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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.
“I am here for regular care. It hurts to swallow.”
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.
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
Difficulty and pain on swallowing
Thin, well-developed black female in NAD, alert and oriented × 3
BP 110/64 mm Hg, P 80 bpm, RR 18, T 35.9°C; Wt 58 kg, Ht 5′5″
Anicteric, has large tattoo on back, no other skin lesions noted
(+) Oral lesions and white plaques, sinuses nontender, PERRLA, ears and nose clear
Supple, no thyromegaly, R neck lymph node 0.7 cm in diameter
S1, S2 without S3, S4, or murmur