Burdened by a Secret: Caring for Older Adults With HIV in Critical Care

摘要

Judith, a 62-year-old African American woman, entered the emergency department reporting tiredness with complaints of chills and shortness of breath. Routine physical assessment, diagnostic tests, and laboratory blood tests, which included a human immunodeficiency virus (HIV) test, revealed that Judith was HIV positive with an elevated serum bicarbonate and white blood cell count, and diffuse infiltrates in her lungs. In addition to the presence of oliguria, blood and protein were detected on urine dipstick, urine was concentrated with limited output, and the patient had dyspnea while sitting in the examination room. Judith's oxygen saturation levels plummeted, and her mental status declined as she slowly began to lose consciousness. She was intubated and immediately transported to the intensive care unit (ICU) for management of acute kidney injury and respiratory distress. Unbeknownst to the care team, Judith had learned about her diagnosis of HIV infection a few months before this admission. She had been with her long-time partner Glen for 20 years following the death of her first husband.