Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests AIDS
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?
Sample Solution
- Relationship between CD4 Levels and Complications:
- CD4 counts >500: Relatively low risk of ADIs.
- CD4 counts 200-500: Increased risk of certain ADIs like PCP and oral thrush.
- CD4 counts <200: High risk of developing severe ADIs like Kaposi sarcoma and cytomegalovirus retinitis.
- Monitoring CD4 Counts:
- Risk assessment: Tracking CD4 trends helps predict the risk of developing ADIs, allowing for proactive interventions like prophylactic medications or earlier initiation of antiretroviral therapy (ART).
- Treatment decisions: CD4 count is a key factor in determining the timing and type of ART to start, ensuring optimal treatment and virus suppression.
- Monitoring response to therapy: Regularly monitoring CD4 levels assesses the effectiveness of ART and identifies potential issues with treatment adherence or drug resistance.
- Approaching the Patient about HIV/AIDS Diagnosis:
- Create a safe and supportive environment: Choose a private, secure space and provide reassurance throughout the conversation.
- Use clear and concise language: Explain the test results simply and avoid technical jargon.
- Focus on education and empower the patient: Provide information about HIV/AIDS transmission, treatment options, and available support services.
- Address emotions and concerns: Acknowledge the patient's emotional response and be prepared to answer questions openly and honestly.
- Connect the patient to resources: Refer them to specialized HIV/AIDS care providers, mental health professionals, and support groups.
- Reportability of AIDS in Florida:
- Reporting confirmed cases of HIV infection and relevant ADIs as mandated by law.
- Maintaining patient confidentiality while fulfilling the reporting requirements.
- Educating the patient about the reporting process and its purpose.