A Guide to Primary Care of People with HIV/AIDS

People with HIV/AIDS can live longer, healthier lives because of advances in treatment of HIV infection. However, longer lives are associated with increased prevalence of 1) adverse effects of HIV infection, 2) adverse effects of the drugs used to treat HIV, and 3) concurrent medical conditions that would occur in the absence of HIV. These long-term complications have put HIV infection in the realm of chronic diseases rather than of infectious diseases, which usually respond to short-term clinical interventions. Effective management of chronic diseases in the primary care setting requires the coordination of interventions that occur at the level of the clinical services, the community supports for those clinical services, and the individual patient. While clinical services begin in the primary care clinic, community supports are needed, and the patient must be engaged to enhance self-management. The coordinated interventions together contribute to the desired clinical outcomes. The Chronic Care Model, which is used in the design and quality improvement activities of clinical services, conceptualizes how these factors impact the clinical outcome of chronic disease management. This book addresses several important aspects of HIV/AIDS care and treatment in a concise, accessible format; it is not meant to be a comprehensive reference book. Recommended references and citations are provided for the reader to be able to access in-depth information on topics that are particularly important and/or controversial. Appropriate use of antiretroviral drugs, treatment of opportunistic infections, symptom management, treatment of concurrent medical conditions, and other specific interventions to treat HIV disease and its complications are addressed. The format of this guide is designed to provide practical information for the common questions that arise in the care of patients with HIV infection. Recognizing the broader array of best practices that contribute to effective clinical outcomes among patients with a complex array of service needs, the authors also address patient evaluation, adherence, mental health, substance abuse, overall clinic management, and other factors that lead to improved patient outcomes according to the Chronic Care Model. Last, because the authors recognize the challenges of maintaining clinical practices in the face of rapidly changing and ever more complex treatment interventions, a chapter on sources for updated and in-depth clinical information is provided. Pediatric HIV/AIDS treatment is not addressed in this book.