Advances in the Diagnosis and

Sponsored by
The Academy of Medicine of New Jersey

through an unrestricted educational grant from
DuPont Pharma.

Credit

The Academy of Medicine of New Jersey designates this activity for a maximum of 1 hour in category 1 credit towards the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

 

Disclosure

Dr. Barnish has nothing to disclose

Objectives

Upon completion of this activity, you should be able to:

• identify at-risk populations for HIV infection and counsel patients on avoiding high-risk behavior and exposures to HIV.
• determine when HIV testing is appropriate and how to adequately explain the implications of a positive test result.
• understand the types of HIV diagnostic tests available and be familiar with the advantages and limitations of each test.
• discuss the importance of antiretroviral therapeutic intervention for HIV-positive pregnant women and how that treatment is administered.
• appreciate the issues of confidentiality, notification of exposed persons, and reporting.
• know how to perform initial staging of an HIV-positive person, including immune status, underlying illnesses, and potentially complicating factors such as social issues and financial circumstances.
• determine the follow-up necessary to maintain the health status of an HIV-infected person, including blood test monitoring, social issues, vaccinations, and physical examinations.
• understand the importance of appropriate antiretroviral therapy to prevent resistance and keep viral load as close to undetectable levels as possible.
• recognize the advent of a failing drug regimen and be able to initiate appropriate adjustments in therapy.
• know when and how to provide prophylaxis against opportunistic infections, including Pneumocystis carinii pneumonia and Mycobacterium avium complex.

Date of release: June 1998

 Introduction

In the 16 years since AIDS entered our collective consciousness, knowledge of the pathogenesis, clinical developments, and social attitudinal changes of the syndrome as well as the HIV virus have progressed at a fast pace. HIV is a retrovirus that progresses through various stages of reproduction. As such, the use of increasingly effective antiretroviral agents to markedly attenuate the progression of the disease is one of the most significant milestones accomplished recently. Over the last 2 years, patient survival has been realistically discussed in terms of decades, potentially, rather than years. Most importantly, these years can have an acceptable quality of life.

These developments have profoundly impacted on the importance of early detection of the disease. Although most of the interventions now available can significantly alter progression of the disease, the best responses occur in the earlier stages of infection. This is true for medication efficacy as well as observation of fewer side effects. As will be shown from the following discussions, these findings have placed more pressure on the medical community and general population to be able to recognize those undiagnosed persons at risk, to detect infection, and to intervene at a time when an impact can be made. Evaluating for the first time an HIV-infected person who has a CD4 lymphocyte count of 600 is markedly different—from a prognosis perspective—from seeing someone with a count of 15.