Healthcare professionals (HCPs) play a vital role in facilitating the individual’s understanding of HIV and its various aspects and empowering self-management skills.1
Ideally, a management plan is negotiated that includes mutual goals for therapeutic intervention within an agreed timeframe, including1:
- Ongoing viral suppression,
- Maintenance of immune function,
- Lifelong good health, and
- Prevention of onward transmission of HIV infection
The development of a long-term management plan should be facilitated with ongoing assessments and durable record keeping and consider the patient’s other health needs and comorbidities.1
Goals of antiretroviral therapy
The key goals of antiretroviral therapy (ART) are:
- Suppression of HIV replication to below the detection limits of 1,2 clinical assays (<20 copies/mL) function2
- Restore and preserve immunologic survival2
- Reduce HIV-associated morbidity and prolong transmission2
- Prevent HIV transmission2
Maximal and durable viral suppression:
- Preserves CD4 T-cell numbers2,3
- Delays of prevents viral resistance2,4
- Decreases inflammation and immune activation, which may contribute to cardiovascular and other end-organ damage observed in PLHIV2,5
- Reduces transmission of HIV2
This incorporates a medical and social history, which includes:
- family history,
- relationship status, and partner’s risk of acquiring HIV (where applicable),
- drug and alcohol history,
- smoking history, and
- sexual history
Genotypic resistance assays to assess viral strains and select treatment strategies are also included.
Consider the individual’s overall health, including:
- oral and dental,
- general systems
- liver, and
- signs and/or symptoms of neurocognitive impairment.
Concomitant medications and the potential for drug-drug interactions should be regularly assessed.
Mental health status1
The presence of mental health issues may negatively impact adherence to ART, poor diet/reduced exercise, social withdrawal, and increased risk taking.
Therefore, psychosocial and mental health assessments at the initial consult are essential and focus on the impact of the diagnosis and coping skills, pre-morbid psychosocial issues, and specific effects relating to stigmatisation and discrimination.
Regimen side effects2
Consider how side effects with ART regimens could impact on lifestyle and any tolerability or toxicity issues experienced with previous regimens in the short and long term.
It is essential that PLHIV have a thorough understanding of the importance of adherence to prevent the development of drug resistance. Counselling interventions, community resources, family and peer advocates can be utilised to provide education about HIV risk behaviours and to support adherence.
In women, it is important that ART selection considers reproductive intent, contraceptive use and hormone replacement therapy.
Reproductive and sexual health counselling should be offered to all PLHIV who are of childbearing potential.