Primary care of the HIV-infected adult
- Todd M Pollack, MD
Todd M Pollack, MD
- Instructor in Medicine, Part-time
- Harvard Medical School
- Howard Libman, MD
Howard Libman, MD
- Deputy Editor — Primary Care (Adult)
- Professor of Medicine, Emeritus
- Harvard Medical School
Over the past two decades, antiretroviral therapy (ART) has radically altered the natural history of HIV infection . Opportunistic diseases have become less common, and mortality has declined such that most treated HIV-infected patients now have a near normal life expectancy [2,3]. More than 50 percent of deaths in HIV-infected patients receiving ART are now related to conditions other than AIDS . HIV infection appears to increase the risk of non-AIDS-related cardiovascular disease, renal disease, liver disease, and malignancies . In addition, a variety of long-term complications associated with ART have been described.
The emergence of non-AIDS-related conditions highlights the important role of the primary care physician. Based on experience from other chronic medical conditions, general practitioners are well suited to oversee and coordinate a multidisciplinary approach to HIV care. One survey of 102 internal medicine physicians and 75 infectious disease specialists found that generalists with extensive experience in HIV management provided high-quality care to these complex patients . In the United States, there will be a future need for increased involvement of primary practitioners in HIV care given the growing prevalence of persons living with HIV .
The role of the primary physician in the care of the HIV-infected adult will be discussed here, with particular attention to clinical monitoring and health care maintenance. The initial evaluation of the HIV-infected adult is addressed elsewhere. (See "Initial evaluation of the HIV-infected adult".)
In the United States, the HIV Medicine Association of the Infectious Diseases Society of America has published guidelines on the primary care of HIV-infected individuals, which were last updated in 2013 . The recommendations provided in this topic are generally consistent with these guidelines.
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- INITIAL EVALUATION
- FREQUENCY OF CLINICAL EVALUATION
- MANAGEMENT OF ANTIRETROVIRAL THERAPY
- MONITORING FOR COMPLICATIONS
- Hematologic, renal, and hepatic toxicity
- Cardiovascular disease
- - Dyslipidemia
- - Glucose intolerance/diabetes mellitus
- - Hypertension
- - Tobacco use
- Chronic lung disease
- Premature bone loss
- Neuropsychiatric disorders
- Cancer and precancerous lesions
- - Cervical cancer
- - Anal cancer
- - Other cancers
- Sexually transmitted infections
- Viral hepatitis
- Less common HIV-specific toxicities
- CONSIDERATIONS FOR SPECIFIC POPULATIONS
- Patients with low CD4 cell counts
- Men who have sex with men
- Older adults
- Long-term nonprogressors
- OTHER PRIMARY CARE ISSUES
- Behavioral risk reduction counseling
- Food safety
- Pet safety
- Travel safety
- Clinical trials
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS