PLWHIV - People living with HIV

Overview

  • As HIV is an STI, people diagnosed with HIV are at risk of other STIs. It is important that baseline STI testing is offered to all people living with HIV (PLWHIV).
  • HIV progression and transmission is increased and facilitated by STIs so an annual offer of routine screening is advised, regardless of risk history.
  • Hepatitis B, hepatitis C and herpes co-infection are common among PLWHIV.
  • Most STIs have a similar presentation and natural history in PLWHIV, although people with profound immunosuppression may have unusual presentations and need specialist management. Sexual transmission of hepatitis C has been reported among men who have sex with men (MSM) with HIV. For further information, see MSM guideline.
  • HIV care providers should discuss sexual history, safer sex, contraception and conception plans with PLWHIV
  • Current evidence suggests that all PLWHIV should start ART as soon as possible after diagnosis.

Testing advice

InfectionConsideration
Chlamydia Consider
self-collection of samples for testing.
Gonorrhoea Consider
self-collection of samples for testing.

If NAAT test result is positive, take swab at relevant site(s) for culture, before treatment. Cultures are the preferred test for samples from non-genital sites.

Syphilis If clinical suspicion of syphilis, refer to the syphilis guideline.
Hepatitis A Vaccinate if not immune.
Hepatitis B Vaccinate if not immune.

Anti-HBs titres should be regularly checked and PLWHIV should receive boosters to maintain Anti-HBs >10.
Hepatitis C If antibody positive, test for hepatitis C NAAT to determine if patient has chronic hepatitis C.
NAAT – Nucleic Acid Amplification Test
Anti-HBs – Hepatitis B surface antibody

Specimen collection

Clinician collected |
Self-collection

Clinical indicators for testing

  • At diagnosis of HIV, testing for other STIs and blood-borne viruses should be offered.
  • Chlamydia, gonorrhoea and hepatitis C testing should be performed at least annually for men who have sex with men (MSM)
  • 3 monthly syphilis serology for MSM with routine HIV monitoring.
  • It is not recommended to routinely test for herpes and genital warts with serology. Consider testing for herpes and genital warts only if there are clinical signs and symptoms.

Special considerations

  • Local support, through a sexual health clinic, is available to assist primary care professionals to manage any often quite complicated situation.
  • Women with HIV should be offered annual cervical screening.

Follow up

If test results are positive or clinical indicators present, refer to STI management section for advice on:

Even if all test results are negative, use the opportunity to:

  • Educate about condom use and risk minimisation
  • Vaccinate for hepatitis A and B, if susceptible
  • Discuss and activate reminders for regular testing according to risk, especially if their behaviors indicate the need for more frequent testing.

Auditable outcomes

  • 100% PLWHIV should have evidence of baseline serology for hepatitis A, hepatitis B, hepatitis C and syphilis in records.
  • 100% sexually active PLWHIV are offered STI testing at least annually.
Last Updated: Thursday, 03 March 2016