clinical care for people with HIV
Clinical care of people living with HIV will involve a partnership between the patient, primary care and specialist centers. Care should address the individual's full range of health-related needs, many of which may change during his or her lifetime. The underlying principle may be described as 'treating the individual and not the disease' (1).
People newly diagnosed with HIV, wherever they are tested, should be offered a full assessment, carried out by an appropriately trained practitioner with specialist expertise in HIV, at the earliest possible opportunity and no later than 2 weeks after receiving a positive HIV test result
- people newly diagnosed with HIV who have symptoms and/or signs attributable to HIV infection (including those of primary infection) may need immediate intervention and so should be able to access urgent (within 24 hours) specialist assessment (2)
Due to the wide use of antiretroviral therapy, physical problems caused by HIV have reduced significantly. HIV patients may present with symptoms caused by:
- problems related to HIV disease
- might be due to discontinuation of antiretroviral therapy (ART) or resistance to ART regimen
- checking the most recent CD4 count will be useful
- side effects or drug interactions due to ART
- a health problem not connected to HIV (2)
Managing HIV related patients include the following:
- initial HIV testing and confirmation of the result
- appropriate counselling during the process of identifying HIV infection
- HIV infection is a stigmatising condition and majority of patients will not be ready to absorb fully the news of a positive test result.
- clinical evaluation
- to determine the full status of the HIV infection to develop a basis for further clinical management
- patient counselling e.g. -
- on issue related to living with HIV
- sexual health advice e.g. - advice regarding safer sex, contraception
- importance of antiretroviral therapy
- monitoring patient health e.g. -
- metabolic abnormalities such as dyslipidaemia and insulin resistance are increasingly seen in HIV infected patients
- a lower threshold of suspicion and investigation of cardiovascular disease is warranted in those with HIV
- healthy diets, exercise, alcohol control, blood pressure checks and smoking cessation should be encouraged
- initiating ART and maintenance
- prevention and treatment of opportunistic infection, other coinfections and comorbidities
- psychological support
- referrals to provide continuity care (1,2,3)
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