Station - Instructions for candidate
You are a doctor in general practice.
Giulia Rossi, a 26-year-old pharmacy assistant, presents today to receive her HIV test results.
| Baseline observations | HR 72 regular, BP 126/78 mmHg, RR 16, SpO2 99% on room air, temperature 36.8 C, alert and orientated |
|---|
Results provided:
HIV antibody/antigen test (4th generation)
| Item | Value | Reference range |
|---|---|---|
| HIV antibody/antigen | Positive | Negative |
CD4 count and lymphocyte subset
| Item | Value | Reference range |
|---|---|---|
| CD4 count | 480 cells/μL | >500 cells/μL |
| CD4 percentage | 22% | >20% |
HIV RNA viral load
| Item | Value | Reference range |
|---|---|---|
| HIV viral load | 62,000 copies/mL | <50 copies/mL |
Full blood count
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 134 g/L | 120-160 g/L |
| White cell count | 6.2 x10^9/L | 4.0-11.0 x10^9/L |
| Platelet count | 210 x10^9/L | 150-400 x10^9/L |
Liver function tests
| Item | Value | Reference range |
|---|---|---|
| AST | 28 U/L | 10-40 U/L |
| ALT | 26 U/L | 7-56 U/L |
| Alkaline phosphatase | 72 U/L | 30-120 U/L |
| Bilirubin | 12 umol/L | 3-20 umol/L |
Renal function
| Item | Value | Reference range |
|---|---|---|
| Creatinine | 78 umol/L | 50-100 umol/L |
| eGFR | >60 mL/min/1.73m2 | >60 mL/min/1.73m2 |
| Potassium | 4.2 mmol/L | 3.5-5.0 mmol/L |
Your tasks are to:
- Take a focused history of the needle-stick exposure and her health and concerns since the injury.
- Explain the positive test result and what HIV is to the patient; address her understanding of prognosis and transmission.
- Establish your immediate management plan, including antiretroviral therapy, baseline monitoring and specialist referral.
- Discuss partner notification requirements and arrange follow-up.
- You do NOT need to perform a physical examination.
- You do NOT need to summarise your findings to the examiner.
This is a 15-minute station, with 2 minutes of reading time.