Guidelines for Counselling About HIV Infection and Disease
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To maintain confidentiality, only the name code the first two letters of the surname followed by the first two letters of the first name is required. Human immunodeficiency virus HIV types 1 and 2 are members of the family Retroviridae. Several weeks after infection with HIV, a number of infected individuals will develop a self-limiting glandular fever—like illness lasting for a week or two seroconversion illness. Infected people may then be free from clinical signs or symptoms for months or years.
The burden of illness is now increasingly due to non-AIDS infections and malignancies, neurological and psychiatric manifestations of HIV, and coronary artery disease accelerated by a pro-inflammatory state induced by HIV. Newer cART regimens are much less toxic, but significant long-term side effects including effects on blood glucose, cholesterol and bone health still occur. Untreated individuals are at risk of specific opportunistic infections and malignancies, and a range of other AIDS-defining illnesses, including:.
Careful history and physical examination, looking for risk factors and clinical manifestations of immunodeficiency, are necessary.
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Molecular techniques, such as polymerase chain reaction PCR to detect proviral DNA sequences, are occasionally necessary to clarify indeterminate results. The period from infection to the primary seroconversion illness is usually 1 to 4. The period from infection to development of anti-HIV antibodies is usually less than 1 month but may be up to 3 months; newer tests have a shorter window period, where a false negative result may be obtained early in infection. There is a group of people with a more rapid onset of disease who develop AIDS within 3—5 years of infection, and another smaller group who do not seem to progress to AIDS.
Occurrence is worldwide. The vast majority of HIV infections occur in developing countries. For the period —, there was a cumulative total of 4, HIV diagnoses in Victoria. Males accounted for 94 per cent of the diagnoses. Male-to-male sexual contact, including homosexual and bisexual contact, accounts for the majority of new diagnoses in men.
In females, heterosexual contact and injecting drug use are the most common risk factors.
Revised Guidelines for HIV Counseling, Testing, and Referral
Infectivity is presumed to be lifelong, although successful therapy with cART can lower the viral load in blood and semen to undetectable levels. The presence of other sexually transmissible infections, especially those with skin or mucosal ulceration, may increase susceptibility. Additional transmission-based precautions apply for specific infections that occur in AIDS patients, such as tuberculosis.
Equipment contaminated with blood or body fluids should be cleaned, and then disinfected or sterilised as appropriate.
Antiretroviral drug therapy is used to treat established HIV infection. Because such treatment is specialised and constantly changing, only those doctors experienced in HIV management should prescribe antiretroviral therapy. For further information, see the current edition of Therapeutic guidelines: antibiotic and the Australasian Society for HIV Medicine website. Other treatment includes specific treatment or prophylaxis for the opportunistic infectious diseases that result from HIV infection. If a person is diagnosed as having HIV infection, the diagnosing practitioner has a responsibility to ensure that sexual and needle-sharing contacts are followed up, where possible.
Assistance with partner notification may be provided by the department through its partner notification officers. The epidemiology of HIV is closely monitored in Victoria. Public health action is informed by enhanced epidemiological information notified to the department. Registration boards should be consulted in relation to their policies regarding healthcare workers with bloodborne viruses.
Recommendations are also included in the Communicable Diseases Network of Australia publication, Australian Guidelines for the management of health care workers known to be infected with blood-borne viruses. Antenatal care should include a comprehensive assessment of HIV risk factors. All pregnant women should be encouraged to undergo HIV testing after appropriate pre-test counselling.
Technical Guidance on HIV Counseling
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When to Initiate ART - AIDS Institute Clinical Guidelines
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