HIV and AIDS Quiz: Ace Your Exams

A 66-year-old man comes to the emergency department with two weeks of dyspnea, fever and a cough productive of blood-tinged sputum. Past medical history is significant for diabetes mellitus, dyslipidemia, HIV, and Pneumocystis carinii pneumonia. The patient is currently compliant with antiretroviral therapy. The patient’s last CD4 count was 450 cells/microL. Current medications include tenofovir-emtricitabine and dolutegravir, atorvastatin, aspirin, and metformin. The patient is sexually active with men and women and uses condoms consistently. The patient does not use intravenous drugs, alcohol, or tobacco. The patient lives in Mississippi in a retirement home and immigrated from India one year ago. Temperature is 38.11°C (100.0°F), pulse is 100/min, respirations are 20/min, blood pressure is 130/75 mmHg, SpO₂ is 94% on room air. The patient is alert and oriented. Oral examination reveals white, mucosal plaques that cannot be scraped off easily. Physical examination reveals scattered rales on pulmonary auscultation. The patient's chest radiograph is depicted below. Which of the following best describes the pathogenesis of this patient’s current infectious process?
 
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