Test result about 2 weeks later

This must be given in consultation (whether positive or negative): avoid the telephone. Table 24.5 Currently available antiretroviral drugs

Nucleoside analogue RT* inhibitors zidovudine (AZT) didanosine (DDI) zalcitabine (DDC) stavudine (D4T) lamivudine (3TC)

Non-nucleoside analogue RT inhibitors nevirapine delavirdine

Protease inhibitors

• saquinavir

• nelfinavir

* RT = reverse transcriptase Reproduced with permission 8

The negative test result

• Provide reassurance.

• Emphasise the safe sex information.

• Counter any suggestion that current risk-taking behaviour is safe.

• Retest if in high-risk category or known HIV contact or in a 'window period' of 12 weeks.

• A test in 3 months helps rule out recent acquisition.

• Maintain confidentiality.

The positive test result

Good pretest history taking, risk assessment and counselling will make the task of informing the patient of a positive test result a lot easier. Being able to inform the patient of an improved prognosis due to combination drug therapy is also of assistance in breaking the news. Be warm and open. Many patients want to be touched for reassurance. The words 'you are not dying' can be firmly stated a few times. Educate the patient about the difference between HIV infection and the acquired immunodeficiency syndrome. Discuss with the patient who he or she is going to tell the result and help the patient decide on the most supportive friend. Ask the patient what he or she is going to do after the consultation and make an appointment for the next day. Give the patient an HIV support line number for overnight telephone support if required. Discuss the issue of contact tracing briefly and in more depth at the next consultation, because sexual contacts should be notified. Start immediate post-test counselling and education. Emphasise that HIV-positive does not equal AIDS and need not lead to it in the short term.

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