Skip to Main Content

++

LEARNING OBJECTIVES

++

After completing this case study, the reader should be able to:

++

  • Describe when antiretroviral therapy should be initiated in patients with HIV infection, and determine the desired outcome of such therapy.

  • Recommend appropriate first-line antiretroviral therapies for the antiretroviral-naive person.

  • Provide patient education on the proper dose, administration, and adverse effects of antiretroviral agents.

++

PATIENT PRESENTATION

++

Chief Complaint

++

“I am here for regular care. It hurts to swallow.”

++

HPI

++

Jenny Baird is a 34-year-old woman diagnosed with HIV infection 2 years ago during a routine exam. At the time of diagnosis, the patient was asymptomatic. She is currently antiretroviral therapy (ART) naïve, and since her diagnosis, she has been following up regularly every 4 months. However, up to this point, she has not been ready to commit to ART. Today she returns for a follow-up visit and reports painful and difficult swallowing over the past 2–3 weeks.

++

PMH

++

  • HIV infection, diagnosed 2 years ago; risk factor heterosexual contact

  • Bronchitis

  • Asthma

  • GERD

++

FH

++

Noncontributory

++

SH

++

  • History of crack cocaine use, last use 1 month ago

  • Smokes marijuana once per month, mainly as an appetite enhancer

  • Tobacco 0.5 ppd

  • EtOH, one to two drinks on weekends

  • Unemployed, lives with partner

  • Sexually active with stable partner, 100% condom use as sole method of contraception; partner is HIV (–) and is aware of her HIV status

++

Medications

++

  • Multivitamin with minerals PO once daily

  • Tums PRN heartburn

  • Albuterol HFA MDI, two puffs Q 6 H PRN SOB

++

All

++

TMP/SMX (rash)

++

ROS

++

Difficulty and pain on swallowing

++

Physical Examination

++
Gen
++

Thin, well-developed black female in NAD, alert and oriented × 3

++
VS
++

BP 110/64 mm Hg, P 80 bpm, RR 18, T 35.9°C; Wt 58 kg, Ht 5′5″

++
Skin
++

Anicteric, has large tattoo on back, no other skin lesions noted

++
HEENT
++

(+) Oral lesions and white plaques, sinuses nontender, PERRLA, ears and nose clear

++
Neck
++

Supple, no thyromegaly, R neck lymph node 0.7 cm in diameter

++
Chest
++

Lungs clear

++
CV
++

S1, S2 without S3, S4, or murmur

++
Abd
++

  • (+) BS, soft, nontender, without HSM

  • (+) Bilateral inguinal lymph nodes 0.5 cm in diameter

++
GU
++

The pelvic exam reveals normal external genitalia. ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.