Case Study – Human Immunodeficiency Virus (HIV)

Case Study – Human Immunodeficiency Virus (HIV)

Human Immunodeficiency Virus (HIV)

HIV compromises the immune system of the body through the destruction of the immune cells, such as the CD4 cells. The disease is transmitted through sexual contact and exchange of body fluids with an infected person. The infection has stages ranging from acute HIV infection to chronic HIV infection and acquired immunodeficiency syndrome (AIDS) (Justiz & Gulick, 2022). This case study revolves around a 45-year-old man suspected to have HIV after having receptive anal sex with a man whose HIV status is not determined. As such, it is essential to determine the HIV test to be conducted, elucidate the days required after exposure to test positive, and explore the administration of PEP and PrEP.

Test to Be Conducted First

During the early stages of HIV infection, the body has yet to develop antibodies that can be detectable in the immune system. Due to this reason, a fourth-generation HIV test is appropriate to detect both HIV-1 and HIV-2 antibodies and p24 antigen, which are detectable soon after the infection, even before the antibodies form. The test is done on the blood sample of the patient, and diagnosis is confirmed through further testing, such as the HIV-1 differentiation assay.

Days Required to Test Positive

If the client in this case study contracted HIV, the time to test positive varies depending on the test to be done. For instance, the p24 antigen will test positive from 14 to 21 days post-exposure, while the HIV antibodies test positive 3 to 4 weeks post-exposure. The time variance is due to the formation of p24 proteins in the body before the antibodies are formed. From this information, it is justifiable to conclude that fourth-generation HIV tests can detect HIV two to three weeks post-exposure.

Administration of PEP and PrEP

Post-exposure prophylaxis (PEP) is used to prevent infection after potential exposure. This therapy involves a combination of antiretroviral drugs for 28 days and should be administered immediately, 2 hours to 72 hours after the exposure. However, it is important to note that the effectiveness of the medication is inversely proportional to the duration post-exposure. Having engaged in receptive anal sex, Mr. Jones is at an increased risk of contracting HIV, and this makes him an ideal candidate for the PEP administration based on the administration criterion.

On the other hand, pre-exposure prophylaxis (PrEP) is a preventive measure for individuals practicing risky behavior that predisposes them to the risk of being infected. It involves taking a pill of combined antiretroviral drugs, commonly tenofovir and emtricitabine, daily. In this case, PrEP should be administered after the completion of the PEP therapy if the client anticipates involving themselves in the risk behavior. In addition, it is important to test for HIV before the start of this therapy to ensure that the client is not infected before the medication is started (World Health Organization, 2016).

References

Justiz, A. A., & Gulick, P. G. (2022). HIV and AIDS syndrome. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK534860/

World Health Organization. (2016). Clinical guidelines: Antiretroviral drugs for HIV prevention. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK374312/

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Case Study – Human Immunodeficiency Virus (HIV)

Case 2
Mr. Jones, a 45-year-old man, is concerned that he has HIV as he had unprotected receptive anal sex with a man.
Answer the following questions.
1. Which HIV test would be conducted first?
2. If he contracted HIV, how many days after exposure would be needed before the test would be positive?
3. Would you consider offering him PEP or PrEP, and if so, why and when?