HIV
Patient Presentation
D.C., a 23 year old male, presented to the ER complaining of diarrhea (>12 BM’s per day), vomiting and anorexia for the past four days. VS: T 99.8, HR 110, RR 16, POx 98% on RA. An IV was started and the patient was given fluids. Labs were ordered to include CBC, BMP, and stool cultures. A history was obtained and revealed no significant medical history. The patient denied any travel, however he reported the diarrhea began after eating at Taco Bell.
Diagnosis
Labs ordered were significant for elevated creatinine 2.8, Na+ 156, and decreased K+ 3.1, . The patient was admitted to the hospital for dehydration with mild renal failure. His stool culture subsequently returned positive for Shigella and he was started on Cipro®. D.C. was discharged after five days and instructed to follow up with Nephrology. Due to the concern for AKI in a young otherwise healthy male, further labs were ordered and an HIV test was positive. Upon initial notification, D.C. revealed he was diagnosed a year ago after testing positive for syphilis, but never followed up. The patient was referred to an ID clinic for additional work up, which revealed a CD4 of 202 (17%) and Viral Load (VL) of 5637.
Treatment
As D.C.’s CD4 is 202, he was borderline for AIDS and recommended to start Anti-Retroviral Therapy (ART) immediately. He was started on Atripla®, a combination pill that contains two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitor. The patient was counseled on the importance of taking this medication consistently due to the risk of resistance.
Outcome
The patient returned in four weeks to evaluate efficacy and tolerance of the medication. D.C. reported taking his medication daily without any missed doses and reported some initial fatigue, which was resolved by the time of visit. Repeat labs showed an improvement with an increased CD4 count of 283 and decreased VL of 1293.
Case created by Dawn Collier, 2012.