Vergeront J M, Reiser W J, Krchnavek K A, Druckenmiller J K, Davis J P
Wisconsin AIDS/HIV Program, Bureau of Communicable, Wisconsin Division of Public Health, Madison 53703-3043, USA.
WMJ. 1998 Dec;97(11):52-61.
The authors review the role of human immunodeficiency virus (HIV) testing in primary care, including an overview of epidemiologic trends of the HIV epidemic; avenues for HIV counseling and testing; HIV testing assays; guidelines for HIV test counseling in primary care; special situations involving testing of pregnant women, infants, and young children; post-exposure prophylaxis; and related resources available to Wisconsin primary care clinicians. HIV disease is a major cause of premature death and disability in the United States. Advances in the understanding of the pathogenesis of HIV and developments of newer antiretroviral therapies have resulted in dramatic changes in the management of HIV disease. Combination antiretroviral drug therapy has resulted in prolonged and near complete suppression of detectable HIV replication in many HIV-infected persons. These clinical developments underscore the importance of early identification and intervention in HIV disease. Intervention during primary HIV infection, the time when the viral burden "set point" is achieved, may present a special window of opportunity to effectively intervene in limiting viral replication in an infected individual. This earliest intervention may have major benefits for infected persons and society at large. Decreasing viral load during primary HIV infection may decrease an individual's infectiousness and thereby decrease the overall rate of transmission of infection to others. Primary care clinicians play a critical role in diagnosing, managing, and preventing HIV infection. Because of the ongoing relationship between patient and health care provider, the primary health care clinician is in the best position to provide HIV risk assessment, testing, related prevention education, and coordination of needed health care. This article presents guidelines for conducting HIV counseling and testing in primary care for purposes of furthering the public health objective of early identification of HIV infection. Clinicians can achieve this objective by including HIV risk assessment during the initial history and physical exam of every patient.
作者回顾了人类免疫缺陷病毒（HIV）检测在初级保健中的作用，包括HIV流行的流行病学趋势概述；HIV咨询和检测的途径；HIV检测方法；初级保健中HIV检测咨询指南；涉及孕妇、婴儿和幼儿检测的特殊情况；暴露后预防；以及威斯康星州初级保健临床医生可获得的相关资源。在美国，HIV疾病是过早死亡和残疾的主要原因。对HIV发病机制认识的进展以及新型抗逆转录病毒疗法的发展，导致了HIV疾病管理的巨大变化。联合抗逆转录病毒药物治疗已使许多HIV感染者的可检测HIV复制得到长期且近乎完全的抑制。这些临床进展凸显了HIV疾病早期识别和干预的重要性。在原发性HIV感染期间进行干预，即病毒载量“设定点”达到之时，可能会提供一个有效干预以限制感染者体内病毒复制的特殊机会窗口。这种最早的干预可能对感染者和整个社会都有重大益处。在原发性HIV感染期间降低病毒载量可能会降低个体的传染性，从而降低感染向他人传播的总体比率。初级保健临床医生在诊断、管理和预防HIV感染方面发挥着关键作用。由于患者与医疗保健提供者之间持续的关系，初级卫生保健临床医生最有能力提供HIV风险评估、检测、相关预防教育以及所需医疗保健的协调。本文提出了在初级保健中进行HIV咨询和检测的指南，以推进早期识别HIV感染这一公共卫生目标。临床医生可以通过在每位患者的初始病史和体格检查中纳入HIV风险评估来实现这一目标。
