| Author | 3 Posts |
Justice
Forum Fanatic
Topics: 101
Posts: 1,958
|
Please vote with your answer
A 47-year-old man with longstanding HIV infection has a 6-month history of increasing abdominal girth. HIV infection was diagnosed in 1995, and treatment with a protease inhibitor-containing antiretroviral regimen was started 2 years ago. Since beginning this regimen, the patient has had consistently undetectable plasma HIV RNA viral loads. His CD4 cell count has increased from 150/μL to 440/μL when last measured, and his weight has decreased from 95 kg (209 Ib) to 90 kg (198 Ib) over the same period. He feels well and is working full time.
Physical examination discloses a small dorsocervical fat pad, wasting in all four extremities, and a protruding abdomen with mild hepatomegaly and some faint striae.
Which of the following is most likely causing this patients current findings?
A. High-grade B-cell lymphoma
B. Cushing’s syndrome
C. HIV lipodystrophy
D. HIV wasting
E. Chronic hepatitis C infection
___________________
Don't live in a town where there are no doctors
|
| guangyu
Forum Elite
Topics: 29
Posts: 308
|
HIV-associated lipodystrophy is a syndrome that occurs in individuals with HIV who are being treated with antiretroviral medications (typically protease inhibitors); this treatment results in lipohypertrophy and lipoatrophy in various anatomic locations. Lipohypertrophy is characterized by the presence of a hypertrophied dorsocervical fat pad, circumferential expansion of the neck, breast enlargement, and abdominal visceral fat accumulation. Lipoatrophy is exemplified by peripheral fat wasting with loss of subcutaneous tissue in the face, arms, legs, and buttocks. In addition, this syndrome is associated with hyperlipidemia, insulin resistance, hyperinsulinemia, and hyperglycemia.
|
| Justice
Forum Fanatic
Topics: 101
Posts: 1,958
|
The correct answer is C
With the advent of highly active antiretroviral therapy came the recognition of a fat redistribution syndrome termed HIV lipodystrophy. The mechanism for this disorder is not well understood but may involve a complex interplay between viral infection and antiretroviral therapy. Protease inhibitors are most closely associated with this syndrome, but nucleoside analogues, most notably stavudine, have also been implicated. The syndrome has also developed in patients who have never received antiretroviral therapy. HIV lipodystrophy may be associated with hyperlipidemia and glucose intolerance. Findings of lipodystrophy consist of some combination of fat wasting, primarily involving the face and extremities (lipoatrophy), with fat accumulation in the abdomen (visceral adiposity), breasts (in women), and sometimes in the face and dorsum of the neck (fat accumulation in the face and neck may mimic features of Cushings syndrome). No effective treatment has been identified to date.
There are no findings at this time to support a diagnosis of lymphoma in this patient. HIV wasting is a late-stage complication that is associated with profound and progressive weight loss and cachexia. Although chronic hepatitis C is a possibility, hepatitis would not explain all of this patients physical findings.
___________________
Don't live in a town where there are no doctors
|
|
| |
| | | |
You don't have permission to post.
|
