1. working with HIV CASE PRESENTATIONS: SARAH BARBER CNS HIV. 01689 866647

2. 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

3. working with PC AND PMH weight loss (May 2010) fatigue back pain (? occupational) headache (2009) knee problems (2008) registered (2005)

4. 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!

5. 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

6. 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

7. 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

8. 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?

9. working with PATIENT B 45 yr old male background - White UK Chef Lived in Bromley long time

10. working with PC and PMH Sore tongue ?OHL (Dec 2010) Whitlow and skin probs (Dec 2010) Crohn’s (09) URTIs (04/05)

11. 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

12. 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

13. 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

14. 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?