Int med noon conf for Aug 5, 2009

1. Management of the Treatment Naïve Patient Jason M. Leider, MD, PhD NBHN Adult HIV Director Associate Professor of Internal Medicine @ AECOM August 5, 2009

2. ST, a 56-year-old white man, presents to your clinic for initial management of HIV infection. He was diagnosed 4 months ago at the local health department where he underwent testing after learning of exposure from a previous sexual partner. He has no signs or symptoms of an opportunistic infection. His past medical history includes a myocardial infarction, hypertension, and dyslipidemia. His CD4 count is 420 cells/µL and his viral load is 83,000 copies/mL. Prior to his appointment, you review the lab results and determine that it may be prudent to recommend initiation of antiretroviral therapy (ART).

6. A 35-year-old black woman who was screened in your office tests positive for HIV on rapid testing. A Western blot test confirms the initial positive screening result. Her only risk factor is 3 male sexual partners in the past 6 years. She reports that she is not currently sexually active. She has no current medical problems and takes no prescription medications. Her initial CD4 count is 387 cells/µL and her initial HIV-1 RNA serum level is 46,000 copies/mL. She is very nervous about having an infection in her body and wants to start treatment as soon as possible.

26. RW, a 57-year-old Hispanic man, presents to your clinic for initial management of HIV infection. He was diagnosed 4 months ago at the local health department where he underwent testing after learning of exposure from a previous sexual partner. He has no signs or symptoms of an opportunistic infection. His past medical history includes a previous myocardial infarction, hypertension, and dyslipidemia. His CD4 count is 410 cells/µL and his viral load is 78,000 copies/mL. Prior to his appointment, you review the lab results and determine that it may be prudent to recommend initiation of antiretroviral therapy (ART).

33. A 27-year-old black woman who was screened in your office tests positive for HIV on rapid testing. A Western blot test confirms the initial positive screening result. Her only risk factor is 4 male sexual partners in the past 5 years. She reports that she is not currently sexually active. She has smoked a pack of cigarettes per day since age 14 but otherwise has no current medical problems and takes no prescription medications. Her initial CD4 count is 378 cells/µL and her initial HIV-1 RNA serum level is 34,000 copies/mL. She wants to start treatment as soon as possible.