CD4 count
Workup
Clinical Presentations
Prophylaxis
Potpourri
100
Toxoplasmosis
What is opportunistic infection at CD4 count of less than 100?
100

CXR shows diffuse, bilateral, interstitial, or alveolar infiltrates. LDH is elevated.

What is PCP pneumonia?

100
A patient with a CD4 count of 150, who has a 3 week h/o fever, non-productive, cough, and dyspena. Lungs are clear to auscultation bilaterally.
What is pneumocystis infection?
100
Trimethoprim-sulfamethoxazole in those with CD4 counts <200
What is prophylaxis for pneumocystis?
100

Vaccinations are okay with this CD4 count

What preventive measures can be undertaken after CD4>200?

200
Mycobacterium Avium Complex
What is opportunistic infection at CD4 count of less than 50?
200
Head CT scan with contrast shows multiple ring enhancing lesions in a patient with a CD4 count of 90.
What is toxoplasmosis?
200
A patient with a CD4 count of 78, who presents to the ED with left sided-weakness and headaches.
What is toxoplasmosis?
200
Macrolide (azythromycin or clathromycin) when CD4 <50.
What is prophylaxis for MAC?
200

CD4 at which you can discontinue prophylaxis for PCP

What is significance of CD4 count to >200 cells/microL for more than three months?

300
Pneumocystis
What is opportunistic infection at CD4 count of less than 200?
300
India ink preparation of the CSF shows the organism in a HIV+ patient with fever and headache
What is cryptococcus meningitis?
300
A patient with a CD4 count of 250, who presents with weight loss, fatigue, and productive cough with blood-tinged sputum of 5-weeks duration.
What is TB infection?
300
Trimethoprim-sulfamethoxazole in patient w/ positive IgG serology for this pathogen
What is prophylaxis for toxoplasma gondii? *Note that these pts should be on bactrim anyway for PCP prophylaxis as soon as CD4 ct is <200, however the dosage increases from single strength to double strength if you they meet criteria for prophylasis for toxo
300

Asymptomatic pt found to have CD4 count of 53 with viral load of 5,000,000. Started on standard HAART therapy. Returns 35 days later with cough, fever, weight loss and night sweats.

What is immune reconstitution inflammatory syndrome?

400
Histoplasmosis
What is opportunistic infection at CD4 count of less than 150?
400
CXR shows cavity opacities. Sputum stain shows acid fast bacilli in patient. PPD is negative.
What is TB in an immunocompromised host?
400
A patient with a CD4 count of 31, who presents with persistent cough, purulent sputum of 3-months duration. He denies any weight loss of fevers.
What is MAC?
400
Fluconazole in patient w/ CD4 <100 and + screen for antigen and not on HAART, who is living in area that is endemic for this pathogen
What is prophylaxis for cryptococcus?
400

Pt with a CD4 count of 50 presents with HA, vomiting, and seizure. MRI showed a single ring enhancing lesion in the brain. CSF analysis is most likely positive for?

What is EBV DNA?

500
Coccidiomycosis
What is opportunistic infection at CD4 count of less than 250?
500
Patient with CD4 count of 550 presents with new onset confusion and seizures. Lumbar puncture shows increased WBCs, increased protein, normal glucose, 300 RBCs, and no organisms on gram stain.
What is herpes encephalitis?
500
A patient with a CD4 count of 50, presents with fever, neck stiffness and positive latex aggulintation.
What is cryptococcus neoformans infection?
500

treated with a drug that causes sideroblastic anemia

What is prophylaxis for HIV+ at any CD4 count with latent TB?

500

Prophylaxis for patient with PMHx of G6PD deficiency with CD4 count of 161

What is dapsone, atovaquone, or aerosolized pentamidine for?

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