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perceived sexual or other risk, so
offer the test again at a subsequent visit and offer information in the interim.
Note that when testing for HIV using the clinical indicator-conditions method, the chance that a test is positive may be as little as 1 in 1000 based on the background prevalence, 12 so most GPs will do many tests and not have any positive results.
WHAT DO I DO WITH THE RESULT?
AS the ordering clinician, arrange for
communication of the result as you would usually do for any testing.
If the result is negative, this is a good opportunity for sexual health promotion, including regular testing and re-testing if inside the window period of infection. In the setting of clinical indicator conditions and no other risk, it is likely that no further HIV testing is required as HIV has been ruled out.
If a positive result has been conveyed to the requesting clinician by the pathologist, this is ideally discussed face to face with the patient, unless the patient has stated they are happy for this conversation to take place over the phone. A face-to-face consultation allows the result to be discussed in an empathetic manner and offers the opportunity to direct the patient to ongoing information and support. ASHM offers a range of supporting clinical resources. 13
All states have an HIV clinical support program that offers specialist advice and linkage to other services( see table 2 and box 4).
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Cutaneous lesions of the nose. In: Head & face medicine Band 6, 2010, S. 7 / CC BY 2.0 / bit. ly / 4fG0Ps7 |
Figure 4. Kaposi sarcoma with characteristic violaceous plaques on the alar and tip of the nose in an HIV-positive female patient. |
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Table 2. HIV referral pathways
Referral pathways for GPs
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Supporting services |
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PROGNOSIS
HIV is a manageable chronic condition when lifelong ARV medication is taken and regular monitoring performed. Many people will have near-normal life expectancy.
The presenting medical condition often improves once ARV therapy is initiated. Combination ARV
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Nationwide
ashm. org. au / resources / hiv-diagnosis-referral
NSW HIV Support Program:
• Patient-centred care and support is at the core of the NSW Ministry of Health’ s HIV Support Program
• The program assists GPs to negotiate additional support, meeting individual needs for each new HIV diagnosis
• The program also provides information for patients around psychosocial and community support services that are available across the state HIV Support Program
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• ACON( AIDS Council of NSW)
• Bobby Goldsmith Foundation( BGF)
• Positive Life NSW
• Pozhet( Positive Heterosexual Service)
• Multicultural HIV and Hepatitis Service( MHAHS)
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All states have an HIV clinical support program that offers specialist advice.
therapy is usually one tablet a day and, in some cases, injectable therapy. These medications have a much improved side-eff ect profile compared with earlier ARV regimens.
Depending on how low the CD4 count is at diagnosis, patients starting ARV regimens may be at risk of immune reconstitution syndrome, a collection of inflammatory disorders associated with paradoxical worsening of a pre-existing infectious process. This could include shingles, PCP and mycobacterium avium complex( MAC), conditions that require management by a specialist in conjunction with the HIV prescriber. It is essential to test for TB in patients with HIV if they are at risk or from high-prevalence countries.
Diagnosing HIV infection before immune depletion( that is, a CD4 count less than 350 cells / μL) improves mortality and morbidity, with ARV therapy allowing immune reconstitution. 14
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Queensland
South Australia
Tasmania
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• STI Contact Tracing for General Practice( Queensland Government)
• Code for the Case Management of Behaviours that Present a Risk for HIV Transmission( SA Health)
• South Australia HIV Primary Care Coordination Program— Specialist Nursing Services( RDNS)
• SHINE SA— not-for-profit provider of primary care services and education for sexual and relationship wellbeing
• Tasmanian Government Sexual Health Services( bit. ly / 40LSjBS)— provides links, guidelines and referral pathways for clinicians in Tasmania
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• HIV Disclosure and the Law( Queensland Government)
• Queensland Positive People( QPP)— Patient resource
• Relationships Australia— Services for people living with HIV
• Positive Life SA— A peer-driven community organisation for people living with HIV / AIDS in South Australia
• South Australia HIV Primary Care Coordination Program— for people living with HIV in South Australia( RDNS)
• SAMESH-SHINE SA— provides support, education and training about sexual health and HIV for men who have sex with men and people living with HIV, as well as services for the broader LGBTIQ community in South Australia
• AIDS Council of South Australia
• The Tasmanian Council on AIDS, Hepatitis and Related Diseases( TasCAHRD)— TasCAHRD / Redthread has provided support for people living with HIV and their families for over 30 years in individual support, including housing and other services
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Victoria |
• The Alfred provides a statewide HIV service, which provides comprehensive care for Victorians affected by or infected with HIV; this includes acute care, chronic illness management, health maintenance, prevention and health promotion |
• Living Positive Victoria( LPV)— a not for profit, community based organisation that, since 1988, has been representing all people living with HIV in Victoria. It is committed to the advancement of human rights and wellbeing of all people living with HIV
• Thorne Harbour Health( formerly the Victorian AIDS Council)— leads the fight against HIV / AIDS by providing care and support to people living with HIV through health promotion and advocacy. It aims to improve the health outcomes for gender, sex and people from sexually diverse communities
• Positive Women Victoria— provides peer support, information and advocacy for women who are living with HIV
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Western Australia |
• Time of Diagnosis specialist advice sheet( WA Department of Health)— a contact list of helpful organisations for GPs and their patients during the time of HIV diagnosis
• Human Immunodeficiency Virus( WA Department of Health)
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