Communication Skills: Explaining a Diagnosis of Humman Immunodeficiency Virus (HIV)

HIV is a common condition, with over 100,000 people in the UK living with the disease. Up to a third of these do not know they have HIV and you may be asked to explain HIV to a patient with a new diagnosis.

OSCE scenario: This 25 year old man has recently been diagnosed with HIV and has some questions. Please discuss with him.

• Introduce yourself
• Wash your hands
• Ask permission to discuss his recent diagnosis with him
• Remind him that anything you discuss will be confidential
• Start by checking his understanding ‘tell me what you understand about HIV’

• HIV is a virus that attacks the body’s immune system
• Untreated it can be serious and cause you to suffer from infections
• However, good treatments are now available and most people living with the disease in the UK live a normal life-span
• If they ask about AIDS:
• AIDS is ‘acquired immunodeficiency syndrome’
• This is when the HIV virus has become very active in the body, usually  because no treatment has been taken
• Increased risk of unusual, difficult-to-treat and potentially life-threatening infections

• There are lots of different ways you can contract HIV:
• Sexual intercourse with an affected individual
• Sharing of needles during intravenous drug use
• Transfusion of infected blood products (rare in modern medicine)
• Transmission from mother to baby
• Healthcare workers: needlestick injury, blood splash
• If there is a known method of transmission then explain to the patient that other people at risk will have to be tested for the condition
• The patient may not know how they contracted HIV – the test cannot tell them where or when they contracted it.

• May not have any symptoms
• Acute HIV can cause a fever, lymph node swelling and a generalised rash
• Chronic HIV symptoms are usually related to infections that you contract rather than underlying HIV

• There are three main-stays of treatment:

1. Treatment of HIV virus
   1. Using antiretroviral therapy (ART)
   2. This is usually a combination of three medications (can sometimes be given in one tablet)
   3. Medications can have serious side effects but you will be informed about these and how to look out for them
   4. You will likely be starting ART soon and will be on medications for life

2. Preventing infections
   1. Depending on your blood tests (CD4 count) you may be given medications to prevent you developing serious infections before you get them (primary prophylaxis – see Table A below)
   2. Depending on occupational and environmental exposure other treatments may also be given e.g. syphilis prophylaxis

3. Treating infections
   1. There are different types of infection which will be treated with different types of medication (see Table B below)
   2. Some infections can cause an increased risk of cancer e.g. Kaposi’s sarcoma, lymphoma

• Your HIV care will be looked after by a specialised HIV team who will monitor your treatment and any potential complications

• Advise yes, the virus can be transmitted by sexual and blood-transmission, as well as vertical transmission (i.e. mother to baby) if they become pregnant
• To avoid this they should:
• Have protected sex (and inform their sexual partner)
• Not donate blood products
• Not share products that may contain traces of blood e.g. razors, toothbrushes, needles
• Comply with ARV treatment which will lower viral load and reduce transmission probability
• If they want to become pregnant reassure them that with well-managed HIV many women have HIV negative children
• Advise that anyone at risk of previous transmission should have an HIV test

• Ask if they have any further questions
• Offer leaflets/information as to where they can get further information e.g. counselling services
• Thank them for their time and give contact details of yourself/HIV team

Table A – primary prophylaxis in HIV

Table B – Infections in HIV

• BHIVA guidelines: www.bhiva.org/guidelines.aspx
• Oxford handbook of tropical medicine pages 69-150
• www.uptodate.com/contents/overview-of-prevention-of-opportunistic-infections-in-hiv-infected-patients

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