NURS 7320

HIV Case Study

Presentation:

§ 35 year old female presented with chief complaints of fever, non-productive cough and
dyspnea which has progressed over one month. She tested HIV-positive 5 years ago and had
a CD4 T-cell count of 650. Treatment with Zidovudine was started. She abruptly stopped her
treatment and did not continue medical follow-ups.

History:

§ Use of heroin and cocaine intravenously for a one-year period 6 years ago. She does not
smoke or drink, has no past STI's and is not sexually active. She has no known drug
allergies.

Physical Examination:

§ Pale, diaphoretic and in acute respiratory distress

§ Oral thrush present
§ Poor inspiratory effort and bibasilar crackles 2/3 of the way up the posterior lung
field
§ Tachycardia without murmurs
§ Abdomen nontender, no enlargement of the liver or spleen
§ Pelvic exam normal except for vaginal candidiasis
§ Neurologic examination was normal
§ She has anorexia, lost 70 pounds over the last 4 months

VS:

§ Temp 103 F
§ BP 110/70
§ HR 96
§ RR 30

Laboratory Results:

§ Hgb: 10.8
§ WBC: 7,500
§ Segs: 43
§ Lymphs: 41
§ Monos: 9
§ Eos: 6
§ Basos: 1
 § Platelets 248,000

§ CD4 count: 235

§ HIV RNA (viral load): 200,000 copies/ml
§ Sputum: positive for Pneumocystis carinii

ABG’s
pH 7.49
pCO2 32
pO2 51
HCO3 23
1. The Significance of 5 years prior:

§ After Exposure

§ Stage 0

§ Difference between Window Period and Seroconversion

§ Tests

o Nucleic acid

o Antibody

o CD4

§ The importance of CD4

§ Cells that have this protein

2. History of the Patient – Transmission

3. Now 5 years later:

§ Progression of the disease

§ Stage 3

§ Advancing clinical manifestations

o Evidence of opportunistic infections

o low CD4 count

o Viral load