CASE LEARNING OBJECTIVES
Identify the typical and atypical signs and symptoms of acute and chronic human immunodeficiency virus (HIV) infection
Identify the desired therapeutic outcomes for patients with HIV infection
Recommend appropriate first-line pharmacotherapy interventions for patients with HIV infection
Describe the components of a monitoring plan to assess the effectiveness and adverse effects of pharmacotherapy for HIV infection
Educate patients about the disease state, appropriate lifestyle modifications, and drug therapy required for effective treatment
"I am ready to start medications."
History of Present Illness
Kim Jones is a 35-year-old African American female recently diagnosed with HIV after presenting with Pneumocystis jiroveci pneumonia. P. jiroveci pneumonia was diagnosed 1 month ago when she presented to the hospital with increased weight loss, SOB, insomnia, nonproductive cough, and unremarkable chest x-ray. During her hospitalization, antiretroviral therapy was discussed but the patient was not ready to start taking it yet. She also had no insurance or way to pay for her medications at the time.
P. jiroveci pneumonia (PJP) diagnosed 1 month ago
She has not seen her father in more than 15 years and her mother is alive with a history of stroke and HTN.
She is currently unemployed and lives with her mother.
Smokes 2 ppd; drinks about 10–12 drinks a week; former crack/cocaine use, but clean for 6 months
Allergy/Intolerance/Adverse Drug Events
Azithromycin 1,200 mg PO weekly
Enalapril 10 mg PO q 24 h
Bupropion XL 150 mg PO q 24 h
(+) Weight loss; decreased appetite; (+) insomnia; (−) SOB; chest pain
Well-appearing African American woman in no acute distress
BP 130/86 mm Hg, P 72, RR 13, T 36.4°C
PERRLA; no evidence of retinopathy. Oropharynx, no evidence of thrush
Neck supple; no lymphadenopathy