1. HIV CNS’s & Health Advisors 24th November 2017
Case Studies
HIV CNS’s & Health Advisors
24th November 2017

2. Nov 2013 – Pneumococcal sepsis Dec 2015 – Dental operation
Case study 1
Hospital admissions:
Nov 2013 – Pneumococcal sepsis
Dec 2015 – Dental operation
Sept 2017 – Oral candidiasis,
Liver abscess.
42 yr old heterosexual
Black female.
Social History
Ongoing issues:
Advancing HIV infection
(Due to non-compliance)
Denial
Isolation
Stigma
Strong Faith beliefs
Tested positive ante-natally
Presented with: Oral thrush, rash, pyrexia.
HIV Positive January 2003
CD4 - 85
VL – 735, 523
-From Congo been positive for 20 years. Witnessed HIV positive pple who survived for long time without ARVs & believes they surviving by prayer. This has shaped her beliefs in her faith to only trust God to save her.
1st 3 children HIV Negative, despite mothers non-adherence in pregnancy to HIV medication
th child HIV POSITIVE. Court order as failure to give child her HIV therapy.
Non-adherence. Disengaged. Letters to GP.
2015 Dental Operation dependent on CD4. Pt re-commenced ARVs’.
Patient pattern ‘to only engage due to symptoms’ therefore ARVs’ short course for symptomatic relief.
2017 taking antibiotics for liver abscess but not ARVs’.
Discharged home with palliative care for management of symptoms “without admission to hospital”.
HCPs’ to remember Patient’s choice Not to take ARVs’ and to respect their wishes.
Patient referred palliative care
Partner confirmed HIV negative on
X3 children negative
X1 child HIV positive born
(Positive child in foster care)
Partner notification ongoing

3. – A&E – SOB, widespread rash, diarrhoea (GP had given piriton and steroids) ?allergy to CTPA contrast
?infectious mononucleosis
?legionella – admitted “no clear explanation for condition & Hypoxia”
Case study 2
ward round – CT review ?PCP D/W ID team suggested HIV test and sputum PCR for PCP
Commence cotrimoxazole
Consider a bronchoscopy
28 yrs caucasian builder, female partner, baby girl 1yr
– A&E increasing SOB, hypoxic (GP treated with ABX &Steroids)
?PE – CTPA some ground glass opacity? Inflammatory change (comment on report that PCP had been discussed) –
CXR – bilat. enlarged lymph nodes
Discharged home advised to improve inhaler technique
Cotrimoxazole commenced- SB ID team noted pharyngeal candida
HIV Positive
SB Health advisor

4. Sexual history prompted HIV screen. 12.10.2005 – HIV POSITIVE CD4 – 61
Case Study 3
Sexual history prompted HIV screen.
– HIV POSITIVE
CD4 – 61
VL - 474, 000
Commence ARVs’
47 year old, African, heterosexual male.
Social History
Issues post diagnosis:
Stigma
Isolated
Depression
Immigration
Adherence
GP referral acute chronic renal failure.
Investigations:
KUB U/S = small kidneys
Egfr = 28
Serum creatinine
Commenced renal dialysis (3 x a week)
2004 -Diagnosed with Chronic Renal failure
-Emigrated from Malawi in Registered with GP and diagnosed with hypertension. DNA’d GP appointments for follow up of BP & U &Es.
-Reffered & admitted to QE HDU with chronic kidney failure. Tested as high risk group. Huge migration early HIV + . Shocked & upset to “Death sentence” & feared would die soon.
-Patient given special leave to stay in the country for haemodialysis + on active transplant list & HIV meds.
-Since transplant adherence with attending FU appointment for Renal transplant & HIV ongoing. As HCPs’ we know dialysis alone, can feel like institutionalisation for patients’ due to numerous appointments until transplant!
-He has since been given leave to remain & travelled to Malawi to see family.
-Living a normal life & currently looking for a girlfriend!
Renal Transplant
Partner notification

5. Oral Thrush - ID , Liver screen (inc. Hep, HIV) USS req.
Case Study 4
Clinical Signs
Deranged LFT’s
Oral Thrush - ID , Liver screen (inc. Hep, HIV) USS req.
56 yrs, Caucasian, from Sutton Coldfield, community phlebotomist.
? Sepsis, IV ABX
No HIV exposure identified
10 day hx fevers, sore throat, rash, treated by GP for tonsilitis
CD4 Count 134
Viral Load 190,89332

6. Partner Notification …….
Case Study 4- Partner
CD4 156
Viral Load 34,2575
Partner Notification …….

7. Case Study 5
Pt admitted declining HIV testing in past due to fear.
59 yr old MSM male
To GP with lesions on arm- reassured and sent away
HIV Positive
KS lesions on arms
Different GP- lethargy, low mood, lymphocytosis – PMH- genital warts, toxoplasmosis, syphilis- HIV test suggested

9. 21 year old female diagnosed @ 18
Case Study 6
21 year old female 18
Attends clinic and is found to be pregnant
Good CD4, low-ish VL
Does not attend appointments for HIV or Antenatal care as arranged
Care leaver, victim of CSE, ADHD, substance abuse, vulnerable ++
But did start medication and VL <40
Rarely attends. Normally when has symptomatic STI’s
Safeguarding & S Work involved. Baby HIV neg, currently in foster care
Never managed any PN