Each HIV-infected patient initially entering into care should have a complete medical history, physical examination, laboratory evaluation, and counseling. The purpose is to confirm the presence of HIV infection, obtain appropriate baseline historical and laboratory data, ensure patient understanding about HIV infection and its transmission, and initiate care. The initial evaluation also should include introductory discussion on the benefits of antiretroviral therapy (ART) for the patient’s health and to prevent HIV transmission. Baseline information then is used to define management goals and plans (DHHS, 2013).
The CD4+ T-cell count (or CD4 count) serves as the major clinical indicator of immune function in patients who have HIV infection. It is one of the key factors in determining the urgency of antiretroviral therapy (ART) initiation and the need for opportunistic infection prophylaxis. it is also the strongest predictor of subsequent disease progression and survival according to clinical trials and cohort studies (DHHS, 2013).
Before 1996 there were three medications available to treat HIV. These drugs were used singly and were of limited benefit. Researchers in 1996 discovered that combinations of these and newer medications dramatically reduced the amount of HIV (viral load) in the bloodstream of a person infected with HIV. Two or three different medications are used in combination. Each one targets a separate part of the virus and its replication. The reduction of deaths from AIDS in the United States has been primarily attributed to this combination therapy, called highly active antiretroviral therapy (HAART).
Many studies have demonstrated that better outcomes are achieved in HIV-infected outpatients who are cared for by a clinician with HIV expertise. Appropriate training and experience, as well as ongoing continuing education, are important components for optimal care. Primary care providers without HIV experience, such as those who provide service in rural or underserved areas, should identify experts in the region who will provide consultation when needed (DHHS, 2013).