Wilbur’s presentation aligns with Human Immunodeficiency Virus (HIV) based on his symptoms and clinical history. HIV is a virus that targets the immune syste

Application of Course Knowledge

Wilbur’s presentation aligns with Human Immunodeficiency Virus (HIV) based on his symptoms and clinical history. HIV is a virus that targets the immune system, particularly CD4+ T-helper cells, leading to immunosuppression. The progressive decline in immune function predisposes individuals to opportunistic infections and systemic complications.

One of the hallmark features of HIV is immune dysregulation, which leads to increased susceptibility to infections and inflammatory dermatological manifestations. Wilbur’s flat, purple-colored rash may be indicative of Kaposi’s sarcoma (KS), a common HIV-associated malignancy caused by human herpesvirus 8 (HHV-8). This condition is strongly associated with advanced HIV disease and AIDS. KS lesions often appear as non-painful, non-pruritic macules, plaques, or nodules, primarily on the skin but can involve mucosal surfaces and internal organs.

Another key finding is a white coating on the tongue, which suggests oral candidiasis (thrush)—a common opportunistic fungal infection in HIV patients due to Candida species overgrowth. Oral candidiasis frequently occurs in individuals with weakened immune function and is one of the early signs of HIV progression.

Additionally, Wilbur reports that he has “been sick a lot lately,” which may indicate recurrent infections, another hallmark of HIV due to its profound effect on immune function.

Diagnostic Tests

To confirm an HIV diagnosis in Wilbur, the following tests would be appropriate:

1.  HIV Screening Tests
   - HIV-1/2 antigen/antibody (4th-generation) test: Detects both HIV antibodies and the p24 antigen, providing an early diagnosis.
   - HIV RNA PCR (Nucleic Acid Amplification Test – NAAT): Useful for detecting acute HIV infection before seroconversion.

2.  CD4+ T-Cell Count and HIV Viral Load
   - CD4+ count: Measures immune system function; a count <200 cells/mm³ indicates AIDS.
   - HIV viral load (HIV RNA PCR): Assesses the level of virus in the blood and helps monitor disease progression.

3. Opportunistic Infection Testing
   - Biopsy of the skin rash: To confirm Kaposi’s sarcoma.
   - Potassium hydroxide (KOH) smear or fungal culture for oral candidiasis.
   - Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP) to assess overall health status and detect abnormalities associated with HIV.

Comparison with Other Conditions

A peer analyzing Wilbur’s case through the lens of Systemic Lupus Erythematosus (SLE) might focus on the rash and recurrent infections, as SLE can also present with skin lesions and immune dysfunction. However, Wilbur’s purple-colored rash is more suggestive of Kaposi’s sarcoma rather than the malar (butterfly) rash seen in SLE. Furthermore, SLE-related rashes are often photosensitive, which is not mentioned in Wilbur’s case.

Additionally, oral candidiasis is not a common feature of SLE but is strongly associated with immunosuppression, as seen in HIV. While both conditions can lead to increased susceptibility to infections, the presence of an AIDS-defining illness like Kaposi’s sarcoma strongly supports an HIV diagnosis over SLE.

Conclusion

Wilbur’s symptoms, including the purple-colored rash, oral candidiasis, and frequent illnesses, align closely with the pathophysiology of HIV/AIDS rather than SLE or allergies. Diagnostic testing, including HIV screening, CD4 count, viral load, and opportunistic infection screening, would be the next appropriate step. If confirmed, timely antiretroviral therapy (ART) is essential for managing his condition and preventing further complications.

References
Fauci, A. S., Lane, H. C. (2020). Human Immunodeficiency Virus Disease: AIDS and Related Disorders. Harrison's Principles of Internal Medicine, 21st Edition.
Panel on Antiretroviral Guidelines for Adults and Adolescents. (2023). Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services.
Centers for Disease Control and Prevention (CDC). (2023). HIV Basics. Retrieved from [https://www.cdc.gov/hiv/basics/](https://www.cdc.gov/hiv/basics/)