The HIV-Infected Adult Patient In The Emergency Department: The Changing Landscape Of Disease
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The HIV-Infected Adult Patient In The Emergency Department: The Changing Landscape Of Disease
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Publication Date

Feburary 2016 (Volume 18, Number 2)

CME

This issue includes 4 AMA PRA Category 1 CreditsTM; 4 ACEP Category I credits; 4 AAFP Prescribed credits; and 4 AOA Category 2A or 2B CME credits.

Authors
 
David L. Gutteridge, MD, MPH
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
 
Daniel J. Egan, MD
Associate Professor, Department of Emergency Medicine, Program Director, Emergency Medicine Residency, Mount Sinai St. Luke’s Roosevelt, New York, NY
 
Peer Reviewers
 
Andy Jagoda, MD, FACEP
Professor and Chair, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Medical Director, Mount Sinai Hospital, New York, NY
 
Roland C. Merchant, MD, MPH, ScD
Associate Professor, Emergency Medicine and Epidemiology, Brown University, Rhode Island Hospital, Providence, RI
 
Abstract

The care of the HIV-infected patient in the emergency department has changed since the development of highly active antiretroviral therapy. This therapy has resulted in longer life expectancies and increased quality of life for HIV-infected patients, and in cases of treatment compliance and success, virtual elimination of AIDS-associated opportunistic infections. As a result, the emergency clinician is now more often confronted with adverse events related to medication and the diseases associated with aging and chronic disease. This issue focuses on the differences in evaluation of HIV patients on long-term therapy and patients with medication noncompliance and low CD4 counts, as well as recognition of life-threatening and rare opportunistic infections. Disease processes related to the effect of longstanding HIV infection, even with good control, on many organ systems are addressed.

Excerpt From This Issue

You arrive for your ED shift and are presented with 3 HIV-infected patients with various chief complaints. The first patient is a 28-year-old man with 1 day of right flank pain, nausea, vomiting, and hematuria. He had a kidney stone a year ago with identical pain, and a point-of-care ultrasound shows asymmetric hydronephrosis; however, a nonenhanced CT scan demonstrates hydronephrosis and hydroureter without a stone. You wonder if the CT eliminates an impacted stone or if there is another explanation.

The second patient is a 42-year-old HIV-infected woman complaining of as many as 3 episodes a day of diarrhea for the past 3 weeks. She denies pain, melena, rectal bleeding, and fevers. Her laboratory test results are unremarkable. You wonder if additional testing is needed and whether sending her home is appropriate.

 

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