HIV/AIDS Treatment and Care : Clinical protocols for the European ...

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Annex 7. Glossary ......................................................................................................................... 39 Annex 8. Beyond the horizon ....................................................................................................... 40 References ...................................................................................................................................... 41
I. Introduction PATIENT EVALUATION AND ANTIRETROVIRAL TREATMENT FOR ADULTS AND ADOLESCENTS HIV/AIDS is chronic lifelong disease with no known cure, and therefore, people living with HIV (PLHIV) have to be followed medically for the rest of their lives (1–3). The core component of treatment and care of PLHIV is provision of antiretroviral treatment (ART). Optimal ART increases the length and quality of life of HIV-infected patients, and reduces the onward transmission of the virus. WHO promotes a public health approach to ART (4), which promotes the rational selection and sequencing of different drug classes into first and second-line regimens with salvage options; simplified and standardised clinical management; and standardised record keeping in order to preserve therapeutic options, minimize drug toxicity and side-effects, maximize adherence and to support the goals of ART. The goals of ART are: • clinical: prolongation of life and improvement of its quality; • immunological: quantitative and qualitative immunological reconstitution, in order to prevent the onset of opportunistic infections; • virological: maximum possible reduction of the viral load for the longest possible time, in order to halt the progression of disease and prevent and delay the development of drug resistance; • epidemiological: reduction, ideally the prevention of onward HIV transmission (5). WHO has produced a series of guidelines to support ART delivery in national programmes and by treatment implementers, which are available on the WHO website http://www.who.int/hiv/universalaccess2010/en/index.html. Particular reference is made in this protocol to the guidelines and recommendations for clinical and immunological staging and to ART guidelines for ART in adolescents and adults. Medical history, examination findings, exact history of ART, laboratory results, results of other medical procedures and social circumstances need to be documented for the entire treatment period, which may be years or even decades long. Such records are crucial for the individual patient as well as for retrospective analysis (for example, in endoscopic procedures, CT scanning, advanced microbiologic testing or viral load (VL) testing). For such purposes, an electronic record-keeping system is advisable, especially at the clinical level. Confidentiality of medical information should be ensured. Optimal HIV-related treatment and care should be delivered by clinical teams. The core clinical team providing basic medical case-management of a patient should ideally consist of a physician (often an infectious disease specialist), a nurse and a social worker or a non-medical service provider. Each of the team members has distinctive roles in providing treatment and care, and their services should be complementary. A network of other specialists and self-help groups should be available in supporting PLHIV (6).
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management of opportunistic infecti
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palliative care for people living w
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III. Initial evaluation palliative
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IV. Treatment palliative care for p
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Type of pain or treatment Usual sta
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Type Symptoms Possible causes Disea
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References palliative care for peop
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VI. Suggested minimum data to be co
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Contents I. Policy and principles .
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I. Policy and principles HIV/AIDS T
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HIV/AIDS TREATMENT AND CARE FOR INJ
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Social factors are: • homelessnes
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Table 3. Interactions between ARV d
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Other medications Use Rifampicin (R
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Table 5. Interactions of illicit dr
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ANNEX 1 ASI6 C © 2004 University o
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• Cardiovascular Hypertension Tac
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Contents I. Epidemiology and natura
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ManageMent of Hepatitis C and HiV C
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Annex 3. Alcohol screening question
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Table 16. a sample of the drug pipe
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3.2. Considerations regarding treat
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278 hiv/aids tReatment and caRe cLi
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I. Prevention strategies Prevention
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Prevention of HePatitis a, B, C and
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Prevention of HePatitis a, B, C and
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5. Contraceptive methods for women
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I. Policy issues Prevention of Hiv
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III. Initial evaluation Prevention
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6. Fungal infections...............
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• Disseminated non-tuberculous my
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Annex 3. Rabies vaccines ..........
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Contents I. Policy issues .........
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I. Policy issues post-exposure prop
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post-exposure prophylaxis for hiv i
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° condom use ° presence of STIs (
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VI. Suggested minimum data to be co
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History of antiretroviral treatment
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Test results: HBV: HCV: HIV: Post-t
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The World Health Organization (WHO)
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