The nucleic acid test (NAT) can detect HIV infection within 10 to 33 days after exposure. Other tests, such as the antigen/antibody test and the antibody test, are less expensive than the NAT. The antigen/antibody test detects the virus within 18 to 45 days of exposure, and it can take 23 to 90 days after exposure before an HIV infection can be detected by the antibody tests (CDC, 2020l). Other lab work that should be done on a newly diagnosed HIV patient are tests for other infections such as tuberculosis (TB). Diagnostic testing, such as a lipid profile should also be considered, since antiretroviral treatment can affect these results (Gilroy, 2023). There are two types of HIV home self-testing, and state laws control availability. An oral rapid self-test sold online at pharmacies offers results within 20 minutes. A mail-in kit can be obtained online or from a healthcare provider, and it will contain supplies to collect blood from a fingerstick. The sample is mailed to a lab, and results are provided by a healthcare provider. People with positive results from home tests or any type of antibody test must take a follow-up test to confirm results. A healthcare provider orders follow-up testing (CDC, 2020l). The disadvantages of home testing are that it may show a false positive, and the patient may become frightened and decide not to follow up for further testing. Once HIV is diagnosed, individuals must be referred for the HIV-positive care needed. A care continuum helps link diagnosis to early care, which leads to viral suppression (Huynh & Kahwaji, 2023). People who test positive for HIV have unique needs. Some will require behavioral referrals such as a substance abuse program, others will need mental health referrals, and still others will need assistance in maintaining housing and employment. Additionally, women should be referred for reproductive counseling. Some newly diagnosed people will need all these services (CDC, 2023). Case study: Nancy Nancy is a resilient individual who has been living with HIV for approximately 15 years. In the earlier stages of her diagnosis, she did not initiate treatment promptly. However, for the past seven years, she has diligently adhered to her antiretroviral therapy (ART) regimen, which has yielded positive results in managing her HIV. During a routine office visit with her physician, Nancy receives encouraging news about the stability of her CD4+ count, indicating a well-controlled HIV infection. However, she expresses concern over her recent symptoms, which include difficulty swallowing and a severe sore throat. Her physician proceeds to conduct a thorough examination and evaluation. Upon examination and evaluation, Nancy is diagnosed with esophageal candidiasis. This condition is a fungal infection of the esophagus caused by Candida species, typically Candida albicans . It is not uncommon among individuals with compromised immune systems, such as those with advanced HIV infection, even when overall HIV management is successful. Key clinical considerations include: Immune reconstitution inflammatory syndrome (IRIS) : Nancy's stable CD4+ count and her adherence to ART suggest immune recovery, which can sometimes lead to the development of IRIS-related complications, including opportunistic infections like esophageal candidiasis.
Healthcare Consideration: Implicit Bias Implicit bias can significantly impact the care provided to patients with HIV/AIDS. Healthcare providers may unconsciously hold stereotypes or biases related to factors such as a patient's sexual orientation, gender identity, race, or socioeconomic status. These biases can lead to disparities in healthcare outcomes in several ways. ● Testing and diagnosis : Implicit bias can influence the decision to offer HIV testing. For instance, providers may be less likely to recommend testing to individuals whom they perceive as lower risk due to biases related to their sexual orientation or race. This can result in delayed diagnoses. ● Treatment decisions : Implicit biases can affect the choice and timing of treatment options. Providers may make decisions based on perceived patient characteristics rather than evidence-based medical criteria, potentially leading to suboptimal treatment plans. ● Communication : Bias can impact the quality of communication between healthcare providers and patients. Patients who perceive bias in their provider interactions may be less likely to engage in care or disclose important information, hindering treatment effectiveness. ● Resource allocation : Implicit bias may influence the allocation of resources, such as access to support services and adherence counseling. Patients who belong to marginalized groups might receive fewer resources or less comprehensive care. To mitigate implicit bias in HIV/AIDS care, healthcare providers should undergo training to recognize and address their biases. Cultural competency programs can enhance sensitivity to the diverse needs of patients. Additionally, healthcare organizations can implement policies and guidelines prioritizing equitable care for all individuals affected by HIV/AIDS. We can work toward a healthcare environment that ensures fair and effective patient care by actively addressing implicit bias. Symptoms and complications: Candidiasis of the esophagus can manifest with symptoms such as difficulty swallowing, severe throat pain, and discomfort during meals. In severe cases, it can lead to complications, including weight loss and malnutrition. Treatment : Esophageal candidiasis typically responds well to antifungal medications, such as fluconazole, which will be administered to Nancy. Additionally, it is essential to continue her ART regimen to maintain overall immune health. Monitoring : Nancy’s treatment progress should be closely monitored. This includes tracking her response to antifungal therapy and ensuring her CD4+ count remains stable. Nancy's healthcare team must provide her with comprehensive education and support: ● Reinforce the importance of strict adherence to both her ART and antifungal medications. ● Counsel Nancy on maintaining a soft diet and proper nutrition to alleviate her swallowing difficulties and aid in her recovery. ● Schedule regular follow-up appointments to monitor her treatment response, CD4+ count, and overall health. ● Recognize the potential emotional impact of this complication and offer mental health support if necessary.
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Book Code: MMD0724
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