Wednesday, June 26th

12:00 p.m. – 12:30 p.m.

Initial Management of the Patient Living with HIV

A 29 year old African American male diagnosed in April 2013 returns for follow-up after review of confirmatory Western blot and ordering of baseline labs. He was diagnosed in the ED during an admission for abdominal pain. He is MSM with multiple partners and admits to unprotected intercourse. He engages in anal insertive intercourse. He admits to daily use of marijuana and alcohol. His last labs were drawn 3 weeks ago. His CD4 count was 575 and his VL was 36,000. His Genotype done in April 2013 showed the virus to be pan sensitive. He states his insurance is active and he wants to start ARV’s. His most recent partner is with him and his status is unknown.

What are the key points of Mike’s case?

What would you do next?

A 42 year old African American woman presents for follow-up visit. She was diagnosed 6 months ago during an anonymous screening at Howard University Hospital. After returning for the confirmatory results she has missed her next 2 appointments. She admits to occasional crack cocaine use and daily alcohol intake. Her CD4 count is 620 and the HIV RNA is 8,375. The Genotype indicates no drug resistance. She eager to start medication today.

What are the key points of Donna’s case?

Discuss your concerns for this patient and how you would address them.

How do you address her eagerness to start ARV’s.

A 29 year old white male was diagnosed HIV+ one week ago by rapid testing returns for confirmatory results which are positive. The CD4 count is 35 and the VL is pending. No other labs were drawn. He states that he has never been tested for HIV before. He is heterosexual, has numerous partners and engages in unprotected intercourse. He denies drug or alcohol use / abuse. He smokes 1 pack of cigarettes daily. This is your first visit with this patient.

He complains of fatigue, recent 20 weight loss and pain with swallowing. He is afebrile and all other VS are stable. NKDAWhile reviewing the labs you begin your history.

What are the key points of Frank’s case?

Discuss your questions first for a male patient, then for a female.

What areas of the physical examination require special attention?