A 26-year-old man comes to the physician for a follow-up examination. He was diagnosed with HIV infection 2 weeks ago. His CD4+ T-lymphocyte count is 162/mm3 (N ≥ 500). An interferon-gamma release assay is negative. Prophylactic treatment against which of the following pathogens is most appropriate at this time?
ACytomegalovirus
BToxoplasma gondii
CMycobacterium tuberculosis
DAspergillus fumigatus
EPneumocystis jirovecii
A 32-year-old man comes to the physician for a follow-up examination 1 week after being admitted to the hospital for oral candidiasis and esophagitis. His CD4+ T lymphocyte count is 180 cells/μL. An HIV antibody test is positive. Genotypic resistance assay shows the virus to be susceptible to all antiretroviral therapy regimens and therapy with dolutegravir, tenofovir, and emtricitabine is initiated. Which of the following sets of laboratory findings would be most likely on follow-up evaluation 3 months later? $$$ CD4 +/CD8 ratio %%% HIV RNA %%% HIV antibody test $$$
A↓ ↓ negative
B↑ ↑ negative
C↓ ↑ negative
D↑ ↓ positive
E↓ ↑ positive
A 52-year-old man is brought to the emergency department because of headaches, vertigo, and changes to his personality for the past few weeks. He was diagnosed with HIV 14 years ago and was started on antiretroviral therapy at that time. Medical records from one month ago indicate that he followed his medication schedule inconsistently. Since then, he has been regularly taking his antiretroviral medications and trimethoprim-sulfamethoxazole. His vital signs are within normal limits. Neurological examination shows ataxia and apathy. Mini-Mental State Examination score is 15/30. Laboratory studies show: Hemoglobin 12.5 g/dL Leukocyte count 8400/mm3 Segmented neutrophils 80% Eosinophils 1% Lymphocytes 17% Monocytes 2% CD4+ T-lymphocytes 90/μL Platelet count 328,000/mm3 An MRI of the brain with contrast shows a solitary ring-enhancing lesion involving the corpus callosum and measuring 4.5 cm in diameter. A lumbar puncture with subsequent cerebrospinal fluid analysis shows slight pleocytosis, and PCR is positive for Epstein-Barr virus DNA. Which of the following is the most likely diagnosis?
ACNS lymphoma
BAIDS dementia
CGlioblastoma
DBacterial brain abscess
EProgressive multifocal leukoencephalopathy
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