Case Study 4

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Case Study 4 Human immunodeficiency virus (HIV)
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Mr Guy Thomas, a 37-year-old accountant, began to
feel unwell soon after returning from a honeymoon
trip to South America. Over the past four days
he has developed a dry cough, has become
increasingly short of breath and has been feeling
feverish. He also has a painless lump in his
mouth, on his upper gum, which appeared a few
months previously.
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Because he feels so unwell, he goes to the
accident and emergency department of his local
hospital from which he is admitted to one of the
wards. On examination of his chest there are few
physical signs but a chest X-ray shows widespread
shadowing .
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Chest X-ray showing bilateral shadowing
extending from both hila to the periphery
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As a result of this finding a bronchial alveolar
lavage was undertaken to determine the cause of
the shadowing. A cell pellet was stained.
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Arrow marks Pneumocystis carinii bodies , line is
10 m ).
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On examination of his mouth a purplish nodular
swelling was visible on the medial side of the
ramus of his upper left mandible. During his
in-patient stay the lump on his gum was biopsied.
Photographs of the lump and its histology are
shown
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a
Tumour (high mag) showing spindle cells (a), slit
vascular spaces () and erythrocytes (arrows)
stained Haematoxylin Eosin. Kaposis sarcoma
Biopsy at low magnification with normal
stratified epithelium (arrow)
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Questions 1. What are the physical
characteristics of a retrovirus? 2. What is the
replication cycle of a retrovirus and what is the
unique component from which this group of agents
takes its name? 3. In what way is the diagnosis
of HIV infection usually made and what would you
understand by the term confirmation in this
context? 4. By what routes is HIV transmitted
between individuals and how may these be
controlled or influenced? 5. What are the major
classes of anti-retroviral drugs in clinical use
and how may the viral response to intervention be
monitored?
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6. Is drug resistance a significant problem for
successful anti-retroviral therapy and what
direct and indirect ways are used to follow its
development in a patient? 7. What is the natural
history of HIV infection and what are the stages
of, and major AIDS-defining illnesses in,
clinical progression? 8. What is the nature and
cause of Kaposi's Sarcoma? Are there are other
parallels in HIV infection? 9. What are the
mechanisms by which HIV is thought to cause
immune suppression and how may the immune system
function be examined? 10. What is meant by the
term pandemic and how can one influence it?
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