Please Sign In or Create an account
HIV and Hodgkin’s lymphoma – a medical dilemma

HIV and Hodgkin’s lymphoma – a medical dilemma

Dr. Khaw is a Sexual Health Advanced Trainee in her third year of part-time training. She is also a clinical skills lecturer with the Medicine Learning and Teaching Unit, University of Adelaide and examines for the Royal Australian College of General Practitioners and Australian Medical Council, SA, Australia

Viral load was undetectable and CD4 count was 276 (24%). In August 2011, she presented with an unplanned pregnancy at 6 weeks gestation. Unfortunately, a month later, she miscarried at 10 weeks gestation. Early October 2011, she developed fevers, nausea and vomiting and was admitted to a country hospital. She was thought to have a lower respiratory tract infection but did not respond to IV antibiotics. She was transferred to the Royal Adelaide Hospital and was unwell on admission.

A CT scan of her neck, chest and abdomen revealed extensive lymphadenopathy. There were bilateral alveolar infiltrates noted in the CT scan of her chest. A lymph node excision biopsy revealed Hodgkin’s Lymphoma of the nodular sclerosis type. The patient decided to return to the UK for treatment of her lymphoma as her family supports are there. She was referred to the Chelsea and Westminster Hospital.

Staging performed revealed a Stage 3b Hodgkin’s Lymphoma. She was managed with full opportunistic infection prophylaxis using cotrimoxazole, fluconazole, acyclovir and azithromycin. She obtained full remission after six cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) combination chemotherapy but developed painful peripheral neuropathy requiring pergabalin. Toxicity and fertility issues were discussed. The patient is now pregnant again at 28 weeks gestation. An overview of HIV associated Hodgkin’s Lymphoma in the era of cART will be presented.

Speakers: Dr. Carole Khaw
Areas of Interest / Categories: Australian Society for HIV 2015, HIV

Australian Society for HIV 2015

An Indigenous cultural appropriateness audit piloted in a sexual health clinic in NSW: making Aboriginal and Torres Strait Islander peoples a priority.

Indigenous Australians experience a greater burden of sexually transmitted infections, however are less likely than the general population to access sexual health services. We examined the effectiveness of an Indigenous cultural appropriateness audit in assessing a sexual health clinic with low rates of Indigenous clients.

High Resolution Anoscopy - Practice makes perfect

Background: Liquid based anal Papanicolaou smears, followed by High Resolution Anoscopy (HRA) guided biopsies are increasingly being advocated to identify areas of High Grade Anal Intraepithelial Neoplasia (HGAIN). We hypothesized that the ability to identify HGAIN would increase with experience of the anoscopist, and that comparison with contemporary Papanicolaou smears might yield insights into technical abilities.

Chlamydia and the Urban Aboriginal Medical Service

Despite the high proportion of young people annually accessing general practices, including Aboriginal Medical Services (AMS), testing for Chlamydia trachomatis remains relatively low in urban areas. A project officer was employed within the Institute of Urban Indigenous Health (IUIH) to serve a mentoring and facilitation role for the SE Queensland network of AMS and their sexual health workers, with a view to improving testing, management and follow-up of chlamydia and other STIs by community controlled medical services.

An optimised eight-colour flow cytometry protocol for the analysis of monocyte heterogeneity and monocyte activation markers during HIV infection.

Monocytes are a heterogeneous cell population having specialised functions and differing phenotype. They are a link between innate immune system and adaptive immune system therefore, to identify if immune activation exists in HIV-1 individuals with controlled virema and recovered CD4 T cell counts, we assessed cell surface monocyte activation markers (MAM) within the monocyte subsets.

The Ask Share Know Project: a research translation study of three consumer questions to enhance treatment decision making

Involving consumers in healthcare decisions is important for high quality care. We previously tested a brief, consumer-led intervention consisting of three questions in a trial employing trained, standardized patients. The intervention enhanced discussion of evidence and increased patient involvement. We now report a research translation study which tested implementation with real patients at a reproductive and sexual health clinic.

Combination prevention with confidence?: A review of where community HIV health promotion evaluation is most, moderately and least developed

Protracted cryptococcal disease: immune reconstitution inflammatory syndrome (IRIS) or not?

Case presentation: A 27 year-old Vietnamese man was diagnosed with HIV in April 2012 when he presented with cerebrospinal fluid (CSF)-culture positive Cryptococcus neoformans meningitis. CD4 count was 4 cells/µL and HIV viral load 228827 copies/mL. He was treated with two weeks of amphotericin B (0.7mg/kg/day) and 5-fluorocytosine (25mg/kg/QID), followed by consolidation and secondary prophylaxis with fluconazole. CSF cultures were negative at two weeks. A ventriculo-peritoneal shunt was inserted to manage persistently raised intracranial pressure and had to be replaced two weeks later due to bacterial shunt infection. Antiretroviral therapy (ART) was commenced after four weeks of treatment, and by September 2012, CD4 count was 107 cells/L and viral load 150 copies/mL.