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to end the HIV epidemic

As an HIV provider, you are on the frontline in the fight against the HIV epidemic. Help Stop the Virus provides healthcare professionals with insights from HIV specialists on HIV care, patient resources, and tools. Together, we can work to Help Stop the Virus.

HIV specialist perspectives: how baseline evaluations help guide patient care


Open, effective communication between patients and physicians is key to developing a relationship that engages HIV patients in care. In the four short videos below, 3 HIV specialists discuss how they educate and connect with their patients while conducting baseline evaluations.4 See the DHHS Guidelines
for more information.

Every HIV-infected patient entering into care should have a comprehensive history taken. This includes a medical history—including antiretroviral (ARV) use and current use of concomitant medications, vitamins, and herbal supplements—and a social/sexual history, including tobacco, alcohol, and recreational drug use, as well as family medical history.1,4

A physical examination should be conducted that reviews HIV-related symptoms and screens for sexually transmitted infections (STIs) and opportunistic infections (OIs) as well as age- and sex-specific health problems. In addition, it is necessary to obtain appropriate laboratory evaluations, including confirmation of HIV diagnosis using an HIV serological test, in order to stage HIV, assist in selecting drug regimens, and determine the need for OI prophylaxis.1,4

The initial evaluation should also include a discussion on the benefits of antiretroviral therapy (ART) for the patient's health and to prevent HIV transmission.1

Information gathered during the baseline evaluation can be used to define patient treatment goals and efforts to optimize adherence to HIV care as well as to assess non-adherence hurdles that can include mental health, social, and economic factors. The evaluation should also assess the patient's readiness for ART.1

Providers should ensure patient understanding about HIV, its transmission, and reduction of any risk behaviors. It is important to recognize how the patient is coping with the diagnosis of HIV infection, to whom they have disclosed their HIV status, and what support systems they have in place.1

Quick Survey

Select an answer below and see the responses of others

Prompt initiation of antiretroviral therapy (ART) in all diagnosed patients regardless of CD4 cell count is recommended in the DHHS Guidelines. What percentage of your newly diagnosed patients present with normal CD4 counts between 500 and 1600 cells/mm3?1,2

While many patients will present with a normal cell count (between 500 and 1600 cells/mm3), recent research has shown that starting treatment even if a patient's CD4 cell count is >500 cells/mm3 significantly improves key patient outcomes.3

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References:
  1. U.S. Department of Health and Human Services. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Available at https://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed July 14, 2016.
  2. CD4 count. AIDS.gov website. Available at https://www.aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/understand-your-test-results/cd4-count/. Updated July 14, 2016. Accessed December 20, 2016.
  3. The INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795-807.
  4. Aberg JA, Gallant JE, Ghanem KG, et al; for the Infectious Diseases Society of America. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV medicine association of the Infectious Diseases Society of America. Clin Infect Dis. 2014;58(1):e1-e34.