Download Chronic disease management of HIV

Chronic disease management
of patients with HIV
Maia Pinsky, MD-R3
Family Medicine Residency of Idaho
 Disclosures
 I have no financial relationship or interest with any
proprietary entity producing health
 care good or services to disclose
Outline
● Overview of HIV care
● Chronic disease management
● Conclusion
 Chronic disease management of HIV
● HIV infection
● Cardiovascular
● Pulmonary
● Neuropsychiatric
● Renal
● Hepatic
● Bone
● Cancer
● Immunizations
● OI Prophlyaxis
Factors that influence chronic disease
Viral infection/immunosuppression
○ Long-term infection may have effects despite normal CD4 count
○ Not completely understood, but may be related to chronic
inflammation
● Medication side effects
○ Many different manifestations
○ May be magnified with prolonged used
○ Drug-drug interactions
● Associated risks
○ May be related to how HIV was contracted
 Cancer
● Cervical cancer
○ 4-5x increased risk of CIN
○ PAP testing for lifetime, more frequent testing interval
● Anal Cancer
○ Anal pap if high-resolution anoscopy is available in community
○ No consensus screening guidelines currently
● Colon, breast, prostate, lung
○ No change in screening recommendations
Resources for physicians
● FMRI
● HIVMA/IDSA Guidelines
● CDC
● AIDSinfo.nih.gov
● National HIV Clinicians Consultation Center - UCSF
● Clinicians Warmline 1-800-933-3413
● HIV Drug Interaction Checker - University of Liverpool
Summary
● HIV has largely become a chronic disease in the US
● Role of primary care physician in coordination with HIV
specialist
● Chronic disease states in pts with HIV - some different
considerations (viral infection, medication side effects,
associated risks) but we can often use the same models for tx
● Prevention is still the key!!
THANK YOU