first cont(r)act the initial evaluation of the hiv infected patient patrick willemot 2010 september...
TRANSCRIPT
![Page 1: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/1.jpg)
First Cont(r)actFirst Cont(r)act
The Initial Evaluation of
the HIV infected patient
Patrick Willemot
2010 September 23
The Initial Evaluation of
the HIV infected patient
Patrick Willemot
2010 September 23
![Page 2: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/2.jpg)
OverviewOverview History
General Health Past Histories Opportunistic Infections
Physical Examination Investigations Health Maintenance
History General Health Past Histories Opportunistic Infections
Physical Examination Investigations Health Maintenance
![Page 3: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/3.jpg)
#1: How did theycome to see you?#1: How did theycome to see you?
Referred by MD? Self-obtained test? Referred by gov’t or insurance? Contact tracing? Transfer of care? (not discussed this time)
Referred by MD? Self-obtained test? Referred by gov’t or insurance? Contact tracing? Transfer of care? (not discussed this time)
![Page 4: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/4.jpg)
#2: Confirm HIV Diagnosis#2: Confirm HIV Diagnosis
HIV Ab ELISA
Confirmatory Western blot
Viral load
p24 antigen - not recommended
HIV Ab ELISA
Confirmatory Western blot
Viral load
p24 antigen - not recommended
![Page 5: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/5.jpg)
Remember to discuss: 4 pointsRemember to discuss: 4 points 1. HIV biology
*transmission (must get into the nitty-gritty)
re-infection risk among seroconcordant partners
mechanism of ARVs and resistance
1. HIV biology *transmission (must get into the nitty-gritty)
re-infection risk among seroconcordant partners
mechanism of ARVs and resistance
![Page 6: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/6.jpg)
Remember to discuss: 4 pointsRemember to discuss: 4 points 2. treatability but incurability
try to normalise it a bit: “like diabetes…”
2. treatability but incurability try to normalise it a bit: “like diabetes…”
NEJM 1998 Mar 26; 338 (13): 853-860.
AIDS 1999 Oct 1; 13 (14): 1933-1942.
![Page 7: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/7.jpg)
Remember to discuss: 4 pointsRemember to discuss: 4 points 3. good prognosis with treatment
HIV ≠ AIDS (usefulness of “AIDS” label debatable)
4. women can bear children safely transmission reduced from 25-30% to <1%
3. good prognosis with treatment HIV ≠ AIDS (usefulness of “AIDS” label
debatable)
4. women can bear children safely transmission reduced from 25-30% to <1%
![Page 8: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/8.jpg)
General HealthGeneral Health Present complaints
Functional Status
Past & present risk behaviours What’s their risk of co-infection? What’s their risk of re-infection? What’s their risk of infecting others?NB: remember to use value-neutral language
Present complaints
Functional Status
Past & present risk behaviours What’s their risk of co-infection? What’s their risk of re-infection? What’s their risk of infecting others?NB: remember to use value-neutral language
![Page 9: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/9.jpg)
Past HistoryPast History A) HIV-associated
OIs, neoplasia B) Non-HIV associated C) STDs D) ARV exposure history
with serial CD4, VL, resistance profiles E) Immunizations
pneumococcal, influenza, viral hep, general
A) HIV-associated OIs, neoplasia
B) Non-HIV associated C) STDs D) ARV exposure history
with serial CD4, VL, resistance profiles E) Immunizations
pneumococcal, influenza, viral hep, general
![Page 10: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/10.jpg)
Risk for Opportunistic InfectionsRisk for Opportunistic Infections
Occupational history
Travel history southwest US states, SE Asia, …
Pets
Occupational history
Travel history southwest US states, SE Asia, …
Pets
![Page 11: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/11.jpg)
Physical ExaminationPhysical Examination Usual
Height & Weight
Dermatologic
Rectogenital, including swabs for SILs
Assessment of cognitive status (MMSE/MoCA)
Usual
Height & Weight
Dermatologic
Rectogenital, including swabs for SILs
Assessment of cognitive status (MMSE/MoCA)
![Page 12: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/12.jpg)
InvestigationsInvestigations CBC, ’lytes, hepatic, renal, pancreatic CD4, VL, resistance profile VDRL, HBV, HCV, Toxoplasma, CMV PPD & CXR G6PD, HLA-B*5701 urinalysis, ECG (stool O+P; strongyloides serology) cervical smear
CBC, ’lytes, hepatic, renal, pancreatic CD4, VL, resistance profile VDRL, HBV, HCV, Toxoplasma, CMV PPD & CXR G6PD, HLA-B*5701 urinalysis, ECG (stool O+P; strongyloides serology) cervical smear
![Page 13: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/13.jpg)
Health MaintenanceHealth Maintenance
partner notification safe(r) sex practices drug rehabilitation/safe(r) use vaccinations (HAV, HBV, influenza,
pneumococcal, general) age-appropriate screening/prevention
partner notification safe(r) sex practices drug rehabilitation/safe(r) use vaccinations (HAV, HBV, influenza,
pneumococcal, general) age-appropriate screening/prevention
![Page 14: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/14.jpg)
Decision to start HAARTDecision to start HAART
Usually not to be taken at first visit… Need a bit more data
CD4, VL and resistance profile decision regarding OI prophylaxis willingness to take medications every day…
Usually not to be taken at first visit… Need a bit more data
CD4, VL and resistance profile decision regarding OI prophylaxis willingness to take medications every day…
![Page 15: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/15.jpg)
SummarySummary
Quite a few data points to cover Your agenda and their agenda may be
different - take your time Remember to address what they’re worried
about will I die can you help me can I have kids?
It may take more than one visit!
Quite a few data points to cover Your agenda and their agenda may be
different - take your time Remember to address what they’re worried
about will I die can you help me can I have kids?
It may take more than one visit!
![Page 16: First Cont(r)act The Initial Evaluation of the HIV infected patient Patrick Willemot 2010 September 23 The Initial Evaluation of the HIV infected patient](https://reader036.vdocuments.net/reader036/viewer/2022062409/5697bfd71a28abf838cae77a/html5/thumbnails/16.jpg)
Questions?
Comments?
Concerns?
Questions?
Comments?
Concerns?