Managing Results

for individuals who test HIV negative
A separate post-test visit is not necessary. Results can be handled as any other negative result is handled in your office. Giving a negative HIV test result can be an opportunity to educate about risk and risk reduction, if indicated.

for individuals who test HIV positive
Given the availability of resources, medical education, and support, a primary care provider, who is willing to do so can provide the necessary care in the majority of situations. In a scenario where that is not possible, or in the advanced stages of infection, consideration should be given to shared patient management with clinicians experienced in HIV.

A positive result should be given face to face in a confidential environment and in a clear and direct manner, as is good clinical practice for any situation where bad news is being conveyed.

Consult with HIV specialty care, if required.

Provide linkages to support and care including medical, emotional, nutritional, psychosocial, spiritual and financial, as with other serious medical diagnoses.

As HIV is a reportable infection, a positive HIV result will be sent to local public health officials. Public health nurses have a wealth of information and resources and can be part of your clinical team in initial management of someone recently diagnosed with HIV infection. They will be involved in the care of individuals with a new HIV infection and the care of their partners. For example, public health nurses can be involved with delivery of the diagnosis, partner notification, and linkage to care.

Counsel on risk reduction. Individuals with recently acquired HIV infection have a much higher potential for transmitting the virus, and safer sexual practices are essential during the acute phase of HIV infection.

With current laboratory standards, false positive tests are exceedingly rare. Nevertheless, since a potential for error exists for diagnostic systems, a second test should be performed to confirm the diagnosis.

Non-attendance for positive results
Notify Public Health as they will have the resources and experience to assist with this issue.

Initial Management of positive HIV test
Review the case with your local Public Health office for consultative expertise related to partner notification and if required, linkage to care and supports.

Providing care to patients diagnosed with HIV
Allow sufficient time to discuss the diagnosis with your patient.
Refer or consult with a clinician experienced in the treatment and management of HIV infection, if appropriate.
Order the standard baseline testing following HIV diagnosis as follows:

  • Repeat HIV Antibody (HIV test)
  • HIV plasma viral load
  • CD4/CD8 cell counts and ratio
  • CBC and differential
  • ALT, AST, Alk Phos, GGT, LDH, Bilirubin, INR, and Amylase
  • Creatinine (eGFR), Na, K, Cl, HCO3, BUN
  • Urinalysis
  • Syphilis screen (RPR)
  • Urine NAT for Gonorrhea and Chlamydia
  • Hepatitis A Total Antibody
  • Hepatitis B (HBsAg, anti-HBs Ab, anti-HBc Ab Total)
  • Hepatitis C Ab, Hepatitis C RNA
  • Toxoplasma IgG
  • Pregnancy test (if appropriate)

Offer ongoing support and assess the psychosocial impacts of a recent HIV diagnosis.

Discuss prevention of transmission and disclosure to past and potential future partners. In Canada, nondisclosure of a positive HIV status may have legal implications. These legalities are evolving. For more information, see:

http://www.aidslaw.ca/site/sex-criminal-law-and-hiv-non-disclosure/

Ongoing care by a primary care provider, with assistance as needed by an expert in HIV care, is extremely important in optimizing patient care.

Provide ongoing care guided by the primary care guidelines and therapeutic guidelines found at the British Columbia Centre for Excellence in HIV/AIDS website pages:

http://www.cfenet.ubc.ca/therapeutic-guidelines/primary-care

http://www.cfenet.ubc.ca/therapeutic-guidelines/adult