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  1. #1
    usmlemate is offline Junior Member
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    Appropriate HIV Serologic Testing

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    A 46-year-old man comes to clinic to establish longitudinal care for his HIV disease. He recently tested HIV-seropositive, but believes he acquired HIV years earlier from a male sex partner who subsequently developed AIDS. In addition, he injected drugs "on a few occasions” while living in Cincinnati, Ohio more than 10 years ago. Physical examination reveals seborrheic dermatitis and oral candidiasis. As part of the initial evaluation of this patient, you order a complete blood count, comprehensive chemistries (including liver enzymes), CD4 cell count, HIV viral load assay, and a PPD skin test. To assess exposure to other infectious agents, you perform additional serologic testing.

    Which of the following tests is (are) appropriate to order at this initial visit?

    A. anti-Toxoplasma IgG
    B. Hepatitis A, B, and C serologies
    C. Histoplasmosis IgG
    D. VDRL (or RPR)
    E. A, B, and D

  2. #2
    usmlemate is offline Junior Member
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    Re: Appropriate HIV Serologic Testing

    Quote Originally Posted by usmlemate
    A 46-year-old man comes to clinic to establish longitudinal care for his HIV disease. He recently tested HIV-seropositive, but believes he acquired HIV years earlier from a male sex partner who subsequently developed AIDS. In addition, he injected drugs "on a few occasions” while living in Cincinnati, Ohio more than 10 years ago. Physical examination reveals seborrheic dermatitis and oral candidiasis. As part of the initial evaluation of this patient, you order a complete blood count, comprehensive chemistries (including liver enzymes), CD4 cell count, HIV viral load assay, and a PPD skin test. To assess exposure to other infectious agents, you perform additional serologic testing.

    Which of the following tests is (are) appropriate to order at this initial visit?

    A. anti-Toxoplasma IgG
    B. Hepatitis A, B, and C serologies
    C. Histoplasmosis IgG
    D. VDRL (or RPR)
    E. A, B, and D
    The correct answer is E.

    Answer A is correct, but other answers are also correct. Serologic testing to determine previous infection with Toxoplasma gondii is indicated for all patients infected with HIV. Almost all cases of toxoplasmosis involving HIV-infected persons occur as a result of reactivation. According to USPHS/IDSA guidelines, patients who are seropositive for anti-Toxoplasma IgG should initiate primary prophylaxis against toxoplasmic encephalitis when the CD4 count is less than 100 cells/mm3. Knowledge of Toxoplasma serostatus is also useful in the evaluation of brain mass lesions, though it does not establish or exclude the diagnosis. Patients without evidence of prior Toxoplasma infection can be counseled in ways to prevent infection.

    Answer B is correct, but other answers are also correct. Injection drug use is the primary route of HCV infection, though a baseline HCV serology (anti-HCV antibody) is recommended in all HIV-infected patients, regardless of mode of transmission. Knowledge of HCV status is useful for interpretation of liver enzyme abnormalities, and a positive result should prompt further evaluation to assess the stage of disease and need for therapy. Male-male sex and injection drug use also place this patient at higher risk of having hepatitis A and B virus infection. HbsAg is indicated to rule out chronic HBV infection, and HbsAb or anti-HBc determine need for vaccination. Similarly, the total-HAV antibody is used to determine the need for hepatitis A vaccination.

    Answer C is incorrect. Routine testing for exposure to histoplasmosis with either histoplasmin skin test or Histoplasma serology is not predictive of disease and is not recommended. Patients who live in or are visiting areas endemic for histoplasmosis can be counseled in ways to reduce risk of exposure. According to USPPHS/IDSA guidelines, patients with a CD4 count less than 100 cells/mm3 who live in a hyperendemic area (more than 10 cases/100 patient-years) can be considered for primary prophylaxis with itraconazole.

    Answer D is correct, but other answers are also correct. Screening for syphilis, with VDRL (or RPR) testing, is indicated at baseline and yearly in all HIV-infected patients. This is especially important among those who engage in male-male sex, those with a history of a sexually-transmitted disease, and those who have unprotected sex. Rates of syphilis among those who have male-male sex have increased for the past few years, likely indicating reduced adherence to safer sexual practices since the advent of HAART.

  3. #3
    navpreet is offline Member 510 points
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    be sensible.........

    whosoever posted the above reply..........it is a humble request to keep such unwanted stuff out of this forum.
    here we are trying hard to study & make something out of ourselves, with the help of each other.
    kindly try to understand......i'll really appreciate it.!!!

  4. #4
    stephew is offline Moderator Guru 512 points
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    if there are inappropriate posts, they should be flagged to the moderators, not responded to.
    Steph
    If you get a warning, put on yer manpants and stop whining about it.

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