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♦ ♦ ♦ ♦ ♦ | Clinical Manual for Management of the HIV-Infected Adult/2006 New England AETC Serving Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Office of Community Programs, University of Massachusetts Medical School 23 Miner Street, Floor G Boston, MA 02215-3318 (617) 262-5657 www.neaetc.org New York/New Jersey AETC Serving New Jersey, New York Mailman School of Public Health Columbia University 722 West 168th Street, 11th Floor New York, NY 10032 (212) 305-8291 www.nynjaetc.org Pacific AETC Serving Arizona, California, Hawai’i, Nevada Department of Family & Community Medicine, University of California, San Francisco 50 Beale Street, Suite 1300 San Francisco, CA 94105 (415) 597-8198 www.ucsf.edu/paetc Midwest AIDS Training and Education Center (MATEC) Serving Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Wisconsin The University of Illinois at Chicago Jane Addams College of Social Work 1640 W. Roosevelt Road, Suite 511 Chicago, IL 60608 (312) 996-1373 www.matec.info Pennsylvania/MidAtlantic AETC Serving Delaware, Maryland, Ohio, Pennsylvania, Virginia, Washington D.C., West Virginia University of Pittsburgh, Graduate School of Public Health, Dept. of Infectious Diseases and Microbiology 130 DeSoto Street A427 Crabtree Hall Pittsburgh, PA 15261 (412) 624-1895 www.pamaaetc.org ♦ ♦ ♦ ♦ ♦ ♦ Texas/Oklahoma AETC Serving Oklahoma, Texas Parkland Health & Hospital System Support Services Building C 4811 Harry Hines Boulevard Dallas, TX 75235 (214) 590-2181 www.aidseducation.org National HIV/AIDS Clinicians’ Consultation Center Department of Family Medicine & Community Medicine University of California, San Francisco San Francisco General Hospital 1001 Potrero Avenue, Building 20-22 San Francisco, CA 94110 (415) 206-5792 www.ucsf.edu/hivcntr AETC National Evaluation Center AIDS Policy Research Center AIDS Research Institute University of California, San Francisco 50 Beale Street, Suite 1300 San Francisco, CA 94105 (415) 597-9213 www.ucsf.edu/aetcnec National Minority AETC Howard University 1840 7th Street, NW, 2nd Floor Washington, DC 20001 (202) 865-8146 www.nmaetc.org AETC National Resource Center François-Xavier Bagnoud Center University of Medicine and Dentistry of New Jersey 30 Bergen Street, ADMC 4 Newark, NJ 07107 (973) 972-5141 www.aidsetc.org International Training & Education Center on HIV (I-TECH) University of Washington 901 Boren Avenue, Suite 1100 Seattle, WA 98104-3508 (206) 685-6841 www.go2itech.org
Initial History Background This chapter includes essential points to cover during an initial clinic intake visit. Conducting a thorough initial history and physical examination is important even if previous medical records are available. This is the best opportunity to get a complete picture of the patient’s HIV disease status and his or her physical and emotional condition, as well as to establish the basis for an ongoing relationship with the patient. Many of the conditions that put immunocompromised patients at risk for disease can be detected early, by means of a thorough assessment. Table 1. Patient Information First Name: Last Name: Section 1—Testing and Assessment | 1–1 The information gathered through the initial history and physical examination will provide a comprehensive standardized database for the assessment and treatment of HIV-related problems, including acute intervention and ongoing supportive care. For essential aspects of the physical examination to cover in an initial clinic intake visit, see chapter Initial Physical Examination. O: Objective Document the patient’s full name, date of birth, date of assessment, and any other information standard to your practice (Tables 1 and 2). Perform a review of systems (Table 3). Date of Birth: ____ / ____ / ______ Date of Assessment: ____ / ____ / ______ Table 2. Initial History Checklist Category / Subject Matter Questions History of Present Illness HIV Testing What was the date of your positive HIV test? Did you have a previous test? If so, when was the last negative HIV test? When do you think you were infected? Treatment Status Where do you usually receive your health care? Have you ever received care for HIV? What was the date of your last HIV care visit? Do you know what your first CD4 (T-cell) count was? What was your lowest CD4 count? What was your highest CD4 count? What is your current CD4 count? Do you know what your first viral load count was? What was your highest viral load count? What was your lowest viral load count? What is your current viral load count? Have you participated in any research protocols? Would you be interested in participating?
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Occupational Postexposure Prophylax
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P: Plan Laboratory Testing Provide
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For hepatitis C, no recommended pro
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Section 2—Health Maintenance and
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as hepatitis C or another sexually
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for treatment is appropriate, and b
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Section 2—Health Maintenance and
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contact with the patient. Patients
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tablet daily of trimethoprim-sulfam
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Opportunistic Infection Prophylaxis
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Discontinuing Primary Prophylaxis P
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Latent Tuberculosis Background Late
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INH may cause liver toxicity and it
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Patient Education ♦ ♦ ♦ ♦
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Reducing Maternal-Infant HIV Transm
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Some states require written informe
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contraindicated during pregnancy be
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Section 3—Antiretroviral Therapy
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Nelfinavir (Viracept) Adequate drug
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Section 4—Complications of Antire
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♦ ♦ ♦ Toronto General Hospita
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Adverse Reactions to HIV Medication
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♦ ♦ ♦ ♦ ♦ Vital signs: No
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egimen, symptoms of fatigue could i
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Recreational Drugs and Antiretrovir
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Section 4—Complications of Antire
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LSD, Mescaline, Psilocin, and Methy
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Immune Reconstitution Syndrome Back
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A: Assessment In the appropriate cl
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Eye Problems Background The immunos
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of
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Fever Background Although fever may
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Headache Background Headache may ha
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Lymphadenopathy Background Lymphade
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Treatment Treatment will depend on
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Neurologic Symptoms Background The
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Pulmonary Symptoms Background Short
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Treatment Once the diagnosis is mad
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Candidiasis, Oral and Esophageal Ba
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Maintenance therapy Use caution whe
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Cervical Dysplasia Background Cervi
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Patient Education ♦ ♦ ♦ ♦ P
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Cryptosporidiosis Background Crypto
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Gonorrhea and Chlamydia Background
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Treatment of Gonorrhea Treatment op
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Hepatitis B Infection Background He
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♦ ♦ ♦ ♦ ♦ Some patients t
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Hepatitis C Infection Background He
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pregnancy. Ribavirin is teratogenic
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Herpes Simplex, Mucocutaneous Backg
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References ♦ ♦ ♦ ♦ ♦ Cent
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Kaposi Sarcoma Background Kaposi sa
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Treatment Treatment of KS is not co
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Molluscum Contagiosum Background Mo
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Mycobacterium avium Complex Backgro
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Table 1. Interactions between Rifab
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Mycobacterium tuberculosis: Treatme
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P: Plan Diagnostic Evaluation Durin
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Table 1. Regimens for Treatment of
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Rifabutin may be substituted for ri
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Non-Hodgkin Lymphoma Background Non
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Patient Education ♦ ♦ ♦ ♦ S
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Toxoplasmosis Background Toxoplasma
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♦ Atovaquone 1,500 mg orally twic
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Linear Gingival Erythema Background
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Background Necrotizing ulcerating p
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Oral Health Background Examination
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Maxillary Tori; Mandibular Tori S:
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Periodontal Disease Background The
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Oral Hairy Leukoplakia Background O
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Oral Ulceration Background Oral ulc
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Oral Warts Background Oral warts ar
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Anxiety Disorders Background Anxiet
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Patient Education ♦ ♦ Behaviora
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Insomnia Background Insomnia is a c
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Suicidal Ideation Background Transi
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Section 8—Neuropsychiatric Disord
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P: Plan ♦ ♦ ♦ ♦ ♦ Check t
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Correctional Settings Background Ca
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Adherence Adherence is one of the m
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Karnofsky Performance Scale Backgro
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