HIV management in general practice

chapter 60 HIV management in general practice



INTRODUCTION AND OVERVIEW


Human immunodeficiency virus (HIV) infection has had, since the early 1980s, a global impact of unprecedented scale, including the decimation of some populations and the retardation of some nations’ development. There have also been revolutions in our understanding of immunology and the pharmacology of anti-retroviral treatments. Researchers in all the sciences have had to change the way they investigate and communicate with affected communities. There have been changes, too, in the way communities are harnessed to prevent and to care, but also in how they can be stigmatised and blamed.


Globally, in 2007, it was estimated that 30–36 million people were living with HIV infection, with a death toll to that point of 1.8–2.3 million.1


General practitioners have always had a central role in the delivery of healthcare to communities (especially marginalised groups) and they have played a key role here as well. Their skills in chronic disease management, their teamwork, their holistic view of health and their long-term relationships with patients and communities all contribute to the care they can bring to the HIV-infected patient.


The HIV epidemic continues to grow and change around the world, influenced by many factors, including but not confined to:








How many HIV-infected patients are managed in general practice? The BEACH study in Australia counted 80 consultations per 100,000 and this low figure would probably be seen in other similar developed countries, where it is a predominantly gay male population that is affected.3


However, within all capital cities there are general practice clinics that have a special interest in sexual health and which would see a vastly greater number of HIV-infected patients. In countries where the prevalence of HIV is much higher and health resources are much more scarce, the GP will be seeing many cases of HIV every day. In those countries HIV is high on the differential diagnosis for any chronic health complaint.


For the GP, therefore, different roles are possible, from sole management, through shared care, to early referral. The role chosen will depend on the setting, the interest of the doctor and the resources available.


In resource-poor communities where there are limited antiviral agents available there will be a higher involvement of primary care / general practice and more reliance on traditional healing and so on. However, even here the number of people with HIV who are taking antiviral medications is growing, with the primary care being delivered in a variety of ways.4


In resource-rich communities there is greater complexity of choices and an interest in complementary/integrative measures. Here there will be more centralisation of care to specialist doctors and clinics. Yet even so there is a large burden of poverty within the HIV-affected community and consequent difficulties in gaining access to best care.5


Other important aspects of this disease are:








PRIMARY PREVENTION IN GENERAL PRACTICE


HIV transmission is mainly the result of certain behaviours. General practice is well placed therefore to tackle the following:







Jun 3, 2017 | Posted by in GENERAL SURGERY | Comments Off on HIV management in general practice

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