Care and treatment

July 28, 2011

The field of HIV/AIDS care is advancing at a breathtaking speed. New developments are rapidily superseded by even newer data. Recommendations for antiretroviral treatment and alternative regimens continue to evolve as new medications are developed and additional data from clinical trials is presented. As a consequence, treatment protocols will not be described here in deference to a recommendation to review the most current HIV/AIDS treatment guidelines available through AIDS Treatment Information Service (ATIS) (United States & Canada: 1-800-HIV-0440; TTY: 1-888480-3739; International: 1-301-519-0459; Mailing Address: HIV/AIDS Treatment Information Service, P.O. Box 6303; Rockville, MD 20849-6303; Web site: http://hivatis.org; E-mail: atis@hivatis.org).

Early medical treatment and a healthy lifestyle can help an individual with HIV stay well. Prompt medical care may delay the onset of AIDS and prevent some life-threatening conditions. A person who has learned that he/she is HIV-positive should see a doctor, even if he/she does not feel sick. Drugs are now available to treat HIV infection and to assist in maintaining health.

Because they are often diagnosed later and generally have poorer access to care and medications, women tend to have higher viral loads and lower CD4 counts upon entering care. Even in care, the health status of HIV-positive women continues to compare poorly to that of their male counterparts. Despite increased attention in recent years, HIV-positive women in care are less likely than men to receive the current standard of care, including regular visits with an experienced clinician, antiretroviral therapy, combination therapy, and/or a protease inhibitor(s). Receipt of care from a less experienced provider is a critical problem, since provider expertise and experience directly affect quality of care and disease progression. Women are less likely to know their viral load or CD4 count, and their medical charts are less likely to contain this information. All of these factors are further exacerbated for poor women and women of color.

Research and experience indicate the following set of conditions to facilitate HIV care for women. (a) The risk for HIV must be perceived. (b) HIV status must be known and the need for and promise of medical care understood. (c) Caregiving responsibilities to children and family members must be met. (d) Basic life needs for food, shelter, and community must be met. (e) Treatment for other problems including substance abuse and mental health disorders must be ongoing. (f) Transportation to appointments must be available. (g) Childcare must be available. (h) Financial means to pay for health care and medications must be available. (i) The patient must encounter medical personnel qualified to treat HIV infection in women. (j) HIV-positive mothers must encounter care that is “family-centered” and coordinated—care that addresses the impact of HIV and barriers to care for the family. (k) All prescribed medications must be available. (l) Informational, psychological, and emotional support from peers and care providers must be ongoing.

At present, the approach to management of HIV disease is the same for both women and men. The clinical course of HIV infection in women does not seem to differ significantly from that in men, with the exception of the associated gynecologic and obstetric conditions and issues. Women may have lower HIV viral loads than men with an equivalent degree of immunosuppression, but do not tend to differ in overall survival or complication-free survival. As both women and men live longer with HIV disease and AIDS, general preventive strategies and health maintenance have become part of routine care. These include smoking cessation, control of hypertension, minimizing cardiovascular risk factors, and routine screening for malignancy (cervical, breast, colon).

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Category: Acquired immunodeficiency Syndrome