Lippincott's primary care practice最新文献

Recent advances have changed the guidelines for diagnosing and managing pediatric human immunodeficiency virus (HIV) infection. HIV-exposed and HIV-infected children should be evaluated by, or in consultation with, pediatric HIV specialists. Primary care practitioners play a vital role in identification of infants and children at risk for HIV infection and can work collaboratively with pediatric HIV specialists to provide state-of-the-art care. With the use of perinatal zidovudine, perinatal transmission rates have been reduced to 3% to 4%, and they may be reduced even further by the use of combination antiretroviral therapy during pregnancy, viral load monitoring, and obstetric interventions. Diagnosis of HIV infection can be determined in all perinatally infected infants by 6 months of age. Combination antiretroviral therapy is the standard of care for HIV-infected children. It has become increasingly effective, but complex. Families living with HIV are affected by a number of psychosocial issues. Disclosure of HIV diagnosis to a child is an important clinical issue. As HIV-infected children grow older, medical and psychosocial issues may impact school performance. The plan of care to address specific needs of HIV-infected children should be a collaborative effort between the children, their families, the primary care team, and the multidisciplinary pediatric HIV specialty team.

Human immunodeficiency virus (HIV) disease is associated with significant psychological stressors that require attention in their own right and can impact medical treatment. Psychological integration of illness occurs in identifiable stages and affects the patient's response to treatment interventions. Syndromes of depression, anxiety, stress, and substance abuse associated with HIV disease require recognition and appropriate treatment. The psychosocial context of treatment is also an important factor in HIV care, especially for special populations. Counseling and support groups are important tools in comprehensive HIV care and should be tailored to the needs of HIV/acquired immune deficiency syndrome (AIDS) patients. Mental health issues also exist for professionals working in HIV care.

Nearly 50 million people worldwide have been infected with human immunodeficiency virus (HIV), and an estimated 12 to 13 million children have been orphaned by the acquired immune deficiency syndrome (AIDS) epidemic. The natural history of HIV infection continues to evolve as researchers and clinicians unearth new facts about the virus and develop new treatment regimens for patients. The status of anti-HIV treatments is never static but constantly changing. Patients and providers struggle with adherence issues. Vaccine development, viewed as an essential step in controlling the epidemic, is complicated by the genetic diversity of the virus and the inability of the body to clear the virus. Tremendous strides have occurred in the HIV/AIDS arena, yet daunting challenges remain. This overview article presents the natural history, the current status, and future trends of HIV infection.

Women are the fastest growing segment of people with acquired immunodeficiency syndrome (AIDS), yet they often receive this diagnosis when the disease is in its advanced stages. New therapies have caused human immunodeficiency virus (HIV) to become a chronic and treatable disease for many of those afflicted. Primary care providers must be cognizant of the initial symptoms to facilitate early diagnosis and prompt treatment for women with HIV. Early signs of HIV in women are subtle. Providers must consider a diagnosis of HIV in women who present with vaginal infections, abnormal pap smears, or sexually transmitted diseases that are unusually severe, recurrent, and resistant to treatment efforts. These signs and symptoms, along with a corroborating history, may be early clues to HIV. Primary care providers, in conjunction with HIV specialists, must strive to decrease the incidence, morbidity, and mortality of the disease in women.

Human immunodeficiency virus (HIV) continues to be the second leading cause of death for persons ages 25 to 44 years in the United States, whereas new HIV infection rates remain steady. Coupled with the advent of new antiviral therapies that have significantly decreased mortality and morbidity rates, the importance of the primary care clinician in HIV prevention, early detection, and treatment is paramount. This article presents HIV risk analysis and prevention strategies for the primary care clinician practice. New HIV testing methods are reviewed as well as the Centers for Disease Control (CDC) pretest and posttest counseling guidelines.