3. • Indicate that patient could be a source
of infection to others and should take
actions to prevent transmission
– no exchange of blood or body fluids
• Encourage patient to disclose HIV status
to:
– sex partners
– needle-sharing partners
4. • Emphasize to HIV-positive woman that
children should be tested for HIV
• Discuss family planning with HIV-
positive woman
– the rate of transmission from mother
to newborn is approximately 20%
– can be decreased to less than 2%
when antiviral therapy is provided
during pregnancy
5. – If she does not want more children,
discuss birth control options
• Establish both a primary care and HIV
provider for the patient and encourage
regular follow-up care.
– For primary care: yearly Papanicolaou
smears for women and routine dental
and eye examinations.
6. – For HIV: follow-up visits every 3
months with laboratory assessment
of CD4+, HIV RNA viral load, CBC with
differential, and comprehensive
metabolic panel.
• Teach patient to recognize and report
important symptoms:
– Change in pattern or magnitude of
temperature elevation
7. – Development of a new focal
complaint:
• skin spots, sore mouth, and
diarrhea
• Emphasize to injection drug users that
continued use may expose them to
additional infection, and such infections
may accelerate disease progression.
– Assist them in finding drug
treatment.
8. • Encourage patient to modify sexual
behaviors for safer sex.
– Use latex male condoms.
– If a man will not use a condom, the
woman can use a female condom.
– Encourage patient to read literature
from various AIDS action groups on
safer sex techniques.
9. • If the patient abuses substances
(drugs, alcohol):
– Encourage enrollment in a treatment
program.
– Caution patient not to share needles
and to join needle-exchange
program, if available.
– If unused needles are not
available, advise cleaning needles
before using with a bleach/water
solution.
10. • Teach patient to optimize immune
system function through:
– sound dietary practices, exercise,
regular sleep
– Promote changes in the direction of
more healthful living
• Some patients may use complementary
or alternative therapies, such as
vitamins, herbs, and teas.
11. – Caution the patient to share these
additional therapies with the primary
provider.
• Refer patient to resources such as:
– Patient-oriented site with many
resources including a list of hotlines
for HIV consumers,
www.thebody.com.
12. – Consumer oriented magazine, which is
available online and by mail, www.poz.com.
– 100 Question and Answers about HIV and
AIDS by Joel Gallant (paperback available at
bookstores). Excellent resource for patients
in easy-to-understand language.
– “100 Questions and Answers about HIV and
AIDS” by the New York State Health
Department, www.
health.state.ny.us/diseases/aids/facts/quest
ions/index.htm or 518-474-3459.
13. • References for health care professionals:
– U.S. Public Health Service,
www.aidsinfo.nih.gov.
Comprehensive Web site with links to
a variety of information sources,
including a list of resources for
consumers.
– Centers for Disease Control and
Prevention with general AIDS
information, publications, resources,
statistics, www.cdc.gov/hiv.
14. – Johns Hopkins University AIDS
Service, www. hopkinshivguide.org/.
General AIDS information, content
review of recent AIDS conferences, e-
mail HIV consult service for providers
and patients.
– International resources,
www.unaids.org/en/. Provides
international view of AIDS epidemic
with links for other international
resources.
15. DRUG ALERT
• Oral contraceptives interact with many protease
inhibitors and NNRTI medications
• Encourage the patient to discuss this with her
obstetrician/gynecologist because she may need
alternative contraception
• Perform careful medication reconciliation after the
visit
• Consult with the pharmacist if there is a question.
16. DRUG ALERT
• Protease inhibitor levels can be affected by St. John's
wort, an herbal treatment for depression
• Discourage patients taking protease inhibitors from
using this over-the-counter herbal remedy.
