Chronic disease management of patients with HIV Maia

Chronic disease management of patients with HIV Maia Pinsky, MD-R 3 Family Medicine Residency of Idaho

�Disclosures �I have no financial relationship or interest with any proprietary entity producing health �care good or services to disclose

Outline ● Overview of HIV care ● Chronic disease management ● Conclusion

�Chronic disease management of HIV ● HIV infection ● Cardiovascular ● Pulmonary ● Neuropsychiatric ● Renal ● Hepatic ● Bone ● Cancer ● Immunizations ● OI Prophlyaxis

Factors that influence chronic disease Viral infection/immunosuppression ○ Long-term infection may have effects despite normal CD 4 count ○ Not completely understood, but may be related to chronic inflammation ● Medication side effects ○ Many different manifestations ○ May be magnified with prolonged used ○ Drug-drug interactions ● Associated risks ○ May be related to how HIV was contracted

�Cancer ● Cervical cancer ○ 4 -5 x increased risk of CIN ○ PAP testing for lifetime, more frequent testing interval ● Anal Cancer ○ Anal pap if high-resolution anoscopy is available in community ○ No consensus screening guidelines currently ● Colon, breast, prostate, lung ○ No change in screening recommendations

Resources for physicians ● FMRI ● HIVMA/IDSA Guidelines ● CDC ● AIDSinfo. nih. gov ● National HIV Clinicians Consultation Center - UCSF ● Clinicians Warmline 1 -800 -933 -3413 ● HIV Drug Interaction Checker - University of Liverpool

Summary ● HIV has largely become a chronic disease in the US ● Role of primary care physician in coordination with HIV specialist ● Chronic disease states in pts with HIV - some different considerations (viral infection, medication side effects, associated risks) but we can often use the same models for tx ● Prevention is still the key!!

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