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 in the blood are a crucial indicator of the immune system’s function and its ability to fight off infections. In AIDS, the human immunodeficiency virus (HIV) specifically targets and destroys CD4 lymphocytes, leading to a decline in their levels. As the CD4 count decreases, the likelihood of clinical complications from AIDS increases. A lower CD4 count indicates a more severe immunodeficiency, making the individual more susceptible to opportunistic infections and certain malignancies associated with AIDS.
- The United States Public Health Service recommends monitoring CD4 counts every 3–6 months in patients infected with HIV to assess the progression of the disease and guide appropriate medical interventions. CD4 monitoring provides valuable information about the individual’s immune status, disease progression, and the need for initiating or modifying antiretroviral therapy (ART). By regularly monitoring CD4 counts, healthcare providers can make informed decisions regarding treatment options and preventive measures to optimize patient care and outcomes.
- When approaching the patient to inform them about their diagnosis of HIV/AIDS, it is essential to approach the conversation with sensitivity, empathy, and respect for the patient’s emotional well-being. Here are some key considerations:
- Choose an appropriate setting: Find a quiet and private place where the patient feels comfortable and safe to discuss sensitive information.
- Use clear and understandable language: Avoid medical jargon and explain the diagnosis in simple terms that the patient can comprehend.
- Provide emotional support: Acknowledge the potential impact of the diagnosis and offer emotional support, reassurance, and resources such as counseling or support groups.
- Address concerns and questions: Give the patient an opportunity to ask questions and provide them with accurate information about the condition, transmission, treatment options, and available support services.
- Offer a support system: Encourage the patient to involve a trusted family member, friend, or partner in the discussion, if desired, to provide additional support.
- Yes, HIV/AIDS is a reportable disease in Florida. As a provider, your responsibility is to report cases of HIV/AIDS to the appropriate public health authorities as mandated by state regulations. Reporting helps in tracking the prevalence of the disease, monitoring trends, and implementing public health interventions to prevent further transmission and ensure appropriate care and support for affected individuals.