Managing HIV in General Practice
1 JUNE 2011
Advances in the care and the treatment of HIV have significantly increased life expectancy for many people living with this illness. In Australia, the focus has shifted from acute illness and palliative care to chronic disease management, which means that many people with HIV now receive much of their care from general practitioners.
Writing in this month’s Australian Prescriber, Adelaide general practitioner Dr Tom Turnbull says given that patients with HIV are living longer, it is important that general practitioners know which problems can be managed in general practice and when these patients should be referred.
“Treatment with antiretroviral therapy is generally lifelong and requires a great deal of commitment from patients, who require continued monitoring and support. Most people with HIV see their doctor every three months for review and routine blood testing. General practitioners can play a pivotal role in helping patients to address problems with their general health, adherence to medications, adverse effects of treatment, psychosocial wellbeing, broader preventive health and sexual health.”
“Sexual health is an important issue in HIV management on many levels. The general practitioner should consider such issues as sexual behaviour and potential risk for HIV transmission as well as the risk of acquiring other sexually transmitted infections.”
“Mental health problems, particularly depression and anxiety disorders, are common among people living with HIV. General practitioners are involved in the management of mental health problems, including pharmacotherapy, developing Medicare-funded mental health treatment plans with their patients and facilitating referral for psychological therapy,” Dr Turnbull writes.
“It is important for general practitioners to be familiar with recommendations around vaccinations. This includes standard vaccinations, like influenza and pneumococcal, which are offered to patients with chronic conditions,hepatitis A and hepatitis B (in those who are not immune), as well as vaccinations relevant for travel.”
Many of the complex issues facing patients with HIV, such as cardiovascular disease, diabetes and osteoporosis, are familiar to general practitioners looking after people with any chronic condition.
“Management plans can assist in a number of ways by clarifying the issues for both the patient and doctor. They enhance communication and can facilitate appropriate referral to allied health practitioners and counsellors,” he writes. Medication-related problems are also common.
“Zidovudine and other antiretrovirals are associated with a benign increase in mean cell volume. This is not harmful, but other causes need to be considered and excluded. Zidovudine can also cause life-threatening haemolytic anaemia and bone marrow suppression. HIV infection causes thrombocytopenia which can respond to antiretroviral therapy.”
“Antiretrovirals interact with a wide range of drugs so check for potential interactions before adding a new drug – start low, go slow and monitor the patient closely. If a patient presents with an adverse event, check if they have recently started any new drugs. It is important to be familiar with some of the potential drug interactions with antiretroviral medicines. Common medications that interact are St John's wort and fluticasone,” Dr Turnbull says.
To read this article and others, visit www.australianprescriber.com
Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published by NPS, an independent, not-for-profit organisation for quality use of medicines funded by the Australian Government Department of Health and Ageing. Australian Prescriber is published every two months, in hard copy that is distributed to health professionals free of charge, and online in full text at www.australianprescriber.com