What to expect on your first Doctor’s visit
You might be heartened or disappointed to know that Doctor’s visits for HIV follow up and treatment are generally very sedate and non-dramatic affairs.
However, the first visit can be daunting and it will be good to know what to expect.
Of course every clinic and every Doctor will have their own guidelines and way of doing things. So don’t expect the visit to follow this to the letter. This is just a guide to let you know generally what to expect.
As with most Doctor’s visits, the same sequence of history taking, physical examination then investigations apply.
The Doctor will start of by asking you some questions with regards to your HIV infection e.g. when it happened, how it happened etc. He will then get some background medical history from you. Please be thorough when giving your doctor this background. Be sure to include any current illnesses, past hospitalizations, past surgeries, allergies etc. Be sure to also tell your doctor if you are on any chronic medications including supplements or herbs. He would then go on to asking more specific questions on how you are currently feeling. This is the time to bring up any symptoms you find suspicious. At this point doctors are trying to find out if you have symptoms of any other STDs, opportunistic infections or other illnesses or diseases unrelated to HIV or STDs.
Apart from the medical history, a social history is just as important. Your doctor will probably want to discuss with you your readiness or preparedness to start medication known as ART (Anti-Retroviral Therapy). This discussion should occur early on even if there is no decision to start ART yet. This is to get you thinking about it and making necessary arrangements for the day that you will inevitably have to start ART. Your doctor might also discuss with you if you still have high risk behaviours like unprotected sex, substance abuse etc. This is important because getting infected again by a different strain of HIV can have consequences on your treatment.
Other parts of the history like social support, mental fitness (or illness), economic factors, medical insurance and others will probably be dealt with by the social worker rather than the doctor.
Your doctor will then go on to a physical examination. Standard measurements like blood pressure, pulse rate, weight, body temperature should be expected. How thorough the rest of the examination will be depends on your doctor and the history that you have provided.
Your doctor will then go on to order investigations or tests for you. We will only be discussing the tests that are specific to HIV treatment. Your doctor might order other tests for other illnesses or infections that you might have (co-morbidities). These will not be covered in this article.
Tests you will most likely need:
|Test||What it is for|
|CD-4 T cell count||To know the health of your immune system. We will discuss this test in greater detail in a separate article.|
|Plasma HIV RNA (viral load)||To know the severity of the HIV infection. We will discuss this test in greater detail in a separate article.|
|Genotypic resistance testing (not usually done if viral load is < 500 copies/ml)||To detect any resistance to ART medicines.|
|Hepatitis A, B and C serology||To detect the presence of Hepatitis infections and the adequacy or need for vaccinations.|
|Complete blood count||Basic blood profile. Measures Red Blood Cells, White Blood Cells, Haemoglobin and Platelets.|
|Blood chemistry, Urea and Creatinine, Urinalysis||To determine the health and function of your kidneys and urinary system.|
|Serum albumin, transaminase, bilirubin||To determine the health and function of your liver.|
|Blood glucose and serum lipids||To detect diabetes, pre-diabetes and high cholesterol.|
Tests you may need:
|Test||What it is for|
|Viral tropism assay||To be done if you need a medicine known as a CCR5 inhibitor.|
|HLA-B 5701 testing||To be done if you need a medicine known as Abacavir (ABC). This is to identify individuals who may develop severe hyper-sensitivity reactions to ABC.|
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Robertson Walk 6238 7810
Bencoolen Street 6884 4119
About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.