HIV and AIDS: Pathology review

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HIV and AIDS: Pathology review

Reproductive system


HIV and AIDS: Pathology review

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 35-year-old man comes to the clinic with a two-week history of fever, night sweats, abdominal pain, and diarrhea. Three years ago, the patient was diagnosed with HIV-AIDS and refused treatment. The patient is sexually active with men and women and uses condoms inconsistently. The patient uses intravenous drugs including heroin and consumes alcohol regularly. He was adopted at the age of five from India and does not have a history of travel outside the United States. Temperature is 36.6°C (98.0°F), pulse is 99/min, respirations are 20/min, and blood pressure is 120/75 mmHg. Physical examination reveals conjunctival pallor, anterior, cervical, inguinal, and axillary lymphadenopathy. Oral examination reveals white, mucosal plaques on the lateral aspect of the tongue that cannot be scraped off. Abdominal examination reveals ascites and hepatosplenomegaly. Laboratory studies are detailed below. CT of the abdomen and pelvis reveals ascites, mesenteric and periaortic lymphadenopathy, and bowel wall thickening. A biopsy specimen of an axillary lymph node is shown below. Which of the following is the most likely diagnosis?
Laboratory value
9  g/dL
Leukocyte count
13,100 /mm3
Platelet count
Alkaline phosphatase
207 U/L
Lactate dehydrogenase (LDH)
421 U/L
CD4+T cell
42 cell/microL
HIV viral RNA quant  
4851 copies/ml
Interferon gamma release    assay (IGRA)  

CDC Public Health Library


Two people come to the infectious disease clinic. The first one’s David, a 42 year old man who has a fever, associated with a cough and difficulty breathing. David mentions that he’s HIV-positive, so you decide to run a blood test, which reveals an alarming T cell count of 180 cells / mm3. You immediately ask for a chest X-ray, which shows gray hazy-looking areas in both lungs. Next comes Charles, a 32 year old man. Charles was referred to the clinic by his dentist, who detected white plaques on both sides of his tongue. When you try to scrape the plaques with a tongue depressor, you realize that they can’t be removed. Upon further questioning, Charles tells you that lately he’s been losing a ton of weight, although he hasn’t been exercising or dieting at all. You decide to ask for an HIV-1/2 antigen/antibody immunoassay, which turns out positive. Okay, now both David and Charles have HIV, which stands for human immunodeficiency virus. HIV specifically targets the cells of our immune system, leading to progressive immunodeficiency, which is when the immune system begins to fail gradually. Ultimately, affected individuals can develop AIDS, or acquired immunodeficiency syndrome. What’s important to note is that AIDS puts at increased risk of certain opportunistic infections or tumors that a healthy immune system would usually be able to fend off.

Now, HIV can be transmitted via certain bodily fluids from an infected person, including blood, genital fluids like semen or vaginal discharge, and breast milk. However, HIV is not present in saliva, sweat, urine, or feces. Now, to contract the infection, these bodily fluids need to come into direct contact with a healthy person's blood, broken skin, or mucosal surfaces.


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