LEARNING OBJECTIVES :
MEDICAL KNOWLEDGE - Students should know:
- CDC case definition of AIDS and HIV infection.
- Signs and symptoms of the acute retroviral syndrome & HIV-related opportunistic infections.
- The relationship between CD4 counts and opportunistic infections, including pneumocystis carinii, candidiasis, cryptococcosis, cryptosporidiosis, cytomegalovirus, Mycobacterium avium complex, tuberculosis, toxoplasmosis, and malignancies, including Kaposi's sarcoma, non-Hodgkin's lymphoma, and cervical carcinoma.
PATIENT CARE SKILLS - Students should be able to:
- History-taking: obtain, document, and present an age-appropriate medical history, that includes HIV infection risk factors, HIV serology results and CD4 lymphocyte counts, history of HIV-related opportunistic infections, AIDS dementia, malignancy, and wasting syndrome.
- Physical Exam: perform a physical exam to establish the diagnosis and severity of disease, including accurate recognition of evidence of infection, malignancy, neurologic disease, or wasting syndrome.
- Differential Diagnosis: generate a differential diagnosis recognizing specific history and physical exam findings that suggest the diagnosis of HIV infection or AIDS and its sequelae.
- Laboratory: recommend when to order and be able to interpret the results of serologic and other diagnostic tests for HIV infection, CD4 lymphocyte count as a predictor of disease, sputum gram, acid-fast, KOH and silver stains, liver function tests, CBC, chest X-ray, and serum and cerebral spinal fluid cryptococcal antigen.
- Develop an appropriate evaluation and treatment plan, including prophylactic antiviral therapy, P. carinii prophylaxis, assessment of PPD status, administration of pneumococcal vaccine, nutritional assessment and supplements, and identification of community health resources.
- Counsel and educate patients about HIV prevention and seroconversion rates.
- Perform consent for testing, pre and post test counseling.
- Students should consider the bioethical and social issues concerning patient confidentiality of HIV infection, understand and have tolerance towards alternative life styles, and maintain a non-judgmental attitude.
- Students should also be able to appreciate end-of-life issues pertaining to AIDS. Students should respect patients' wishes regarding declining medical treatment (autonomy).
RECOMMENDED READING :
- HIV infection, Harrison's On-Line. http://harrisons.accessmedicine.com/server-java/Arknoid/amed/harrisons/co_chapters/ch309/ch309_p01.html
- CDC website: http://www.cdc.gov/hiv/bscience.htm