HIV

Routine HIV Screening in Cancer Patients in the Emergency Department

Original Articles, Volume 17, Issue 2, Pages 57 – 116 (2018)

Abstract

Treatment of human immunodeficiency virus(HIV) in cancer patients improves outcomes and reduces transmission of this oncogenic virus. HIV testing rates of cancer patients are similar to the general population (15-40%), despite the association with cancer. Our aim was to increase HIV screening in the Emergency Department(ED) of a comprehensive cancer center through a quality initiative. Testing increased significantly during the intervention (p<0.001; 0.15/day to 2.69/day). Seropositive HIV rate was 1.4% (12/852), with incidence of 0.3%. All patients were linked to care. Incident cases were between 36 and 55 years of age. Barriers encountered included confusion regarding the need for written consent for HIV testing, failure to consider ordering the test, and concerns regarding linkage to care.

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HIV – lessons from a late diagnosis

Case Reports, Volume 15, Issue 2, Pages 49 - 108 (2016)

Late HIV diagnosis is the most important predictor of HIV-related morbidity and mortality in the UK and often results from missed testing opportunities during earlier contact with health services. The HPA now recommends routine HIV testing be commissioned as a priority for all general medical admissions in high prevalence areas, such as Milton Keynes. We present the case of a patient admitted to our Medical Admissions Unit (MAU) managed initially for presumed septic complications of metastatic disease who was later found to have terminal HIV disease. In keeping with UK-wide experience which we review, a local audit following this case found MAU HIV test coverage increased after routine testing but not after staff education alone, and resulted in implementation of routine HIV testing in our MAU.

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A case of haemophagocytic syndrome in HIV-associated disseminated histoplasmosis

Case Reports, Volume 10, Issue 3, Pages 121 - 172 (2011)

Abstract

Disseminated histoplasmosis is an opportunistic infection which is commonly associated with HIV. Haemophagocytic lymphohistiocytosis (HLH) has been described as a secondary phenomenon to infection, collagen – vascular disorders and malignancies. In patients with HIV, cases of reactive haemophagocytic syndrome associated with disseminated histoplasmosis have been reported with CD4 counts of less than 50 cells/μl (450-1660 cells/μl). We report a case of a 25 year old man with HIV who presented with a CD4 count of 153 cells/μl and would suggest that this diagnosis should be considered at higher CD4 counts than previously reported.

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A young woman with HIV and hemiparesis

Case Reports, Volume 12, Issue 1, Pages 1 - 64 (2013)

Abstract

Progressive Multifocal Leucoencephalopathy (PML) is a rare and invariably fatal neurological disease that is seen patients with untreated HIV infection and as a complication of immune suppression with agents such as natalizumab. With the increasing occurrence of HIV, it is important to consider this condition in the differential diagnosis of patients with neurological features. We present the case of a young woman with a long history of HIV infection who presented with neurological symptoms; recognition of this diagnosis enabled identification of her poor compliance with treatment. The investigation and treatment of this condition is discussed.

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Medical Emergencies in Human Immunodeficiency Virus (HIV) Infection

Clinical Reviews, Volume 3, Issue 2, Pages 45 - 84 (2004)

Abstract

With increasing awareness, earlier diagnosis, and aggressive use of anti-retroviral therapy, more people with HIV are living longer so that the average survival time from diagnosis is now significantly better than what it was 10 years ago. As a consequence of this, more patients with HIV are now presenting to hospitals and emergency departments as acute medical emergencies either directly related to their HIV infection, or their treatment.1 An awareness of the potential problems with which these patients can present to hospital, plus guidance on their management is essential to all acute care physicians. In this article we outline the general management of patients with HIV presenting as emergencies to hospital, and then systematically focus on some of the more common clinical problems which may arise.

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