HIV, viral hepatitis and STIs a guide for primary care 2008 Edition ABOUT ASHM The Australasian Society for HIV Medicine is a peak representative professional body for medical practitioners and other health care workers in Australasia who work in HIV, viral hepatitis and related disease areas. It was formed in 1988 (as the Australian Society of AIDS Physicians). It changed its name in 1989 to reflect a broader membership base and was incorporated in New South Wales in 1990. ASHM became a registered charity in 2003. ASHM is a key partner in the Australasian and regional response to HIV, viral hepatitis and related diseases. It works closely with government, advisory bodies, community agencies and other professional organisations in Australia and the Asia Pacific region. It conducts broad education programs in HIV and viral hepatitis for medical practitioners, health care providers and allied health workers and manages programs of continuing medical education. ASHM is governed by an elected voluntary board and managed by a secretariat. It receives support from the Australian Government Department of Health & Ageing, the Australian Government’s Agency for International Development (AusAID), State and Territory Departments of Health and the private sector, and has established the ASHM Foundation which raises funds in support of educational activities. ASHM works on a range of issues affecting its members, including education and training, resources, HIV treatment, viral hepatitis, international/development issues and professional affairs. ASHM conducts an annual medical scientific conference. In addition, the ASHM Conference Division provides professional conference organisation to third parties. BENEFITS OF ASHM MEMBERshIP: Journal Club, a quarterly review of relevant international journal articles ASHMNews, quarterly electronic member newsletter The ASHM Directory, an annual desktop compendium of useful HIV, STI and viral hepatitis related services Discount on registration to the ASHM annual conference and continuing medical education activities Access to resources. In addition, members involved in education or teaching can access resources from ASHM for use in their programs Reduced subscription to: HIV Medicine, published by the British HIV Association and the European AIDS Clinical Society; Sexual Health, the journal of the International Union against Sexually Transmitted Infections, Asia-Pacific; and the Journal of HIV Therapy published by Mediscript Free online access to Medline and the journal AIDS through our OVID gateway Access to scholarship, support and award programs Participation in the development of public health policy and committees Regular Email Alerts on relevant issues and activities Australasian Society for HIV Medicine, LMB 5057 Darlinghurst NSW 1300 Australia Ph: 61 2 8204 0700 • Fax: 61 2 9212 2671 • Email: [email protected] • Website: www.ashm.org.au HIV, viral hepatitis and STIs a guide for primary care Editors David Bradford AM MB BS FAChSHM FRCS(Ed) FRCS(Eng) Dip Ven Gregory Dore BSc, MBBS, FRACP, MPH, Andrew Grulich MBBS, FAFPHM, MSc, PhD Jennifer Hoy MBBS, FRACP, Grad. Dip. Epidemiology and Biostatistics Michael Kidd MBBS, MD, DCCH, Dip. RACOG, FRACGP, Ronald McCoy MBBS, FRACGP Gail Matthews MBChB MRCP(UK) FRACP Anne Mijch MBBS, FRACP, Grad. Dip. Epidemiology and Biostatistics, Simone Strasser MBBS, MD, FRACP HIV, viral hepatitis and STIs: a guide for primary care is published by the: Australasian Society for HIV Medicine (ASHM) Locked Bag 5057, Darlinghurst, NSW 1300 Telephone (61) (02) 8204 0700 Facsimile (61) (02) 9212 2382 Email [email protected] Website http://www.ashm.org.au First published 2001 Reprint (with revisions) 2004 Update and expansion to include STIs 2008 Editors: David Bradford, Gregory Dore, Andrew Grulich, Michael Kidd, Jennifer Hoy, Ronald McCoy, Gail Matthews, Anne Mijch, Simone Strasser Copy Editor: Mary Sinclair Printed by: Paragon Print Australasia HIV, viral hepatitis and STIs : a guide for primary care Darlinghurst, NSW: Australasian Society for HIV Medicine, 2008 ISBN 978-1-920773-50-2 Includes index HIV (Viruses)--Handbooks, manuals, etc. HIV infections--Handbooks, manuals, etc. Hepatitis, Viral--Handbooks, manuals, etc. Sexually transmitted diseases--Handbooks, manuals, etc. 616.9792 © Australasian Society for HIV Medicine Inc. 2008 ABN 48 264 545 457 CFN 17788 Apart from any fair dealing for the purpose of research or study, criticism or review, as permitted under the Copyright Act 1968, no part of this book may be reproduced by any process without written permission. Primary health care providers are granted a non-exclusive licence to copy information for patient consultation. Direct enquiries to the Australasian Society for HIV Medicine (ASHM). Effort has been made to get permission from copyright owners for use of copyright material. We apologise for any omissions or oversight and invite copyright owners to draw our attention to them so that we may give appropriate acknowledgment in subsequent reprints or editions. The statements or opinions that are expressed in this book reflect the views of the contributing authors and do not necessarily represent the views of the editors or publisher. Every care has been taken to reproduce articles as accurately as possible, but the publisher accepts no responsibility for errors, omissions or inaccuracies contained therein or for the consequences of any action taken by any person as a result of anything contained in this publication. All terms mentioned in the book that are known to be trademarks have been appropriately capitalised. ASHM cannot attest to the accuracy of this information. Use of a term in this book should not be regarded as affecting the validity of any trademark. Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication, the ultimate responsibility rests with the prescribing clinician. For detailed prescribing information or instructions on the use of any product described herein, please consult the prescribing information issued by the manufacturer. Contents Acknowledgments ................................................................................................................................................................................. 4 Preface ...................................................................................................................................................................................................... 6 Introduction to HIV, viral hepatitis and STIs Chapter 1 HIV, HBV, HCV and STIs: similarities and differences .......................................................................................... 9 Joe Sasadeusz, Stephen Locarnini, Michael Kidd, David Bradford, Mark Danta Risk assessment and diagnosis Chapter 2 Blood-borne viruses and STIs: might this patient be positive? Epidemiology and transmission .............................................................................................................................. 28 Nicholas Medland, Andrew Grulich, Gregory Dore, David Bradford, Daniel Madeddu, Siobhan Bourke, Simone Strasser, Gail Matthews Chapter 3 Talking with the patient: risk assessment and history-taking ......................................................................... 38 Sarah Huffam, Paul Haber, Jack Wallace, David Bradford Chapter 4 Exposure and acute HIV infection ........................................................................................................................... 46 Jonathan Anderson, John McAllister, Jon Willis, Phillip Keen, Ronald McCoy, Andrew Grulich, Christopher Bourne Chapter 5 Exposure and acute viral hepatitis .......................................................................................................................... 54 Jeffrey Post, George Marinos, Ingrid van Beek, Mary Burns Chapter 6 Signs and symptoms of chronic HIV disease ........................................................................................................ 63 Gary Rogers, Anne Mijch, Alan Brotherton Chapter 7 Signs and symptoms of chronic viral hepatitis .................................................................................................... 71 Moira Sim, Wendy Cheng, Gregory Dore, Kelly Beers Chapter 8 Testing for STIs and STI signs, symptoms and syndromes ............................................................................... 80 David Bradford Chapter 9 Talking about testing: pre-test and post-test discussion .................................................................................. 90 Katherine Fethers, Paul Andrews, Ronald McCoy, Paul Harvey, Jenean Spencer Management in the primary care setting Chapter 10 Primary care management of HIV disease ............................................................................................................ 99 David Orth, Jennifer Hoy, Warren Fitzgerald, John Patten, Anthony Allworth Chapter 11 Primary care management of chronic viral hepatitis ......................................................................................... 111 Robert Feller, Simone Strasser, Jeff Ward, Gillian Deakin Chapter 12 Primary care management of STIs .......................................................................................................................... 125 David Bradford Professional issues Chapter 13 Standard precautions and infection control .......................................................................................................