Infections that last

August 2009

FocusInfections that last

Long term management of people with HIV

Volume 38, No.8, August 2009 Pages 574-577

Justin T Denholm

Michelle K Yong

Julian H Elliott

Background

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.

Objective/s

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.

Discussion

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.

Management of human immunodeficiency virus (HIV) infection has greatly benefited from the development and introduction of a range of new medications and treatment strategies over the past decade. The use of combination antiretroviral therapy (cART) generally results in rapid and sustained control of HIV viraemia and sustained increase in CD4+ T-cell numbers. With improvements in efficacy of ART, the treatment goal has shifted to suppression of plasma HIV viral load to below the limit of detection of routine assays (<50 copies/mL) in all patients. In most patients virological suppression will be associated with an ongoing increase in peripheral CD4+ T-cell count into the normal range. These advances have greatly altered the prognosis of HIV infected patients, leading to decreased opportunistic infections such as Pneumocystis pneumonia and increased longevity.1 The ongoing care of people living with HIV has increasingly focused on common elements of chronic disease management.

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Correspondence afp@racgp.org.au

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