Presentation on theme: "Working with HIV CASE PRESENTATIONS: SARAH BARBER CNS HIV. 01689 866647."— Presentation transcript:
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?