Clinical Manual for Management of the HIV-Infected ... - myCME.com
Clinical Manual for Management of the HIV-Infected ... - myCME.com
Clinical Manual for Management of the HIV-Infected ... - myCME.com
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1–14 | <strong>Clinical</strong> <strong>Manual</strong> <strong>for</strong> <strong>Management</strong> <strong>of</strong> <strong>the</strong> <strong>HIV</strong>-<strong>Infected</strong> Adult/2006<br />
A: Assessment and Plan<br />
After <strong>com</strong>pleting <strong>the</strong> initial history and physical<br />
examination:<br />
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Complete <strong>the</strong> patient’s database with <strong>the</strong><br />
in<strong>for</strong>mation garnered through <strong>the</strong> history and<br />
physical examination.<br />
Document a problem list, assessment, and plan <strong>for</strong><br />
patient care.<br />
Complete follow-up or laboratory studies suggested<br />
by <strong>the</strong> history and physical exam. (See chapter Initial<br />
and Interim Laboratory and O<strong>the</strong>r Tests.)<br />
Prescribe opportunistic infection (OI) prophylaxis<br />
as appropriate. (See chapter Opportunistic Infection<br />
Prophylaxis.)<br />
Refer <strong>for</strong> dental, nutrition, social services, and<br />
mental health care as appropriate.<br />
Refer <strong>for</strong> any additional specialty care identified in<br />
<strong>the</strong> history or physical exam.<br />
Order any appropriate vaccinations. (See chapter<br />
Immunizations <strong>for</strong> <strong>HIV</strong>-<strong>Infected</strong> Adults and<br />
Adolescents.)<br />
Make follow-up appointment with health care<br />
provider.<br />
Answer <strong>the</strong> patient's questions.<br />
Patient Education<br />
A very important aspect <strong>of</strong> caring <strong>for</strong> <strong>HIV</strong>-infected<br />
individuals is educating patients about <strong>HIV</strong> infection,<br />
including goals <strong>of</strong> care and ways <strong>of</strong> achieving those<br />
goals.<br />
Review <strong>the</strong> following with each patient:<br />
<strong>HIV</strong> disease<br />
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Transmission and progression<br />
Significance <strong>of</strong> CD4 count and <strong>HIV</strong> viral load<br />
Possible treatment approaches<br />
Disclosure—whom <strong>the</strong> patient may need to tell<br />
about <strong>HIV</strong> status; approaches to disclosure<br />
<strong>HIV</strong> transmission prevention and risk reduction <strong>for</strong> <strong>HIV</strong>-positive<br />
individuals<br />
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Safer-sex approaches, including <strong>the</strong> use <strong>of</strong> condoms/<br />
latex barriers during all sexual contacts<br />
Safer use <strong>of</strong> recreational drugs<br />
Nutrition<br />
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Maintaining a healthy weight<br />
Nutritional support resources, if appropriate<br />
Importance <strong>of</strong> including a nutritionist in medical<br />
care<br />
Mental health<br />
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Stress reduction<br />
Rest and exercise to enhance a healthy mental state<br />
Adherence<br />
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Importance <strong>of</strong> keeping medical appointments<br />
Need <strong>for</strong> adhering to any medication regimen and<br />
<strong>the</strong> consequences <strong>of</strong> missed <strong>HIV</strong> medication doses<br />
Return appointment<br />
References<br />
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Aberg, Gallant, et al. Primary Care Guidelines <strong>for</strong><br />
<strong>the</strong> <strong>Management</strong> <strong>of</strong> Persons <strong>Infected</strong> with Human<br />
Immunodeficiency Virus: Re<strong>com</strong>mendations <strong>of</strong> <strong>the</strong> <strong>HIV</strong><br />
Medicine Association <strong>of</strong> <strong>the</strong> Infectious Diseases Society<br />
<strong>of</strong> America. Clin Infect Dis 2004 Sep 1;39(5):609-<br />
29. Available online at www.journals.uchicago.edu/<br />
CID/.<br />
Bartlett JG, Cheever L. A Guide to Primary Care<br />
<strong>of</strong> People with <strong>HIV</strong>/AIDS, 2004 Edition. Rockville,<br />
MD: Department <strong>of</strong> Health and Human Services,<br />
<strong>HIV</strong>/AIDS Bureau. 2004. Available online at hab.<br />
hrsa.gov/tools/primarycareguide/.<br />
Bartlett JG, Gallant JE. 2005-2006 Medical<br />
<strong>Management</strong> <strong>of</strong> <strong>HIV</strong> Infection. Baltimore: Johns<br />
Hopkins University Division <strong>of</strong> Infectious Diseases;<br />
2005. Available online at hopkins-aids.edu/mmhiv/<br />
order.html.<br />
Hollander H. Initiating Routine Care <strong>for</strong> <strong>the</strong> <strong>HIV</strong>-<br />
<strong>Infected</strong> Adult. In: Sande MA, Volberding PA,<br />
eds. The Medical <strong>Management</strong> <strong>of</strong> AIDS, 5th ed.<br />
Philadelphia: WB Saunders; 1997:107-112.<br />
U.S. Public Health Service, Infectious Diseases<br />
Society <strong>of</strong> America. Guidelines <strong>for</strong> preventing<br />
opportunistic infections among <strong>HIV</strong>-infected<br />
persons—2002. MMWR Re<strong>com</strong>m Rep. 2002 Jun<br />
14;51(RR08);1-46. Available online at aidsinfo.nih.<br />
gov/Guidelines/. Accessed May 19, 2006.
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