A 55 year old male who are HIV positive since 6 years ago came to the walk-in cl

Question

A 55 year old male who are HIV positive since 6 years ago came to the walk-in clinic for yellowing of the skin. He is under anti-retroviral therapy with successful results, the last time he came to the clinic was 6 months ago and the viral titer is low and showed no signs/symptoms. He admitted to have a monogamous protected sexual intercourse with his 10-year-male sexual partner. He has no other complaints besides the yellow skin color he experience since 5 days ago. He and his partner have been using heroine injection using shared needles routinely since 10 years ago. He said the last time he used it was about a month ago using a shared needle with his partner. This is his first time experiencing this condition and his partner did not complained of any signs/symptoms so far.

Physical exam: A middle age male, normal weight, yellow-appearing, Looks alert to the place and time. Temperature: 380 Celsius (normal: 36.10-37.20) Blood pressure: 105/70 mmHg normal 120/80 mmHg) heart rate: 95 beat/minute (normal 60-100 x/minute) respiratory rate: 14/minute (normal 12 20 x/minute) Skin and sclera of the eyes appear yellow, conjunctivae look normal. Heart: heart sound normal, no heart enlargement, no murmur Lung: clear to auscultation. Liver and spleen: no enlargement. i need the answer to look like the photos posted below

I need 3 possible diagnoses thats can be causing this symptoms. Please take note of the family history and past illness when diagnosing. please detail why you chose those 3 diagnoses, and how they can be tested for

Explanation / Answer

Answer:

1) Liver damage: When the red blood cells die, the liver and spleen take the heme and converts it to bilirubin. Bilirubin is a greenish yellow in color. At first the bilirubin is not soluble in fluid, but the liver takes it and makes it into
a soluble form, which the bilirubin is them able to combine with other substances to form bile which flows from the liver to the intestines through tube like structures known as ducts. This bile helps us to digest the fats we eat. Bilirubin is always in our blood.
When the liver is damaged, the functions of changing this bilirubin from a non soluble form to a soluble form doesn't happen and the bilirubin either stays in the blood or is released back into the blood. Because of it coloring, it goes to areas like the whites of the eyes, mucous membranes and the skin area and make them appear yellow to an orange color. If the bilirubin level is high then it might be a liver damage.
2) Hepatotoxicity : Hepatotoxicity means damage to the liver caused by a medicine, chemical, or herbal or dietary supplement. Hepatotoxicity can be a side effect of many different HIV medicines.

People taking HIV medicines should know about this potential side effect of some HIV medicines. In some cases, damage to the liver can be life-threatening.

3)lactic acidosis : One of the symptoms of lactic acidosis is Jaundice - yellowing of the skin.

For detection liver function test needs to be done for the patient.Liver function tests (LFTs or LFs) are groups of blood tests that give information about the state of a patient's liver. These tests include prothrombin time (PT/INR), aPTT, albumin, bilirubin (direct and indirect), and others. Liver transaminases (AST or SGOT and ALT or SGPT) are useful biomarkers of liver injury in a patient with some degree of intact liver function.

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