Acquired Immunodeficiency: HIV Quiz

A 23-year-old woman at 40 weeks’ gestation arrives at the labor and delivery area saying she has been having contractions for the past several hours.  The patient is unmarried and is not certain of the identity of the child’s father.  She denies any prenatal care. She was treated for Chlamydia last year and herpes simplex 5-years ago.  On examination, her blood pressure is 110/72 mmHg, her temperature is 99 F (37.2 C), heart rate 80/min, and respirations 18 breaths/min. There are no active herpetic lesions found on the vulva or within the birth canal. A rapid assay for anti-HIV antibodies is positive.  The patient is started on zidovudine.  Twenty-four hours after admission she gives birth to a healthy 6.4 pound girl. Which of the following is the best method to determine whether the infant is infected with HIV?

A 52-year-old man is evaluated for a 3-week history of abdominal discomfort associated with weight loss, nausea and vomiting.  He now reports difficulty swallowing and has not been able to eat or drink in the past 24 hours.  The patient was diagnosed with HIV 18 years ago, and despite appropriate therapy, he now has 30 CD4 cells/µL.  On physical examination his temperature is 38.2 C (100.8 F), blood pressure 130/83 mmHg, pulse rate 90/min, and respiration rate 24/min.    Palpation reveals a soft abdomen and there are active bowel sounds. There is generalized lymphadenopathy, but no masses are palpable. Deep epigastric palpation elicits flinching.   A biopsy of a supraclavicular node is shown:

(Image from CDC public health image library)

For which of the following reasons is an AIDS patient especially susceptible to this disease?

A 38-year-old HIV-positive male has been in the care of a specialist since his diagnosis 10 years ago.  Over that period, the physician has changed the anti-retroviral maintenance cocktail three times and his current CD4 cell count is 900/µL.  Which of the following is the best means to evaluate the efficacy of an anti-retroviral regimen?

A 46-year-old man who is seropositive for HIV has been in the care of a specialist for the past 5 years.  It has been a struggle to find an anti-retroviral regimen which can be tolerated by the patient and shows efficacy in control of the virus.  Since the beginning of his treatment, his CD4 count has declined from 1100 to 500, despite all efforts at control.  Which of the following parameters is likely to have shown a parallel decline to his CD4 count over this time?

A 49-year-old HIV-positive male has had his viral load kept below 30 copies of HIV RNA per ml for the past three years using lamivudine and nelfinavir.  He now presents with a viral load of 55,000 copies/Ml.  Which of the following is the most likely cause of the genetic mutability that has caused the loss of efficacy of this anti-retroviral regimen?