The role of clinicians in HIV diagnosis and care in Sri Lanka
Dr Harshini Fernando Consultant Physician National Hospital of Sri Lanka.
Outline • Epidemiology of HIV in Sri Lanka. • Identification of the most at risk and vulnerable
populations. • When to suspect and test for HIV ?
• Presentations of HIV positive patients. • Importance of early diagnosis of HIV.
• Care given to HIV patients in a medical ward.
Epidemiology of HIV in Sri Lanka • Cumulative HIV cases at the end of the quarter 2013 - 1739
• Adult prevalence - <0.1% • Current estimated number of PLHIV - 4200 • Reported cases
Identifying most at risk and vulnerable populations • Most at risk populations – – – –
Commercial sex workers Men who have sex with men Prisoners Drug users
• Vulnerable populations – – – – – – – –
Beach boys Middle east returnees Garment factory workers Out of school youth Military personnel Long distance truck drivers Sea men Psychiatric patients in mental hospitals
Identifying most at risk and vulnerable populations
When to suspect & test for HIV ? • Importance of taking a detailed history including the sexual history. • • • • •
Homosexual Bisexual Multiple partners Condom use Symptomatic partner
• Social history • Recreational drug use • Occupation • Foreign travel
When to suspect & test for HIV ? • • • • • • • • •
Pyrexia of unknown origin Unexplained weight loss Unexplained diarrhoea Patients with recurrent infections Herpes zoster with multi dermatomal involvement Unexplained lymphadenopathy Atypical pneumonia Suspected or diagnosed STIs Haematological • • • •
Leucopenia Neutropenia Thrombocytopenia Pancytopenia
When to suspect & test for HIV ? Extensive tinea infection
When to suspect & test for HIV ? Skin rash - Pluritic papular eruptions
When to suspect & test for HIV ? Oral candidiasis
Presentations of HIV patients
Importance of early diagnosis of HIV • Late diagnosis is associated with increased mortality, morbidity and impaired response to ART (BHIVA 2008). • The prognosis and further transmission are further improved with early detection of HIV before the onset of significant immunocompromization. • It is a basic responsibility of a health care provider to recommend HIV testing and counseling for persons presenting to health care facilities with signs and symptoms of illness that could be attributable to HIV (WHO and BHIVA recommendation). • Hence it can also encourage ‘normalization' of HIV testing.
Care given to PLHIV in a medical ward • Multi disciplinary action • No stigma and discrimination • Confidentiality (disclosing the sero status) • Education of health care team to avoid; – Deferential treatment – Denial of care – Verbal abuse/gossip
• If immunocompromized in an isolation room with few patients.
Acknowledgement Dr. Prageeth Premadasa Registrar in Venereology, Ward 49