HIV for the Primary Care Practitioner

Robert Bettiker, M.D., M.G.A.
Disclosures		Relationship: Yes Grants/Research Support: N/A Consultant: Cubist Pharmaceuticals Honorarium: Glaxo, Roche, Pfizer Other: Intends to reference unlabeled/unapproved uses of drugs or products in presentation (HIV PRC for diagnosis of Acute HIV)

Dr. Robert Bettiker is an Assistant Professor of Medicine in the Section of Infectious Diseases at Temple University Hospital in Philadelphia, PA. He received a Bachelor’s degree in Chemistry from Massachusett’s Institute of Technology, a Master’s degree in Government Administration from the University of Pennsylvania and his medical degree from Georgetown University Medical School. Dr. Bettiker completed his medical residency and Infectious Disease fellowship at Temple University Hospital. He is board-certified in Internal Medicine and in Infectious Diseases and is a member of the American Academy of HIV Medicine.

Incidence

HIV/AIDS is the seventh leading cause of death in the 15-24 age group … and many more cases go unreported. Primary care physicians should work with HIV experts, says the author, because of the complicated regimens involved in treatment. He defines HIV and warns that HIV and AIDS are not necessarily interchangeable, and discusses the indications for highly Active Anti-Retroviral Therapy (HAART) which consists of three or more antiviral drugs whose goal is to drive down the viral load to undetectable levels. It has slowed the death rate from HIV/AIDS.

Dr Bettiker argues that primary care physicians are well placed to diagnose HIV/AIDS and lists six types of individuals who should be tested. He details misapprehensions about how HIV/AIDS is transmitted and the importance of conveying that HIV is not a death sentence. He discusses several tests, including the HIV PCR test to detect viral RNA in the blood.

The physical exam should involve weight measurement at each visit, and oral evaluation to detect for Kaposi’s sarcoma or lymphoma .Lab results are important, with the CD4 T lymphocyte count and the HIV viral load help determine severity of the disease. Toxoplasma gondii may reactivate in severely immunocompromised patients. The author notes that HIV patients should receive annual flu shots, and ophthalmologic and dental exams.

The lecture concludes with a description of the four types of HIV medications currently approved by the FDA – how they work, and their major side effects including lactic acidosis in HIV/AIDS and Abacavir hypersensitivity in anti-HIV therapy.