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Long-Term HIV Management: Case Study of a 52-Year-Old Man with Persistent CD4 Challenges

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This case study discusses the medical journey of a 52-year-old man who has been HIV-positive since 1989. His CD4 count has fluctuated between 110-130 throughout the years. Despite multiple medical interventions, he initially resisted antiretroviral therapy (ART). The patient developed non-specific interstitial pneumonitis and later diagnosed cryptococcal meningitis, receiving treatment with amphotericin and fluconazole. After significant improvement, he began considering ART. Key observations include his evolving health status and readiness for treatment based on improved CD4 levels.

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Long-Term HIV Management: Case Study of a 52-Year-Old Man with Persistent CD4 Challenges

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  1. CASE 5 • 52 yo man • HIV+ since 1989 • CD4 nadir 110

  2. CASE 5 MAR 2010-JULY 2013 • CD4 110-130 • Does NOT and has NEVER wanted HIV meds despite my best efforts and warnings

  3. CASE 5 NOV-DEC 2013 • Develops cough/soboe…non specific interstitial pneumonitis…felt to be hypersensitivity based • Worked up by respirologist and bronchoscopy/BAL performed to r/o opportunistic infection

  4. CASE 5 NOV-DEC 2013 • Treated with high dose steroids with great effect from a respiratorystandpoint

  5. CASE 5 DEC 2013-JAN 2014 • Develops headaches/fever/decreased LOC and experiences a stroke • Diagnosed with Cryptococcal meningitis and treated with Amphotericin followed by Fluconazole with effect…steroids stopped

  6. CASE 5 FEB 2014 • Much improved and now asymptomatic with no stroke sequelae • Still not ready to initiate ARVS but is ready now to consider them

  7. CASE 5 FEB 2014 • Wants to see bloodworknow that he is better and off steroids • CD4 120 • Wants ARV recommendations… baseline genotype done

  8. CASE 1 BASELINE GENOTYPE FEB/2014

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