HIV/AIDS

Approach to Hiv
• History taking & Physical Examination
-Constitutional symptom: fever, lost of weight and lost of appetite.
-CNS: headache, dizziness, seizures, sleep disturbances
-GIT: oral thrush, odynophagia, diarrhea or blood in stool.
-Respiratory: chronic cough and shortness of breath especially on exertion.
-skin lesions, rash.
-Soft tissue swellings.
-urethral discharge or genital ulcers.
• Past Medical/Surgical History
-history of TB, hepatitis, herpes
-DM, IHD, HPT, Renal disorder, Dyslipidaemia.
• Drug History
-avoid drug interaction after commencement of ART
• Social History
-recreational drug user
-any recent tattooing done, recent blood transfusion
-smoking, alcohol
-occupation
-multiple sexual partner, MSM
• Signs
-weight loss
-altered mental status
-lymph node swelling
-skin lessions/ rash
• Laboratory Findings
Investigations:
To confirm HIV diagnosis HIV Serology
-Chemiluminescent Microparticle Immuno
Assay (CMIA) (detects p24 antigen and hiv
antibodies)
- Particle Agglutination (detects Hiv Antibody)
Evaluation of HIV disease HIV Viral Load
Cd4 cell count
Screening of coinfections -VDRL
-HBsAg/ Anti HBs
-HCV RDT

PTB Screening -Chest x-ray

-Sputum Afb
Hematology FBC (low hb, low wbc, low platelet count)
Biochemistry RP, LFT
FBS, FLP
• Treatment
-Antiretroviral therapy (ART) is recommended for all HIV-infected individuals, regardless of CD4 count, to
reduce the morbidity and mortality associated with HIV infection.

-Also to prevent HIV transmission.

-Pre ART Counselling, should be given to individual prior to initiating ART. This includes
1. Understanding of HIV, ART and their potential side effect
2. Perception of personal need of ART
3. Readiness to start therapy including timing and dosing regime
4. Willingness to adhere to lifelong therapy.
5. Psychological and neurocognitive issues that could impact on adherence.
6. Socio economic factors that could impact on adherence
7. Future parenting and pregnancy plan
8. Future follow up and monitoring plan.

-ART Counseling
1. To ensure that patient knows the correct dosage and potential adverse effects
2. To plan follow up sessions and provide contact details if urgent consultation is required due to adverse
effects
3. To discuss the possible occurrence of Immune reconstitution inflammatory syndrome (IRIS) after starting
HAART
-2 NRTI+1 NNRTIs are the preferred option

-The use of D4T(Stavudine) is discouraged, for patients who started on D4T, they should
be switched to TDF (Tenofovir) or AZT(Azidothymidine) after the first 6 months to avoid
its long term adverse effects.

-TDF should be avoided in patients with chronic kidney disease with CrCl <50ml/min

-TDF preferred in patients with Hepatitis B co-infection as it has activity against HV and
Hepatitis B

-AZT should not be initiated in patients with baseline hemoglobin <8.0g/dl, due to bone
marrow toxicity

-NVP is associated with higher risk of rash, Steven-Johnson Syndrome and hepatotoxicity

-NVP must be avoided in women with CD4 count >250 cells/mm3 and men with baseline
CD count >400 cells/mm3 due to significant increase in incidence of symptomatic hepatic
events

-EFV is the NNRTI of choice in individuals with TB/HIV co-infection who are receiving
rifampicin-based TB treatment
Thank You