HIV: TEST & PREVENTIONSNUR AINA BINTI AB KADIR

THE SECOND POST- POSITIVE RESULT CONSULTATION (1-2 WEEKS LATER)

Give results of repeat HIV test and baseline tests

Explore patient’s understanding, feelings, coping abilities and spiritual issues

Some of the common questions that patients with HIV infections ask are-sick, treatment, surroundings, social and legal issues

Give appropriate reassurance Discuss support systems

THE SECOND POST- POSITIVE RESULT CONSULTATION (1-2 WEEKS LATER)

Check personal prophylaxis Reinforce lifestyles strategies- give

suggestions Recommend meditation and appropriate

literature Provide appropriate referrals :specialist

counsellors, self-help and support groups Advise patients about their legal and

ethical responsibilities Organise contact tracing

THE SECOND POST- POSITIVE RESULT CONSULTATION (1-2 WEEKS LATER)

Address the difficult issue of telling sexual partners

If the patient is unwilling to inform sexual partners/ is uncertain of who they may be- contact tracing organisations

If a patient refuses to inform a sexual partner of the risk, then the doctor may disclose this information:

Clear risk of transmission If the patient has been given education &

counselling-ignored

THE SECOND POST- POSITIVE RESULT CONSULTATION (1-2 WEEKS LATER)

If the doctor in the case has sought advice from colleagues & institutional ethics committee & before disclosure discussed it with the medical defence organisation

Then, the doctor should provide the patient with written advicenotifyrefuses

Discuss ‘safer sex’ guidelines: condom usage

CONTINUING MAINTENANCE CONSULTATIONS

Provide appropriate support, encouragement and counselling.

Frequency depends on CD 4 cell count Examination: Check general condition, temperature and weight. Look for unusual lung infection, diarrhoea, skin lesions,

tongue and oropharynx, fevers, wasting and neurological signs.

Examine for signs of CMV retinitis (at risk if CD4 count <100 cells/µL).

Monitor for depressive illness. Look for early signs of AIDS-related dementia.

CONTINUING MAINTENANCE CONSULTATIONS

Tests: CD 4 cell count and syphilis serology; viral load test; chest X-ray and induced sputum, faeces microculture, Candida mouth swabs and herpes swabs appropriately

Treat intercurrent illness. Prophylaxis—this is managed according to

immune status: if CD4 count <200 cells/µL use cotrimoxazole to prevent opportunistic infections, particularly PJP.

RED FLAGS FOR HIV INFECTION PERSISTENT Fever Headache Weight loss Diarrhea Dry cough Dyspnoea on

exertion Visual disturbance Neurological Psychiatric

LABORATORY Viral

count>10000 copies/mm

Cell count 200-250µL or less

CONTACT TRACING Contacts of HIV-positive patients should be traced

and offered testing with counselling. Patients with HIV infection must be advised of the

risk they pose to seronegative sexual partners A person who has HIV or is at risk of HIV infection

must not make any blood, semen or tissue donation.

PREVENTION OF HIV INFECTION

PREVENTION OF HIV INFECTION ‘Safer practices’ Condoms: lubricants K-Y gel/Lubafax Discuss alternative sex practices Emphasise the importance of being in

control with drug taking, IV usage, safe sex practices, needle exchange program.

The most important biological risk factor for HIV transmission is the presence of other active STIs in either partner.

PREVENTION OF HIV INFECTION Health professionals Very care when taking blood

samples/using sharps Advise safe disposal of sharps & other

disposables, appropriate sterilisation of material

Gloves should be worn for all invasive procedures

Management of needle-stick injuries Blood donors need to be carefully

screened.

COMMUNITY EDUCATION Educating the community in a non-

emotional, responsible way about AIDS should be a priority.

AIDS education in schools in particular can be an important strategy.

People with HIV infection would be appropriate resource educators and the use of videos would be a most appropriate medium for education

WHEN TO REFER?? onset of a life-threatening opportunistic

infection the need to initiate antiretroviral drug

therapy administration of prophylactic

pentamidine therapy serious psychological problems related

to HIV-positive status

REFERENCES Murtagh’s

General Practices 5th edition,page 248-250

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