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About the AIDS Education and Training Centers Based in leading academic centers, the AETCs serve all 50 states, the District of Columbia, Puerto Rico, the US Virgin Islands, and the six US-affiliated Pacific Jurisdictions. Sixty-six universities participate in the program. The AETCs aim to increase the number of healthcare providers who are effectively educated to counsel, diagnose, treat, and medically manage individuals with HIV infection, and prevent high-risk behaviors that lead to HIV transmission. Training targets providers who serve minority populations, the homeless, rural communities, persons in correctional facilities and migrant health centers, and Ryan White CARE Act-funded sites. AETCs focus on training a diverse group of clinicians including Regional and National AIDS Education and Training Centers ♦ ♦ Delta Region AETC Serving Arkansas, Louisiana, Mississippi Louisiana State University, Health Sciences Center, School of Public Health 136 South Roman Street, 2nd floor New Orleans, LA 70112 (504) 903-0788 www.deltaaetc.org Mountain Plains AETC Serving Colorado, Kansas, Nebraska, New Mexico, North Dakota, South Dakota, Utah, Wyoming Department of Medicine, Division of Infectious Diseases, University of Colorado Health Science Center 4200 East 9th Avenue Campus Box A089, SOM 2623 Denver, CO 80262 (303) 315-2516 www.mpaetc.org Preface—About this Manual | physicians, nurses and advanced practice nurses, physician assistants, oral health professionals, and pharmacists. Since the first AIDS cases were identified, knowledge about the disease and its treatment has increased exponentially. The AETC program was designed to improve the dissemination of new information to interdisciplinary healthcare providers through expert clinical consultation, intensive clinical rotations and preceptorships, workshops and seminars, hands-on supervised clinical experience, and technical assistance. The AETC program is administered by the Health Resources and Services Administration (HRSA), HIV/ AIDS Bureau (HAB). ♦ ♦ ♦ Northwest AETC Serving Alaska, Idaho, Montana, Oregon, Washington Center for Health Education and Research, University of Washington 901 Boren Avenue, Suite 1100 Seattle, WA 98104 (206) 221-4694 www.northwestaetc.org Southeast AIDS Training and Education Center (SEATEC) Serving Alabama, Georgia, Kentucky, North Carolina, South Carolina, Tennessee Department of Family and Preventive Medicine, Emory University School of Medicine 735 Gatewood Road, NE Atlanta, GA 30322-4950 (404) 727-2929 www.seatec.emory.edu Florida/Caribbean AETC Serving Florida, Puerto Rico, U.S. Virgin Islands USF Center for HIV Education and Research, University of South Florida 13301 Bruce B. Downs Boulevard, MHC-1715 Tampa, FL 33612 (813) 974-4430 www.FAETC.org
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Page 3 and 4: Table of Contents Clinical Manual f
Page 5 and 6: Clinical Manual for Management of t
Page 7 and 8: Preface—About this Manual | Clini
Page 9: Previous Editions Atlanta Contribut
Page 13 and 14: Initial History Background This cha
Page 15 and 16: Past Medical and Surgical History S
Page 17 and 18: Social History Relationship Situati
Page 19 and 20: Table 3. Review of Systems For each
Page 21: Psychiatric Mood Depression screeni
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Page 33 and 34: Interim History and Physical Examin
Page 35 and 36: HIV Classification: CDC and WHO Sta
Page 37 and 38: WHO Clinical Staging of HIV/AIDS an
Page 39 and 40: Determining Risk of HIV Progression
Page 41 and 42: CD4 Monitoring and Viral Load Testi
Page 43 and 44: Table 1. Correlation between CD4 Ce
Page 45 and 46: Primary HIV Infection Background Pr
Page 47 and 48: Rapid HIV Testing Background It is
Page 49: Patient Education In general settin
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Page 55 and 56: Nutrition Background Maintaining go
Page 57 and 58: O: Objective Physical Examination P
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Difficulty Chewing or Swallowing or
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Nonoccupational Postexposure Prophy
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Once the decision is made to instit
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Section 2—Health Maintenance and
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Antiretroviral Therapy Background P
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Initiating Therapy: DHHS ARV Guidel
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Table 1. Initial Antiretroviral Reg
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Responding to Apparent Treatment Fa
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ARV treatment in resource-limited s
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Adherence Background For HIV-infect
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adherence, such as mental health is
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Appendix 1. Scales to Assess Adhere
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Resistance Testing Background As of
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Resistance Testing in Patients with
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Care of HIV-Infected Pregnant Women
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social services for food, housing,
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Table 2. Recommended Evaluation and
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Special Considerations for OI Proph
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Hyperbilirubinemia Women who are ta
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Patient Education ♦ ♦ ♦ ♦
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Section 3—Antiretroviral Therapy
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Abnormalities of Body-Fat Distribut
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Pharmacologic Measures Recombinant
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Dyslipidemia Background In HIV-infe
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Table 2. Classification of Triglyce
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Table 3. Drug Treatments for Lipid
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Patient Education ♦ ♦ ♦ Revie
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Insulin Resistance and Hyperglycemi
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Anemia Background Anemia is usually
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Check the testosterone level in ind
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Diarrhea Background Diarrhea is a c
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P: Plan Diagnostic Evaluation For s
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Ear, Nose, Sinus, Mouth Background
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Mouth and Throat The oral cavity is
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Esophageal Problems Background Esop
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References ♦ ♦ ♦ ♦ Dieteric
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Fatigue Background Fatigue is defin
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Nausea and Vomiting Background Naus
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♦ ♦ ♦ Lorazepam (Ativan) may
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Vaginitis/Vaginosis Background Vagi
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Treatment: Alternative regimens ♦
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Anal Dysplasia Background Anal canc
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Patient Education ♦ ♦ ♦ Women
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6-6 | Clinical Manual for Managemen
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Candidiasis, Vulvovaginal Backgroun
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Cryptococcal Disease Background Cry
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up to 30 mL of CSF to lower the ICP
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Cytomegalovirus Disease Background
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CMV retinitis Treatment consists of
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Dermatologic Staphylococcal Infecti
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Known or suspected MSSA SSTI Treat
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Herpes Zoster/Shingles Background S
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Histoplasmosis Background Histoplas
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Patient Education ♦ ♦ ♦ ♦ H
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Section 6—Disease-Specific Treatm
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Table 1. World Health Organization
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Table 3. Monitoring for Toxicity Si
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Pelvic Inflammatory Disease Backgro
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Table 1. Treatment Regimens for Pel
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Pneumocystis Pneumonia Background P
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Table 1. Standard and Alternative P
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Progressive Multifocal Leukoencepha
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Seborrheic Dermatitis Background Se
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Sinusitis Background Sinusitis is d
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Syphilis Background Syphilis is a s
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Treponemal antibody tests (TP-PA [T
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Some patients retain reactive (low-
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Pain Syndrome and Peripheral Neurop
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Pharmacologic interventions The fol
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Palliative Care and HIV Background
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GASTROINTESTINAL Nausea, vomiting
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Advance Care Planning Advance care
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Depression Background Major depress
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of symptoms. The risk of recurrence
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Panic Disorder Background Panic dis
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♦ If benzodiazepines are used, th
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Sulfa Desensitization Background Tr
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Patient Education Background It has
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Web-Based Resources Background The
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