Strategies that can help physicians assess for HIV and talk with patients about concerns regarding quality-of-life issues.
Frank J. Palella, MD: Patients who are presenting with acute or very recent HIV infection may or may not have an acute syndrome that can resemble influenza or infectious mononucleosis. These symptoms and signs can include fever, swollen lymph nodes in the neck, groin, or armpits, rash, sore throat, and if it’s severe enough, severe headache or even acute meningitis. Generally speaking, this illness—if it does occur—occurs within a couple of weeks after the initial infection. When we’re assessing risk for this occurrence, we like to ask questions that help us elucidate whether patients fall into the biggest risk groups for HIV: being sexually active, particularly among men who have sex with men; having multiple partners; having unprotected sex; and using injection drugs.
Quality-of-life issues can lead to challenges in both the treatment of HIV and in patients’ overall health. Persons with HIV, in particular, tend to have quality-of-life issues that include anxiety, mental health issues, substance use such as alcohol or recreational drugs, and oftentimes employment, housing, or even food insecurity. Quality-of-life issues are important because if they aren’t addressed head on, they can comprise barriers to optimal medication adherence as well as to overall health optimization.
I can’t stress how important it is to encourage patients with HIV to disclose concerns they have regarding their quality of life and to proactively, on the part of clinicians, undertake quality-of-life assessments to try to ascertain whether quality-of-life issues might exist. These can also include, for parents, childcare issues and obligations that might get in the way of their own self-care, or employment-related issues that might impact their ability to take medications at certain times. Clearly, we talk about the life span of persons with HIV, but the life span in some ways is secondary to the health span. Overall health includes consideration of quality of life. We’re looking for quality as well as quantity of life when we undertake assessment and therapeutic approaches for persons with HIV.
Patients need to feel comfortable. Persons with HIV who are in care need to feel comfortable disclosing these issues, and it’s the responsibility of the health care providers to create an environment in which they feel comfortable disclosing issues regarding their life, including situational issues, mental health and substance-use issues, issues impacting employment, housing, security, and food security, and even issues that might impact their immediate physical well-being like potential abuse situations in the home, their living situations, or their relationships. [It is important for us] as health care providers to be aware of this but also to have it as part of our prescribed approach, to go through these issues in a way in which we’re open-ended in our questioning and follow up on the responses that patients give us. We need to be in a situation to systematically ascertain whether these conditions or issues exist.
Transcript edited for clarity.