A 37-year-old HIV-infected man with a CD4 count of 13 cells/mm3 and a HIV RNA greater than 1 million copies/ml presents with a 1-week history of shortness of breath. The patient has a history of pulmonary Kaposi’s sarcoma that previously responded to chemotherapy. He is dizzy and unable to take more than three steps due to dyspnea, but denies fever, cough, or chest pain. His alat pembesar payudara current medications include tenofovir-emtricitabine (Truvada), zidovudine, lopinavir-ritonavir (Kaletra), dapsone, and weekly azithromycin, cara memperbesar payudara all of which were started 4 weeks ago. His glucose 6-phosphate dehydrogenase (G6PD) screen was normal. On examination, he is afebrile, but appears pale; his lips are a dark grayish-brown color. His oxygen saturation on room air is 86%. alat pembesar payudara His room air arterial blood gas demonstrates the following: pH 7.54, PaCO2 32 mmHg, Pa02 112 mmHg. The blood is a brownish color when drawn.
A 44-year-old man with CDC stage C3 HIV and a recent CD4 count of 191 cells/mm3 presents to clinic to establish care with a new provider. He has a history of Pneumocystis pneumonia, HIV-related dementia, and chronic obstructive pulmonary disease (COPD). His current medications consist of tenofovir-emtricitabine (Truvada), stavudine (Zerit), fosamprenavir (Lexiva), ritonavir (Norvir), dapsone, ranitidine, risperidone (Risperdal), metoprolol, and inhaled albuterol. Over the course of the next few months, obat perangsang wanita he requires several visits to the emergency room and admissions to the hospital for COPD exacerbations. He responds to brief courses of oral corticosteroids, so he is started on inhaled fluticasone (Flovent), as well as intranasal fluticasone (Flonase, Veramyst) for allergic rhinitis. During the following 6-12 months, he develops weight gain (more than 40 pounds) with central fat deposition, a dorsocervical fat pad, purple abdominal striae, easy bruising, hypertension, hyperlipidemia, and deep venous thrombosis (Figure 1 and Figure 2). He also experiences worsening of his psychiatric symptoms, including anxiety, agitation, depression, and psychosis.
A 31-year-old HIV-infected woman presents with severe diarrhea and dizziness. She has long-standing HIV disease and her most recent CD4 count was 24 cells/mm3. For approximately 2 years, she has not taken any medications related to her HIV disease. The diarrhea began about 10 days ago and now she is having 10 to 15 watery stools per day, abdominal cramping, and nausea. Physical examination shows a thin female with a temperature of 38.1°C, blood pressure of 86/60 mmHg, cara memperbesar penis and minimal diffuse abdominal tenderness with deep palpation. A modified acid-fast stain on a stool sample is presumptively identified as Cryptosporidium species (Figure 1).