Ryan Orre is a 37-year-old single male who has come to his health care provider because of the recent onset of a chronic sore throat and flulike symptoms, including swollen lymph nodes in the neck and armpits, tiredness, fever, and night sweats. During this office visit, Ryan appears extremely anxious and troubled. When questioned about his apparent nervousness, Ryan states, “You don’t understand; I’m gay. But I’ve always been very careful and practice safe sex. What if I have AIDS? What will I do? I don’t want to die.” The health care provider acknowledges Ryan’s fears and spends additional time allowing Ryan to express his concerns. The process of diagnosing HIV infection is discussed with the patient and initiated. Ryan’s medical history reveals he is allergic to penicillin, which results in rash and pruritus. Although Ryan does not currently take any prescribed medications, he recently started multivitamin and nutritional supplements due to a recent loss of weight. The patient denies any current recreational drug use, but admits he occasionally used IV drugs during his college years. He has not used them in the past 8 years. No past history of medical or psychiatric illness exists. He has never had surgery. Ryan does not use tobacco products. He reports drinking alcoholic beverages several times weekly but never to excess. Ryan explains that he has had several male sexual partners over the past 10 years but feels that he has been consistent in his use of condoms. He currently lives alone and works as a sales representative with a local computer firm. A series of laboratory diagnostic tests found the following abnormal results: white blood cell (WBC) count of 2,950/mm 3 and CD4 count of 550/mm 3. Ryan is hospitalized with the preliminary diagnosis of sepsis and to rule out HIV. A test for HIV viral load is ordered.
1. You are the nurse caring for Ryan in the hospital. On the first evening he is hospitalized, Ryan asks if you think his provider will be prescribing antiretroviral therapy. Given this situation, how would you explain the factors that determine when antiretroviral therapy should be initiated?
2. Ryan’s CD4 count is still within low-normal range but his HIV viral load comes back significantly increased, indicating HIV infection. After talking with the provider, Ryan asks you to explain again the difference between HIV infection and AIDS. How would you explain this?
3. Ryan’s provider has decided to start him on antiretroviral therapy and Ryan will begin taking efavirenz (Sustiva), tenofovir (Viread), and emtricitabine (Emtriva). What will be the best method of teaching Ryan about these drugs? What other factors should be considered when talking with Ryan?