WCIM 2014 SEOUL KOREA 157
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0422 Infectious Disease
A Case of Human Immunodefi ciency Virus Infection Presenting Severe Thrombocytopenia
Seokyoung KOH1, Jaehyun CHO1, Hongsoon LEE1, Nakhyun KWON1, Jungeun KIM1 National Police Hospital, Korea1
Introduction: Though the hematological abnormality emerges frequently in HIV-in- fected patients and AIDS patients, it is rarely accompanied by a serious thrombocyto- penia (<25,000/microL) especially on the early phase of disease. We report a clinical experience of HIV infection case in which a serious thrombocytopenia accompanied by bleeding tendency on the early phase in a patient without underlying disease.
Case: A 43-year-old man went through a medical test (basic blood test, abdominal ultrasonography) at a local clinic because of being bruised easily for the last 6 months.
With the platelet count of 20,000/microL, he was recommended for further evalua- tion and transferred to our hospital. There were no signifi cant medical Hx. and family history. His vital signs were stable, had no remarkable fi nding in physical examination.
There were no remarkable results on his laboratory studies except the thrombocyto- penia and being anti-HIV antibody positive with positive Western blot. According to the peripheral blood smear examination, serious thrombocytopenia without abnormal morphological change was proposed. His thrombocytopenia was considered due to the HIV infection, and no other AIDS defi ning disease was found. The CD4 positive T lymphocytes count was 277/microL, and CD8 positive T lymphocytes count was 825/
microL, HIV RNA level lower than 20 copies/mL. He was treated with Highly Active Antiretroviral Therapy(HAART) and the platelet count began to increase gradually and reached 130,000/microL seven months later.
Discussion: Bleeding tendency due to thrombocytopenia in AIDS patients is rarely reported. The mechanism related to hematological abnormality has not been revealed clearly yet. However, based on the many reports, in which the white blood cell count and platelets are normalized after antiretroviral therapy, it may be assumed that it is possible to recover hematopoietic stem cell, which was damaged by reversible mecha- nism, when HIV replication is inhibited.
PS 0423 Infectious Disease
Kap Study on HIV among Final Year Nursing Students in Sri Lanka
Nishamany Geethika NANAYAKKARA1, Gveshika ABEYRATHNA2, R.C.W.
RAJAPAKSHA3, Ananda WIJEWICKRAMA2
National School of Nursing, Sri Lanka1, Infectious Diseases Hospital, Sri Lanka2, Nursing Training School, Sri Lanka3
Background: Stigma and discrimination of HIV/AIDS patients in hospital settings is a major drawback in the treatment of patients. Knowledge, attitudes and practices of Sri Lankan nurses towards HIV/AIDS patients remains unclear.
Methods: A cross sectional KAP study was done in a nursing training school in Sri Lanka on fi nal year nursing students. A self-administered questionnaire to assess the knowledge, attitudes and practices was given to fi ll anonymously. The responses were analyzed using SPSS version 17.
Results: 222 students responded: 94.6% believing that HIV can be asymptomatic but infectious; 73% believing that a HIV patient can stay for >5 years without getting AIDS. 58.1% thought HIV is highly contagious while 10.4% thought it is transmitted through mosquitoes. >90% believed that it cannot be transmitted by using common toilets with patients by sharing bed linen. 82.9% and 24.3% respectively thought that proper condoms use and anti-retroviral treatment would reduce the transmission.
Though 95% would adhere to universal precautions and 91.9% wash hands before touching patients, only 55% thought that gloves & gowns are not needed for any contact with patients. 44.1% would consider PEP after occupational needle stick injury. Although 86% believed that HIV patients has the right to same care as others, 31.1% believed that they should be kept separately from other patients. 34.7% were worried of getting HIV from the work place. 62.2% feel sympathetic towards the pa- tients and 51.8% had little sympathy towards those who got HIV from sexual promis- cuity. Only 65.3% believed patients are entitled to confi dentiality while 77% believed that HIV status should be revealed ward staff before venepuncture.
Conclusions: Though nursing students’ knowledge about HIV/AIDS pathogenesis is good, knowledge on transmission is inadequate. Attitudes and practices are poor and needs further improvement.
PS 0424 Infectious Disease
Meningeal Hemangiopericytoma in an HIV-Positive Patient: A Case Report and Review of Literature
Roland Benedict REYES1, Marc Edsel AYES1, Regina BERBA1, Cybele ABAD1 Department of Medicine, The Medical City, Philippines1
Background: Three AIDS-defi ning malignancies have been associated with the hu- man immunodefi ciency virus (HIV): Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and cervical carcinoma. However, new cases of non-AIDS defi ning malignancies also have been increasingly associated with HIV. One of these is a rare intracranial malignancy, meningeal hemangiopericyotma.
Case Description: A 32-year old HIV-positive male, not on highly active antiretro- viral therapy, was admitted to our hospital due to generalized weakness and sudden onset hearing loss. Cranial MRI was done, which revealed a temporal nodule with the following considerations: granuloma, meningioma or metastases. A craniotomy was performed and the mass excised. Results from the biopsy showed meningeal hemangi- opericytoma. The patient was then started on antiretroviral therapy (Lamivudine, Ten- ofovir, and Efavirenz) and was discharged for radiation therapy and metastatic work- up as an outpatient. On follow-up seven months later, metastatic work up revealed multiple hepatic foci not previously documented suggestive of metastasis short of biopsy sampling.
Conclusions: This case of an intracranial hemangiopericytoma in an HIV-positive patient is the second case thus far presented, based on our systematic and extensive search of the literature
PS 0426 Infectious Disease
Late Presenters to HIV Care in the Era of Free Antiret- roviral Therapy
Rajaram Deepak MADI1, Sathish V1, Basavaprabhu ACHAPPA1, Sathish RAO1 Kasturba Medical College, India1
Background: Highly active antiretroviral therapy (HAART) is available free of cost in India as a part of our national ART programme since 2004.Early diagnosis and initiation of HAART are key components for the success of HIV control programmes.
Late presentation with low baseline CD4 cell count is a strong prognostic marker for early mortality among HIV patients. The main aim of our study was to identify late presenters based on initial CD4 cell count testing. We also wanted to identify factors associated with late presentation.
Methods: This retrospective hospital based study was carried out at Kasturba Medical College. The study group included 474 newly diagnosed HIV patients registered in the ART clinic of KMC between February 2012 and February2013. Subjects with CD4 T cell count below 200 cells per cubic millimetre were classifi ed as late presenters. Subjects with CD4 T cell counts less than 50 cells per cubic millimetre were termed as very late presenters. Statistical analysis was performed with SPSS software.
Results: The mean age of our study population was 41.60±9.28years. Majority of our study population were males 327(69%). Median CD4 count at diagnosis was 188 cells per cubic millimetre ([IQR] 93-366 ). 208(44%) patients had WHO stage 4 disease at presentation. 251(53%) were late presenters and 223(47%) were early present- ers.47(9.9%) were very late presenters.Male gender(p=.03) and residing in rural area (p=.001) had a signifi cant positive association with late presentation.
Conclusions: More than fi fty percent of patients were late presenters despite ART being available free of cost in India. Late presentation poses a signifi cant threat to the success of our national ART programme.HIV/AIDS care intervention programmes must target men and the rural population as they are vulnerable for late presentation as shown in our study.
