HIV

• Post-diagnosis counselling

Once the diagnosis of HIV is confirmed, post-diagnosis counselling should be done with the patient in a confidential and culturally-sensitive manner. An HIV diagnosis should only be announced with the patient alone in the room. Remember that patients with HIV can be extremely stigmatized in some cultures. This is why we always emphasize confidentiality first.

The first step is to explain the diagnosis and make sure the patient understands the transmission modes and potential complications of HIV. The patient should know that while there is currently no cure for HIV, safe and effective antiretroviral treatments are available in Canada, and these will allow him/her to live a normal life if they are taken every day. Because appearances can be very important in some cultures, we usually tell our patients that no one will be able to tell they have HIV if they stay healthy and take their medications as prescribed.

• Assess for opportunistic infections

The next step is to make sure that the patient does not have any symptom or sign of an opportunistic infection - fever, cough, shortness of breath, profuse diarrhea, dysphagia, headaches, etc. If this is the case, the patient should be referred to the Emergency Department for further investigations and should not wait to be seen as an outpatient.

• Report the infection to the appropriate public health agency

HIV is a nationally notifiable disease in Canada. Unless reporting is done automatically by the laboratory, the ordering physician should directly notify the local public health agency in charge. An adequate public health investigation should then be performed to notify and offer testing to potential contacts. The patient should be encouraged to disclose the infection to his/her close sexual partner, and children of infected women should all be tested.

• Referral

All HIV-positive patients should be referred to an HIV specialist. Unless the clinical situation warrants it, we do not usually order any additional investigations while waiting for the referral. Recommendations may vary however depending on the local guidelines. Most specialized HIV clinics in Canada will take care of ordering the additional investigations (including CD4 count and viral load), initiating treatment, providing the necessary vaccinations and screening for latent tuberculosis.