Help Patients Manage HIV Health
The prognosis for people living with HIV (PLHIV) has steadily improved since 2009 when new antiretroviral therapies (ART) have become available. However, this brings about a new set of challenges as PLHIV are increasingly developing common health problems that are seen in the general population.1 Many PLHIV stay virally suppressed with effective ART, but they may also be dealing with health complications, comorbidities, and problems adhering to long-term HIV care.2 Help your patients with HIV manage their health by sharing the tips and guidance below.
HELP PLHIV MAINTAIN VIRAL SUPPRESSION
Initiating ART as soon as possible after an HIV diagnosis is recommended.3 Viral suppression with ART reduces morbidity and mortality and may also reduce the incidence of opportunistic infections (OIs).4 However, in 2016, only 61.5% of PLHIV in one US-based study* were virally suppressed.5 Counsel patients at clinic visits to help them understand the implications of HIV infection and the importance of maintaining ART adherence.
*41 states and D.C. (42 jurisdictions), in patients aged 13 years or older who were diagnosed by year end 2015 and were alive at year end 2016.
KEEP PLHIV FOCUSED ON PRIMARY CARE
People living with chronic HIV infection face an increasing number of primary care concerns that can lead to serious illness.3 Cardiovascular disease, hypertension, osteoporosis, malignancies, diabetes, and kidney disease affect PLHIV in greater proportions and at earlier ages than the general population.6
Screening for primary care conditions may also vary for PLHIV from the general population. For example, while osteoporosis screening is recommended to start at the age of 65 for the general population, for PLHIV it’s recommended at the age of 50.6
In one survey of practicing US infectious disease (ID) physicians, the most commonly reported barrier to primary care screening was that patients declined to be tested; other barriers included inadequate time allotted for clinic visits and non-adherence to ART.6 Patients may need help understanding their primary care health risks and the importance of screening. Educating PLHIV on primary care concerns with regard to HIV may help motivate their engagement in care.
Patient education can be offered during clinic visits and cover a range of topics, including7:
HIV risk reduction
General preventative healthcare and health maintenance
Safer sex practices and disclosure to sexual partners
Substance use and smoking cessation
Nutrition, exercise, diabetes and lipid abnormalities
Domestic violence and other psychosocial issues
The US Department of Health and Human Services provides a number of easy-to-understand fact sheets on primary care and other topics and may be a good starting place for patients to explore.8
72%
of ID physician survey respondents (n=322) cited patient refusal as a barrier to primary care screening6
MITIGATE RISK FOR OPPORTUNISTIC INFECTIONS
Because of a weakened immune system, OIs occur more frequently and are more severe in PLHIV.9 The incidence of OIs has decreased with effective ART; yet, some PLHIV may be vulnerable if they don’t know they have HIV, if they’re not on treatment, or if they’re not virally suppressed. All PLHIV should be familiar with common OIs—such as candidiasis, various cancers, tuberculosis, pneumonia, and others—and work closely with healthcare professionals for OI prevention and treatment.
In addition to maintaining adherence to prescribed medications, help patients understand the following steps for minimizing and preventing OIs by:
Limiting exposure to germs and sexually transmitted infections
Not consuming unpasteurized milk, cheese, or fruit juices; raw seed sprouts; or undercooked eggs
Not drinking untreated water; using bottled water and water filters
Not sharing drug equipment
Getting vaccinated
For PLHIV who develop an OI or want to learn more about OIs, the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents may be helpful.
MONITOR FOR HEPATITIS AND TUBERCULOSIS (TB)
Like HIV, hepatitis B (HBV) and hepatitis C (HCV) are transmitted primarily through sexual contact and injection drug use.10 Co-infection can have serious medical consequences, including an increased risk for liver-related mortality. PLHIV should be counseled on HBV/HCV transmission risks from sexual contact, sharing needles, and unregulated tattooing and body piercing, as well as methods to prevent liver damage.4 HBV vaccines are also recommended for PLHIV and their partners and family members.
In 2018, it was determined that PLHIV were 19 times more likely than the general population to contract TB, which was the leading cause of death for PLHIV worldwide, accounting for roughly 1 in 3 AIDS-related deaths.11 Routine screening is recommended for all PLHIV to ensure early detection and prevent active TB infection. Studies have demonstrated that treatment for latent TB infection in PLHIV reduces the risk of active TB.3
ENCOURAGE PATIENTS TO STAY IN CARE
Keeping PLHIV in regular care is critical for addressing the numerous health concerns at play with chronic HIV infection and promoting positive health outcomes.2 Help PLHIV make the connection that those who stay in care are more likely to be virally suppressed and less likely to develop OIs.
Consider implementing strategies to make it easier for PLHIV to stay in care, such as2,3:
Providing case management to help patients navigate the healthcare system
Removing care barriers by providing transportation to medical appointments, co-locating services, and providing bilingual and culturally competent care
Helping patients recognize the importance of keeping appointments and reminding patients of appointments, using informational brochures/posters and reminder calls
Including peer advocates, outreach workers, and navigators/case managers, as well as all clinic personnel including staff, to provide an optimal care experience that constructively affirms attendance and problem solves with patients to overcome barriers to care
In 2016, while 74.2% of PLHIV received medical care,
only 57.6% met the criteria for continuous care5*
*41 states and D.C. (42 jurisdictions), in patients aged 13 years or older who were diagnosed by year end 2015 and were alive at year end 2016.
References:
1. Aberg J, Gallant J, Ghanem K, et al. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2014;58(1): e1–e34.
2. Higa D, Marks G, Crapaz N, et al. Interventions to improve retention in primary care: a systematic review of U.S. studies. Curr HIV/AIDS Report. 2012; 9(4):313-325.
3. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. AIDSinfo website. http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf. Published December 18, 2019. Accessed March 2, 2020.
4. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents. AIDSinfo website. https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/0. Published February 11, 2020. Accessed March 2, 2020.
5. Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2017. HIV Surveillance Supplemental Report 2019;24(No. 3). http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published June 2019. Accessed March 2, 2020.
6. Lakshmi S, Beekmann S, Pohlgreen P, et al. HIV primary care by the infectious disease physician in the United States—extending the continuum of care. AIDS Care. 2018 May; 30(5):569–577.
7. Primary care approach. Johns Hopkins University HIV Clinical Guidelines Program website. https://www.hivguidelines.org/hiv-care/primary-care-approach/. Published April 2011. Accessed March 2, 2020.
8. Understanding HIV/AIDS fact sheets. AIDSinfo website. https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets. Published March 2, 2020. Accessed March 2, 2020.
9. AIDS and opportunistic infections. Centers for Disease Control and Prevention website. https://www.cdc.gov/hiv/basics/livingwithhiv/opportunisticinfections.html. Published August 6, 2019. Accessed March 2, 2020.
10. HIV and hepatitis coinfections. World Health Organization website. https://www.who.int/hiv/topics/hepatitis/hepatitisinfo/en/. Accessed March 2, 2020.
11. HIV-associated tuberculosis [fact sheet]. World Health Organization website. https://www.who.int/tb/areas-of-work/tb-hiv/tbhiv_factsheet.pdf. Published 2019. Accessed March 2, 2020.
HVUWCNT190034 April 2020
