Communication Skills: Explaining a Diagnosis of Humman Immunodeficiency Virus (HIV)

HIV is a common condition, with over 100,000 people in the UK living with the disease. Up to a third of these do not know they have HIV and you may be asked to explain HIV to a patient with a new diagnosis.

OSCE scenario: This 25 year old man has recently been diagnosed with HIV and has some questions. Please discuss with him.


Introduction
  • Introduce yourself
  • Wash your hands
  • Ask permission to discuss his recent diagnosis with him
  • Remind him that anything you discuss will be confidential
  • Start by checking his understanding ‘tell me what you understand about HIV’

 

What is HIV?
  • HIV is a virus that attacks the body’s immune system
  • Untreated it can be serious and cause you to suffer from infections
  • However, good treatments are now available and most people living with the disease in the UK live a normal life-span
  • If they ask about AIDS:
    • AIDS is ‘acquired immunodeficiency syndrome’
    • This is when the HIV virus has become very active in the body, usually  because no treatment has been taken
    • Increased risk of unusual, difficult-to-treat and potentially life-threatening infections

 

How did I get it?
  • There are lots of different ways you can contract HIV:
    • Sexual intercourse with an affected individual
    • Sharing of needles during intravenous drug use
    • Transfusion of infected blood products (rare in modern medicine)
    • Transmission from mother to baby
    • Healthcare workers: needlestick injury, blood splash
  • If there is a known method of transmission then explain to the patient that other people at risk will have to be tested for the condition
  • The patient may not know how they contracted HIV – the test cannot tell them where or when they contracted it.

 

What are the symptoms?
  • May not have any symptoms
  • Acute HIV can cause a fever, lymph node swelling and a generalised rash
  • Chronic HIV symptoms are usually related to infections that you contract rather than underlying HIV

 

What is the treatment?
  • There are three main-stays of treatment:
  1. Treatment of HIV virus
    1. Using antiretroviral therapy (ART)
    2. This is usually a combination of three medications (can sometimes be given in one tablet)
    3. Medications can have serious side effects but you will be informed about these and how to look out for them
    4. You will likely be starting ART soon and will be on medications for life
  1. Preventing infections
    1. Depending on your blood tests (CD4 count) you may be given medications to prevent you developing serious infections before you get them (primary prophylaxis – see Table A below)
    2. Depending on occupational and environmental exposure other treatments may also be given e.g. syphilis prophylaxis
  1. Treating infections
    1. There are different types of infection which will be treated with different types of medication (see Table B below)
    2. Some infections can cause an increased risk of cancer e.g. Kaposi’s sarcoma, lymphoma
  • Your HIV care will be looked after by a specialised HIV team who will monitor your treatment and any potential complications

 

 

Can I give the virus to others?
  • Advise yes, the virus can be transmitted by sexual and blood-transmission, as well as vertical transmission (i.e. mother to baby) if they become pregnant
  • To avoid this they should:
    • Have protected sex (and inform their sexual partner)
    • Not donate blood products
    • Not share products that may contain traces of blood e.g. razors, toothbrushes, needles
    • Comply with ARV treatment which will lower viral load and reduce transmission probability
  • If they want to become pregnant reassure them that with well-managed HIV many women have HIV negative children
  • Advise that anyone at risk of previous transmission should have an HIV test

 

Finish
  • Ask if they have any further questions
  • Offer leaflets/information as to where they can get further information e.g. counselling services
  • Thank them for their time and give contact details of yourself/HIV team


For reference: prophylaxis and treatment of infections in HIV

Table A – primary prophylaxis in HIV

Condition

Medication

When to start

When to stop

Pneumocystis

Co-trimoxazole

CD4 < 200

CD4 > 200

TB

Isoniazid

+ve Tuberculin skin test but no signs active TB OR close contact with known active TB

After 6 months

Mycobacterium avium complex (MAC)

Azithromycin once/week

CD4 < 50 and no signs active MAC

CD4 > 50

Influenza A + B

Influenza vaccine

All HIV patients

 

Streptococcus pneumonia

Pneumococcal infections

All HIV patients, then repeat depending on CD4 count

 

 

Table B – Infections in HIV

Class

Agent

Condition

Treatment

Bacterial

Mycobacterium tuberculosis

TB

Anti-TB medication

 

Mycobacterium avium complex

Respiratory illness

Azithromycin + ethambutol

 

Salmonella

Diarrhoea

Ciprofloxacin

Viral

CMV

Retinitis

CNS disease

Gangciclovir

 

EBV

Non-Hodgkin’s lymphoma

CHOP

ART

 

Herpes zoster

Shingles

Aciclovir

 

Hepatitis B

Hepatitis, cirrhosis

ART containing tenofovir and lamivudine (active against HBV)

 

JC virus

Progressive multifocal leucoencephalopathy (PML)

ART

 

Human herpes virus 8

Kaposi’s sarcoma

ART

Fungal

Crytococcus neoformans

Cryptococcal meningitis

Amphotericin B + flucytosine à fluconazole maintenance

 

Candida albicans

Candida (oral, oesophageal, vaginal)

Nystatin

Fluconazole

 

Histoplasmosis

Rash, respiratory illness

Amphotericin

 

Pneumocystis jiroveci

Pneumonia

Co-trimoxazole

Parasitic

Toxplasma gondii

Cerebral Toxoplasmosis

Pyrimethamine + sulphadiazine + folinic acid

 

Cryptosporidium

Diarrhoea

Start ART



References:

written by: naina_mccann, first posted on: 19/01/2017; 17:18

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