Key Points

• A behaviorally based, sexually transmitted infection, HIV affects multiple organ systems.

• No longer uniformly fatal, HIV disease is becoming a chronic condition that requires regular monitoring.

• Family physicians can expect to play a pivotal role in diagnosing HIV infection and monitoring age-related illnesses and medication side effects.

Know Syphilis in all its manifestations and relations, and all other things clinical will be added unto you.

WB Bean (1968)

Human immunodeficiency virus (HIV) infection may reasonably be called the "Syphilis" of the modern age. Both diseases are behaviorally based and sexually transmitted; both affect multiple organ systems; and both pose special clinical and public health challenges. This chapter discusses issues in the care of HIV-positive patients important to family medicine residents and physicians. Primary care physicians and trainees have treated HIV-positive patients since HIV was identified as the virus that causes acquired immunodeficiency syndrome (AIDS) and can expect to play a central role in coordinating the care of HIV-positive patients for the following reasons:

1. The Centers for Disease Control and Prevention (CDC) recommends universal voluntary testing of patients age 13 to 64 in all health care settings as of September 2006. This helps make HIV testing a routine part of medical care, decreases anxiety and stigma, encourages safer behaviors, and extends life. An additional benefit is reduced HIV transmission. Regular primary care physician visits present a unique opportunity for the patient to be tested and for the physician to assume responsibility for HIV testing.

2. As patients with HIV/AIDS age, they can expect to develop age-related illnesses that family medicine physicians are qualified and trained to monitor and treat.

3. Highly active antiretroviral therapy (HAART) prolongs lives but causes metabolic, cardiovascular, renal, hepatic, neuropsychiatric, and rheumatologic side effects that require monitoring and management.

4. HIV infection is transforming from a uniformly fatal illness to a chronic condition, with increasing numbers of people living with, and not dying from, HIV/ AIDS. The care of patients living with HIV illness must now focus on common elements of chronic disease management.

Box 17-1 presents a timeline on HIV/AIDS and antiretro-

viral therapy.

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