Mr Simon, age 36, presents to his family physician with concerns about his weight. He has gained 20 kg in the past 4 months, and has developed purple striae on his abdomen. His body mass index (BMI) is currently 34, and on physical examination, he is found to have a rounded face, a large dorsal fat pad, and a waist circumference of 112 cm. His blood pressure is elevated at 145/95 mmHg, while all other vitals are normal. He also mentions worsening acne on his face, shoulders, and upper back, as well as mild depression for the past 3 months. His past medical history is significant only for an appendectomy at age 10. He has no family history of diabetes, obesity, or cardiac disease. The only medication he has been on for the past 3 years is a multivitamin supplement. He does not smoke, drinks approximately 5 alcoholic drinks per week, and does not take any illicit drugs.
Linda is a healthy, 25-year-old married woman living in the city of Toronto who presents with questions about human immunodeficiency virus (HIV) prevention. Linda and her husband met on an online dating forum in 2011 and married each other one year later while they were both seronegative. She describes her and her husband as having an “open” marriage and have had 2 and 5 extramarital partners, respectively. In 2014, Linda’s husband was incidentally diagnosed with HIV infection after donating blood at a clinic, and Linda received testing shortly thereafter which came back negative for HIV. His viral load had reached 20 000 copies/mL and he immediately began highly active antiretroviral therapy (HAART). His infection has stabilized with undetectable viral loads and a CD4+ T-helper cell count of 1000 cells/μL; however, the risk of transmission has created damaging tensions within their marriage. Prior to his diagnosis Linda reports condom usage of less than 50% for both herself and her husband; however, the anxiety and fear of infection has prompted usage of over 90%. Linda wants to be at ease in her sexual endeavours but is motivated to remain uninfected so she can be healthy to take care of her husband. She read about a new drug on Twitter that can prevent HIV infection in non-infected people and requests your counsel on it. She has an unremarkable history with respect to sexually transmitted infections (STIs), drug use, smoking and hepatitis, and has had no recent symptoms of fever, malaise, or sore throat.
No abstract
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