People with HIV/AIDS can live longer, healthier lives because of
advances in treatment of HIV infection. However, longer lives are
associated with increased prevalence of 1) adverse effects of HIV
infection, 2) adverse effects of the drugs used to treat HIV, and
3) concurrent medical conditions that would occur in the absence of
HIV. These long-term complications have put HIV infection in the
realm of chronic diseases rather than of infectious diseases, which
usually respond to short-term clinical interventions. Effective
management of chronic diseases in the primary care setting requires
the coordination of interventions that occur at the level of the
clinical services, the community supports for those clinical
services, and the individual patient. While clinical services begin
in the primary care clinic, community supports are needed, and the
patient must be engaged to enhance self-management. The coordinated
interventions together contribute to the desired clinical outcomes.
The Chronic Care Model, which is used in the design and quality
improvement activities of clinical services, conceptualizes how
these factors impact the clinical outcome of chronic disease
management. This book addresses several important aspects of
HIV/AIDS care and treatment in a concise, accessible format; it is
not meant to be a comprehensive reference book. Recommended
references and citations are provided for the reader to be able to
access in-depth information on topics that are particularly
important and/or controversial. Appropriate use of antiretroviral
drugs, treatment of opportunistic infections, symptom management,
treatment of concurrent medical conditions, and other specific
interventions to treat HIV disease and its complications are
addressed. The format of this guide is designed to provide
practical information for the common questions that arise in the
care of patients with HIV infection. Recognizing the broader array
of best practices that contribute to effective clinical outcomes
among patients with a complex array of service needs, the authors
also address patient evaluation, adherence, mental health,
substance abuse, overall clinic management, and other factors that
lead to improved patient outcomes according to the Chronic Care
Model. Last, because the authors recognize the challenges of
maintaining clinical practices in the face of rapidly changing and
ever more complex treatment interventions, a chapter on sources for
updated and in-depth clinical information is provided. Pediatric
HIV/AIDS treatment is not addressed in this book.
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