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 relationship between levels of CD4 lymphocytes and the likelihood of clinical complications from AIDS is well-established. CD4 lymphocytes, also known as T-helper cells, play a crucial role in the immune system. In HIV/AIDS, the virus specifically targets and destroys CD4 cells. As the CD4 cell count decreases, the immune system becomes severely compromised, making the individual more susceptible to opportunistic infections and malignancies. Generally, a lower CD4 count is associated with a higher likelihood of clinical complications, as it indicates a weakened immune response. In this case, the patient’s CD4 count of 280 (normal range: 600–1500 cells/L) and CD4% of 18% (normal range: 60%–75%) suggest significant immunosuppression, contributing to the development of various AIDS-related complications.
- The United States Public Health Service recommends monitoring CD4 counts every 3–6 months in patients infected with HIV for several reasons:
- Assessment of Immune Function: CD4 counts provide crucial information about the status of a patient’s immune system. Regular monitoring helps healthcare providers assess the progression of HIV infection and the effectiveness of antiretroviral therapy (ART) in restoring or maintaining immune function.
- Treatment Decisions: CD4 counts are used to guide treatment decisions, including the initiation of ART. When CD4 counts fall below a certain threshold, usually around 200 cells/L, it is an indication to start antiretroviral treatment to prevent further immune system damage.
- Disease Progression: Monitoring CD4 counts over time allows healthcare providers to track disease progression and adjust treatment regimens accordingly.
- Prevention of Opportunistic Infections: Knowing a patient’s CD4 count helps identify their risk of developing opportunistic infections, which can be prevented or managed with appropriate prophylactic measures.
- Overall Health Assessment: Regular CD4 monitoring is essential for assessing the overall health and prognosis of HIV-infected individuals.
- Informing a patient about their diagnosis of HIV/AIDS requires a sensitive and compassionate approach. Here are steps to consider:
- Choose the Right Setting: Find a quiet, private, and comfortable setting where you can have a confidential conversation without interruptions.
- Build Trust: Establish a rapport with the patient and ensure they feel comfortable and supported. Show empathy and understanding.
- Use Clear and Simple Language: Explain the diagnosis using plain language that the patient can easily understand. Avoid medical jargon.
- Provide Information: Offer information about HIV/AIDS, its transmission, treatment options, and available support services.
- Answer Questions: Allow the patient to ask questions and provide honest and accurate answers.
- Discuss Treatment: If appropriate, discuss treatment options, including antiretroviral therapy, and the importance of adherence.
- Offer Emotional Support: Recognize the emotional impact of the diagnosis and offer resources for counseling and support groups.
- Respect Autonomy: Ensure the patient’s autonomy in decision-making regarding their healthcare.
- Maintain Confidentiality: Emphasize the importance of confidentiality and discuss who the patient would like to involve in their care.
- Yes, HIV/AIDS is a reportable disease in Florida, as it is in all U.S. states. Healthcare providers are legally obligated to report cases of HIV/AIDS to public health authorities. Reporting serves several important purposes, including:
- Surveillance: Reporting helps public health authorities monitor the spread and prevalence of HIV/AIDS in the state, which is crucial for planning and implementing public health interventions.
- Prevention: Timely reporting allows for contact tracing and partner notification, helping to prevent further transmission of the virus.
- Resource Allocation: Reporting data helps allocate resources for HIV prevention, treatment, and support services effectively.
- Epidemiological Research: Data on reported cases are used for epidemiological research to better understand the patterns and trends of HIV/AIDS.
As a provider, your responsibility is to report confirmed cases of HIV/AIDS to the Florida Department of Health or the relevant public health agency following state and federal reporting guidelines while maintaining patient confidentiality. It’s essential to inform the patient about this reporting requirement during the diagnosis discussion to ensure transparency.