Preventive counseling, screening, and therapy for the patient with newly diagnosed HIV infection

The epidemic of human immunodeficiency virus (HIV) continues, and the infection is converting into a treatable chronic disease; therefore, it is increasingly important for family physicians to be current with and comfortable in providing basic care to patients infected with HIV. Important aspects of counseling and patient education include stabilization of psychosocial issues and prevention of HIV transmission through behavior change counseling. Reporting HIV and acquired immunodeficiency syndrome (AIDS) is mandatory in most states, whereas partner notification laws vary from state to state. Baseline evaluation includes screening for comorbid conditions such as viral hepatitis, syphilis, and tuberculosis, as well as common HIV-related manifestations such as recurrent candidal infections and thrombocytopenia. Baseline testing includes CD4+ T-lymphocyte cell counts and HIV viral RNA levels to assess HIV disease stage, and numerous studies to screen for opportunistic infections. Initial preventive interventions include patient education to reduce exposure to infections, treatment of comorbid conditions such as human papillomavirus-related dysplasia, and vaccinations such as for pneumococcus and hepatitis B. Prophylaxis against opportunistic pathogens is recommended when CD4+ cell counts fall below 200 cells per mm3. Lastly, the indications for antiretroviral therapy include symptomatic patients or those with AIDS, and pre-AIDS patients with CD4+ cell counts of 200 to 350 cells per mm3 or HIV RNA above 55,000 to 100,000 copies per mL.