Module 5: Management Of Employees With HIV/AIDS At Primary Level - Staging (Continued)

Management of different stages:

Stages 1 and 2:

Counselling and psychosocial support and counselling on sexual behaviour:

• Give the patient the knowledge to make important personal and social decisions.
• Counsel on condom use.
• Counsel on contraception.
• Syphilis serology - screen for latent syphilis.
• Cervical smear - increased risk of cervical cancer. This should take place yearly if possible.
• Look for TB - good indicators are weight loss and cough for more than 2 weeks.

Stages 3 and 4:

• Actively look for opportunistic infections and in particular TB.
• Provide prophylaxis for opportunistic infections.

Prophylaxis for opportunistic infections:

• Cotrimoxazole 960 mg daily.
• It has been shown to decrease morbidity and mortality.
• Provide cotrimoxazole if CD4 cell count <200 cells/µl or if clinically stage 3 or 4.
• A common side effect is a maculopapular rash.

Weight loss is common. The causes are:

• HIV itself - wasting.
• TB.
• Oesophageal candidiasis.
• Anorexia - depression.
• Chronic diarrhoea.
• Unable to afford food.

Note that there is a stigma associated with weight loss.