Related Subjects:
|AIDS (HIV) Neurological Disease
|AIDS (HIV) Respiratory disease
|AIDS Dementia Complex (HIV)
|AIDS HIV Infection
|AIDS(HIV) Gastrointestinal Disease
|Acute Retroviral Syndrome (HIV)
|HIV and Post-Exposure Prophylaxis (PEP)
|HIV and Pre-exposure prophylaxis
|HIV associated nephropathy (HIVAN)
|HIV disease Assessment
1️⃣ Confirming the Diagnosis (NICE NG60 / BHIVA)
- Diagnosis confirmed using UK laboratory algorithm (4th-generation Ag/Ab assay with confirmatory testing).
- If acute infection suspected → perform HIV RNA PCR.
- Baseline CD4 count and HIV viral load must be measured at diagnosis.
- Document last negative test to estimate duration of infection.
2️⃣ Comprehensive Clinical Assessment (BHIVA Standard of Care)
🩺 Medical History
- Symptoms of acute seroconversion (fever, rash, pharyngitis, lymphadenopathy).
- Previous ART exposure (including PEP/PrEP).
- History of opportunistic infections or AIDS-defining illnesses.
- Cardiovascular risk factors (smoking, diabetes, hypertension, dyslipidaemia).
- Liver disease risk (HBV/HCV co-infection, alcohol excess).
- Renal history (important for tenofovir selection).
- Mental health screening and psychosocial assessment.
- Sexual history and STI risk (BASHH standards).
- Discussion of partner notification (confidential and supported).
🔍 Physical Examination
- Weight, BMI, and nutritional status.
- Lymphadenopathy.
- Oral examination (candidiasis, ulcers).
- Skin (seborrhoeic dermatitis, Kaposi’s sarcoma).
- Chest examination (TB signs).
- Abdominal exam (hepatosplenomegaly).
- Neurological screen if CD4 likely <200.
3️⃣ Baseline Investigations (BHIVA 2024)
🧪 HIV-Specific
- CD4 count.
- HIV viral load.
- Baseline resistance genotype (prior to ART).
🧪 Routine Bloods
- FBC.
- U&E and eGFR.
- LFTs.
- Lipid profile.
- HbA1c or fasting glucose.
- Bone profile if indicated.
🦠 Co-Infection Screening (BHIVA / BASHH / UKHSA)
- Hepatitis B (HBsAg, anti-HBc, anti-HBs).
- Hepatitis C antibody ± PCR.
- Syphilis serology.
- NAAT for gonorrhoea/chlamydia (site-specific).
- TB screening (IGRA ± CXR if indicated).
- Toxoplasma IgG if CD4 expected <200.
4️⃣ Immunisation Review (UKHSA Green Book / BHIVA)
- Influenza annually.
- Pneumococcal (PCV followed by PPV23).
- Hepatitis A & B vaccination if non-immune.
- HPV vaccination where eligible.
- COVID-19 vaccination per national programme.
- Avoid live vaccines if CD4 <200 cells/mm³.
5️⃣ Initiation of ART (BHIVA 2024)
- ART recommended for all individuals regardless of CD4 count.
- First-line: integrase inhibitor-based regimen + two NRTIs.
- Consider renal function, HBV status, pregnancy potential, and drug interactions.
- Explain U=U (Undetectable = Untransmittable).
- Arrange follow-up viral load at 4–8 weeks.
6️⃣ Opportunistic Infection Prophylaxis (BHIVA)
- Co-trimoxazole if CD4 <200 (PCP prophylaxis).
- Toxoplasmosis prophylaxis if CD4 <100 and IgG positive.
- TB preventive therapy where indicated.
7️⃣ Follow-Up Monitoring (BHIVA)
- Viral load every 3–6 months once suppressed.
- CD4 less frequent once stable >350 and suppressed.
- Annual cardiovascular risk review (QRISK3).
- Routine cancer screening per national programmes.
🧠 Clinical Perspective
- Modern HIV care is chronic disease management — cardiovascular prevention is as important as viral suppression.
- Most patients achieve undetectable viral load within 3 months of ART.
- Early engagement, psychological support, and adherence counselling determine long-term outcomes.
📚 Core Guideline Sources
- BHIVA Guidelines for the Treatment of HIV-1-Positive Adults (latest update 2024).
- BASHH Partner Notification & STI Guidelines.
- NICE NG60 – HIV testing.
- NICE NG193 – Antimicrobial prescribing (opportunistic infection context).
- UKHSA Green Book – Immunisation of immunocompromised adults.
- EACS Guidelines Version 12 (2023–2025 cycle).
