Long term management of people with HIV

Advances in the treatment of human immunodeficiency virus (HIV) have resulted in sustained improvements in the general health and longevity of people living with the virus. Primary care continues to be predominantly delivered by high caseload general practitioners and specialists, but GPs with limited HIV experience are increasingly likely to have contact with HIV positive patients through shared care arrangements.

The aim of this article is to review the management of stable patients with HIV and to provide an approach to important elements of their ongoing care.

The long term care of people living with HIV is increasingly focused on chronic disease management and health promotion. Specific issues include mental health; drug and alcohol use; sexual and reproductive health; cardiovascular, renal, liver and bone disease; malignancies; and prevention, including immunisation. Treatment side effects such as lipodystrophy and peripheral neuropathy are less common with newer agents, but other toxicities are increasingly recognised. The majority of people living with HIV can be managed in the general practice setting, with specialist support where appropriate.