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1–8 | Clinical Manual for Management of the HIV-Infected Adult/2006 Genitourinary Genital Do you have any lesions or sores on your genital area now, or have you in the past? Have you ever had genital herpes? If yes, how often do you have outbreaks? When was the most recent outbreak? Women Have you had any lower abdominal pain? Have you noticed a vaginal discharge or odor? Do you have any burning or pain on urination? Frequent urination? Do you lose control of your urine or have problems getting to the bathroom before you start to urinate? Men Have you noticed any swelling or testicular pain? Musculoskeletal Skin Do you have difficulty starting your stream of urine? Are you getting up at night to urinate? Have you had burning or pain on urination? Do you lose control of your urine or have problems getting to the bathroom before you start to urinate? Have you ever had kidney stones? Do you have any difficulty developing an erection or maintaining one? Any discharge from your penis? Do you have any muscle aches or pains? Back pain, joint pain, and/or swelling? Have you ever broken any bones? Do you have chronic pain? Describe the pain—location, duration, rating (scale of 1-10), alleviation factors. Herpes Zoster Have you ever had chickenpox (varicella)? Have you ever had “shingles” (zoster)? Where were the lesions? Tinea Do you have fungal infections on your skin, especially groin, fingernails, toenails, or feet? Folliculitis Do you have any itchy bumps on your face, back, or chest? Seborrhea Do you have flaking or itching on your skin or scalp? Skin Lesions Have you noticed any rash or skin problems? If so, where? Neurologic Have you noticed any new moles, bruises, or bumps on your skin? Do you have any moles that changed shape, size, or color? Headache How often do you get headaches? Describe the headaches—location, timing, duration, alleviating or aggravating factors. Do they cause nausea or vomiting? Does sensitivity to light lead to headaches? Memory Do you have difficulty with your memory or ability to concentrate? If so, describe. Gait Have you noticed any changes in the way you walk? Neuropathy Do you have any numbness, tingling, burning, or pain in your hands or feet? Seizures Have you ever had a seizure or “fit”? If so, describe the seizure—When? How long did it last? Loss of consciousness? Was medical care sought? Weakness Do you have or have you had any weakness in your arms or legs? Endocrine Diabetes Have you had any increase in thirst, hunger, or urination? Thyroid Have you noticed changes in your energy level? Do you have intolerance to heat or cold? Have you noticed changes in your hair (thinning, coarse texture)? Sex Steroids Have you noticed any changes in your libido? Hematologic/Lymphatic Adenopathy Do you have swollen glands? If so, describe—location, painful, size if measurable. Bruising or Bleeding Have you noticed easy bruising or prolonged bleeding after injury? Nosebleeds or bleeding gums?
Psychiatric Mood Depression screening: Have you experienced a decrease in your interest or pleasure in your activities? Have you felt depressed, down, or hopeless? Do you feel more angry, sad, depressed, numb, irritable, or anxious than usual? Have any major life events have occurred to cause you to feel sad or depressed? When did these events occur? Sleep How is your sleep? How many hours do you sleep each night? What is your sleeping schedule—time to bed and time to rise? Do you take naps? A: Assessment and Plan ♦ ♦ ♦ ♦ Conduct a physical examination, focusing on subjective findings elicited in the history. (See chapter Initial Physical Examination.) Note: If significant time has elapsed between the ROS and physical exam, perform another ROS. Compose a problem list. Initiate a medication list (if appropriate). Order baseline/intake laboratory work. (See chapter Initial and Interim Laboratory and Other Tests.) Refer the patient to social services, mental health, community and other resources, or other clinic services as needed. During today’s visit or a future visit: ♦ Perform PPD testing if not done in the last year, or if the patient was previously PPD negative. The patient can return to have the PPD read. ♦ ♦ Perform immunizations for pneumonia (Pneumovax), influenza (as appropriate), and other immunizations as indicated. (See chapter Immunizations for HIV-Infected Adults and Adolescents.) Provide counseling on prevention of HIV transmission (eg, safer sex and injection practices), as appropriate. References ♦ ♦ ♦ ♦ ♦ Section 1—Testing and Assessment | 1–9 Aberg, Gallant, et al. Primary Care Guidelines for the Management of Persons Infected with Human Immunodeficiency Virus: Recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2004 Sep 1;39(5):609- 29. Available online at www.journals.uchicago.edu/ CID/. Bartlett JG, Cheever L. A Guide to Primary Care of People with HIV/AIDS, 2004 Edition. Rockville, MD: Department of Health and Human Services, HIV/AIDS Bureau. 2004. Available online at hab. hrsa.gov/tools/primarycareguide/. Bartlett JG, Gallant JE. 2005-2006 Medical Management of HIV Infection. Baltimore: Johns Hopkins University Division of Infectious Diseases; 2005. Available online at hopkins-aids.edu/mmhiv/ order.html. Hollander H. Initiating Routine Care for the HIV- Infected Adult. In: Sande MA, Volberding PA, eds. The Medical Management of AIDS, 5th ed. Philadelphia: WB Saunders; 1997:107-112. U.S. Public Health Service, Infectious Diseases Society of America. Guidelines for preventing opportunistic infections among HIV-infected persons — 2002. MMWR Recomm Rep. 2002 Jun 14;51(RR08);1-46. Available online at aidsinfo.nih. gov/Guidelines/. Accessed May 19, 2006.
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Page 7 and 8: Preface—About this Manual | Clini
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Page 27 and 28: Initial and Interim Laboratory and
Page 29 and 30: Section 1—Testing and Assessment
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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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