HIV

Emergency referrals

Consider urgent referral for patients with the following:

  • Evidence of AIDs
    • Opportunistic infections
      • Pneumocystis infection
      • Widespread candida infection
      • Extensive seborrheic dermatitis
      • Kaposi sarcoma
      • TB
    • CD4 count of less than 200 cells/mm3

Features that may lead to more urgent categorisation

  • All new cases of HIV will be seen as Cat 1
  • Management of high risk HIV exposure (post exposure prophylaxis)

Other important information for referring practitioners

Lifestyle changes

  • All patients with HIV infection should practice safe sex and inform all sexual partners
  • Occupational factors may need to be considered especially in health service professions
  • Adopt healthy lifestyle with regular exercise, stop smoking and reduce alcohol intake

Medical management

  • All people with HIV should be referred to a specialist for consideration and management of anti- viral therapy
  • Educate the patient about the disease
    • Consider referral to psychologist to help with adjustment
    • Strongly advise the importance of compliance with medication
    • Monitor for side effects of medication
    • The GP should be familiar of the common side effects of anti HIV therapy
  • Communicate regularly with the patients specialist regarding changes on the patient’s condition
  • Please see map of Medicine links for information on exposure to HIV and post exposure prophylaxis

Drugs used in HIV treatment

  • Nucleoside/nucleotide reverse transcription inhibitor (NRTI)
  • Non-nucleoside reverse transcription inhibitors (NNRTI)
  • Protease inhibitors
  • Integrase inhibitors
  • Fusion inhibitors
  • Entry inhibitors
  • Fixed dose combination drugs

Referral requirements

A referral may be rejected without the following information.

  • History of condition (date diagnosed), include last 3 specialist letters if has been seen previously by a specialist
  • If referring for advice re serious exposure likely to lead to infection requiring post exposure prophylaxis state clearly in the referral and mark urgent

It is important to note that post-exposure prophylaxis needs to commence within 72 hours of exposure.

  • Opportunistic infections suggesting AIDS
  • Sexual history include likely or known mode of infection
  • Drug history including non-prescription drug use
  • Treatment up to date if any
  • Investigations
    • FBC, E/LFTs, lymphocyte subsets
    • HIV viral load
    • HIV 1 & 2 serology

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander
  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary
  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)