# Presentation: 307887

## Care of the HIV-infected Adolescent

- Sue Ellen Abdalian, MD
- Tulane University Health Sciences Center

## HIV Pre-Test Counseling

- Personal Risk Assessment & Reduction Plan
- Assessment of Knowledge
- Provide Education
- Determine Client Motivation for Testing
- Assess & Develop Support and Coping Strategies
- Testing Risk/Benefit Analysis
- Informed Consent for Testing

## HIV Post-Test Counseling

- Review and interpret results
- Elicit reaction to results
- Review risk reduction plan
- Review/develop sources of support
- Disclosure strategies
- Assist with Continued Care and Follow-up

## On-Center Services

- Care Team
- Nurse
- Doctor
- Mental Health
- Counseling
- Care Plan
- Medical
- Behavioral

## HIV/AIDS Care Off-Center

- Comprehensive and Multidisciplinary
- Patient-centered, one-stop health care
- Psychosocial care and support
- Coordinated primary and sub-specialty health care
- Aggressive Case Management
- Continuous Risk Reduction
- Empowerment and Peer Support

## Health Care Team

- Primary care nurse
- Social Worker
- Primary care physician
- Health educator
- Nutritionist
- Mental Health provider
- Subspecialists

## HIV/AIDS Care - Initial Evaluation

- Medical and psychosocial history
- Current review of systems
- Full PE including GYN evaluation
- Laboratory Assessment
- Staging

## Initial Laboratory Assessment

- CBC, differential, platelets
- Immunodeficiency Panel (CD4)
- HIV Viral Load
- Comprehensive Chemical Profile
- Hepatitis Screen Anti-HCV, Anti-HAV, Anti-HBsAg
- UA - if ≥1+ protein: quantify, renal ultrasound
- Varicella & Toxoplasma gondii antibodies

## HIV/AIDS Care

- Immunizations - complete schedule
- MMR & varicella vaccines unless significant immunosuppression
- HBV vaccine if not immune
- Pneumococcal vaccine every 5 years
- HAV vaccine for selected patients
- Meningococcal vaccine if living on-center
- PPD & prophylaxis if ≥5mm reaction
- PAP every 6 months, refer if abnormal

## HIV/AIDS Treatment (DHHS, 2004)

| Clinical Category | CD4 Count | Viral Load | Recommend |
| --- | --- | --- | --- |
| Symptomatic | Any value | Any value | TREAT |
| Asymptomatic
AIDS | CD4+ <200/mm2 | Any value | TREAT |
| Asymptomatic | CD4+ >200/mm2
But < 350/mm2 | Any value | Offer therapy esp. if VL >20,000 |
| Asymptomatic | CD4+ >350/mm2 | >100,000 c/mL | Consider therapy or observe |
| Asymptomatic | CD4+ >350/mm2 | <100,000 c/mL | Observe |

## Pitfalls in Medical Treatment

- Communication
- Living Conditions
- Availability of food & proper cooking
- Water source, need for filtered/bottled
- Secure storage, refrigeration
- Privacy
- Time diffusion, organization, & priorities

## Pitfalls in Medical Treatment

- Complex Medical Regimens
- Access to Treatment
- Substance Abuse and Polypharmacy
- Intent to follow treatment
- hidden agenda
- Alternative therapies

## Overcoming the Pitfalls

- Keep Medical Regimens *clear & simple*
- Integrate Regimens Into Daily Routine
- Assess Readiness for Antiretroviral Therapy
- Help Anticipate Obstacles to Adherence
- Patient-centered Problem-solving
- Frequent Appointment Intervals to check in, review progress and problem-solving

## Patient Barriers to Effective Care

- Fear of Exposure and Loss
- Denial
- Cognitive Immaturity
- Lack of Perceived Need
- Lack of Knowledge
- Lack of Skills
- Lack of Social Support