Case 8
Download
1 / 16

Case 8 - PowerPoint PPT Presentation


  • 141 Views
  • Uploaded on

Case 8. 38 year-old man from Sub-Saharan Africa Came to UK in 2001 Living in London First wife died 10 years ago of TB Remarried for 7 years, wife currently pregnant (antenatal HIV screening negative). Case 8: PMH. 2001 Registered with GP 2004 Hypertensive – treatment started

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Case 8' - zhen


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Case 8
Case 8

38 year-old man from Sub-Saharan Africa

Came to UK in 2001

Living in London

First wife died 10 years ago of TB

Remarried for 7 years, wife currently pregnant (antenatal HIV screening negative)


Case 8 pmh
Case 8: PMH

2001 Registered with GP

2004 Hypertensive – treatment started

Recurrent knee problems

2006 Arthroscopy - conservative treatment recommended

2007 PUO/suspected malaria

Admitted for 48 hours and found to be anaemic (Hb 9.8)

Treated with anti-malarials and antibiotics.

HIV test not offered

2008 >10 kg weight loss noted

Said he had been trying to lose weight as previously overweight


Case 8 late july 2009
Case 8: late July 2009

Presented to GP with:

  • Flu-like illness

    (presumed H1N1 treated with Tamiflu)

  • Herpes Zoster left trunk

    Offered HIV test

    • HIV positive

    • CD4 189

    • Viral load 90,000

    • Hb 8.7


Case 8 summary
Case 8: summary

2001 Registered with GP

From 2004 Seeing GP for hypertension

2006 Pre-op screening - arthroscopy

2007 Admitted for PUO/suspected malaria and anaemia

2008 GP notes >10 kg weight loss since Nov 2007

2009 Seen by GP for Herpes zoster

HIV diagnosed: CD4 189, VL 90,000


Q at which of his healthcare interactions could hiv testing have been performed
Q: At which of his healthcare interactions could HIV testing have been performed?

  • When he first registered with his GP?

  • When he saw GP for hypertension?

  • When he was admitted by the orthopaedic team for arthroscopy?

  • When he was admitted for PUO/malaria and noted to have anaemia?

  • When his GP noted his >10kg weight loss?

  • Should he have been referred to GUM to see a trained counsellor before HIV testing?


Who can test
Who can test? have been performed?


Who to test
Who to test? have been performed?


Who to test1
Who to test? have been performed?


Who to test2
Who to test? have been performed?


Who to test3
Who to test? have been performed?

2008 Report on the

global AIDS epidemic

HIV prevalence (%) in adults (15–49) in Africa, 2007


Who to test4
Who to test? have been performed?


Rates of HIV-infected persons accessing have been performed?

HIV care by area of residence, 2007

Source: Health Protection Agency, www.hpa.org.uk


At least 5 missed opportunities! have been performed?

If current guidelines used, HIV diagnosed 8 years earlier

2001 Registered with GP

From 2004 Seeing GP for hypertension

2006 Pre-op screening - arthroscopy

2007 Admitted for PUO/suspected malaria and anaemia

2008 GP notes >10 kg weight loss since Nov 2007

2009 Seen by GP for Herpes zoster

HIV diagnosed: CD4 189, VL 90,000


Learning points
Learning Points have been performed?

  • This patient came from an area of high HIV prevalence, but was not offered an HIV test in numerous contacts with healthcare services

  • His wife had tested HIV-negative, but this is no guarantee of his being HIV-negative

  • A perceived lack of risk should not deter you from offering a test when clinically indicated

  • HIV screening should be a routine test on presentation of a blood dyscrasia, PUO or weight loss of otherwise unknown cause


Key messages
Key messages have been performed?

  • Antiretroviral therapy (ART) has transformed treatment of HIV infection

  • The benefits of early diagnosis of HIV are well recognised - not offering HIV testing represents a missed opportunity

  • UK guidelines recommend universal HIV testing for patients from groups at higher risk of HIV infection

  • UK guidelines recommend screening for HIV in adult populations where undiagnosed prevalence >1/1000 as it has been shown to be cost-effective


Also contains have been performed?

UK National Guidelines for HIV Testing 2008

from BASHH/BHIVA/BIS

Available from:

[email protected] or 020 7383 6345


ad