Many of the conditions that put immunocompromised patients at risk of disease can be detected early, by means of a thorough history and physical evaluation.
See chapter Initial History.
Assess the patient's general appearance, affect and demeanor in answering questions, body language, and other relevant characteristics. Measure vital signs; perform a physical examination. These measurements establish a baseline against which future measurements can be compared.
Table 1. Vital Signs
|Height||Should be measured at baseline and annually.|
|Weight||Record at each visit.|
|Temperature||Record at each visit.|
|Blood pressure||Record at each visit. The BP cuff size should be appropriate for the patient's arm circumference.|
|Heart rate||Record at each visit.|
|Respiratory rate||Record at each visit.|
|Oxygen saturation||Record at each visit.|
|Waist, hip circumferences||Waist and hip circumference should be measured at baseline for comparison in case the patient later develops obesity or lipoaccumulation related to antiretroviral therapy (ART); repeat as indicated.|
|Body mass index (BMI)||BMI can be helpful in assessing underweight or overweight conditions, HIV/AIDS-related weight loss, and ART-related weight gain. Perform at baseline and upon changes in weight.|
|* Anal Pap test: Consider this test if follow-up evaluation of an abnormal Pap test result is available. Rates of anal dysplasia and anal cancer are higher in HIV-infected women and men than in HIV-uninfected individuals; see chapter Anal Dysplasia.|
|Genitals / Rectum|
|Extremities / Musculoskeletal|
|Neurologic||Assess the following:|
A/P: Assessment and Plan
After completing the initial history and physical examination, do the following:
- Enter the information garnered through the history and physical examination into the patient's chart or database.
- Continue to develop the problem list, assessment, and plan for patient care.
- Complete follow-up or laboratory studies suggested by the history and physical examination. (See chapter Initial and Interim Laboratory and Other Tests.)
- Prescribe opportunistic infection prophylaxis as appropriate. (See chapter Opportunistic Infection Prophylaxis.)
- Arrange for any appropriate vaccinations. (See chapter Immunizations for HIV-Infected Adults and Adolescents.)
- Refer for dental, nutrition, and social services, as well as case management and mental health care, as appropriate.
- Refer for any additional specialty care needs identified in the history or physical examination.
- Make follow-up appointment with health care provider.
- Answer the patient's questions.
- Aberg JA, Gallant JE, Ghanem KG et al.; HIV Medicine Association of the Infectious Diseases Society of America. Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jan;58(1):e1-e34.
- Hollander H. Initiating Routine Care for the HIV-Infected Adult. In: Sande MA, Volberding PA, eds. The Medical Management of AIDS, 5th Edition. Philadelphia: WB Saunders; 1997:107-112.
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Accessed December 1, 2013.
- Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Accessed December 1, 2013.