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Case #825
HIV

A 45-year-old African American man diagnosed with HIV infection 8 years ago

Release Date: November 5, 2009
Expiration Date: November 4, 2010

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Chief Complaint

Increasing shortness of breath (SOB) and dyspnea on exertion (DOE) over the last 48 hours following a 6 week history of a dry, persistent cough

History of Present Illness

James is a 45-year-old African America man who was diagnosed with HIV infection 8 years ago when treated as a syphilis contact at a local heath department. He was treated for primary syphilis. James was referred to an HIV clinic with a viral load of 79,000 copies/mL and a CD4 count of 555 cells/mm³. Antiretroviral (ARV)-naïve, James did not access medical care because he was “not feeling bad.”

Also diagnosed with hepatitis C virus (HCV) infection at the time he was treated for syphilis

History of hypertension

About a month ago, James developed a persistent cough accompanied by chest pain. After 2 weeks of exacerbating symptoms, patient went to the emergency department (ED). He was given an inhaled bronchodilator and anticholinergic for his newly-diagnosed asthma and was told that his x-rays were normal. The asthma medications somewhat alleviated his breathing problems. In the past week, James complained of fevers, chills, difficulty breathing, headache, and pain when swallowing.


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Disclosures and Important Information

In cooperation with MedCases, LLC

Supported by an educational grant from Boehringer Ingelheim.

Release Date: November 5, 2009

Expiration Date: November 4, 2010

Estimated time to complete this activity: 2.0 hours

Accreditation Statement

The Association of Nurses in AIDS Care (ANAC) is approved as a provider of continuing education by the Virginia Nurses Association which is accredited as an approver of continuing education in nursing by the American Nurses Commission on Accreditation.

Credit Designation Statement

ANAC designates this educational activity for 2.0 contact hours.

Statement of Responsibility

ANAC takes responsibility for the content, quality, and scientific integrity of this online activity.

Faculty

Director, HIV Services
Tampa General Hospital
Clinical Assistant Professor
USF College of Medicine
Infectious Disease and International Medicine
Nurse Practitioner
Specialty Care Center
Hillsborough County Health Department
Tampa, FL

Faculty Reviewer

Adult Nurse Practitioner
VA Medical Center
Infectious Disease Clinic
Baltimore, MD

Target Audience

This course is designed for members of ANAC, as well as other registered nurses and nurse practitioners.

Prerequisites

There are no prerequisites.

Statement of Need

Globally, there are an estimated 33.2 million people infected with Human Immunodeficiency Virus (HIV). There were 2.5 million new infections in 2007, while more than 2.1 million people died of AIDS-related illnesses. Since the beginning of the epidemic in the U.S. in 1981, approximately 565,000 people have died due to HIV/AIDS. In the U.S., there are approximately 1.2 million people living with HIV/AIDs, of whom nearly 25% are unaware of their disease state. There are more than 440,000 people with AIDS, with 40,000 new cases of HIV/AIDS added every year.

With the introduction of newer, more effective, and safer drugs, there has been a significant reduction in the number of deaths due to AIDS and more patients with HIV infection are living longer than before. Though there has been a decline in mortality due to HIV infection, there has been no proportionate decrease in the number of new infections. Further, because an increasing number of HIV patients on Highly Active Antiretroviral Therapy (HAART) are living longer, they are now more prone to acquire diseases of aging and long-term adverse effects of HAART. All these factors have contributed to transforming what once was an acute disease into a chronic disease with comorbidities such as diabetes, hypertension, coronary heart disease, and dyslipidemia.

An increasing number of these patients are seen by the nursing community in various settings such as community clinics, specialized HIV clinics, methadone clinics, psychiatric centers, and in hospitals where these patients are admitted with opportunistic infections. This imposes a need for the nurses to be intimately acquainted with HIV infection, as well as its long-term effects and comorbidities. There is a need for nurses to be informed about different aspects of HIV infections including the basic science, diagnosis, psychosocial issues, patient management and education strategies, adherence, and the changing face of HIV therapy, including the newer evidence and treatment guidelines.

Objectives

After completing this activity, you should be able to:

Describe the recent advances, new evidence, and updated guidelines related to HIV treatment regimen
Identify the challenges to early diagnosis and continuous monitoring of HIV infection
Explain how new evidence can impact strategies for managing patients with HIV/Hepatitis B or HIV/Hepatitis C coinfection to further improve sustained virologic response with reasonable safety
Illustrate the need and strategies for the comprehensive management of patients with comorbidities such as diabetes, hypertension, renal failure, and coronary heart disease
Analyze the role of nurses in education, counseling, and treatment of patients to overcome practical challenges in adherence to their regimen and medical follow-up

Method of Participation

This Internet-based activity takes approximately 2 hours to complete. You should review the objectives and cases, answer the multiple-choice posttest, and complete an evaluation form online. Once completed, you will be able to save your certificate to your own computer and print it on your own printer.

Disclosure Statement

All faculty members participating in continuing education programs accredited by the Association of Nurses in AIDS Care are expected to disclose any real or perceived conflict of interest related to the content of the program.

The following was reported:

Faculty

Gregory F. Parr, MSN, CRNP, ACRN, has no real or perceived conflict of interest that relates to this program.

Don Kurytka, PhD, NP has indicated that he as received grant/research support from: Gilead Sciences Inc, Merck Serono, and Tibotec Pharmaceuticals; and is on the speakers’ bureau for Bristol-Myers Squibb Company, Gilead Sciences Inc, GlaxoSmithKline, Tibotec Pharmaceuticals, and Virco Pharmaceuticals.

Planning Committee

Kevin Blanchet, PhD, Lillie Chen, and Daryl Ehrentreu, RPh, MBA have no real or perceived conflict of interest that relates to this program.

Notice of Off-Label Use Presentations

In accordance with US Food and Drug Administration (FDA) requirements regarding the disclosure of off-label, investigational, or unapproved recommendations for the use of drugs or devices, you are advised that content in this activity does not contain reference(s) to uses of drugs or devices that are off-label, investigational, or unapproved in the United States. The following information is provided for educational purposes and not to endorse off-label use.

No faculty member has indicated that they have included information on off-label products.

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Hardware/Software Requirements and Technical Assistance

This Web-based CME activity is best experienced using a current generation browser, such as Internet Explorer 5.5 or higher. This Web site requires that JavaScript and session cookies be enabled. In addition, you will require the Adobe Flash Player plugin to view the case simulation.

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128 MB RAM
Windows 98 or newer
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Audio playback with speakers for programs that have video content
Internet Explorer 5.5 or higher or Mozilla Firefox 1.0 or higher or Apple Safari
1024 x 768 resolution
Broadband connection highly recommended

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Confirmation

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