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Kevin Hohner, age 37, has shortness of breath and cough. He reports weight loss of 10 pounds in the last 2 months. He state that he has had pneumonia twice in the past  year. He has a prior history of unprotected homosexual sex with multiple partners but has been in a stable relationship for the past six years. HIs partner is HIV negative, but Mr. Hohner has not been tested for HIV.

His physical exam is as follows:

· Vital signs normal except for elevated respiratory rate

· Crackles in lower half of lung fields, with inspiratory and expiratory rhonchi

· Reddish-brown, flat lesions on chest and arms.

· Cardiac, abdominal and neurologic examinations normal

· Perianal vesicular and ulcerative lesions

Labs:

· Serum electrolytes, BUN, and creatinine are normal

· Chest x-ray shows diffuse infiltrates

· CD4+ cells 180 cells/microliter (low); CD4+/CDB+ cells ratio below normal

· Anti-HIV antibodies present: HIV viral particle load substantial

Mr. Hohner’s diagnoses are AIDS, pneumocystis pneumonia, Kaposi sarcoma and perianal herpes simplex virus.

1. Why did Mr. Hohner develop Kaposi sarcoma, an unusual type of cancer?

2.Why is his CD4+ T cell count so low?

3. What is the relationship between his low CD4+ T cell count and Mr. Hohner’s pneumocystis pneumonia?

4. Given the usual course of HIV infection, how long has Mr. Hohner most likely been HIV positive?

5. Why did her have HIV infection for so long before it was discovered?

Please include references outside of McCance and respond to your classmates. Feel free to include your own experiences, lessons learned in working with HIV patients. Answer the questions as if you are answering these are presented to you by your patient who is a college graduate in computer science.

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