A patient with chronic, stable HIV comes to you with a new STD

A patient with chronic, stable HIV comes to you with a new STD. What prevention considerations should be covered in this visit?
For the patient who has had a stable course of disease, a new STD can be a sign of emerging social, emotional, or substanceabuse problems. These potential problems should be addressed in addition to the STD.
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During the history, cover topics related to acquisition of the new STD—number of new partners, number of episodes of unsafe sex, and types of unsafe sex.
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Address the personal risks associated with high-risk behavior, e.g., viral superinfection and HIV/STD interactions.
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Address personal or social problems (including substance abuse and domestic violence) that might have led to a change in behavior resulting in the acquisition of the new STD; refer to social services, if necessary.
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Address other issues (e.g., adherence to HAART) that may be affected by personal or social problems. Check viral load if nonadherence is evident or is suspected.
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During the physical examination, include a careful genital and rectal examination and screen for additional STDs, such as syphilis, trichomoniasis, (for women), chlamydial infection (for sexually active women aged <25 years and selected populations of men and women), and gonorrhea (for selected populations of men and women).
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Discuss the need for partner notification and referral for counseling and testing.
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Note in the chart that risk behavior should be addressed in future visits and that tailored counseling may be needed for the patient.
3. A patient with chronic, stable HIV has been seen regularly in a health care setting. What should be included in this patient’s routine clinical care?
Discussion of sexual and needle-sharing practices should be integrated into a routine part of clinical care.
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Periodically (e.g., annually) screen for STDs. STDs to be included in screening should be determined by patient’s sex, history of high-risk behavior, and local epidemiology of selected STDs.
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Reiterate general prevention messages and patient education regarding partner notification, high-risk behaviors associated with transmission, prevention of transmission, or condom use, as deemed appropriate by the clinician.
4. A patient who has been treated with HAART for 2 years comes to you. At the time of treatment initiation, CD4+count was 200 cells/μL and the viral load was 50,000 copies/ml. The response to therapy was prompt; CD4+ count increased to 500 cells/μL, and the viral load has been undetectable since soon after treatment began. The patient now has mildly elevated cholesterol, some mild lipodystrophy, and facial wasting. He states that he would like to stop HAART because of the side effects. What should you tell this patient?
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Inform the patient that upon stopping HAART, CD4+ count and viral load will likely return to pretreatment levels with risk for opportunistic infections and progression of immune deficiency.
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Inform the patient that increase in viral load to pretreatment levels will likely result in increased infectiousness and risk for transmission of HIV to sex or needle-sharing partners.
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Counsel the patient regarding the option of changing the HAART regimen to limit progression of metabolic side effects.