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1–2 | Clinical Manual for Management of the HIV-Infected Adult/2006 Risk for HIV and Other Sexually Transmitted Diseases How do you think you were exposed to HIV? Sexual Please tell me about any experience you’ve had with unprotected anal, vaginal, or oral sex. Have you had sex with men? With women? Have any of your sex partners: Told you they were HIV infected or had AIDS? Told you they used injection drugs? Ever been in jail or prison? Had a sexually transmitted disease? Had hemophilia? Received a blood transfusion? Have you ever received donated sperm during artificial insemination? Substance Use Please tell me about your experience with injected substances. Have you shared your needles or injection equipment (works) with another individual? Transfusion Did you receive any blood or blood products between 1977 and 1985? Occupational Have you had an on-the-job injury that involved contact with a body fluid? Tattoos Do you have any tattoos? What was the injury, and was HIV evaluation a part of the work injury follow-up? Were sterile needles and ink-wells used to place your tattoo? HIV-Related Illnesses What opportunistic infection(s) have you had, if any? (PCP, MAC, cryptococcal meningitis, TB, etc) Active Tuberculosis (TB) and TB Testing History What year(s) were you diagnosed with the above? Have you had cancer(s)? What other HIV-related illnesses have you had? When was your last TB skin test (PPD)? What were the results of this test? Have you ever had a positive TB skin test? What year and what health care setting? What medications did you take and for how long? Have you ever had active tuberculosis? Medications Are you taking HIV medications now? If so, can you name them or describe them, and give their dosing frequency? How many doses have you missed in the last 3 days? The last week? The last month? What HIV medicines have you taken in the past (names or descriptions)? [If possible, have patient list all ARVs and ARV combinations, with dates and corresponding CD4 counts and viral loads.] When did you start and stop them (dates)? Do you know why you stopped these medications? Do you know what your HIV viral load or your CD4 counts were while you were taking your medications? Have you ever had a resistance test done? What other medications are you taking now? What herbs, over-the-counter (OTC) products, or vitamins are you taking now?
Past Medical and Surgical History Section 1—Testing and Assessment | 1–3 Chronic Diseases Do you have any chronic conditions, such as diabetes, high blood pressure, heart disease, cholesterol problems, asthma, emphysema, sickle cell disease, ulcers, acid reflux, irritable bowel syndrome, thyroid disorders, kidney or liver problems, or mental health disorders? If so, do you receive medical care for these conditions? Previous Illnesses Have you had any hospitalizations? Where, when, and for what reason? Have you had any surgeries? When and where? Have you had any major illnesses, including mental health conditions? Hepatitis Have you ever had hepatitis? What type (A, B, C)? Do you have chronic hepatitis? Do you know your immunity status to hepatitis A or hepatitis B? Have you been vaccinated? Gynecologic When was your last Papanicolaou (Pap) smear? What were the results? Have you ever had an abnormal Papanicolaou (Pap) smear? When was your last menstrual period? What is the usual length of your cycle? Have you noticed changes in your menstrual cycle? Have you had any lower abdominal pain? Do you get yeast infections? How often? Do you get urinary infections? Have you ever had kidney stones? Obstetric How many pregnancies have you had? How many miscarriages or therapeutic abortions? How many live births? Ages of children now? Was HIV tested during any pregnancy? Did you deliver an infant while you were HIV infected? Was HIV medication given during pregnancy and delivery? Do you have children who are HIV infected? Do you intend to become pregnant? Anorectal History Have you ever had an anal Papanicolaou (Pap) smear? Sexually Transmitted Infections (STIs) What were the results? Have you ever been treated for: Syphilis? Vaginitis? Genital herpes? NGU (nongonococcal urethritis)? Gonorrhea? Genital warts (HPV)? Chlamydia? Proctitis? Pelvic inflammatory disease (PID)?
Page 1 and 2: Clinical Manual for Management of t
Page 3 and 4: Table of Contents Clinical Manual f
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Page 7 and 8: Preface—About this Manual | Clini
Page 9: Previous Editions Atlanta Contribut
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Page 23 and 24: Initial Physical Examination Backgr
Page 25 and 26: Genitals/Rectum • Inspect the gen
Page 27 and 28: Initial and Interim Laboratory and
Page 29 and 30: Section 1—Testing and Assessment
Page 31: Patient Education ♦ ♦ ♦ ♦ D
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Page 53: References ♦ ♦ ♦ ♦ ♦ ♦
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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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♦ ♦ ♦ ♦ ♦ Navas E, Martin
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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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