HIV long case

Question 1

Questions that are relevant in HIV patients?
- How did you get it?
- Risk factors
- Medications related questions

Answer 1

1. How did you get HIV?
   - when, how long ago? were you unwell with it? Was there any HIV/AIDs defining illness?
   - Whats you CD4 count? What was your HIV viral load?
   - How did you get it via IVDU, sexual transmission, vertical transmission? Did you acquire this locally or overseas during travel ? (impt in term of drug resistance)
   - were you on any antibiotics , anti fungal therapy? Azithromycin? Pentamidine? Bactrim?
   - Did you have any eye, brain infection, Toxo or diarrhoea - cryptosporidia
   -
2. Risk factors:- acquiring new strain and transmission as well as psychological RF/stigmata of HIV
   - are you still active sexually? stable partner?
   - Does partner aware of diagnosis?
   - How many partners in the last 6 months/ week? Do you have anal sex? Do you have any partner that are negative/positive? do you or they used PREP if frequent interaction with new partner present?
   -Are you IVDU? Do you live with anyone else at home? Family? children - do they know of diagnosis, do they have HIV too?
3. Medications:
   - Do you recall your medication initiially? Were you commenced on any antibiotics? as earlier then
   -current medications- developed any side effects from these? what and did it stop or change the meds?
   - any break through of viral load? there is a specific terminology for this.
   -What is your current viral load?
   -has ever been higher? Have you ever had resistance strain?
   -Whats your viral load then?
   -have you missed any tablets? How often do you missed in a month?
   - What do you associate when you’re taking your tablets? Before breakfast upon waking up or with breakfast.
   -Do you have side effects to any of your drugs in the past or presents that I need to know to avoid.

Question 2

HIV related question in history
4. Complications associated with infection- STD, PJP, TB, Bartonella, Toxoplasmosis and psychosocial
5. Complications of HIV- other chronic illness and cancers (IHD, peripheral neuropathy, lipodystrophy, kaposi sarcoma and anal cancer)
6.Psychosocial and how this is affecting his life financially, psychococially and overall impact

Answer 2

4. Opportunistic infections:
   Complications associated with infections- Have you had STD before? did you get any treatment? any current risk factor for re-infections. Any previous history of PJP and medications for this- bactrim, pentamidine, Toxoplasmosis- meningitis, TB- isoniazid for latent TB? active TB therapy in the past.
   -Have you any other infection related to HIV?
   -Have you had penumonia/TB?
   -Have you a brain, eye lesion needing injections/ foscarnet injection or IV antibiotics /antiviral- valganciclovir?
   -Chronic diarrhoea and weight loss
   -Have you ever taken bactrim, fluconazole or Azithromycin
5. Do you have any history of chest pain, USA, angiogram in the past, Echo, ECG, SOB, leg swelling, OSA, sleeping difficulty, High BMI, lipid profile, diabetes, Peripheral neuropathy, Stroke, recurrent falls ,lymphoma, Kaposi sarcoma, cervical cancer, anal cancer and screening just like any other gen med cases.
6. Family history, allergic and drug adverse reactions.
7. Social history- financial- r u able to afford your medications, pay bills and rent, work- supportive? Aware of diagnosis? GP, Support groups, Will, EPA, EPG and AHD, Travel and sex history as prev. Dementia
8. Examination

Question 3

Examinations of HIV patients

Answer 3

1. Oral candida
2. Oral lesion/ hoarse voice-head and neck cancer from oral sex/ HPV
3. Lipodystrophy/ lipoatrophy in arms and legs- skinny but intraabdominal fat increases due to indinavir metabolic toxicity
4. Skin lesion- Kaposi sarcoma and non-melanomatous skin cancer
5. Diabetes
6. Ischaemic cardiomyopathy
7. Peripheral neuropathy from
8. Hepatocellular cancer from Hep B infections
9. Lymphoma- NHL- Burkitts lymphoma
10. Anal cancer

Question 4

Opportunistic infections

Answer 4