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Posted: July 17th, 2022
The patient, a 30-year-old homosexual man
Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition
AIDS (Acquired Immunodeficiency Syndrome)
Case Studies
The patient, a 30-year-old homosexual man, complained of unexplained weight loss, chronic
diarrhea, and respiratory congestion during the past 6 months. Physical examination revealed
right-sided pneumonitis. The following studies were performed:
Studies Results
Complete blood cell count (CBC), p. 156
Hemoglobin (Hgb), p. 251 12 g/dL (normal: 14–18 g/dL)
Hematocrit (Hct), p. 248 36% (normal: 42%–52%)
Chest x-ray, p. 956 Right-sided consolidation affecting the posterior
lower lung
Bronchoscopy, p. 526 No tumor seen
Lung biopsy, p. 688 Pneumocystis jiroveci pneumonia (PCP)
Stool culture, p. 797 Cryptosporidium muris
Acquired immunodeficiency syndrome
(AIDS) serology, p. 265
p24 antigen Positive
Enzyme-linked immunosorbent assay
(ELISA)
Positive
Western blot Positive
Lymphocyte immunophenotyping, p. 274
Total CD4 280 (normal: 600–1500 cells/L)
CD4% 18% (normal: 60%–75%)
CD4/CD8 ratio 0.58 (normal: >1.0)
Human immune deficiency virus (HIV)
viral load, p. 265
75,000 copies/mL
Diagnostic Analysis
The detection of Pneumocystis jiroveci pneumonia (PCP) supports the diagnosis of AIDS. PCP is
an opportunistic infection occurring only in immunocompromised patients and is the most
common infection in persons with AIDS. The patient’s diarrhea was caused by Cryptosporidium
muris, an enteric pathogen, which occurs frequently with AIDS and can be identified on a stool
culture. The AIDS serology tests made the diagnoses. His viral load is significant, and his
prognosis is poor.
The patient was hospitalized for a short time for treatment of PCP. Several months after he was
discharged, he developed Kaposi sarcoma. He developed psychoneurologic problems eventually
and died 18 months after the AIDS diagnosis.
Case Studies
Copyright © 2018 by Elsevier Inc. All rights reserved.
2
Critical Thinking Questions
1. What is the relationship between levels of CD4 lymphocytes and the likelihood of
clinical complications from AIDS?
2. Why does the United States Public Health Service recommend monitoring CD4
counts every 3–6 months in patients infected with HIV?
3. This is patient seems to be unaware of his diagnosis of HIV/AIDS. How would you
approach to your patient to inform about his diagnosis?
4. Is this a reportable disease in Florida? If yes. What is your responsibility as a
provider?
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The relationship between levels of CD4 lymphocytes and the likelihood of clinical complications from AIDS is that as the CD4 count decreases, the likelihood of complications increases. The CD4 cells are a type of white blood cell that play a key role in the body’s immune response. In individuals with AIDS, the virus attacks and destroys these cells, leading to a decrease in the number of CD4 cells. As the number of CD4 cells decreases, the individual becomes more susceptible to opportunistic infections and other complications.
The United States Public Health Service recommends monitoring CD4 counts every 3-6 months in patients infected with HIV because this allows for early identification of declines in the patient’s immune system. As the CD4 count decreases, the patient becomes more susceptible to infections and other complications. By monitoring the CD4 count regularly, healthcare providers can identify declines early and take appropriate action to prevent or manage complications.
When approaching a patient to inform them of their diagnosis of HIV/AIDS, it is important to be sensitive and empathetic. The patient should be informed of the diagnosis in a private setting and given time to process the information. The healthcare provider should provide the patient with clear and accurate information about the diagnosis, including the implications for their health and the available treatment options. The healthcare provider should also provide the patient with emotional support and resources for coping with the diagnosis.
Yes, in Florida, HIV/AIDS is a reportable disease. As a healthcare provider, it is my responsibility to report the case to the Florida Department of Health within five days of the diagnosis. This is to help track the spread of the disease and monitor its impact on the population, as well as to provide resources for those living with HIV/AIDS.
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