Basic management and monitoring of HIV infection

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Once HIV infection is diagnosed, a person has a life-long condition which will go through several stages and has many consequences. The disease needs to be managed by people with HIV themselves as well as their healthcare providers.

An overview of the needs of a person with HIV infection (not necessarily in order of priority) is as follows:

1. Education / information – learning how to best take care of yourself, staying informed about new treatments or approaches
   
2. Maintaining general health – self care, nutrition
   
3. Financial planning – medical aid, future provision for self and dependents
   
4. Monitoring HIV disease – regular medical check-ups, monitoring tests
   
5. Preventing opportunistic disease – avoiding exposure, alertness to early signs of disease, prophylactic medication
   
6. Psychological health – informing others, dealing with stigma, spiritual support, managing anxiety and depression
   
7. Sexual and reproductive – safer sex for partners and self, whether to have a baby, avoiding infection of the baby
   
8. Antiretroviral treatment
   
9. Terminal care – care and treatment during the final stages of the disease.

Monitoring HIV disease
A person with HIV should see a healthcare provider regularly, which may be as little as twice a year if you have no symptoms and are coping well, or more frequently - perhaps four times a year if symptoms have started and antiretroviral treatment is being taken, or as frequently as required when very ill (daily or weekly).

Even if you are fairly well, these regular visits to your healthcare provider are important because they may lead to new conditions being detected and treated early on, before they become dangerous or beyond treatment. Also, it allows your healthcare provider to start preventative treatments (prophylactic medication) in good time.

At each visit, a medical history should be taken of symptoms or other problems, followed by a physical examination to look for signs of HIV related disease.

The physical examination would usually include:

• Checking body weight
  
• Inspection and/or palpation (feeling) of
  o Skin
  o Mouth and teeth
  o Lymph nodes
  o Respiratory system
  o Abdomen
  o Genitals
  
• Eyes: eyesight can be tested by reading from a chart, and the back of the eye (retina) can be examined using a special torch (opthalmoscope).
  
• Examining the nervous system usually involves some basic tests of strength, reflexes and co-ordination of the limbs, tests that the cranial nerves (nerves of the head) are functioning, and sometimes tests of memory and thought.

The following tests that require samples for laboratory analysis may also be done:
Certain blood tests are usually done regularly and will require that one or more tubes of blood are taken through a needle, usually from a vein in the arm.

• Full blood count: this test looks at the levels of the different cells that make up blood - red cells, white cells and platelets. Any or all of these types of blood cells can be low in a person with HIV, due directly to effects of the virus or because of opportunistic infections or cancers. Some of the causes of low blood cells can be treated.
  
• A CD4 T-cell count specifically measures the level of the special white cells (T helper cells) that are infected and destroyed by HIV. It is important to keep track of the level of your CD4 cells since this indicates how severe your immune deficiency is.
  
• A viral load test may be done from time to time, and will be done regularly if a person is taking antiretroviral treatment. The viral load test shows the level of HIV in the blood, with higher levels meaning more virus activity and quicker damage to the immune system.

At the first visit, and sometimes at follow up visits, tests for other infections that are passed on through sex (sexually transmitted diseases or “STDs") will be done, so that these infections can be treated if possible. These include blood tests for syphilis and Hepatitis B.

Sometimes other investigations may be done, depending on a person’s symptoms - for example, a chest X-ray to detect TB (tuberculosis) in the lungs.

If a person is on TB treatment or antiretroviral treatment, other blood tests may be done to check that the liver and kidneys are functioning well, since almost all drugs are processed by the liver or kidneys and sometimes cause damage to these organs. 

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