Biktarvy Pros and Cons
Post-test counseling for HIV+ individuals Biktarvy pros and cons should cover: 1. Information on available medical treatment and counseling services. 2. Development of a comprehensive care plan for the patient. 3. Coping with emotional consequences of learning results, including development of a social support plan. 4. Behavior change to prevent transmission, including how to use condoms and, where appropriate, how to enter drug/alcohol treatment programs. 5. Discrimination problems that could be caused by disclosure of antibody status. (In general, patients should be encouraged to share positive test results only with their closest intimates and to wait before telling others.
Discussing disclosure with professional or peer support group/systems is helpful in making these decisions.) 6. Need to notify partners. Partner Notification Notification strategies available to HIV+ patients include the following: . The patient notifies partner(s) without specific Biktarvy pros and cons assistance by the physician. . The patient notifies partner(s) after receiving specific counseling and assistance from the physician. .
The physician requests the assistance of a public health officer by calling (617) 522-3700, X403. Medical Assessment and Treatment The following medical services have clear public health implications, and should be provided to all HIV+ individuals: . Syphilis serology . Mantoux tuberculin skin test; chest x-ray . Hepatitis screen . Family planning or pregnancy management, where appropriate . Pap smear . Pneumococcal (pneumovax) vaccine . Annual inactivated influenza vaccine.
A Special Note on T4-Cell Monitoring Monitoring a patient's T4-cell (CD 4 lymphocytes) counts, percentages, and ratios of T4/T8 has become the standard mechanism for staging the progress of HIV disease. (See Appendix III.) It should be noted here, however, that test results are somewhat variable from lab to lab. In addition, the number of observable CD 4 cells in an individual patient tends to vary diurnally. As a general rule, therefore, treatment should not be undertaken on the basis of a single T4-cell reading but should be based on an established trend line or otherwise confirmed reading.
Treatment Strategies A variety of diagnostic, therapeutic, and prophylactic measures for medical care of HIV+ individuals are available. Developing therapies and immunological monitoring of CD 4 T-Cells (and other measures of immune function) play an increasingly important role in patient management. The federal Centers for Disease Control and the Massachusetts Department of Public Health recommend Biktarvy pros and cons the following measures for PCP prophylaxis: 1. Unless contraindicated, prophylaxis for Pneumocystis carinii pneumonia (PCP) is recommended for all HIV infected persons with: a. history of a previous episode of PCP, or b. total CD 4 count below 200/mm 3 , or c. CD 4 count below 20% of total lymphocytes. 2. Monitoring of total or percentage of CD 4 counts at least every six months is recommended for all HIV infected persons.
Quarterly monitoring of CD 4 counts is appropriate for all HIV+ persons with CD 4 counts below 200, and may be indicated more frequently in the presence of active symptomatology. -8- 3. Regimens recommended for PCP prophylaxis include: a. oral trimethoprim-sulfamethoxazole (TMP-SMX) 160 mg TMP and 800 mg SMX twice daily with 5 mg leucoverin once daily, or b. aerosolized pentamidine (AP), 300 mg every four weeks via the Respirgard II jet nebulizer.
For additional information, contraindications and precautions for health care workers, see MMWR Guidelines for Prophylaxis Against Pneumocystis carinii pneumonia (PCP) for Persons Infected with Human Immunodeficiency Virus, June 16, 1989. Furthermore, if you have a patient(s) Biktarvy pros and cons who should be receiving aerosol pentamidine but this service is not available in your office or clinic, you should see Appendix VII of this document for advice on how arrangements may be made for this service.
Zidovudine (AZT) can significantly decrease the rate of disease progression in HIV+ people whose CD 4 cell count is below 500. This finding is true for persons with or without HIV-related symptoms. For patients who are asymptomatic, a dosage of 100 mg 5 times a day can be employed with very infrequent adverse reactions. For patients who have had PCP, the FDA now recommends a regimen of 200 mg 6 times a day for 30 days followed by 100 mg 6 times a day thereafter. Currently, there are no recommendations for prophylactic treatment for pregnant women or children under 13 years of age.
However, several clinical trials are in progress. Follow-Up To assure a high standard of care, it is important to evaluate seropositive patients medically and psychologically and to develop and implement a treatment plan and preventive strategies either directly or through referral. A network of medical, psychological, and social support services can be of significant value for the health and well-being of HIV-infected individuals. The MDPH recommends that physicians be familiar with the community Biktarvy pros and cons resources available to assist the patient with a variety of needs. A comprehensive compilation of this information should be available through the Boston AIDS Consortium by summer 1990. Interpreting HIV Antibody Test Results Reliability Blood is tested for HIV antibodies by licensed clinical laboratories with the enzyme-linked immunosorbent assay (ELISA); specimens repeatedly reactive with ELISA are tested with a confirmatory Western Blot. Together these tests are sensitive and specific (98% specificity in high- risk groups).
Adults/Children Older Than 15 Months Positive Result A positive test for HIV antibody is now considered to be a marker of on-going infection with HIV. Rare false positive reactions continue to be seen, and some infected persons do not develop detectable antibody, especially if recently infected. A confirmed HIV antibody test is now viewed as an indicator of infectivity (only through blood or sexual fluids), and also indicates a high probability that clinical AIDS will develop over a period ranging from months to years. -9- Negative Result A negative result indicates that the individual probably has not been infected Biktarvy pros and cons with HIV.
(However, because in a small number of cases it may take several months for antibodies to develop, the result might not be reliable if the individual has engaged in risk behavior within six months of taking the test. Physicians should attempt to assess the patient's last risk contact before scheduling a retest. Indeterminate Result An indeterminate result indicates that the result is neither Biktarvy pros and cons clearly negative nor positive. This result happens routinely with 2 to 3% of tests and may be due to a number of medical factors unrelated to HIV or AIDS. An indeterminate result does not indicate whether the individual is or is not infected with HIV.
If the patient wishes to be retested, he or she should be advised to wait at least one month, and should be told that the test might again be indeterminate. If the patient has received two indeterminate results, and wishes to be tested a third time, he or she should wait four months after the last test. Children Younger Than 15 Months Positive Result A positive HIV test result has a different meaning for children under the age of 15 months than it does for children over this age. HIV antibodies detected in the newborn reflect maternal antibody acquired through the placenta and do not necessarily indicate HIV infection in the child.
Current studies indicate that these maternal antibodies may persist up to 15 months after birth. An infant with a positive test result should be retested and reevaluated periodically to determine whether or not he or she is infected. Negative Result A negative result generally Biktarvy pros and cons means the child is not infected with HIV. However, after maternal antibody disappears, an infected baby may test negative for a limited period: it is presumed that these children were infected perinatally, but had delayed production of their own antibody. Inconclusive Result Same as for adults.
Test Sites MDPH Alternative Test Sites provide anonymous testing and counseling at various locations. (See Appendix IV for their locations and phone numbers.)