g to the combined impact of HIV testing, prevention counseling, and treatment

activities aimed at HIV-positive people (CDC, 2013).

AIDS-related fatalities worldwide, which peaked at 2.4 million in 2005 and have

been progressively declining since then, were predicted to be 1.5 million in 2013.

(UNAIDS, 2014a). Despite the fact that Sub-Saharan Africa bears the brunt of HIV/AIDS,

HIV and AIDS have a substantial impact on nations in South and Southeast Asia,

Eastern Europe and Central Asia, and Latin America (CDC, 2014b; UNAIDS, 2014b).

I. PATHOMECHANICS

People who are HIV-positive are more likely to have risk factors for bone loss,

including smoking, drinking alcohol, use of opioids, low testosterone, and a lower intake

of calcium and vitamin D. The virus, which causes HIV/AIDS, itself make your bones

more likely to break. And some anti-HIV medications my raise your chances for bone

less. That can cause your bones to become fragile. If you lose too much bone mass, or

density, you doctor may diagnose you with osteoporosis, A smaller level of bone loss

called osteopenia. And the people with HIV will get osteoporosis or osteopenia, at least

twice as likely to break a bone as those who don’t have a virus.

II. PATHOPHYSIOLOGY

Virus enters the immune cells (CD4 cells)

Gets integrated to the cells nucleus

Replicates inside the cells

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 Ultimately destroys the immune cells

Immunodeficiency

Multiple Infections

A human immunodeficiency virus (HIV) infection damages the cell-mediated immune

system, resulting in acquired immunodeficiency syndrome (AIDS). HIV causes a wide

range of opportunistic infections (OI) and tumors, as well as causing direct harm to

several organs. The incidence of latent and acquired infections, as well as the lifespan of

HIV-infected individuals, determine the patterns of opportunistic diseases (OD) in

different areas of the world. As individuals relocate, their OD habits alter. Many of the

frequent OIs are prevented by recently adopted extremely potent antiretroviral

chemotherapy, but it also brings a wide range of toxic pathological damage. Longer

longevity allows new HIV-related illnesses to emerge (Lucas, 2002). Many important

cells in the human immune system combat infection and kill aberrant cells, including

lymphocytes known as T-cells, which control the immune system's response to foreign

antigens. HIV infects CD4 'helper' cells, which are a specific kind of T-cell. They're

termed so because they don't eliminate or neutralize foreign antigens themselves, but

instead alert and attract other immune cells to do so.

HIV quickly seeks out and infects CD4 cells after entering a host's body. The virus

takes over the function of CD4 cells and transforms them into factories that create

multiple copies of the virus on a daily basis; between 10 million and 10 billion new virus

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 cells can be produced. CD4 cells have a substantially shorter lifespan once infected and

are eventually eliminated; their decreasing quantity in the host promotes immunological

failure and infection vulnerability. The course of HIV infection is sometimes classified

into phases, however it is difficult to exactly demarcate people into discrete, distinct

stages in reality. Individual HIV progression is influenced by a variety of variables,

including genetics and comorbidities. Because HIV is genetically complex and frequently

mutates, viral variables such as viral gene deletions, viral subtype, and coreceptor use

can all influence the rate of HIV progression. As a result, the stages serve as a guide.

III. SIGNS & SYMPTOMS

The symptoms of HIV vary depending on the stage of infection. Though people living

with HIV tend to be most infectious in the first few months after being infected, many are

unaware of their status until the later stages, the infection progressively weakens the

immune system, they can develop other signs and symptoms, such as swollen lymph

nodes, weight loss, fever, diarrhea, and cough. Without treatment, they could also

develop severe illnesses such as tuberculosis (TB), cryptococcal meningitis, severe

bacterial infections, and cancers such as lymphomas and Kaposi's sarcoma.

Other symptoms include:

• headaches

• sore throat

• excessive fatigue

• chills

• muscle pain

• swollen lymph nodes in the armpits, neck, or groin

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 • a red or discolored, itchy rash with small bumps

• mouth ulcers or oral thrush

IV. COURSE

The first noticeable stage is primary HIV infection. This stage is also called acute

retroviral syndrome (ARS), or acute HIV infection. It usually causes flu-like

symptoms, so it's possible for someone in this stage to think they have severe flu or

another viral illness rather than HIV. Fever is the most common symptom.

V. PROGNOSIS

HIV infection progresses to AIDS in approximately 10 years, with death following

within three years after onset of AIDS. With appropriate treatment, a 20-year-old with

HIV infection can expect to live to reach 71 years of age. This dramatic increase in

life expectancy emphasizes the need for early diagnosis and treatment. Moreover,

with newer treatment regimens and guidelines, there is every reason to think that life

expectancy will continue to increase in patients who are able to receive appropriate

treatment. There are some factors that decrease life expectancy, including use of

illicit drugs and the coexistence of other conditions like chronic hepatitis.

VI. DIAGNOSIS

The most frequent technique to diagnose HIV is through blood testing. These tests

check for antibodies to the virus that the body produces in an effort to combat it. People

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 who have been exposed to the virus should get tested right once, since developing

antibodies to the virus can take anywhere from six weeks to a year.

ELISA Test The enzyme-linked immunosorbent assay (ELISA) test is used to identify

HIV infection. When an ELISA test results in a positive result, a Western blot test is used

to confirm the diagnosis. If you receive a negative ELISA test but suspect you have HIV,

you should be tested again in one to three months. Because antibodies aren't created

immediately after infection, you may test negative for a few weeks to a few months after

being infected, yet ELISA is highly sensitive in chronic HIV infection. Even if your test

results are negative during this time period, you may still have a high amount of the virus

and be at risk of infection.

The only home test that has been approved by the US government is the home test.

The Home Access Express Test, which is available at pharmacies, is approved by the

Food and Drug Administration. Saliva tests are taken using a cotton pad from the inside

of your cheek. The pad is placed in a vial and sent to be tested at a laboratory. In three

days, the results will be released. A blood test should be used to confirm positive

results. The quantity of HIV in your blood is measured by a viral load test. It's often used

to track treatment progress or diagnose HIV infection early on. The reverse transcription-

polymerase chain reaction (RT-PCR), branched DNA (bDNA), and nucleic acid

sequence-based amplification test is three methods for measuring HIV viral load in the

blood (NASBA). These exams are based on the same basic ideas. HIV is identified

utilizing DNA sequences that attach to the virus specifically. It's vital to keep in mind that

findings may differ from one test to the next.

VII. CASE DISCUSSION

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HISTORY

A 47-year-old woman presented with a chief complaint of fever of 103 �F, non-

productive cough, and dyspnea which has progressed over one week. She has tested

HIV-positive 5 years ago at which time her CD4 lymphocyte count was 583. Zidovudine

was started, but she stopped taking it after one month and did not return to her doctor for

follow-up. She has anorexia and lost 70 pounds over the last 3 months.

She used heroin and cocaine intravenously for a six-month period 6 years ago. She

does not smoke or drink, has no past STD's and is not sexually active. She has no

known drug allergies (NKDA).

PAST HISTORY

She has bees diagnosed having a human Immunodeficiency Virus (HIV) in the

past 5 years ago and has no other past medications has been taken up by the patient

other than the Zidovudine that was started when she was diagnosed until she stopped

after a month of taking the said medication.

PERSONAL AND SOCIAL HISTORY

She has a history of using drugs such as heroine and cocaine. She does nto drink

alcoholic drinks, does not smoke, and did not even have any sexual intercourse in her

past. Moreover, she did not have any STDs as well. The case study does not explain her

social life

PHYSICAL EXAMINATION (FROM HEAD TO TOE)

She was pale, diaphoretic, and had severe breathing problems. T 37.4 degrees

Celsius, P 96 beats per minute, R 30 beats per minute, BP 110/70. Oral thrush was

discovered. Poor inspiratory effort and bibasilar crackles were seen 2/3 of the way up

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 the posterior lung field during an examination of the lungs. There was a tachycardia but

no murmurs in her heart. Her abdomen was not painful, and her liver and spleen were

not enlarged. Except for vaginal candidiasis, the pelvic exam was normal. The

neurologic evaluation revealed no abnormalities.

LABORATORY WORK UP/EXAMINATIONS AND X-RAY/UTZ ETC. (OTHERS

IF ANY AS NEEDED)

Hgb: 10.8 g/dl

WBC: 7,500/mm3

Segs: 43, Lymphs: 41, Monos: 9, Eos: 6, Basos: 1

Platelets 248k/mm3

ABG: 7.48(pH)/32(pCO2)/51(pO2)/23(HCO3)

CD4: %=11.#=235/mm3

HIV RNA level: 234,000 copies/ml

Induced sputum: Direct fluorescence positive for Pneumocystis carinii

VIII. INITIAL IMPRESSION (DISEASE/ILLNESSES/PROBLEM)

It has been shown in her laboratory, specifically in her induced septum that she may

be positive for Pneumocystis Carinii

CLINICAL PRESENTATION

The fungus Pneumocystis jirovecii causes Pneumocystis pneumonia (PCP),

which is a deadly illness. The majority of persons who have PCP have a medical

condition that weakens their immune system, such as HIV/AIDS, or are taking

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 medications (such as corticosteroids) that reduce the body's capacity to fight pathogens

and illness. Since the patient has been diagnosed with HIV last 5 years ago, it is not

impossible for her to have the said disease knowing that HIV attacks the immune system

of the patient which has caused the Pneumocystis pneumonia.

IX. FINAL DIAGNOSIS

Due to her immune deficiency which she attained last 5 years ago and diagnosed

to be HIV, the patient indeed became positive for Pneumocystis pneumonia, a

deadly disease or illness due to the weakening of their immune system caused by

the immunodeficiency they have. The patient, according to her laboratory records

have shown that she became positive for Pneumocystis Carinii

TREATMENT

PCP requires the use of a prescription medication. PCP can be fatal if left

untreated. Trimethoprim/sulfamethoxazole (TMP/SMX), also known as co-

trimoxazole and marketed under the trade names Bactrim, Septra, and Cotrim, is the

most commonly used therapy. This drug is taken orally or intravenously for three

weeks.

Side effects of TMP/SMX include redness and fever. If a patient is unable to take

TMP/SMX, other medications are available.

PREVENTION

Multiple outbreaks, each caused by a different strain of Pneumocystis, have been

documented among kidney transplant patients.5-11,40 Although these findings

strongly suggest that isolating patients with known PCP from patients at high risk for

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 PCP may be beneficial, there is insufficient evidence to support isolation as standard

practice to prevent PCP. Adults and adolescents with HIV, including pregnant

women and those on ART, should receive PCP chemoprophylaxis (AI).12,13,41

People with a CD4 cell percentage of less than 14 percent should also be considered

for PCP prophylaxis (BII).12,13,41 If ART initiation is delayed and frequent CD4

count monitoring (e.g., every 3 months) is impossible, some experts recommend

starting PCP chemoprophylaxis at CD4 (AII).

References
Central, PubMed. 2013. "CASE STUDY OF A PATIENT WITH HIV-AIDS AND VISCERALLEISHMANIASIS CO-
INFECTION IN MULTIPLE EPISODES - PMC." www.ncbi.nlm.nih.gov.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105092/.

Clinic, Mayo. 2022. "HIV/AIDS - Symptoms and causes." https://www.mayoclinic.org/diseases-

conditions/hiv-aids/symptoms-causes/syc-20373524#:~:text=HIV%20is%20caused%20by
%20a,helping%20your%20body%20fight%20disease.

Contributor, N. (2020, June 15). HIV 1: epidemiology, pathophysiology and transmission | Nursing Times.
Nursing Times. 2020.

15-06-2020. Contributor, N. (2020, June 15). HIV 1: epidemiology, pathophysiology and transmission |
Nursing Times. Nursing Times; www.nursingtimes.net. .

2020, June 15. "HIV 1: epidemiology, pathophysiology and transmission Nursing Times. Nursing Times."
https://www.nursingtimes.net/clinical-archive/immunology/hiv-1-epidemiology-
pathophysiology-and-transmission-15-06-2020/.

2022. "HIV/Aids | Health Knowledge. (n.d.). HIV/Aids | Health Knowledge."

https://www.healthknowledge.org.uk/public-health-textbook/disease-causation-diagnostic/2b-
epidemiology-diseases-phs/infectious-diseases/hiv-aids.

2002. "The pathology of HIV infection - PubMed. ."

https://pubmed.ncbi.nlm.nih.gov/11969128/#:~:text=The%20acquired%20immunodeficiency
%20syndrome%20(AIDS,HIV%20directly%20damages%20some%20organs.

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