Working with HIV CASE PRESENTATIONS: SARAH BARBER CNS HIV. 01689 866647.
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Transcript of Working with HIV CASE PRESENTATIONS: SARAH BARBER CNS HIV. 01689 866647.
working with
HIV CASE PRESENTATIONS:
SARAH BARBER CNS HIV.
01689 866647
working with
PATIENT A
• 36 year old Black African male
• Lives in Anerley, originally from
Ivory Coast – in UK for 5 years
• refuse collector
• married with a 4 year old child
working with
PC AND PMH
• weight loss (May 2010)
• fatigue
• back pain (? occupational)
• headache (2009)
• knee problems (2008)
• registered (2005)
working with
RESULTS and ACTION
• HIV +ve and Hep B +ve
• Referred GUM (June 2010)
• Results confirmed
• o/e nil specific but self reports fatigue
and wt loss
• CD4 100 and viral load 1 439 594!
working with
TREATMENT AND ACTION
• starts HAART – ATRIPLA -
also effective against Hep B
• starts SEPTRIN PCP prophylaxis
• wife tests HIV –ve therefore
no need to test child
• back pain likely mechanical
working with
RESULTS AND RESPONSE
• July 2010 – CD4 up to 160
• viral load down to 8 516
• tolerating treatment well
• very relieved GP did test
working with
ONGOING RESULTS AND RESPONSE
• Sept. CD4 210 – stop septrin
viral load 615
• Oct. viral load 118,
Hep B DNA <100,
• Jan 2011, CD4 360, V/L <50
• Feels very well
working with
SUMMARY
• Pt from high risk background
• very advanced HIV disease
• relatively asymptomatic - lucky
• responds well re HIV and Hep B -
life saving
• wife negative – HIV prevention
• Could we have tested sooner?
working with
PATIENT B
• 45 yr old male
• background - White UK
• Chef
• Lived in Bromley long time
working with
PC and PMH
• Sore tongue ?OHL (Dec 2010)
• Whitlow and skin probs (Dec 2010)
• Crohn’s (09)
• URTIs (04/05)
working with
RESULTS AND ACTION
• HIV test +ve, referred GUM (Jan)
• confirmatory test +ve
• Gay man – never tested before -
didn’t perceive at risk
• Partner tested HIV +ve
working with
RESULTS AND ACTION
•CD4 210, v/l 11 306
• o/e mouth sore, fungal skin rashes
fatigue and diarrhoea on/off
• mouth swab - candida
• STI screen NAD
working with
TREATMENT AND RESPONSE
•HAART – Truvada efavirenz (Feb)
• fluconazole and topical daktakort
• CD4 280, V/L 144 (March)
• mouth and skin better
•CD4 270, V/L <50 (April)
• well and grateful to GP
working with
SUMMARY
• Pt from high risk background
• symptomatic – advanced disease
• Good therapy response– life saving
• prevention – education about HIV
and future safer sex
• Could we have tested him sooner?