Question

HIV Case Study

Case Study

Patient Profile

J.N., a 35-year-old African American woman, was admitted to the hospital in respiratory distress. AIDS and Pneumocystis jiroveci pneumonia (PCP) were both diagnosed 2 days ago.

Subjective Data

• Seen by an HCP 6 years ago for pain behind the sternum and difficulty swallowing, diagnosed as esophageal candidiasis; positive HIV-antibody test at that time
• Has consistently refused ART because, “We can't afford it”
• Married to Jim, a former IV drug user, for 15 years until his recent death from AIDS-related complications
• Has two children, ages 8 and 10; neither has been tested for HIV infection
• Experiences fatigue and frequent oral and vaginal candidiasis outbreaks
• Expresses concern about the welfare of her children, who are at home with her sister, and says, “Maybe I should take better care of myself for them”

Objective Data

• 5 ft 6 in tall, 100 lb, temperature 100.4° F (38° C), O2 saturation 92% on 3 L of O2 via nasal cannula
• CD4+ T cell count 185 cells/µL
• Viral load 55,328 copies/µL
• Hematocrit 30%

Interprofessional Care

• Trimethoprim/sulfamethoxazole
• Combination antiretroviral therapy: tenofovir and emtricitabine (Truvada), with darunavir and cobicistat (Prezcobix)

QUESTION

1. Why did J.N.’s initial medical problem (esophageal candidiasis) lead to an HIV test?

Answer 1

HIV stands for Humman Immunodeficiency Virus.It harms your immune system by destroying the white blood cells that fight infection .This put you at risk for serious infections and certain cancer.   

Mucocutaneous candidiasis occurs in 3 forms in person with HIV infection  ; * Oropharyngeal candidiasis * Esophageal candidiasis * Vulvovaginal candidiasis

Oropharyngeal candidiasis; It is among the initial manifestation of HIV -Induced immunodeficiency to be recognized and typically affects the majority of persons with advanced untreated HIV infection.    Esophageal candidiasis; It is an opportunistic infection of the esophagus by candida albicans .This disease usually occurs in patients in immuno compromised states(example;post-chemotherapy and AIDS).This is one of the most common infection in countries where combination antiretroviral therapy (ART) is a routine part of the standard of care.

Vulvovaginal candidiasis; It is an important concern for women with HIV infection,although the relationship of vulvovaginal candidiasis to HIV infection remain unclear.   

Esophageal candidiasis is the most common opportunistic infection affecting people with HIV infection or AIDS .It is considered as an important marker of immune suppression and may be the initial manifestation of the disease in about 10% of HIV -Infected adults.Main symptoms;white lesion on the lining of your esophagus that may look like cottage cheese and may bleed if they are scraped,pain or discomfort when swalloing ,dry mouth,difficult swalloing,nausea,vomitting,weight loss,chest pain and so on..