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200 Pneumocystosis Toxoplasmosis Cryptococcosis Coccidioidomycosis Cryptosporidiosis 50 Disseminated MAC infection Histoplasmosis CMV retinitis CNS lymphoma

Console.Write("Enter your age: "); string inputAge = Console.ReadLine( ); int myInt = Convert.ToInt32(inputAge); if (myInt >= 18) Console.WriteLine("You may buy a ticket.");

Figure 31 1 Relationship of CD4 count to development of opportunistic infections MAC, Mycobacterium avium complex; CMV, cytomegalovirus; CNS, central nervous system

systems involved, aiming to diagnose treatable conditions rapidly As can be seen in Figure 31 1, the CD4 lymphocyte count provides very important prognostic information Certain infections may occur at any CD4 count, while others rarely occur unless the CD4 lymphocyte count has dropped below a certain level For example, a patient with a CD4 count of 600 cells/mcL, cough, and fever may have a bacterial pneumonia but would be very unlikely to have Pneumocystis pneumonia

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Many individuals with HIV infection remain asymptomatic for years even without antiretroviral therapy, with a mean time of approximately 10 years between exposure and development of AIDS When symptoms occur, they may be remarkably protean and nonspecific Since virtually all the findings may be seen with other diseases, a combination of complaints is more suggestive of HIV infection than any one symptom Physical examination may be entirely normal Abnormal findings range from completely nonspecific to highly specific for HIV infection Those that are specific for HIV infection include hairy leukoplakia of the tongue, disseminated Kaposi s sarcoma, and cutaneous bacillary angiomatosis Generalized lymphadenopathy is common early in infection 1 Systemic complaints Fever, night sweats, and weight loss are common symptoms in HIV-infected patients and may occur without a complicating opportunistic infection Patients with persistent fever and no localizing symptoms should nonetheless be carefully examined, and evaluated with

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a chest radiograph (Pneumocystis pneumonia can present without respiratory symptoms), bacterial blood cultures if the fever is greater than 385 C, serum cryptococcal antigen, and mycobacterial cultures of the blood Sinus CT scans or sinus radiographs should be considered to evaluate occult sinusitis If these studies are normal, patients should be observed closely Antipyretics are useful to prevent dehydration Weight loss is a particularly distressing complication of long-standing HIV infection Patients typically have disproportionate loss of muscle mass, with maintenance or less substantial loss of fat stores The mechanism of HIV-related weight loss is not completely understood but appears to be multifactorial AIDS patients frequently suffer from anorexia, nausea, and vomiting, all of which contribute to weight loss by decreasing caloric intake In some cases, these symptoms are secondary to a specific infection, such as viral hepatitis In other cases, however, evaluation of the symptoms yields no specific pathogen, and it is assumed to be due to a primary effect of HIV Malabsorption also plays a role in decreased caloric intake Patients may suffer diarrhea from infections with bacterial, viral, or parasitic agents Exacerbating the decrease in caloric intake, many AIDS patients have an increased metabolic rate This increased rate has been shown to exist even among asymptomatic HIVinfected persons, but it accelerates with disease progression and secondary infection AIDS patients with secondary infections also have decreased protein synthesis, which makes maintaining muscle mass difficult Several strategies have been developed to slow AIDS wasting Effective fever control decreases the metabolic rate and

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