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?
- What is the relationship between levels of CD4 lymphocytes and the likelihood of clinical complications from AIDS?
The levels of CD4 lymphocytes are directly related to the immune system’s functionality. CD4 cells, also known as T-helper cells, are crucial in coordinating the immune response. In HIV/AIDS, the virus specifically targets and depletes these cells. As the CD4 count decreases, the patient’s immune system becomes progressively compromised, increasing the susceptibility to opportunistic infections and other complications. Clinical complications, such as opportunistic infections (e.g., Pneumocystis jiroveci pneumonia) and malignancies (e.g., Kaposi sarcoma), are more likely and severe as CD4 levels fall below critical thresholds (e.g., below 200 cells/µL).
- Why does the United States Public Health Service recommend monitoring CD4 counts every 3–6 months in patients infected with HIV?
Regular monitoring of CD4 counts every 3–6 months is recommended to:
- Assess the patient’s immune status and disease progression.
- Guide treatment decisions, such as the initiation or adjustment of antiretroviral therapy (ART) and prophylaxis for opportunistic infections.
- Evaluate the effectiveness of ART and detect treatment failures early.
- Provide information to anticipate and manage potential complications associated with low CD4 counts.
- Ensure timely intervention to improve clinical outcomes and quality of life.
- This patient seems to be unaware of his diagnosis of HIV/AIDS. How would you approach your patient to inform them about his diagnosis?
Approaching a patient to inform them about an HIV/AIDS diagnosis requires sensitivity, empathy, and clear communication. Here are some steps to follow:
- Prepare the Setting: Ensure privacy and a quiet environment to have a confidential conversation without interruptions.
- Build Rapport: Start the conversation with empathy and understanding. Establish trust by showing genuine concern for the patient’s well-being.
- Assess Understanding: Ask the patient what they know about their health status and any recent symptoms or concerns.
- Deliver the News: Clearly and calmly explain the diagnosis. Use simple, non-technical language. For example, “I have some important information about your health. The tests we conducted have confirmed that you have HIV, which is the virus that can lead to AIDS.”
- Provide Information: Explain what HIV/AIDS is, how it affects the body, and the implications for their health. Reassure them that treatments are available that can help manage the condition.
- Emotional Support: Allow time for the patient to process the information and express their emotions. Offer support and be prepared to answer questions.
- Next Steps: Discuss the treatment plan, including antiretroviral therapy, regular monitoring, and lifestyle modifications. Provide resources for counseling and support groups.
- Follow-Up: Schedule follow-up appointments and ensure the patient has contact information for further questions or concerns.
- Is this a reportable disease in Florida? If yes, what is your responsibility as a provider?
Yes, HIV/AIDS is a reportable disease in Florida. As a healthcare provider, it is your responsibility to:
- Report the Diagnosis: Notify the Florida Department of Health about the diagnosis of HIV/AIDS within the required timeframe. Reporting helps public health authorities track and manage the spread of the disease.
- Ensure Confidentiality: Maintain patient confidentiality throughout the reporting process. Only share information necessary for public health purposes.
- Educate the Patient: Inform the patient about the reporting requirements and reassure them that their information will be kept confidential.
- Provide Resources: Offer the patient resources for further information, support, and counseling. Direct them to local health departments or organizations that provide assistance to individuals with HIV/AIDS.
- Follow Public Health Guidelines: Adhere to guidelines and protocols established by public health authorities for the management and reporting of HIV/AIDS cases.