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HIV CASE PRESENTATIONS: SARAH BARBER CNS HIV. 01689 866647

HIV CASE PRESENTATIONS: SARAH BARBER CNS HIV. 01689 866647. 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. PC AND PMH. weight loss (May 2010) fatigue

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HIV CASE PRESENTATIONS: SARAH BARBER CNS HIV. 01689 866647

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

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

  4. 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. 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. RESULTS AND RESPONSE • July 2010 – CD4 up to 160 • viral load down to 8 516 • tolerating treatment well • very relieved GP did test

  7. 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. 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. PATIENT B • 45 yr old male • background - White UK • Chef • Lived in Bromley long time

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

  11. 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. 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. 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. 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?

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