Posted: May 23rd, 2023

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests

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?
__________________-
The levels of CD4 lymphocytes play a crucial role in determining the likelihood of clinical complications from AIDS. CD4 lymphocytes are a type of white blood cell that helps coordinate the immune response. HIV specifically targets and destroys CD4 cells, leading to a weakened immune system. As the CD4 cell count decreases, the immune system becomes progressively weaker, making the individual more susceptible to opportunistic infections and malignancies associated with AIDS. The lower the CD4 cell count, the higher the risk of developing clinical complications and experiencing more severe manifestations of the disease.

The United States Public Health Service recommends monitoring CD4 counts every 3–6 months in patients infected with HIV for several reasons. Firstly, CD4 cell count serves as an indicator of immune function and disease progression. Regular monitoring allows healthcare providers to assess the status of the immune system and determine the appropriate timing for initiating or modifying antiretroviral therapy (ART). Secondly, CD4 cell counts can help guide prophylactic treatment decisions to prevent opportunistic infections. Lastly, monitoring CD4 counts over time provides valuable information on the effectiveness of the treatment regimen and the overall health of the patient.

When approaching a patient to inform them about their diagnosis of HIV/AIDS, it

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