Posted: January 26th, 2023

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
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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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Sample Answer Writing Guide:
Case Study: A 30-year-old Homosexual Man with AIDS
This case study describes the presentation and diagnosis of a 30-year-old homosexual man with AIDS, who complained of unexplained weight loss, chronic diarrhea, and respiratory congestion during the past six months. The aim of this paper is to critically analyze the diagnostic results and answer related critical thinking questions.

Diagnostic Results:
Physical examination revealed right-sided pneumonitis. Diagnostic tests showed hemoglobin (Hgb) levels of 12 g/dL (normal: 14–18 g/dL), hematocrit (Hct) levels of 36% (normal: 42%–52%), and right-sided consolidation affecting the posterior lower lung. Bronchoscopy showed no tumor, but lung biopsy revealed Pneumocystis jiroveci pneumonia (PCP). Stool culture revealed Cryptosporidium muris, and AIDS serology tests showed positive results for p24 antigen, enzyme-linked immunosorbent assay (ELISA), and Western blot. Lymphocyte immunophenotyping revealed CD4 count of 280 (normal: 600–1500 cells/L), CD4% of 18% (normal: 60%–75%), CD4/CD8 ratio of 0.58 (normal: >1.0), and HIV viral load of 75,000 copies/mL.

Diagnostic Analysis:
The detection of PCP supported the diagnosis of AIDS. PCP is an opportunistic infection that occurs 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 that frequently occurs with AIDS and can be identified on a stool culture. The positive AIDS serology tests made the diagnosis, and the patient’s viral load was significant, indicating poor prognosis.

Critical Thinking Questions:

What is the relationship between levels of CD4 lymphocytes and the likelihood of clinical complications from AIDS?
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. CD4 cells 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.

Why does the United States Public Health Service recommend monitoring CD4 counts every 3–6 months in patients infected with HIV?
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.

This patient seems to be unaware of his diagnosis of HIV/AIDS. How would you approach your patient to inform him of his diagnosis?
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.

Is this a reportable disease in Florida? If yes, what is your responsibility as a provider?
Yes, in Florida, HIV/AIDS is a reportable disease. As a healthcare provider, it is my

gitongaedwin13@gmail.com
Is this a reportable disease in Florida? If yes, what is your responsibility as a provider?
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.

Reporting of HIV/AIDS cases is required by law in Florida under Florida Statutes Section 381.004. The law mandates that healthcare providers, laboratories, and other entities that provide HIV testing or treatment must report all HIV/AIDS cases to the Florida Department of Health.

The healthcare provider must provide the patient’s demographic information, laboratory results, and risk factors for HIV transmission. The reporting process is usually done electronically through the Florida Electronic Disease Surveillance System (FEDSS).

It is important for healthcare providers to comply with the reporting requirements to help prevent the spread of HIV/AIDS and to ensure that those living with the disease receive appropriate care and support.

References
Centers for Disease Control and Prevention. (2022). HIV Basics. https://www.cdc.gov/hiv/basics/index.html

Pagana, K. D., & Pagana, T. J. (2018). Mosby’s manual of diagnostic and laboratory tests. Elsevier.

National Institutes of Health. (2021). HIV/AIDS. https://www.niaid.nih.gov/diseases-conditions/hivaids

Florida Department of Health. (2022). HIV/AIDS Section. http://www.floridahealth.gov/diseases-and-conditions/aids/index.html

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