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Hello
I'd like some advice please. I'm a 3rd year pod student and am writing an essay for my pathology module.
I'd like to know how you would manage an HIV patient with onychocryptosis. There is very little literature on the subject and I could do with a few pointers.
Many thanks,
pottypod

 

Universal precautions, the same as every patients.

A patient does not have to tell you their HIV, HBV, HBC status so assume all are infected

 

I have a reasonably high HIV case load - thanks to referrals from a local sexual health clinician.

Persons with, or without, HIV are likely to present for podiatric opinion and treatment due to peripheral neuropathy in particular.

HIV induced peripheral neuropathy is one of the major issues I manage, but this has lesssed with newer HIV drug protocols. Some of the guys diagnosed and treated some time ago with older drugs may have issues with respect to this though...worth reading up on if you have this type of caseload.

Same issues as all other forms of PN though...

LL

 

Thanks LL. There is very little pertinent research on this subject, which is of use to me. If one of your patients with HIV came to you with an infected ingrowing (hallux) toenail what would you do in your practice? I've spoken to a few other people including a community pharmacist and the general the consensus would be the manage them in the same way as a patient without HIV: antibiotics then nail surgery (PNA with phenol). Then address their HAART with their consultant i.e. protease inhibitors and their side effects etc.
I'd be interested what you have to say if you see HIV patients regularly.
Many thanks for your previous response.
Best wishes
Rebecca

 

I do not think an uncomplicated onychocryptosis generally requires any prophylactic antibiotics prior to a soft tissue surgical procedure providing current viral load and CD4 count are acceptable. Immunocompromised patients don't automatically need to be managed this way, unless we were talking about surgical joint fusion/replacement where the risks of an infected prosthesis would be unacceptable. However, if your theretical patient were presenting with infection - then this is the same procedure as all other patients - I&D, antibiotics, and a delayed definitive procedure. Bottom line is that HIV status does not affect the nature of what needs to be done, its simply a consideration like any other part of the medical history (eg diabetes, RA).

However, I cannot point to any guidelines or evidence for this except for the school of common sense...;)

LL

 

Thanks for such a quick response. Thats pretty much confirmed what I thought and what others have said.
Thanks again!