Case #806: 44-Year-Old African American Male with Cardiometabolic Comorbidities and Coinfections

Initial Presentation

Chief Complaint

Pain and swelling in axilla, fatigue, and general sick feeling

History of Present Illness

Two weeks ago, William, a 44-year-old African American male who was 6 weeks into his incarceration, reported to the infirmary at the correctional center. He was examined for axillary swelling, which he reported had been increasing in size for several weeks. He was provided systemic antibiotics at that time, but experienced no improvement, and the swelling continued to grow. He is now returning to the infirmary, with complaints of pain, redness, and discharge from the swelling in his left axilla that burst 4 days earlier.

On further questioning, William admits to feeling weak and sick, and having vague muscular and body pain for the two weeks since his last visit. He complains of vague muscular and body pain. Although William was not willing to undergo tests for HIV/HBV/HCV previously, he is now counseled and subsequently agrees to undergo the testing.

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Estimated time to complete this activity: 2.0 hours

Accreditation Statement

The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement

The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Statement of Responsibility
The Johns Hopkins University School of Medicine takes responsibility for the content, quality and scientific integrity of this CME activity.

Target Audience

This activity is intended for primary care physicians, infectious disease specialists, physician assistants, nurse practitioners, and pharmacists involved in providing care to HIV patients in correctional systems.

Prerequisites

There are no prerequisites.

Statement of Need

This activity will update you on the latest developments in HIV Antiretroviral (ARV) Drug Resistance, therapeutic strategies for incarcerated patients including new ARV options, current ARV efficacy, safety, and pharmacokinetic data, as well as the treatment of patients with comorbities (specifically cardiovascular disease and mental health disorders) and co-infections (specifically hepatitis, tuberculosis and sexually transmitted diseases).

Educational Objectives

• Describe the impact of HBV/HCV co-infections on outcome of HIV disease status, and identify the practice guidelines for effective management of HIV patients with these coinfections
• Discuss the significance of metabolic comorbidities in HIV patients and explain how selection of appropriate drug regimens affect overall outcomes in an HIV patient
• Assess suitable clinical interventions for treatment of skin and soft tissue infections, including MRSA, among incarcerated patients
• Identify strategies that the multidisciplinary team can utilize to bridge the gap with community-based HIV providers to maintain continuity-of-care received while in prison

Method of Participation

This internet-based activity takes approximately 2 hours to complete. You should review the important information on this page, complete the case, answer the multiple-choice post-test and complete an evaluation form online. A score of at least 70% is required to successfully complete the program. Once completed you will be able to save your certificate to your own computer and print it on your own printer.

Disclosure Statement

As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following.

Patricia Barditch-Crovo, MD, Lisa A. Scotti, BSN, ACRN, MPH, and Patricia Threats, RN, have indicated that they have not received financial support for consultation, research or evaluation or has a financial interest relevant to this online activity.

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For Further Information
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