Ms. C.W. is a college student with an active social life. She is in a relationship with a fellow classmate who says that he has not had many relationships before theirs. After a party, they engage in unprotected sex, although they usually use a condom. She believes she will be safe because he shows no signs of AIDS and comes from a nice home. Several weeks later her friend tells her he just tested HIV+. She immediately seeks advice and testing from the campus health center and is told that three tests over several months will be done. She is offered zidovudine (AZT) as a preventive medication that may reduce infectivity.
1. Why does the health care center recommend more than one test for HIV antibody status?
2. What is the action of zidovudine (AZT) in preventing infection with HIV?
Ms. C.W.’s second test shows presence of HIV antibodies and she is diagnosed as HIV+. Although this is a great shock to her, her physician and counselor help her to accept the fact that she is HIV+ and can most likely live several years if she takes a combination of antiretroviral drugs. Ms. C.W.’s CD4 helper cell count rises and remains in a healthy range. She pursues a career and meets a man whom she marries.
3. What is the risk of transmission of HIV to men versus women? What are considered very high-risk sexual practices?
4. What factors might the couple consider in deciding whether to have a child?
Ms. C.W. becomes pregnant and seeks information from her specialist about the risk of transmission of HIV to her unborn child.
5. What is the risk of transmission of HIV during pregnancy and labor and delivery?
6. How can the risk of infection be reduced before birth, during delivery, and after birth?
7. Why is blood testing of her newborn daughter for HIV not done until 3 to 6 months after birth?
8. Ms. C.W. wants to breast feed her daughter, but is told by her doctor that she should not do so. Why should she not breastfeed?
Ms. C.W.’s daughter is not infected and grows into a healthy toddler. Six years later, Ms. C.W. develops a chronic cough, overwhelming fatigue, recurrent diarrhea, and a sore mouth. Her physician diagnoses AIDS with PCP pneumonia, oral thrush, and infectious diarrhea. Blood test show a significant reduction in CD4 helper T cells. Ms. C.W. is admitted to hospital for treatment.
9. There is no notice on Ms. C.W.’s room that she is HIV+. Why is this not done to reduce infection of the staff by HIV?
10. What is the significance of a reduction in CD4 helper T cells?
11. Ms. C.W. remains antibody positive for HIV; why don’t the antibodies reduce viral load?
12. What is the cause of her pneumonia and oral infection?
13. What is the prognosis for Ms. C.W. if these infections cannot be controlled and if her CD4 helper T cell count does not return to more normal levels?
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