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2007
German

2006
Portuguese
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2005
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Spanisch

2003
Persian (Farsi)

Sven Philip Aries and Bernhard Schaaf

The initial interview

Can and should be spread over several appointments at short intervals.

What the patient should know afterwards

• In general terms, how the virus causes illness.
• The difference between being HIV-infected and suffering from AIDS.
• The importance of CD4 cells and virus burden.
• How third parties can become infected and how this can be avoided with a great degree of certainty.
• That additional venereal diseases should be avoided, as these can worsen the course of HIV infection; and that it is, at least in theory, possible to become infected with another more pathogenic or resistant strain of HIV.
• Where HIV therapy comes in and how good it can be.
• A healthy balanced diet and regular physical exercise can help improve the prognosis.
• Smoking increases the risk of a number of complications.
• Where to find further information.
• The self-help groups and facilities available in the area for the support of HIV-infected patients.
• What further tests are planned and their usefulness for future treatment.

More? HIV Medicine 2007, Chapter 15: Download

HIV Medicine
15th edition
818 pages
PDF, 3.7 MB

What the doctor should know afterwards Infection and risk § When, where and why was the positive HIV test performed? Was there a negative test prior to this? What risks has the patient taken in the meantime? The question regarding risks can help in the assessment of potential dangers for the patient in further treatment. In the case of a patient without recognizable risk, the test result may be held in doubt until confirmation is given (see also "Laboratory"). § Where has the patient been recently? This is important because certain germs, which are dangerous for the immunodeficient patient, occur in specific regions. For example, someone who has lived in Hollywood for a lengthy period has a relevant risk of histoplasmosis (which is very rare in Europe). § What drugs are consumed? Large amounts of alcohol are not only toxic to the liver, but also make adherence more difficult due to loss of control. For smokers, the cardiovascular complications of lipodystrophy during therapy are more threatening. § Family history of diabetes. § Tuberculosis among contacts of the patient. Concomitant illnesses § What previous illnesses, what concomitant illnesses? § Former treated or untreated infections and STDs, including syphilis and Hepatitis B/C? § What medications are taken regularly/occasionally? Social § What is the social background of the patient? What does he do professionally? What duties does he have to fulfill? What are his priorities? Who knows about his infection? Who will help him when he becomes ill? Who does he talk to about his problems? Does he have any friends who are also infected? Is he interested in getting in touch with social workers or self-help groups? The Laboratory § The HIV test is checked in a cooperating laboratory. Cross-reactive antibodies, for example in the case of collagenosis, lymphoma or recent vaccination can lead to false-positive test results. Western blot is only positive if gp41+120/160 or p24+120/160 react. § The HIV-viral load is mandatory. A HIV resistance test should be done if available. § Complete blood count: 30-40 % of all HIV patients suffer from anemia, neutropenia or thrombopenia. Check-up at least every 3-6 months, asymptomatic patients included. § CD4 cell count at the beginning and every 3-4 months thereafter. Allow for variations (dependent on time of day, particularly low at midday, particularly high in the evening; percentage with less fluctuation). § Electrolytes, creatinine, GOT, GPT, gGT, AP, LDH, lipase. § Blood sugar determination in order to assess the probability of metabolic side-effects when undergoing antiretroviral therapy. § Lipid profile, as a baseline determination to check the course of metabolic side-effects when undergoing antiretroviral therapy. § Urine status (proteinuria is often a sign of HIV-associated nephropathy). § Hepatitis serology: A and B, in order to identify vaccination candidates; Hepatitis C, in order to possibly administer HCV therapy prior to ART. § TPHA test. § Toxoplasmosis serology IgG. If negative: important for differential diagnosis, if CD4 cells <150/µl - prevention of infection (no raw meat). If positive: medical prophylaxis if necessary. § CMV serology (IgG). For the identification of CMV-negative patients. If negative: important for differential diagnosis, then information about prevention (safe sex). In cases of severe anemia, transfusion of CMV-negative blood only. If positive: prophylaxis if necessary. § Varicella serology (IgG). If negative: in principle, active vaccination with attenuated pathogens is contraindicated, but at > 400 CD4 cells/µl it is probably safe and perhaps useful. The examination § Physical diagnosis, including an exploratory neurological examination (incl. vibration sensitivity and mini-mental test). § Tuberculin skin test according to Mendel Mantoux with 10IE. Positive if greater than 5 mm: give prophylaxis; if negative: repeat examination annually. The role of the new Interferon-gamma Release Assays is under investigation. § Chest X-ray. Contradictory recommendations, probably only makes sense in case of positive tuberculin skin test, in smokers and in patients with suspected disease of the thoracic organs. § Sonographic scan of the abdomen and lymphnodes. A harmless, informative examination as a baseline finding, but not mentioned in the standard guidelines. § ECG and pulmonary function test. Simple tests to rule out any cardiovascular and pulmonary disease. § For women, a PAP smear upon initial diagnosis, after 6 months and then, if negative, once a year. Important because of the approx. 1.7-fold increase in the risk of cervical carcinoma. § For homosexually active males, an anal PAP smear is recommended every 3 years (due to approx. 80-fold increase in risk of anal carcinoma). § Especially at low CD4 cell counts (e.g. <200/µl) funduscopy (ophthalmological consultancy!) in order to rule out active CMV retinitis or scars. Advisable in cases of good immune status also (photographic documentation as a baseline). § Nutritional advice and/or treatment of malnutrition. § Verifying vaccinations (see chapter on vaccinations). § Checking the necessity of OI prophylaxis. § Checking the indication for an antiretroviral therapy.