Chapter 147: HIV Infection: The Antiretroviral-Naïve Patient Level II

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LEARNING OBJECTIVES

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

• Describe when antiretroviral therapy should be initiated in patients living with HIV.

• List the treatment goals of antiretroviral therapy.

• Design an appropriate antiretroviral regimen for an antiretroviral-naïve person living with HIV based on patient-specific data.

• Provide patient education on recommended antiretroviral agents to ensure adherence and minimize adverse effects.

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. She was asymptomatic at the time of diagnosis. She is currently antiretroviral therapy (ART) naïve, and since her diagnosis she has been following up regularly every 6 months. However, up to this point, she has not been ready to commit to ART. Today she returns to the HIV Specialty Clinic for a follow-up visit and reports painful and difficult swallowing over the past 2–3 weeks.

PMH

HIV positive, diagnosed 2 years ago; risk factor heterosexual contact

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; cigarette smoking, 0.5 ppd; EtOH, one to two drinks on weekends; unemployed, lives with partner; sexually active with stable partner, 100% condom use; partner is HIV (–) and is aware of her HIV status

Medications

Multivitamin with minerals one tablet PO once daily

Albuterol HFA two puffs Q 6 H PRN SOB

Calcium carbonate antacid one to two tablets PRN heartburn

Oral contraceptive one tablet PO daily

All

TMP/SMX (rash)

ROS

Difficulty and pain on swallowing

Physical Examination

Gen

Thin, well-developed black woman 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/Lymph Nodes

Supple, no thyromegaly, (+) ...