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HIV as a complex care scenario

(Vienna, 19 July 2010) In 1995 there were 300 HIV patients coming to the Vienna General Hospital AKH for regular care, and now fifteen years later this figure has already risen to 1,200 patients. Until the 1990s HIV infection was still seen as a death sentence, but today more than 90 percent of patients are treated successfully. It is, however, difficult to treat "late presenters", those people who are unaware of their disease for a long time and whose immune system is already badly damaged. According to estimates this is around one in four affected people.

We interviewed Aids specialist Prof. Armin Rieger on this and other questions associated with the theme of HIV/Aids in Austria.

How can the so-called "late presenters" be motivated to take an Aids test at an earlier stage?
We need the issue to be constantly in the media. The Life Ball is important and raises attention once a year, but we need to have focus on this issue for the other 364 days a year. Today Aids affects all income, educational and professional groups. There is a lack of awareness particularly among people with heterosexual orientation and in the 50 plus generation, these people feel safe because they are not among the "typical" risk groups. "Barrier-free", i.e. low-threshold access to HIV tests would be another important step here. The earlier the disease is detected, the easier it is to treat and the less likely it is that the infection is passed on unwittingly.

Why would you recommend that patients with suspicion of having HIV or who are infected with HIV visit the AKH?
Because we have twenty years of experience and have set up a highly-specialised Aids outpatient ward with the entire diagnostic repertoire. A team of doctors is available for our patients from Monday to Friday, and for working patients on Tuesday from 7.00 am. Although we are an outpatient ward with appointments, appointments are not absolutely necessary. We offer a wide range of languages as well as access to clinical psychologists, nutritional advice and a social worker. Our established team of doctors includes specialists in dermatology and venereology, colleagues in training and also two experienced general practitioners. Our patients are also treated by nursing staff with many years of experience. All these factors ensure the highest care quality and also guarantee long-term compliance at the same time.

What is the quality of life of the average Aids patient today?
Modern HIV therapeutics are already very well tolerated, there are patient-friendly coformulations and many of those affected can lead a life almost free of side effects today. Patients include, for example, doctors, pilots and managers, people from all occupational groups – and many of our patients continue to exercise their profession too.

Sounds like a medical success story. Where are the problems?
The main crux is still that the disease is hushed up in large parts of society and the way those affected are dealt with is often influenced more by misconceptions and fears than by objectivity. HIV patients are still stigmatised, with all the negative effects on the success of their medical treatment. Our current findings are concentrated on the ideal time to begin antiretroviral therapy and the desired and undesired long-term effects of the individual substances.

You have been dealing with Aids for more than 15 years. Why?
This infection basically affects every organ system and in its progression can have a highly varied spectrum of pathologies from many different specialist disciplines. This clinical diversity, the work with, at the time, mostly younger patients from all social classes and the possibility in recent years of following, up close, one of the most exciting and successful medical developments were the main reasons that I concentrated on this disease.

What are the challenges associated with this?
To meet the changing care scenario requirements. On the one hand we still see patients with the most serious opportunistic pathologies, almost exclusively as a consequence of too late diagnosis of the underlying disease. On the other hand we need to look after a growing collective mainly consisting of outpatients who require increasing cooperation with other specialist disciplines. Patients are no longer excluded from organ transplants because of their life expectancy and today HIV infection is no longer a reason to forgo family planning and the desire to have children. On account of the complexity of an HIV infection and its treatment and also because of the associated fears, many patients are treated via our Aids outpatient ward. HIV centres therefore also often play the role of a primary care provider.

What role does communication play when dealing with your patients?
We have to put ourselves in our patients’ shoes and translate central technical terms and processes in a way which can be understood and include these people in decision-making processes. The drugs prescribed by us have to fit in with the daily structure of our patients in order to become a fixed component of their life. Here our patients have to understand why they have to take which drug when and how, and which consequences there may be if they stop taking a drug. We have to meet this challenge every day.

Many thanks for the interview!