Makindo Medical Notes

Main causes of death nowadays are coronary artery disease, liver failure (Often have Hep B/C) and lymphoma

New HIV Patient Check

When a patient is newly diagnosed with HIV, a comprehensive initial assessment is essential to evaluate their health status, determine the stage of the infection, and develop an appropriate management plan. This document outlines the key components of a new HIV patient check.

Medical History

• Personal and Family Medical History:
  • Chronic illnesses (e.g., diabetes, hypertension).
  • History of opportunistic infections or other HIV-related conditions.
  • Family history of diseases, including cancer and cardiovascular disease.
• HIV-Related History:
  • Date and circumstances of HIV diagnosis.
  • History of HIV-related symptoms or illnesses.
  • Previous HIV testing and results.
• Sexual History:
  • Number of sexual partners and types of sexual activities.
  • History of sexually transmitted infections (STIs).
  • Use of condoms and other preventive measures.
• Substance Use History:
  • Use of tobacco, alcohol, and recreational drugs.
  • History of intravenous drug use and needle sharing.
• Psychosocial History:
  • Mental health status and history of mental illness.
  • Social support systems and living conditions.
  • Employment and financial status.

Physical Examination

• General Appearance: Assess for signs of wasting, malnutrition, or lymphadenopathy.
• Vital Signs: BP, heart rate, respiratory rate, and temperature.
• Head and Neck: Examine for oral thrush, oral hairy leukoplakia, lymphadenopathy.
• Chest: Auscultation for respiratory infections or abnormalities.
• Abdomen: Palpation for hepatomegaly, splenomegaly, or other masses.
• Skin: Check for rashes, lesions, or Kaposi's sarcoma.
• Neurological Examination: Assess for cognitive function, motor skills, and sensory deficits.

Laboratory Tests

• HIV-Related Tests:
  • CD4 count to assess immune function.
  • HIV viral load
  • HIV genotypic resistance testing to guide ART.
• Baseline Blood Tests:
  • Complete blood count (CBC) to check for anaemia, leukopaenia, or thrombocytopaenia.
  • U&E (creatinine), Glucose.
  • LFTs (ALT, AST, bilirubin).
  • Lipid profile to assess cholesterol levels.
• Screening for Co-infections:
  • Hepatitis B and C serology.
  • Tuberculosis screening (e.g., TB skin test or IGRA).
  • STI screening (e.g., syphilis, gonorrhea, chlamydia).
• Other Tests:
  • Pregnancy test for women of childbearing age.
  • Urinalysis for kidney function and infections.
  • Toxoplasmosis serology, if indicated.

Immunizations

• Review immunization history and update as needed.
• Recommended vaccines may include:
  • Influenza vaccine annually.
  • Pneumococcal vaccine.
  • Hepatitis A and B vaccines.
  • Human papillomavirus (HPV) vaccine.
  • Tetanus, diphtheria, and pertussis (Tdap) vaccine.

Initiation of Antiretroviral Therapy (ART)

• Discuss the benefits and importance of ART.
• Review potential side effects and management strategies.
• Determine the most appropriate ART regimen based on:
  • CD4 count and HIV viral load.
  • HIV resistance testing results.
  • Comorbid conditions and potential drug interactions.
• Emphasize the importance of adherence to ART for optimal outcomes.

Education and Counseling

• Provide information about HIV and its transmission.
• Discuss safer sex practices and harm reduction strategies.
• Address mental health and psychosocial support needs.
• Encourage engagement with support groups and community resources.

Follow-Up Care

• Schedule regular follow-up visits to monitor HIV progression and ART effectiveness.
• Repeat laboratory tests periodically to assess immune function and viral load.
• Screen for and manage potential complications and co-infections.
• Provide ongoing education and support to maintain adherence and overall health.