Pneumocystis carinii pneumonia-bilateral,

fluffy pulmonary infiltrates, prominent in the

hilum and base of the lungs.
The course is typical. There are three phases of
HIV infection.
•The first (early, acute) phase is characterized
by a high level of virus production and viremia;
the symptoms are non-specific.
• In the second (middle, chronic) phase, which
was the initial presentation here, there is a
smoldering, low-level HIV replication,
predominantly in lymphoid tissues, which may
last several years.
• The final (crisis) phase is characterized by a
breakdown of host defenses, viral replication,
and the symptoms of persistent fever, fatigue,
weight loss, and diarrhea.
. Pneumocystis of Lung - Low Power
Bronchial washings or sputum samples may
be collected to diagnose pneumocystis
 Cerebral Atrophy - Head CT
The computerized tomographic (CT) scan
demonstrates widening of the sulci and expansion of
the cerebral ventricles, indicative of cerebral atrophy
HIV Encephalopathy, Brain, Luxol Fast Blue (LFB) Stain
- Low Power

This stain is used to highlight areas of demyelination,

characteristic of HIV encephalopathy.
. HIV Encephalopathy - High Power
 . Retina - Funduscopic Exam
A funduscopic examination of the patient's
retina revealed multiple retinal hemorrhages
and regions of purulent exudate.
Small Bowel, Mycobacterium Avium Intracellular - Gross
shows a nodular appearance of the entire length of the small
bowel.
. Small Bowel, Mycobacterium
Avium Intracellular
 Colon, Cytomegalovirus (CMV) - Gross
Cytomegalovirus infection of the colon
presented in this patient as patchy ulcerations
and pseudomembrane formation.
Colon, Cytomegalovirus (CMV) -
Low Power
Leukoencephalopathy (PML) - Gross
PML is caused by a papovavirus which
infects the oligodendroglia directly,
causing necrosis
Toxoplasma Encephalitis - Low Power
. CNS Lymphoma - Medium Power
. Kaposi's Sarcoma - Clinical/Micro
 What is the significance of the falling
CD4 counts in this patient?
HIV infection is stratified into three categories:
CD4+ cells
•greater than or equal to 500/µL; 
•200­499/µL;
• <200/µL.
 If the count is above 500/µL, there is a low 
probability of progression.

 If the count is below 200/µL, or is rapidly 
falling, the probability of progression is high.