Transcript all slides - Capitol Region Telehealth Project

I. Jean Davis, PhD, PA, AAHIVS
Manager - Clinical Services
Desert AIDS Project

Discuss the benefits of Antiretroviral Therapy in
reducing mortality and/or AIDS-related
morbidity.

Discuss the role of ART in reducing the risk of
disease progression in individuals infected with
HIV.

Discuss the role of ART in the prevention of
transmission of HIV for individuals infected with
HIV.

Mr. Wilson is a 35 year old Black male, diagnosed with HIV 5 years ago. He
initiated a medication regimen at the time of diagnosis, but returned to IV
drug abuse 3 years ago and was lost to care. The patient denies a history
sexual activity with men. He states that he acquired HIV while injecting drugs.
He does not recall the name of the ART, but states he was taking at least 2
medications.

Patient has been married for 1 year. His wife is a case manager at the
substance abuse center where he “resolved his need to use drugs”, 2 years
ago.

Mr. Wilson states he has mild high blood pressure and started taking Dyazide
over a year ago. He was told he had borderline diabetes. He states he has
never taken medication for his diabetes. He has a family history of
cardiovascular disease, diabetes and cancer. His eldest brother had both
legs amputated 4 years ago at age 62 and died last year due to
complications.
Inpatient Management
Serologic
Testing
OI
Prophylaxis
Outpatient Management
HAART

Less than one-third of HIV-infected individuals
in the United States have suppressed viral
loads.

Despite remarkable improvements in HIV
treatment and prevention, economic and
social barriers resulting in:
 Morbidity
 Mortality
 HIV infections persist

The evaluation of Initiating or Restarting Therapy should
include:


a discussion on the benefits of antiretroviral therapy (ART)
The following laboratory tests performed during patient visits
can be used to stage HIV disease and to assist in the selection
of ARV drug regimens:




HIV antibody testing
CD4 T-cell count (CD4 count)
Plasma HIV RNA (viral load)
Complete blood count, chemistry profile, transaminase levels, blood
urea nitrogen (BUN), and creatinine, urinalysis, and serologies for
hepatitis A, B, and C viruses
 Fasting blood glucose and serum lipids
 Genotypic resistance testing

ART has dramatically reduced HIV-associated
morbidity and mortality and has transformed
HIV disease into a chronic, manageable
condition.

Patients should also be told that untreated HIV
infection will eventually lead to immunological
deterioration and increased risk of clinical
disease and death.

HIV-associated immune deficiency, the direct effects of HIV on end organs, and
the indirect effects of HIV associated inflammation on these organs all most
likely contribute to HIV-related morbidity and mortality.

Untreated HIV infection may have detrimental effects at all stages of infection.

ART is beneficial even when initiated later in infection.

Sustaining viral suppression and maintaining higher CD4 count may delay,
prevent, or reverse some non-AIDS-defining complications:
 HIV associated kidney disease
 Liver disease
 CVD
 Neurologic complications
 Malignancies

In addition, effective treatment of HIVinfected individuals with ART is highly
effective at preventing transmission to sexual
partners.

Clinicians should also inform patients that
viral suppression from effective ART can
reduce the risk of sexual transmission to
others.

Mr. Wilson is a 35 year old Black male, diagnosed with HIV 5 years ago. He
initiated a medication regimen at the time of diagnosis, but returned to IV
drug abuse 3 years ago and was lost to care. The patient denies a history
sexual activity with men. He states that he acquired HIV while injecting drugs.
He does not recall the name of the ART, but states he was taking at least 2
medications.

Patient has been married for 1 year. His wife is a case manager at the
substance abuse center where he “resolved his need to use drugs”, 2 years
ago.

Mr. Wilson states he has mild high blood pressure and started taking Dyazide
over a year ago. He was told he had borderline diabetes. He states he has
never taken medication for his diabetes. He has a family history of
cardiovascular disease, diabetes and cancer. His eldest brother had both
legs amputated 4 years ago at age 62 and died last year due to
complications.





What additional history do we need?
What lab tests should we order?
What co-morbidities are our concerns?
What impact would ART have on his quality
of life and health?
What health promotion, disease prevention
education would you provide for Mr. Wilson?
Howard University HURB 1
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Washington, DC 20001
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202-667-1382 (Fax)
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