THEME INFECTIONS THAT LAST Julian H Elliott MBBS, FRACP, PhD, is Assistant Head, Clinical Research, Infectious Diseases Unit, Alfred Hospital and Burnet Institute, Melbourne, Victoria. Michelle K Yong MBBS, FRACP, is HIV Research Fellow, Infectious Diseases Unit, Alfred Hospital, Melbourne, Victoria. Justin T Denholm BMed, MBioethics, is a research registrar, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Victoria. justin.denholm@mh.org.au Management of human immunodeficiency virus (HIV) infection has greatly benefited from the development and introduction of a range of new medications and treatment strategies over the past decade. The use of combination antiretroviral therapy (cART) generally results in rapid and sustained control of HIV viraemia and sustained increase in CD4+ T-cell numbers. With improvements in efficacy of ART, the treatment goal has shifted to suppression of plasma HIV viral load to below the limit of detection of routine assays (<50 copies/mL) in all patients. In most patients virological suppression will be associated with an ongoing increase in peripheral CD4+ T-cell count into the normal range. These advances have greatly altered the prognosis of HIV infected patients, leading to decreased opportunistic infections such as Pneumocystis pneumonia and increased longevity. 1 The ongoing care of people living with HIV has increasingly focused on common elements of chronic disease management. While patients with HIV should have at least intermittent contact with an experienced cART prescriber, many patients prefer to also maintain contact with their usual general practitioner. Chronic disease management Many of the challenges of long term management of HIV infection are common to other chronic conditions, and GPs will be familiar with strategies such as the use of recall and reminder systems and Medicare chronic disease item numbers. General practice management plans enable documentation of all relevant health issues, development of action and monitoring plans, clarification of multidisciplinary team care arrangements, and facilitate access to Medicare funded allied health professionals. Supporting long term treatment adherence is a central component of HIV care and is enhanced by good communication and effective collaboration between doctor and patient 2 and the use of multidisciplinary teams. 3,4 Long term management of people with HIV Background Advances in the treatment of human immunodeficiency virus (HIV) have resulted in sustained improvements in the general health and longevity of people living with the virus. Primary care continues to be predominantly delivered by high caseload general practitioners and specialists, but GPs with limited HIV experience are increasingly likely to have contact with HIV positive patients through shared care arrangements. Objective The aim of this article is to review the management of stable patients with HIV and to provide an approach to important elements of their ongoing care. Discussion The long term care of people living with HIV is increasingly focused on chronic disease management and health promotion. Specific issues include mental health; drug and alcohol use; sexual and reproductive health; cardiovascular, renal, liver and bone disease; malignancies; and prevention, including immunisation. Treatment side effects such as lipodystrophy and peripheral neuropathy are less common with newer agents, but other toxicities are increasingly recognised. The majority of people living with HIV can be managed in the general practice setting, with specialist support where appropriate. 574 Reprinted from AUSTRALIAN FAMILY PHYSICIAN Vol. 38, No. 8, August 2009