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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.
“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. 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.
HIV positive, diagnosed 2 years ago; risk factor heterosexual contact
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
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
Difficulty and pain on swallowing
Thin, well-developed black woman 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, (+) bilateral cervical lymph nodes 0.7 cm in diameter