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CLINICAL POINTERS

CLINICAL EXAMINATION

BASELINE INYESTIGATIONS

Risk behayiour/group

See opposiie

AJI

•    Contact wrth HfYendemic area

Recent arrivai $exuai tourisitopatriate Heanh-care worker BJood traretuston reclpłem

•    Sexualiy aclue

Men who have sex with men Commercial sex woiker Unproteded sex with numerous partners

•    mjection drug user

•    Partner d Hiv-lnfected person

KEY HISTORY POINTS

Confirmed diagnosis in risk group

HIV (assessing time ol HlV acguisition/likdihood of resi stance)

•    CD4C0unt

•    Virai load (VI)

•    Hepatite B (HBV) status

•    Iłepatios C (HCV) antibody

•    nv resistance test

•    Cervlcal smear in women

•    tfepatihs A (HAV) igG antibody

•    Toxopła$ma antibody

•    Cytomegakn/lrus (CMY) IgG antibody

•    Treponema serology

•    Genitounnary mediwie screen

C04 < 200 ceUs/mm’

•    Herpes zoster

•    Actlve tubcraitoss

•    Recurrent pneumococcal pneumofra

•    Demenba

•    B-cell lymphoma

•    Paul-Bunnell negative glandufer tever

•    Necrotlslng gingivitls

•    Other hiv symptomatic cfcsease (Bo* 14.5)

•    Other AJDS-detining dtsease (Box 14.6)

lnvestigations

•    Tt¥omt)ocytopenia/atypjcaityniphocyiosis

•    Lymphopenia

•    Pasitiye markers lor hepaiihs B. hepatits C or syphihs

•    Previous negative wv test

•    Hcstory consistenl with serocorwcrsion (p 400)

•    Known HfV-intected ex-/current partner

? On medcation

•    Eptsodes ot 'unsafe' sex m high risk srtuattons (e g saunas)

•    Previous antenatai screening

•    Mtstoiy d herpes zoster

General

•    Chesi X-ray

•    HCV-RNA

•    Cryptococcal antigen

•    Stoolforova,cystsandparasites

C04 < lOOcelłs/mm’

•    CMVPCR

•    Dilated fundoscopy

•    Electroencephaiogram (ECO

•    Mycobactenal Wood cultures

PRE-TEST COUNSELLING

Oiscuss purpose d test Carry out rtsk assessment Exptixe knowtedge and exptain naturai rustocy ot hiv

Oiscuss transmission and risk reduction Assess likety coptng strategy Explam test proceduro OMaln inlormed consent

i

LABORATORY CONFIRMATION

•    ftrthptace, residence. occupatlon

•    Tuberculosis: past history or contact

•    Travel history/animal contacis

•    Immunisation history (BCG. hepatflls A and B)

•    Recrealional drug use

•    Past sexuaiiy transmltied infecbons

•    Partner and cfokken

•    Others’ kncwledge ot status (to contact if needcd)

•    GP awareness and permission to inform

POST-TEST COUNSELLING

FURTHER ISSUES

On

Immunisations

Hepatibs A and hepatltis B if nonimmune

Pneumovax (at Iniuai dagnose and then 3-5-yearty)

Influenza (yearly)

Consrder tetanus booster (if injcction drug user)

Counsdlmg

Serology using commeroal enzyme-inked immunosorbent assay (ELISA) screening test'

Test resutt negatlve:

Second test 3 months atter last exposure

Test resutt positrve Resiit contirmed using two diflerent immunoassays aiktfor Western biot Second samplo checked Nucleic acid amplilication test⁷ łf: Serocoiwersion suspected Confirming vertical transmission

Test resutt negatńre

•    Oiscuss transmission and need for behaviour modilication

Sater sex, needie exchange

•    Advtse second test 3 months atter last exposure

•    Support ii uninlected partner Test resutt positive

Safe sex/behaviour modification Cryptospońdiai risk and need to boil water

Toxoptosma risk and sale handling ol catsłtter: undercooked meat Lwe vaccmes and travei Orerthe-counter medicines (1 on highty actwe anhretrowrai therapy (HAART) Plans for pregnancy

' Commonty lor HIV-1 antibody. i*V-2 antibody and p24 anbgsn.

¹ Eg. pdymerase cham reaction (PCR) or branched-chain ONA assay.

•    Expłain signilicance and Impiicatlons d resutt

Fcar d disdosure Dłscrlmlnation^sociai re|ection

•    Organise urgent medcat follow-up

•    Assess copmg strategy

•    ProYide verbai and wrltten information

•    Oiscuss conhdenbaiity ssues

•    Organise emotionai and practical support (names/numbers)

Repeat tcsts

Treponemai antibody 3-4 times/year IBV markers every f-2 years HCV antibody every 1-2 years HBVs antibody m Immunised persons to assess need for booster Cemlcal smear yearty loxopiasma and CMV serology ii negatwe ritialty, yearty

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