What are the key considerations for managing co-infections in patients with HIV in a primary care setting?

Key considerations for managing co-infections in patients with HIV within a primary care setting include:

• Ensure regular attendance and coordination with specialist HIV services: Primary care should support patients to attend specialist clinics for monitoring of HIV infection using CD4 count and viral load, which guide risk assessment for opportunistic infections and co-infections. If patients do not attend specialist care, primary care can consider assessing immunity (e.g., CD4 count) after discussion with specialists and laboratories, and discuss prophylactic treatment options for opportunistic infections such as pneumocystis pneumonia with the specialist team ¹,².
• Screening and testing for co-infections: Offer and recommend testing for hepatitis B and C in people with HIV, as co-infection is common and requires integrated management. Testing should be done with consent, accompanied by pre- and post-test discussions, and linked to appropriate care pathways including immunisation and treatment ⁴.
• Medication review and management of drug interactions: Take a detailed medication history including over-the-counter, herbal, and recreational drugs, as antiretroviral therapy (ART) can have serious interactions with many other drugs. Do not adjust or discontinue ART without specialist advice. Use available resources such as www.hiv-druginteractions.org and the British National Formulary to check for interactions before starting or stopping any medication ¹,².
• Address mental health and social factors: People with HIV are at increased risk of mental health problems, which can affect adherence to ART and attendance at specialist services. Mental health conditions should be assessed and managed as usual, with referral to specialist services as needed, and awareness of potential drug interactions with ART ¹,².
• Health promotion and immunisation: Provide information on health promotion, screening, immunisation, sexual and reproductive health, and support for end-stage HIV disease as part of holistic care ².