1. Management of the Newly Diagnosed Patient. June 21-22, 2014 Belgrade, Serbia Patrick Byrne RGN. BSc (Hons) Nurse Practitioner Royal Free Hospital London

2. Time line of ARV’s

4. Meet Joe…… Generally Healthy and enjoying life Apart from asthma, No significant PMH. Non Smoker, Occasional Alcohol Presents to GP with 5 day history of cough. GP prescribes course of Antibiotics Follow up appointment booked for 1 week.

5. 3 days later………. Joe presents at A&E Developed increased shortness of breath. Lethargy Desaturation on exercise. Looks awful Admitted to General Medical Ward

6. What do you think is happening with Joe?

7. Investigations Carried out. Chest X-Ray U&E, LFT, FBC Blood Cultures What would you add to this list?

8. Additional testing… HIV Test HLA-B5701 Resistance Test CD4 HIV Viral Load Avidity/De-tuned test

9. The results (1) HIV TestPositive HLA-B5701Negative Resistance TestNo Resistance Nothing unusual with these results

12. Results (2) CD489 (10%) HIV Viral Load> 1,000,000, Avidity/De-tuned test0.03 Chest X-raySuggestive of PCP Joe is 18 Years old

13. What is Unusual about this presentation?

14. A Bit more about Joe. Joe sero-converted 6 weeks following his first ever sexual encounter. Like all teenagers he was exploring his sexuality. He is a very frightened and angry young man. His Knowledge of HIV is poor. He feels that his life is over.

15. DISCUSSION As Nurses, What can we do to support Joe?

16. From Joe’s perspective… Is he going to die? Would he be able to continue with his studies. Joe’s main anxiety was focused on his sexuality. (Nobody knew he was gay.. Not even him!) How does he explain, A)His sexual orientation B)The fact that he is positive C)The fact that he has an AIDS Diagnosis This is not how it was meant to be!

17. Disclosure: Disclosure is a process Personal decision One size does not fit all Difficult due to own feelings about HIV Can be a powerful support or devastating

18. The update. With the support of the MDT Joe went on to make a full recovery. He continued his studies and graduated with an MSc. He remains on the same ARV’s (LPV/r TRU) CD4 went up to 845 Viral load <50 Copies ml It was 4 years before he had his next sexual encounter and a further 2 years before he told anyone of his Diagnosis. His Family and Partner are very supportive.