विवरण
In family medicine, HIV prevention is a vital aspect of comprehensive healthcare. Family physicians play a crucial role in promoting awareness and providing education about HIV transmission and risk factors to individuals and families. They offer counseling and support for safer sexual practices, including the use of condoms and pre-exposure prophylaxis (PrEP), as well as encourage regular HIV testing and screenings for those at risk. Family medicine practitioners also advocate for vaccination against HIV-related infections like hepatitis B, and they engage in the early detection and management of HIV cases, aiming to reduce transmission rates and improve the overall health of their patients.
सारांश
- HIV prevention in family practice has evolved significantly, transforming HIV from a fatal disease to a chronic, manageable condition with near-normal life expectancy due to advancements in treatment and prevention strategies. The key focus is on early detection, treatment, and preventing transmission, especially in heterosexual relationships prevalent in India.
- Transmission occurs through sexual activity, blood/body fluids, and mother-to-child routes. Diagnosis requires testing, with a multi-step LISR (Enzyme-Linked Immunosorbent Assay) approach ensuring accuracy, unlike viral load tests. Treatment initiation should be prompt, ideally within seven days of diagnosis, deviating from past practices of waiting for CD4 counts to drop.
- Anti-retroviral therapy (ART) typically involves a three-drug combination, improving patient health, life expectancy, and eliminating HIV transmission risk. ART reduces viral load and inflammation, minimizing the risk of transmission and size of viral reservoirs. The concept of "undetectable equals untransmissible" emphasizes viral suppression.
- Condom use remains a recommendation, but ART plays a crucial role in prevention. Post-exposure prophylaxis (PEP) should be considered after high-risk exposures like condom rupture, ideally started within 72 hours. Pre-exposure prophylaxis (PrEP) is also an option, especially for serodiscordant couples desiring children.
- Considerations during family planning involve encouraging the HIV-positive partner to start ART, and achieving viral suppression before attempting conception. For same-sex male couples, oral PrEP or on-demand dosing strategies can be used. Long-acting injectable options like cabotegravir are also emerging.
- Special situations like pregnancy require consistent ART to minimize mother-to-child transmission. Breastfeeding can be made safer with ART. Addressing opportunistic infections, addictions, domestic violence, and stigma are crucial aspects of comprehensive HIV management in family practice.
- Vaccinations against various diseases such as COVID, hepatitis, pneumococcal infections, and human papillomavirus are important for HIV-positive individuals. Some vaccines are contraindicated due to being live attenuated. Regular HIV testing is essential for those at risk.
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