A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

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A Guide to Primary Care of People with HIV/AIDS Chapter 2: Approach to the Patient 2 12 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau
A Guide to Primary Care of People with HIV/AIDS Chapter 3: Core Elements of HIV Primary Care Chapter 3: Core Elements of HIV Primary Care INITIAL EVALUATION ONGOING CARE KEY POINTS SUGGESTED RESOURCES John McNeil, MD John V. L. Sheffield, MD John G. Bartlett, MD 3 INITIAL EVALUATION What are the goals of the initial evaluation? The goals will depend to a large extent on why the patient is being seen by the primary care provider, which may be because of symptoms, the need for evaluation after a positive HIV test, referral, for a consultation, etc. The initial evaluation should be tailored to the patient’s specific need, but the following are the usual goals of the initial evaluation: • Evaluate HIV-related complaints that require immediate intervention • Establish a strong patient-provider relationship with clear lines of communication • Initiate a complete medical database (Table 3-1) • Assess the patient’s understanding of HIV disease • Identify health needs for current medical problems, including those associated with mental health, substance abuse, hepatitis, and hypertension • Assess the need for social and psychological intervention • Assess the need for consultants for medical, social, or psychiatric care • Describe HIV disease in lay terms, including natural history, laboratory tests (CD4 cell count and viral load), complications, treatment, and outcome • Describe methods of transmission and of prevention This is a large menu, and there may need to be several “first visits.” What are the important aspects of the initial evaluation in patients with symptoms? It is critical to learn quickly if the patient has any HIVrelated complications that indicate advanced disease and may require rapid intervention. The most common presentations related to earlier HIV disease are thrush, weight loss, skin lesions of Kaposi’s sarcoma, Pneumocystis carinii pneumonia (PCP), and fever. Patients with HIV can also have medical conditions that stem from other causes, such as headaches, upper respiratory infections (URI), gastroesophageal reflux disease (GERD), hypertension, diabetes, or heart disease. Distinction between these and conditions that are HIV-related may be obvious, but when not, the best laboratory test is a CD4 cell count, which represents the barometer of immune function with HIV infection. Nearly all HIV-related complications occur when the CD4 cell count is
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