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 that as CD4 lymphocyte levels decrease, the likelihood of clinical complications and opportunistic infections increases. CD4 lymphocytes are a type of white blood cell that play a crucial role in the immune system. In a healthy individual, CD4 counts are typically within the normal range (600-1500 cells/L), but in HIV-infected individuals, the virus attacks and destroys these CD4 cells, leading to a weakened immune system. When the CD4 count drops significantly, below a certain threshold, the risk of developing AIDS-related complications and infections, such as Pneumocystis jiroveci pneumonia (PCP), Kaposi sarcoma, and other opportunistic infections, increases significantly. In this case, the patient had a CD4 count of 280 cells/L (below the normal range), which is indicative of severe immunosuppression and is associated with a high risk of clinical complications.
- The United States Public Health Service recommends monitoring CD4 counts every 3-6 months in patients infected with HIV for several reasons:
- CD4 counts provide important information about the patient’s immune status and the progression of their HIV infection.
- Regular monitoring helps healthcare providers assess the effectiveness of antiretroviral therapy (ART) and determine when to start or adjust treatment.
- CD4 count trends can help predict the risk of opportunistic infections and AIDS-related complications.
- Monitoring CD4 counts also aids in identifying patients who may need prophylactic medications or additional healthcare interventions to prevent infections.
- Informing a patient about their diagnosis of HIV/AIDS requires sensitivity, empathy, and clear communication. Here is a suggested approach:
- Choose an appropriate setting: Find a quiet, private, and comfortable space where you can have a confidential conversation.
- Build trust: Establish rapport with the patient, ensuring they feel safe and supported.
- Use plain language: Avoid medical jargon and explain the diagnosis in simple terms.
- Provide emotional support: Acknowledge the patient’s feelings and offer emotional support. Let them know they are not alone and that there are effective treatments available.
- Discuss treatment options: Explain the importance of early treatment with antiretroviral therapy (ART) and its benefits.
- Offer resources: Provide information on support groups, counseling services, and healthcare resources for HIV/AIDS patients.
- Address questions and concerns: Encourage the patient to ask questions and address any concerns they may have.
- Follow up: Schedule a follow-up appointment to discuss treatment plans and ongoing care.
- In many states, including Florida, HIV/AIDS is considered a reportable disease. As a healthcare provider, your responsibility includes reporting the diagnosis to the appropriate public health authorities in accordance with state and local regulations. Reporting is crucial for tracking the spread of the disease and for public health surveillance. It helps in monitoring and managing the HIV/AIDS epidemic and ensuring that appropriate public health measures can be taken to control its spread. Be sure to familiarize yourself with the specific reporting requirements and procedures in your state.