HIV/AIDS
General competencies
1. Recognize HIV risk factors
2. Recognize the symptoms of acute retroviral syndrome, such that the physician
might appropriately diagnose and treat HIV infection in these settings
3. Perform a sexual and substance-use history
4. Council patients regarding HIV risk factors, prevention, diagnosis, and
treatment
5. Recognize and elaborate a treatment plan for specific manifestations and
complications of HIV/AIDS
6. Knowledge of the important screening procedures in the context of HIV
infection: PPD, Pap smear, HBV, HAV, HCV, Chest X-Ray, syphillis,
toxoplasmosis, specific screening for bacterial, viral and fungal infections
where available
7. Tailor treatment plans based on knowledge of local HIV resources
8. Understand the ethical and social context of HIV in Haiti, and its impact on the
care of special populations. It is especially important to understand the social
stigma surrounding HIV/AIDS within the community.
Topic Areas
1. HIV/AIDS
a. Epidemiology
b. Anatomy
c. Pathophysiology/Etiology
d. Clinical manifestations
e. Risk factors
f. History and physical exam
g. Diagnostic Tests
h. Differential diagnosis
i. Management
j. Psychosocial implications
Highlighted teaching points
1. Epidemiology
a. Epidemiology of the HIV/AIDS pandemic: local, regional and
international perspective
b. Modes of transmission: IV drug use, sexual contact, vertical transmission
(intrauterine, intrapartum, postpartum, breast-feeding)
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c. Other exposure to body fluids (blood and blood products, needle sticks)
WHO HIV classification
Anatomy
a. HIV Virology/Structure
Pathophysiology/etiology
a. HIV lifecycle
Clinical manifestations
a. Opportunistic infections
b. AIDS-associated malignancies
c. AIDS encephalopathy
d. HIV-associated dementias
e. HIV-associated nephropathy
f. Hematologic manifestations: leukopenia, pancytopenia, anemia, ITP, TTP,
g. HIV wasting syndrome
h. Neurologic manifestations: peripheral neuropathies, acute and chronic
inflammatory demyelinating polyneuropathies
i. Specific manifestations in children (failure to thrive, abnormal
milestones, lymphoid interstitial pneumonia etc)
j. Specific presentations in women: cervical dysplasia and cancer, breast
cancer, vulvar/vaginal dysplasia and cancer, recurrent vaginal infections
k. Co-infection with Hepatitis A, B, C
Risk factors
a. Screening in the context of other STIs
Diagnostic tests
a. Laboratory testing
i. ELISA and Rapid Diagnostic Testing
ii. Confirmatory testing: Western Blot, HIV RNA PCR (during acute
infection)
iii. CD4 + count
iv. Viral load
v. Resistance testing: Viral phenotype, viral genotype, viral tropism
assays
b. Indications for testing
i. Risk assessment and recommendations for voluntary testing in
populations at high risk
ii. Clinical assessment in the context of suspected new HIV infection
or chronic HIV infection, or of an AIDS defining illness
c. Test results and counseling
i. Confidentiality issues
ii. Public health case reporting
8.
iii. Partner notification
Management
a. When to initiate anti-retroviral therapy, assessing compliance, assessing
for and managing emergence of resistance, monitoring for side effects of
therapies
b. Knowledge of the services available locally for care of patients with
HIV/AIDS
c. Preventative medicine and vaccination in the HIV-infected patient
d. Knowledge of when to initiate prophylactic therapy and when to halt
therapy with immune recovery
e. Management of HIV/AIDS in pregnant women and in the post-partum
period
f. Special consideration for health care providers
i. Occupational risks of HIV infection
ii. Post-exposure prophylaxis regimens
References:
1. American Academy of Family Physicians. (2008). Recommended Curriculum
Guidelines for Family Medicine Residents, AIDS (Reprint No. 278), Leawood,
Kansas.