Newly Diagnosed AIDS with Multiple Opportunistic Infections Despite a Recent Negative Rapid HIV Test

Background Human Immunodeficiency Virus (HIV) is a fairly prevalent disease in the United States, with an estimated 1 million persons infected with HIV-1.1 Despite a decrease in Acquired Immunodeficiency Syndrome (AIDS), the prevalence of HIV is increasing, which has led to recent changes in HIV testing guidelines.2 Newly diagnosed patients should ideally be linked to care and receive intervention and antiretroviral therapy (ART) allowing them to maintain a near normal life expectancy. Case Presentation The patient is a 23-year-old African American male with no significant past medical history. He presented to the emergency department (ED) with fevers, weakness, worsening right-sided chest pain, and shortness of breath associated with a productive cough. When he presented with similar symptoms two weeks ago, he was treated for pneumonia with azithromycin. Symptoms initially improved but then worsened five days prior to returning to the ED. He had odynophagia for the last three weeks causing him to avoid solid foods. Additionally, he reported loss of vision in his right eye for two months which started as blurriness but progressed to only appreciating light versus dark. Left eye vision was intact. He took no chronic medications and denied drug allergies. Surgical and family history was non-contributory. He rarely drank alcohol and denied tobacco or drug use. He is homosexual and became sexually active at the age of fourteen with inconsistent condom use. He reported a negative rapid HIV test at a local clinic one month ago and his last sexual contact was three months prior to presentation

The spectrum of eye disease in hospitalized adults living with HIV, 1995-2010.

Eye disease is a well-documented complication of HIV infection. Opportunistic infections generally comprised the majority of pre-antiretroviral therapy (ART) eye complications. With the introduction of ART, opportunistic infections diminished. However, early ART regimens were cumbersome regarding side effects and pill burden, making patient compliance difficult. Newer ART regimens are better tolerated and consist of fewer pills, theoretically making compliance easier and therapy more effective. The aim of this chart review study is to examine eye disease epidemiology in HIV patients as ART has evolved. We reviewed 222 admissions at Thomas Jefferson University Hospitals for 188 patients. These cases were divided into two groups. The first group was comprised of patients admitted from 1995 through 2003, while the second group consisted of patients admitted from 2003 to 2010. Eye disease epidemiology was compared between the two groups. Our study did note a significant decrease in eye diseases caused by opportunistic infections in the 2003-2010 patient group. Noninfectious eye disease is a significant complication in this group

A Case of Fanconi’s Syndrome in a Patient with HIV

Introduction Tenofovir disoproxil fumarate (TDF) is a nucleotide analogue reverse transcriptase inhibitor (NtRTI), which blocks reverse transcriptase, an enzyme found in HIV. Since its approval for use in HIV by the FDA in 2001, it has contributed to effective treatment in numerous patients. The most common side effects include nausea, vomiting, diarrhea, asthenia, abdominal pain and hepatotoxicity. A less common side effect is nephrotoxicity leading to Fanconi’s syndrome. Here is an interesting case of Fanconi’s Syndrome caused by Tenofovir. Case A 50-year-old Caucasian female with a past medical history of HIV and Hepatitis C presented to the Emergency Department with hypokalemia and acute renal failure. She had been diagnosed with HIV in 2003 and was being managed on co-formulated Truvada (Emtracitabine/Tenofovir) and Efavirenz since 2008. She was previously on Lamivudine/Zidovudine and Efavirenz, which were discontinued due to side effects. Over the past month, the patient was noted to have hypokalemia and worsening serum creatinine (sCr), which was being treated with potassium supplements and avoidance of NSAIDs. On presentation she denied any diuretic use, nausea, vomiting, diarrhea, weakness, fatigue, paralysis, palpitations, syncope, lightheadedness or chest pain. The patient’s HIV was under good control (last CD4 count of 1400 cells/mm3 and viral load undetectable at \u3c20 copies/ml), and her viral load for hepatitis C was negligible (HCV RNA quantitative real time PCR \u3c43 IU/ ml). She did not have any history of seizure disorder, refractory migraine or use of drugs such as zonisamide or carbonic anhydrase inhibitors. Pertinent medications included Truvada 1 Tablet every 48 hours and Efavirenz 600 mg at bedtime. She had no drug allergies. Social history was only positive for 1 pack per day of cigarette use for many years. On physical exam the patient was afebrile and her vital signs were stable. She appeared to be in no apparent distress. She was alert and oriented to time, place and self. She did not have any scleralicterus or thrush in her throat. She had moist mucous membranes. Her pulmonary, cardiovascular, abdominal and neurological exams were normal. She did not have any costrovertebral angle tenderness. She also had no pedal edema. Her laboratory data were as follows: sodium 135 mmol/L (normal 135-146mmol/L), potassium 1.9 mmol/L (normal 3.5-5mmol/L), chloride 97 mmol/L (89-109 mmol/L), bicarbonate 22 mmol/L (24-32 mmol/L), BUN 20 mg/dL (normal 7-26 mg/dL), creatinine1.7 mg/dL (0.7-1.4 mg/dL), anion gap 16 mmol/L (4-16 mmol/L), magnesium 1.9 mEq/L (1.3-2.1 mEq/L), phosphate 2 mg/dL (2.4-4.5 mg/dL)(low). Urinalysis showed yellow urine with a pH of 7.0, 1+ Glucose, 1+ protein, urine potassium 13 mmol/L, urine osmolality 211 mmol/L, serum osmolality 293 mmol/L. Serum creatinine and potassium in 2008 were 0.8 mg/dL and 3.6 mmol/L respectively, and 1mg/dL and 3.5 mmol/L six months ago. Renal ultrasound showed mildly echogenic kidneys suggesting renal parenchymal disease