HIV Management Returning to Primary Care Providers

Tuesday, November 1, 2011

As HIV more widely is considered a chronic disease and HIV care is returning more to the primary care workforce, AIDS Education and Training Centers are available to support the health care teams starting with those with little experience in HIV to develop the knowledge and skills needed to care for this often underserved population, to those who continue to need ongoing support to continue to provide state-of-the-art care for people living with HIV.The journal article explains the way these centers can help by sharing the story of one patient and health care provider in rural America.

A 32-year old uninsured woman, living in a rural town in the Deep South, presents to the emergency room at a local hospital with complaints of cough and fever. She is diagnosed with pneumonia and given a prescription for an antibiotic. It takes a few days to raise the money for the prescription but she eventually fills it and improves with treatment. Over the next several months, she goes to three different free-care clinics for vaginal yeast infections. One year after the initial episode of pneumonia, she returns to the same hospital with gradually increasing shortness of breath, a non-productive cough, and a low-grade fever. Her chest x-ray reveals a bilateral interstitial pattern and her PaO2 [partial pressure of oxygen in arterial blood] is 52. She is admitted to the hospital and clinically worsens over the next 24 hours, requiring intubation. Bronchoscopy reveals the patient has Pneumocystis jiroveci pneumonia and the patient is found to be HIV-infected. Her CD4 lymphocyte count is 34 cells/hpf.