The

n e w e ng l a n d j o u r na l

of

m e dic i n e

TEACHING points

DIAGNOSIS AND TREATMENT OF OPPORTUNISTIC INFECTIONS IN PATIENTS WITH

HIV INFECTION
Routine screening for the human immunodeficiency virus (HIV) is recommended
for all adolescent and adult patients in all health care settings according to the most
recent recommendations from the Centers for Disease Control and Prevention and
the Preventive Services Task Force.
The measurement of arterial blood gases provides valuable information that can
help to determine the cause of hypoxemia and acidbase abnormalities.
Pneumocystis pneumonia should be considered in patients with severe hypoxemia
when imaging studies of the lungs show an interstitial or infiltrative pattern. It
remains the most prevalent opportunistic infection in patients infected with HIV. If
the diagnosis is suspected, risk factors for HIV infection should be identified and a
detailed history of sexual partners and practices should be obtained.
To reduce the risk of disease progression, antiretroviral therapy (ART) is recommended for all patients infected with HIV. Measurement of serum CD4 T-cell
counts and blood levels of HIV-1 RNA helps to establish the prognosis and can be
used to monitor the effectiveness of the response to ART. The CD4 T-cell count in
HIV infection is a strong determinant of the risk of opportunistic infections. Understanding the relationship between levels of CD4 T cells and the risk of infection is
essential to the effective administration of prophylactic therapies.

These teaching points are drawn from the Interactive Medical Case. For more complete information,
see Nou DD, Vaidya A, Dichtel L, Katz JT, McGowan K. A woman with fever and dyspnea. N Engl J
Med 2014:370:e25.