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Patient case: HIV/AIDS

Discussion

A 32-year-old man presents to the clinic with a three-month history of unintentional weight loss, chronic diarrhea, night sweats, and persistent fatigue. He also reports recurrent oral ulcers and a nonproductive cough that has worsened over the past two weeks. He has no significant past medical history but admits to multiple unprotected sexual encounters in the past.

On examination, he appears thin and fatigued. His temperature is 38.2°C (100.8°F), and his heart rate is 98 bpm. He has oral thrush and generalized lymphadenopathy. Chest auscultation reveals mild bilateral crackles. Laboratory tests show a low CD4+ count of 120 cells/µL, and an HIV-1/2 antibody test returns positive. A sputum test is positive for Pneumocystis jirovecii, confirming Pneumocystis pneumonia (PCP), an opportunistic infection associated with advanced HIV/AIDS.

The patient is diagnosed with AIDS and started on antiretroviral therapy (ART) along with trimethoprim-sulfamethoxazole for PCP treatment and prophylaxis. Nutritional support and counseling on medication adherence are also provided. Over the following months, his condition stabilizes, and his CD4+ count begins to recover with consistent ART use.

Questions
1. What is the most likely diagnosis in this patient?

a) Tuberculosis

b) HIV/AIDS with opportunistic infection

c) Chronic viral hepatitis

d) Lymphoma

2. Which opportunistic infection is most likely responsible for this patient’s respiratory symptoms?

a) Pneumocystis jirovecii pneumonia (PCP)

b) Bacterial pneumonia

c) Influenza

d) Fungal sinusitis

3. What is the most appropriate initial treatment for this patient’s PCP?

a) Acyclovir

b) Trimethoprim-sulfamethoxazole (TMP-SMX)

c) Azithromycin

d) Rifampin

4. What is the best long-term management for this patient’s HIV infection?

a) Symptomatic treatment only

b) Delaying treatment until symptoms worsen

c) Immediate initiation of antiretroviral therapy (ART)

d) Monthly antibiotic therapy instead of ART

Reveal answers

Answers

1. Answer: b) HIV/AIDS with opportunistic infection

The combination of weight loss, chronic diarrhea, oral thrush, and a low CD4+ count strongly suggests AIDS with opportunistic infections.

2. Answer: a) Pneumocystis jirovecii pneumonia (PCP)

PCP is a common opportunistic infection in patients with AIDS, typically presenting with a dry cough, dyspnea, and fever, especially when CD4+ counts are below 200 cells/µL.

3. Answer: b) Trimethoprim-sulfamethoxazole (TMP-SMX)

TMP-SMX is the first-line treatment for PCP and also serves as prophylaxis in patients with low CD4+ counts to prevent future infections.

4. Answer: c) Immediate initiation of antiretroviral therapy (ART)

ART should be started as soon as possible to suppress viral replication, improve immune function, and prevent further opportunistic infections.

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