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)

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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!

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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

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RESULTS AND RESPONSE

• July 2010 – CD4 up to 160

• viral load down to 8 516

• tolerating treatment well

• very relieved GP did test

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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

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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?

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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)

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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

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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

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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

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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?