CD4 Hana — HIV & Opportunistic Infections
CD4 < 200 = AIDS-defining risk — white oral patches, cough, weight loss
Hana admits she stopped her HIV medications months ago because she felt fine. Now she has white patches coating her tongue and a dry cough that won't go away.
Hana was diagnosed with HIV several years ago but has been inconsistent with her antiretroviral therapy (ART). As her CD4 T-cell count falls, her immune system loses the ability to fight organisms it would normally handle easily, opening the door to opportunistic infections like Pneumocystis jirovecii pneumonia (PJP) and oral candidiasis (thrush). A CD4 count below 200 cells/mm³ defines progression to AIDS and prompts prophylactic antibiotics. Strict adherence to ART is what keeps the viral load undetectable and the immune system intact.
Read CD4 Hana's full story →The story arc
The setup
Hana was diagnosed with HIV five years ago and had been doing well on ART until she quietly stopped taking it.
The turn
Over several months her viral load climbs and her CD4 count begins a slow, silent decline that she doesn't notice.
The crisis
She develops white, cottage-cheese-like patches on her tongue that scrape off with bleeding underneath, along with a dry cough, fever, and progressive shortness of breath. CD4 is 180 cells/mm³.
The save
Hana restarts ART under close supervision, is started on prophylactic trimethoprim-sulfamethoxazole for PJP prevention/treatment, given antifungal therapy for the thrush, and counseled extensively on the importance of strict daily adherence.
NCLEX study section — HIV & Opportunistic Infections
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Safety & Infection Control
Take this chapter into practice questions on the same topic.