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Teachable Moment
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September 3, 2019

Interpreting CD4 Counts in a Patient With HIV

Author Affiliations
  • 1Department of Infectious Disease, University of Texas Southwestern, Dallas
  • 2Department of Internal Medicine, SUNY Downstate Medical Center, Brooklyn, New York
JAMA Intern Med. Published online September 3, 2019. doi:10.1001/jamainternmed.2019.3642

A man in his 40s with human immunodeficiency virus (HIV) infection being treated with combination antiretroviral therapy (cART), cutaneous Kaposi sarcoma in remission, and lymphedema of both legs was admitted with acute-onset right lower extremity pain, swelling, and erythema. It was associated with rigors, chills, and subjective fevers for a day. On presentation, he was tachycardic to 120 bpm and hypotensive with blood pressure of 86/62 mm Hg. He had redness and swelling in his right leg with no associated crepitus or palpable collections. A computed tomographic scan of his right leg did not show any abscess. He was diagnosed with HIV infection in 2014 and had been adherent to an abacavir-dolutegravir-lamivudine regimen since then. His nadir CD4 count at diagnosis was 314/µL with HIV viral load always being undetectable since then. In the clinic, 3 months previously, his CD4 and viral load were 990 and undetectable, respectively.

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