HIV Care Provider Definitions
New York State Department of Health AIDS Institute, April 2017
Experienced HIV care provider: Practitioners who have been accorded HIV-Experienced Provider status by the American Academy of HIV Medicine (AAHIVM) or have met the HIV Medicine Association’s (HIVMA) definition of an experienced provider are eligible for designation as an HIV Experienced Provider in New York State.
Nurse practitioners and licensed midwives who provide clinical care to HIV-Infected individuals in collaboration with a physician may be considered HIV Experienced Providers provided that all other practice agreements are met (8 NYCRR 79-5:1; 10 NYCRR 85.36; 8 NYCRR 139-6900)
Physician assistants who provide clinical care to HIV-infected individuals under the supervision of an HIV Specialist physician may also be considered HIV Experienced Providers (10 NYCRR 94.2)
Expert HIV care provider: A provider with extensive experience in the management of complex patients with HIV.
All FDA-Approved HIV Medications
Reviewed May 2021
Listed below are all FDA-approved HIV medications as of February 8, 2021, with links to the Clinical Info HIV.gov drug database. For professionals, the links open the FDA label pages, and for consumers, the links open the AIDSinfo patient information pages. The list is organized by drug class, with individual drugs listed in alphabetical order. Combination drugs are also listed in alphabetical order.
Nucleoside Reverse Transcriptase Inhibitors (NRTIs): characteristics
- Abacavir (ABC; Ziagen): FDA label | Patient info
- Emtricitabine (FTC; Emtriva): FDA label | Patient info
- Lamivudine (3TC; Epivir): FDA label | Patient info
- Tenofovir Disoproxil Fumarate (TDF; Viread): FDA label | Patient info
- Zidovudine (AZT, ZDV; Retrovir): FDA label | Patient info
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): characteristics
- Doravirine (DOR; Pifeltro): FDA label | Patient info
- Efavirenz (EFV; Sustiva): FDA label | Patient info
- Etravirine (ETR; Intelence): FDA label | Patient info
- Nevirapine (NVP; Viramune, Viramune XR [extended release]): FDA label | Patient info
- Rilpivirine (RPV; Edurant): FDA label | Patient info
Protease Inhibitors (PIs): characteristics
- Atazanavir (ATV; Reyataz): FDA label | Patient info
- Darunavir (DRV; Prezista): FDA label | Patient info
- Fosamprenavir (FPV; Lexiva): FDA label | Patient info
- Ritonavir (RTV; Norvir): FDA label | Patient info
- Saquinavir (SQV; Invirase): FDA label | Patient info
- Tipranavir (TPV; Aptivus): FDA label | Patient info
Fusion Inhibitor: characteristics
CCR5 Antagonist: characteristics
Integrase Inhibitors (INSTIs): characteristics
- Cabotegravir (CAB; Vocabria): FDA label | Patient info
- Dolutegravir (DTG; Tivicay): FDA label | Patient info
- Raltegravir (RAL; Isentress, Isentress HD): FDA label | Patient info
- Abacavir/Lamivudine (ABC/3TC; Epzicom): FDA label | Patient info
- Abacavir/Dolutegravir/Lamivudine (ABC/DTG/3TC; Triumeq): FDA label | Patient info
- Abacavir/Lamivudine/Zidovudine (ABC/3TC/ZDV; Trizivir): FDA label | Patient info
- Atazanavir/Cobicistat (ATV/COBI; Evotaz): FDA label | Patient info
- Bictegravir/Emtricitabine/Tenofovir Alafenamide Fumarate (BIC/FTC/TAF; Biktarvy): FDA label | Patient info
- Cabotegravir/Rilpivirine (CAB/RPV; Cabenuva): FDA label | Patient info
- Darunavir/Cobicistat (DRV/COBI; Prezcobix): FDA label | Patient info
- Darunavir/Cobicistat/Emtricitabine/Tenofovir Alefenamide (DRV/COBI/FTC/TAF; Symtuza): FDA label | Patient info
- Dolutegravir/Lamivudine (DTG/3TC; Dovato): FDA label | Patient info
- Dolutegravir/Rilpivirine (DTG/RPV; Juluca): FDA label | Patient info
- Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate (DOR/3TC/TDF; Delstrigo): FDA label | Patient info
- Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate (EFV/FTC/TDF; Atripla): FDA label | Patient info
- Efavirenz/Lamivudine/Tenofovir Disoproxil Fumarate (EFV/3TC/TDF; Symfi, Symfi Lo): FDA label | Patient info
- Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Fumarate (EVG/COBI/FTC/TAF; Genvoya): FDA label | Patient info
- Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil Fumarate (EVG/COBI/FTC/TDF; Stribild): FDA label | Patient info
- Emtricitabine/Rilpivirine/Tenofovir Alafenamide Fumarate (FTC/RPV/TAF; Odefsy): FDA label | Patient info
- Emtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate (FTC/RPV/TDF; Complera): FDA label | Patient info
- Emtricitabine/Tenofovir Alafenamide Fumarate (FTC/TAF; Descovy): FDA label | Patient info
- Emtricitabine/Tenofovir Disoproxil Fumarate (FTC/TDF; Truvada): FDA label | Patient info
- Lamivudine/Tenofovir Disoproxil Fumarate (3TC/TDF; Cimduo): FDA label | Patient info
- Lamivudine/Zidovudine (3TC/ZDV; Combivir): FDA label | Patient info
- Lopinavir/Ritonavir (LPV/r; Kaletra): FDA label | Patient info
ARV Drug Name Abbreviation Key
|Abbreviation||Full Drug Name|
|COBI or c||cobicistat|
|EFV/TDF/FTC||efavirenz/tenofovir disoproxil fumarate/emtricitabine|
|EVG/c/TDF/FTC||elvitegravir/cobicistat/tenofovir disoproxil fumarate/ emtricitabine|
|PI/c||cobicistat-boosted protease inhibitor|
|PI/r||ritonavir-boosted protease inhibitor|
|TDF||tenofovir disoproxil fumarate|
Online Resources for Education, Information, and Services
- AIDSinfo: Training for Health Care Providers
- AIDS Education Training Center (AETC):
- Centers for Disease Control and Prevention (CDC):
- E-patients.net: Salzburg Statement on Shared Decision Making
- HIV and Aging: hiv-age.org
- National Center for Transgender Equality: 2015 U.S. Transgender Survey
- New York City Department of Health and Mental Hygiene (NYC DOHMH): Making the Sexual History a Routine Part of Primary Care
- New York State Department of Health (NYS DOH):
- CEI: HIV, HCV & STD Clinical Education Initiative
- NYS AIDS Institute Training Center
- Partner Services: What Health Care Providers Need to Know
- Payment Options for Adults and Adolescents for Post Exposure Prophylaxis Following Sexual Assault
- Payment Options for Adults and Adolescents For Post Exposure Prophylaxis for all other Non-Occupational Exposures
- PrEP and PEP Information & Resources
- Provider Reporting & Partner Services
- Sexually Transmitted Diseases
- Northeast/Caribbean AETC: Care of People Aging with HIV Toolkit
- University of California San Francisco (UCSF):
- U.S. Department of Veterans Affairs: National Center for PTSD
- AIDSinfo (DHHS guidelines): https://aidsinfo.nih.gov/guidelines
- CDC HIV/AIDS Guidelines and Recommendations: http://www.cdc.gov/hiv/guidelines/
- IAS-USA Practice Guidelines: https://www.iasusa.org/guidelines
- UCSF: Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People
- NYS DOH:
- Communicable Disease Reporting Requirements
- Expedited Partner Therapy: A Guide for Partner Care
- HIPAA Information Center
- HIV Uninsured Care Programs: Summary
- HIV/AIDS Laws & Regulations
- HIV/AIDS Testing, Reporting and Confidentiality of HIV-Related Information
- NYSDOH: Rules, Regulations & Laws
- Partner Services: What Health Care Providers Need to Know
- Payment Options for PEP Following Non-Occupational Exposures Including Sexual Assault
- PrEP and PEP Information & Resources
- U.S. Courts: courtsystem.org
- MCN: Migrant Clinicians Network
- National Institutes of Health (NIH): Clinicaltrials.gov
- New York eHealth Collaborative: NYEC
- New York State (NYS):
- AIDS Institute Provider Directory (HIV, HCV, PEP, PrEP)
- Council of Health-System Pharmacists (NYSCHP)
- Department of Health
- Office of Victim Services
- AIDS Drug Assistance Program (ADAP) Formulary
- AIDS Institute
- NYC: LifeNet
- NYC: Contact Notification Assistance Program (CNAP)
- NYC: Expedited Partner Therapy
- Medicaid Managed Care and Family Health Plus Pharmacy Benefit Information Center
- NYC: Mayor’s Office for People with Disabilities
- NYC: Mayor’s Office for People with Disabilities: American Sign Language Interpreters in New York
- NYSDOH HIV Uninsured Care Programs
- Office of Alcoholism and Substance Abuse Services
- Office of Mental Health
- Sexual Assault Forensic Examiner (SAFE) Program
- STD Clinics in New York State
- Wadsworth Center
- UCSF Clinician Consultation Center
Use of Dolutegravir in Individuals of Childbearing Capacity
Lead author Geoffrey A. Weinberg, MD, with the Medical Care Criteria Committee, February 2020
Evidence from multiple studies indicates no difference in rates of total birth defects among infants exposed to antiretroviral (ARV) medications during the first trimester compared with infants exposed later in pregnancy. ARVs are generally considered safe and may be taken by pregnant patients with HIV without increasing the risk of infant birth defects.
Small risk associated with DTG: There is, however, a small increased risk of neural tube defects (NTDs) in infants exposed to dolutegravir (DTG) during the periconception period [Zash, et al. 2018; Zash, et al. 2019; Reefhuis, et al. 2020]. NTDs are birth defects, including meningomyelocele and spina bifida, thought to occur very early after conception when the embryonic neural tube is being formed. The neural tube closes by approximately 8 weeks gestational age, which is 8 weeks after the last menstrual period or approximately 6 weeks post-conception. Ingestion of folic acid or folate by a pregnant individual significantly lowers the rate of NTDs; all individuals in the United States who are pregnant or trying to conceive and engaged in prenatal care are routinely administered 400 µg of folic acid daily. The background rate of NTDs in the general population in the United States and in other countries that routinely fortify food with folate or folic acid is low: approximately 0.07% of all births (7/10,000 births) [Reefhuis, et al. 2020].
In a large observational clinical trial conducted in Botswana, a country in which food is not routinely fortified with folate or folic acid, the rate of infant NTDs with maternal DTG-based antiretroviral therapy (ART) use at conception was 0.30% (95% confidence interval [CI], 0.13-0.69). In infants exposed to non–DTG-based ART at conception, the rate was 0.10% (95% CI, 0.06-0.17). The rate in infants born to mothers who did not have HIV was 0.08% (95% CI, 0.06-0.10) [Zash, et al. 2019]. These data suggest that the risk of NTDs with use of DTG-based ART at conception is 3-fold greater than that associated with non–DTG-based ART but that the actual effect size is small—perhaps 2 infants with NTDs for every 1,000 births [Zash, et al. 2019]. This slight increase in NTD rates is lower than that found initially by the same investigators [Zash, et al. 2018], and although statistically significant, contains wide CIs and may require recalculation as more data are collected [Zash, et al. 2018; van De Ven, et al. 2019; Zash, et al. 2019; Reefhuis, et al. 2020]. The effects of DTG on folate metabolism have not been confirmed, but it is notable that very few women in the trial received folate before conception and approximately half received it throughout pregnancy [Zash, et al. 2019].
Benefits of DTG: In contrast to this potentially small increase in NTD risk are the known benefits of DTG as a component of ART for all adults, pregnant or not, and many children. DTG is potent, rapidly reduces viral load, has a high barrier to HIV genetic resistance, and is generally well-tolerated. Moreover, folate deficiency is uncommon in countries such as the United States, and the apparent added risk of infant NTDs associated with DTG use is small. Thus, both the U.S. Department of Health and Human Services and the World Health Organization consider DTG a preferred ARV drug for individuals with HIV in all trimesters of pregnancy and an alternative for those with HIV who are trying to conceive.
Informed decision-making: When caring for an individual with HIV who is very early in the first trimester of pregnancy (<8 weeks post-last menstrual period) or trying to conceive, clinicians should provide the above information and engage the patient in joint decision-making regarding choice of ARVs [Redfield, et al. 2019]. If an alternative ART regimen that does not include DTG is the best choice, preferred alternatives to DTG during pregnancy include raltegravir, ritonavir-boosted atazanavir, or ritonavir-boosted darunavir (see the NYSDOH AI guideline Selecting an Initial ART Regimen > Specific Factors to Consider and Discuss With Patients). No data currently exist to support the use of bictegravir or cobicistat-boosted elvitegravir during pregnancy or the period surrounding conception.
DHHS. Recommendations for the use of antiretroviral drugs in pregnant women with HIV infection and interventions to reduce perinatal HIV transmission in the United States. 2020 https://aidsinfo.nih.gov/guidelines/html/3/perinatal/224/whats-new-in-the-guidelines [accessed 22 Jan 2020]
Redfield RR, Modi S, Moore CA, et al. Health care autonomy of women living with HIV. N Engl J Med 2019;381(9):798-800. [PMID: 31339674]
Reefhuis J, FitzHarris LF, Gray KM, et al. Neural tube defects in pregnancies among women with diagnosed HIV infection – 15 jurisdictions, 2013-2017. MMWR Morb Mortal Wkly Rep 2020;69(1):1-5. [PMID: 31917782]
van De Ven NS, Pozniak AL, Levi JA, et al. Analysis of pharmacovigilance databases for dolutegravir safety in pregnancy. Clin Infect Dis 2019. [PMID: 31595301]
Zash R, Holmes L, Diseko M, et al. Neural-tube defects and antiretroviral treatment regimens in Botswana. N Engl J Med 2019;381(9):827-840. [PMID: 31329379]
Zash R, Makhema J, Shapiro RL. Neural-tube defects with dolutegravir treatment from the time of conception. N Engl J Med 2018;379(10):979-981. [PMID: 30037297]
GOALS Framework for Sexual History Taking in Primary Care
Developed by Sarit A. Golub, PhD, MPH, Hunter College and Graduate Center, City University of New York, in collaboration with the NYC Department of Health and Mental Hygiene, Bureau of HIV, July 2019
Background: Sexual history taking can be an onerous and awkward task that does not always provide accurate or useful information for patient care. Standard risk assessment questions (e.g., How many partners have you had sex within the last 6 months?; How many times did you have receptive anal sex with a man when he did not use a condom?) may be alienating to patients, discourage honest disclosure, and communicate that the number of partners or acts is the only component of sexual risk and health.
In contrast, the GOALS framework is designed to streamline sexual history conversations and elicit information most useful for identifying an appropriate clinical course of action.
The GOALS framework was developed in response to 4 key findings from the sexual health research literature:
- Universal HIV/STI screening and biomedical prevention education is more beneficial and cost-effective than risk-based screening [Wimberly, et al. 2006; Hoots, et al. 2016; Owusu-Edusei, et al. 2016; Hull, et al. 2017; Lancki, et al. 2018].
- Emphasizing benefits—rather than risks—is more successful in motivating patients toward prevention and care behavior [Weinstein and Klein 1995; Schuz, et al. 2013; Sheeran, et al. 2014].
- Positive interactions with healthcare providers promote engagement in prevention and care [Bakken, et al. 2000; Alexander, et al. 2012; Flickinger, et al. 2013].
- Patients want their healthcare providers to talk with them about sexual health [Marwick 1999; Ryan, et al. 2018].
Rather than seeing sexual history taking as a means to an end, the GOALS framework considers the sexual history taking process as an intervention that will:
- Increase rates of routine HIV/STI screening;
- Increase rates of universal biomedical prevention and contraceptive education;
- Increase patients’ motivation for and commitment to sexual health behavior; and
- Enhance the patient-care provider relationship, making it a lever for sexual health specifically and overall health and wellness in general.
The GOALS framework includes 5 steps:
- Give a preamble that emphasizes sexual health. The healthcare provider briefly introduces the sexual history in a way that de-emphasizes a focus on risk, normalizes sexuality as part of routine healthcare, and opens the door for the patient’s questions.
- Offer opt-out HIV/STI testing and information. The healthcare provider tells the patient that they test everyone for HIV and STIs, normalizing both testing and HIV and STI concerns.
- Ask an open-ended question. The healthcare provider starts the sexual history taking with an open-ended question that allows them to identify the aspects of sexual health that are most important to the patient, while allowing them to hear (and then mirror) the language that the patient uses to describe their body, partner(s), and sexual behaviors.
- Listen for relevant information and fill in the blanks. The healthcare provider asks more pointed questions to elicit information that might be needed for clinical decision-making (e.g., 3-site versus genital-only testing), but these questions are restricted to specific, necessary information. For instance, if a patient has already disclosed that he is a gay man with more than 1 partner, there is no need to ask about the total number of partners or their HIV status in order to recommend STI/HIV testing and PrEP education.
- Suggest a course of action. Consistent with opt-out testing, the healthcare provider offers all patients HIV testing, 3-site STI testing, PrEP education, and contraceptive counseling, unless any of this testing is specifically contraindicated by the sexual history. Rather than focusing on any risk behaviors the patient may be engaging in, this step focuses specifically on the benefits of engaging in prevention behaviors, such as exerting greater control over one’s sex life and sexual health and decreasing anxiety about potential transmission.
Resources for implementation:
- Script, rationale, and goals: Box 1, below, provides a suggested script for each step in the GOALS framework, along with the specific rationale for that step and the goal it is designed to accomplish.
- The 5Ps model for sexual history-taking (CDC): Note that the GOALS framework is not designed to completely replace the 5Ps model (partners, practices, protection from STI, past history of STI, prevention of pregnancy); instead, it provides a framework for identifying information related to the 5Ps that improves patient-care provider communication, reduces the likelihood of bias or missed opportunities, and enhances patients’ motivation for prevention and sexual health behavior.
|Box 1: GOALS Framework for the Sexual History
|Component||Suggested Script||Rationale and Goal Accomplished|
|Give a preamble that emphasizes sexual health.||I’d like to talk with you for a couple of minutes about your sexuality and sexual health. I talk to all of my patients about sexual health, because it’s such an important part of overall health. Some of my patients have questions or concerns about their sexual health, so I want to make sure I understand what your questions or concerns might be and provide whatever information or other help you might need.||
|Offer opt-out HIV/STI testing and information.||First, I like to test all my patients for HIV and other sexually transmitted infections. Do you have any concerns about that?||
|Ask an open-ended question.||
Pick one (or use an open-ended question that you prefer):
|Listen for relevant information and probe to fill in the blanks.||
|Suggest a course of action.||
Alexander JA, Hearld LR, Mittler JN, et al. Patient-physician role relationships and patient activation among individuals with chronic illness. Health Serv Res 2012;47(3 Pt 1):1201-1223. [PMID: 22098418]
Bakken S, Holzemer WL, Brown MA, et al. Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. AIDS Patient Care STDS 2000;14(4):189-197. [PMID: 10806637]
Flickinger TE, Saha S, Moore RD, et al. Higher quality communication and relationships are associated with improved patient engagement in HIV care. J Acquir Immune Defic Syndr 2013;63(3):362-366. [PMID: 23591637]
Hoots BE, Finlayson T, Nerlander L, et al. Willingness to take, use of, and indications for pre-exposure prophylaxis among men who have sex with men-20 US cities, 2014. Clin Infect Dis 2016;63(5):672-677. [PMID: 27282710]
Hull S, Kelley S, Clarke JL. Sexually transmitted infections: Compelling case for an improved screening strategy. Popul Health Manag 2017;20(S1):S1-S11. [PMID: 28920768]
Lancki N, Almirol E, Alon L, et al. Preexposure prophylaxis guidelines have low sensitivity for identifying seroconverters in a sample of young Black MSM in Chicago. AIDS 2018;32(3):383-392. [PMID: 29194116]
Marwick C. Survey says patients expect little physician help on sex. JAMA 1999;281(23):2173-2174. [PMID: 10376552]
Owusu-Edusei K, Jr., Hoover KW, Gift TL. Cost-effectiveness of opt-out chlamydia testing for high-risk young women in the U.S. Am J Prev Med 2016;51(2):216-224. [PMID: 26952078]
Ryan KL, Arbuckle-Bernstein V, Smith G, et al. Let’s talk about sex: A survey of patients’ preferences when addressing sexual health concerns in a family medicine residency program office. 2018;2. https://journals.stfm.org/primer/2018/ryan-2018-0004
Schuz N, Schuz B, Eid M. When risk communication backfires: randomized controlled trial on self-affirmation and reactance to personalized risk feedback in high-risk individuals. Health Psychol 2013;32(5):561-570. [PMID: 23646839]
Sheeran P, Harris PR, Epton T. Does heightening risk appraisals change people’s intentions and behavior? A meta-analysis of experimental studies. Psychol Bull 2014;140(2):511-543. [PMID: 23731175]
Weinstein ND, Klein WM. Resistance of personal risk perceptions to debiasing interventions. Health Psychol 1995;14(2):132-140. [PMID: 7789348]
Wimberly YH, Hogben M, Moore-Ruffin J, et al. Sexual history-taking among primary care physicians. J Natl Med Assoc 2006;98(12):1924-1929. [PMID: 17225835]