Treatment Plan
Treatment Plan
– complexed and carried out by secondary care
Antiretroviral therapy:
- Initiated/monitored in secondary care
- Aim: CD4 >500
If there is a new diagnosis & no indication for urgent referral:
- Discuss diagnosis with patient and suggest urgent referral (aim to be seen in <48 hours, but can be seen up to 2 weeks after testing positive)
If the patient develops acute AIDS-related symptoms:
- Admit is:
- Acutely unwell
- Respiratory symptoms suggestive of LRTI (pneumonia/TB) o Visual symptoms (CMV Retinitis) o Kaposi sarcoma of the lung/gut is suspected o Serious life-threatening adverse effects of ART – Refer if:
- Respiratory (likely admission, but discuss if unsure)
- GI (Oesophageal candidiasis/persistent diarrhoea/co-infection of viral hepatitis) o Skin (Kaposi sarcoma)
- Oral (severe or resistant oral candidiasis, if gingivitis/dental abscess then refer to dentist) o Genital
- Warts – gum clinic
- Cancer features – 2wk referral (?anal squamous cell carcinoma is linked to HIV patients)
- Cervical screening – Colposcopy should be done initially and then annually
Post-exposure prophylaxis:
- Within 24 hours (up to 72 hours)
- Medical emergency if occupations & sexual potential exposures – need urgent referral & post-exposure prophylaxis (continue for 4 weeks)
- Review within 48 hours or 2 weeks if positive