for people living with HIV.

OBJECTIVES

  • To provide consensus guidelines for the management of HIV-positive individuals in the primary care setting
  • To provide flow-care sheets based on the guidelines that can be used as an electronic or paper-based template

For more information, click HERE

DOWNLOAD: Primary Care Guidelines (pdf)

Adults

HIV treatment has evolved dramatically since highly active antiretroviral therapy (HAART) was first introduced at the Vancouver International AIDS Conference in 1996. HIV infection has been transformed into a chronic, usually manageable condition, heightening the importance of informed treatment decisions. Expert use of HAART can provide durable viral suppression, immune reconstitution, and clinical benefit while minimizing drug resistance and potentially adding decades of acceptable quality of life.

These updated guidelines incorporate new drugs and monitoring strategies while reflecting the revised understanding of HIV as a chronic inflammatory disease, which has been shown to lead to organ dysfunction, increased risk of cardiovascular disease, and a variety of cancers. Finally, the new guidelines incorporate, for the first time, the notion of an added preventive effect of HAART.

DOWNLOAD: Adult Therapeutic Guidelines (PDF)

Pediatric

The management of HIV disease in children is a shared responsibility of community physicians and pediatric HIV specialists. These guidelines focus on the role of pediatricians and family practitioners in the care they can offer to children who are HIV infected and to uninfected infants born to HIV infected mothers.

Please visit the Clinical Guidelines page on the BC Women’s Hospital website for additional resources.

DOWNLOAD: Pediatric Therapeutic Guidelines (PDF)

Accidental Exposure

The Accidental Exposure Therapeutic Guidelines are intended to assist healthcare workers caring for persons who have been exposed to HIV through blood and body fluids in the work place or community.

The guidelines provide a framework for a program of expert advice and prompt antiretroviral prophylaxis for accidental exposures in the healthcare setting and community. This program does not provide coverage for events that arise in the course of an individual’s personal life, such as consensual adult sex or incidents in drug-using environments.

For information on how to obtain medication for prevention of HIV infection following a high risk exposure, please call the St Paul’s Hospital Ambulatory 1-888-511-6222

DOWNLOAD: Accidental Exposure Therapeutic Guidelines

Opportunistic Infection

Despite the reduction in the incidence of HIV-related opportunistic infections since the introduction of highly active antiretroviral therapy (HAART) in 1996, significant numbers of patients continue to present with advanced HIV disease and the full spectrum of opportunistic infections associated with severe CD4 lymphopenia. These infections occur more often in marginalized patient populations who are not engaged in antiretroviral therapy and other preventive measures, such as vaccination programs and opportunistic infection prophylaxis.

Recent changes with respect to opportunistic prophylaxis and treatment include the immune reconstitution inflammatory syndromes (IRIS), which may occur in approximately 25% of patients who begin HAART in the setting of advanced HIV disease and CD4 counts below 100 cells/mcL. Criteria for discontinuing opportunistic infection prophylaxis have also been established for patients who experienced antiretroviral-therapy-induced immune reconstitution.

DOWNLOAD: Opportunistic Infection Therapeutic Guidelines

Sexual Assault

PLEASE READ THE FOLLOWING DISCLAIMERS BEFORE DOWNLOADING THE SEXUAL ASSAULT THERAPEUTIC GUIDELINES

From the BC Centre for Excellence in HIV/AIDS:

August 7, 2012
Re: Women’s Assault Guideline

This guideline is the specific guideline used by the Sexual Assault Teams at BC Women’s Hospital. It is not a provincial or national guideline and although it is supported by other organizations, it is not intended to define practice outside the Sexual Assault Team at BC Women’s Health. It does not preclude or exclude any other appropriate medical or legal evaluations which would occur in the setting of a sexual assault and those standards of care should still be met.

The BC Centre for Excellence in HIV/AIDS has included this guideline on its website to make it more readily available to healthcare practitioners.

The BC Centre for Excellence is not establishing a standard of care for sexual assaults and practitioners should follow their best practice policies.

Yours sincerely,

Alastair McLeod, MD
Chair, Committee on Accidental Exposures, BC Centre for Excellence in HIV/AIDS

 


 

From BC Women’s Hospital and Health Centre:

The following guideline has been developed for use within BC Women’s Hospital and Health Centre. There are support systems at BC Women’s Hospital and Health Centre that may not exist in other clinical settings and therefore any adoption of these materials cannot be the responsibility of BC Women’s Hospital and Health Centre.

Agencies other than BC Women’s Hospital and Health Centre should use this information as a guideline for reference purposes only. All materials are the property of BC Women’s Hospital and Health Centre and may only be reprinted in whole or in part with our express permission.

For further information, please contact BC Women’s Sexual Assault Service at 604-875-2881.

Thank you.

I have read these disclaimers and agree to their terms:

DOWNLOAD: Sexual Assault Therapeutic Guidelines

Pregnant Women

Supportive non-directive counseling regarding reproductive choices, high risk prenatal care, modified management of labour and delivery, and postpartum and infant care are all important components in the comprehensive care of the HIV infected woman and her infant. The provision of pregnancy and reproductive health care in HIV infected women should involve a collaboration with individuals experienced in the management of high risk pregnancy and HIV care of women and infants.

In British Columbia (BC), the Women and Family HIV Centre (Oak Tree Clinic), a program of BC Women’s Hospital and Health Centre, provides clinical care and guidance for this population of HIV infected and exposed adults and children. The interdisciplinary team at the Oak Tree Clinic works in partnership with the BC Centre for Disease Control for surveillance and with the BC Centre for Excellence in HIV/AIDS for drug therapy and overall provincial coordination.

Longitudinal surveillance on pregnancy outcomes in HIV positive women are tracked in BC through information provided by clinicians throughout the province who care for HIV positive pregnant women and their infants. This is vital for the continuous quality improvement of antiretroviral prescribing in pregnancy.

DOWNLOAD: Care of HIV Positive Pregnant Women and Interventions to Reduce Perinatal Transmission Guidelines (pdf)

Non-Occupational Post Exposure Prophylaxis (NPEP)

In British Columbia, publicly funded antiretroviral drugs are available for exposure to HIV in occupational settings and for sexual assault cases, administered through the BC Centre for Excellence in HIV/AIDS (BC-CfE) post-exposure prophylaxis (PEP) program.

The BC-CfE with the support of Pharmacare has developed an 18-month pilot project to look at the occurrence of non-occupational exposures that may be high risk for subsequent HIV infection. The pilot has been implemented at six sites:

St. Paul’s Hospital Emergency Department and Immunodeficiency clinic (IDC), VCH Downtown Community Health Clinic (DCHC) and Health Initiative for Men (HiM), PHSA – BCCDC Bute St. Clinic, and Private Spectrum Health Clinic.

DOWNLOAD: NPEP Guidelines (pdf)

Pre-Exposure Prophylaxis (PrEP)

Guidance for the use of Pre-Exposure Prophylaxis (PrEP) for the prevention of HIV acquisition in British Columbia

Guidelines are for information purposes only, and do not imply BC-CfE endorsement or recommendations regarding provincial funding of PrEP in British Columbia

DOWNLOAD: PrEP Guidelines (pdf)