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INTRODUCTION

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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

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PATIENT PRESENTATION

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Chief Complaint

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"I am ready to start medications."

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History of Present Illness

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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.

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Past Medical History

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P. jiroveci pneumonia (PJP) diagnosed 1 month ago

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Depression × 5 years

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HTN × 5 years

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Family History

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She has not seen her father in more than 15 years and her mother is alive with a history of stroke and HTN.

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Social/Work History

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She is currently unemployed and lives with her mother.

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Tobacco/Alcohol/Substance Use

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Smokes 2 ppd; drinks about 10–12 drinks a week; former crack/cocaine use, but clean for 6 months

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Allergy/Intolerance/Adverse Drug Events

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Sulfur drugs

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Medication (Current)

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Dapsone 100 mg PO q 24 h

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Azithromycin 1,200 mg PO weekly

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Enalapril 10 mg PO q 24 h

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Bupropion XL 150 mg PO q 24 h

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Review of Systems

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(+) Weight loss; decreased appetite; (+) insomnia; (−) SOB; chest pain

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Physical Examination

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General
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Well-appearing African American woman in no acute distress

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Vital Signs
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BP 130/86 mm Hg, P 72, RR 13, T 36.4°C

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Weight 130 lb (59 kg)

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Height 65 in. (165.1 cm)

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No pain

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Skin
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Supple; (−) rashes

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HEENT
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PERRLA; no evidence of retinopathy. Oropharynx, no evidence of thrush

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Neck and Lymph Nodes
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Neck supple; no lymphadenopathy

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Chest
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Clear to ...

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