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 people living with HIV (PLWH) in the province of British Columbia since the introduction of potent antiretroviral treatment in 1996. The Primary Care Guidelines for the Management of HIV/AIDS in Adults in British Columbia, along with other therapeutic guidelines, have been developed by the BC-CfE to provide support for care and treatment programs for PLWH. These guidelines also respond to the need to expand HIV treatment to meet the goals of 90-90-90 in British Columbia and respond to requests from primary care providers in the community for HIV-specific guidelines.
- To provide consensus-based guidelines for the management of primary care for PLWH.
- To provide practical and easily accessible information and resources for primary care providers of PLWH in the province of British Columbia.
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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.
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.
- Post-Exposure Prophylaxis (PEP)
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
- HIV Pre-Exposure Prophylaxis (PrEP)
In British Columbia, PrEP is available through the BC Centre for Excellence in HIV/AIDS (BC-CfE) Drug Treatment Program at no cost to qualifying patients deemed clinically at risk of HIV infection. Please use the links below to learn about PrEP eligibility, enrolment in the Drug Treatment Program, and how PrEP medication may be obtained.
- 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.
- 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.