General Instructions The purpose of this discussion is to examine disease processes associated with a client scenario following the instructions below. The course faculty will reveal the disease process at the end of the week. Step 1: Carefully read the following client scenario: Wilbur, a 55-year-old male client, presents to the NP complaining of a flat, purple- colored rash on his back and chest. Wilbur states the rash is not painful or itchy. He states it has been there for months, and he has also developed a white coating on his tongue and has “been sick a lot lately.” Step 3: Answer the discussion prompts below with explanation and detail, providing complete references for all citations. A. Human Immunodeficiency Virus (HIV) is a type of retrovirus that involves host immune system dysfunction; ultimately leading to immune compromise and possibly full progression to Acquired Immunodeficiency Virus (AIDS). Underlying pathophysiological mechanisms associated with the disease start in the transmission phase. HIV is transmitted through heterosexual activity, blood exposure, or maternal-child transmission before or during childbirth (Rogers, 2022). The structure of HIV is a viral capsid protein encased in an envelope. This structure includes an outer membrane with two glycoproteins called gp41 and gp120. Once exposed, HIV replication begins. During replication, the virus attaches to macrophages and dendritic cells, these cells then carry the retrovirus into lymph nodes. Attachment occurs with the binding of gp120 from the HIV virus to CD4 receptors (Pérez et al., 2020). Additionally, further attachment takes place on the chemokine receptors allowing conformational changes to occur leading to full cell attachment via gp41 fusion. After attachment, the affected cell is released into the cytoplasm where reverse transcriptase converts HIV RNA into dsDNA. Initially, these newly affected cells lay dormant until activated. Once activated this cell undergoes activation and proliferation. This triggers the transcription of the proviral DNA into mRNA, which is then translated into viral proteins (Liu et al., 2023). These newly synthesized proteins along with the viral genome combine at the host cell to form new virions allowing the virus to exit the cell and affect neighboring cells. In the case of Wilbur the 55-year-old male the clinical manifestations such as “being sick a lot lately”, the oral thrush, and the rash on his posterior and anterior trunk are all suggestive of Acute HIV progressing into Chronic HIV. The proliferation of HIV-affected cells is a progressive process. This would explain his onset of symptoms. B. Wilburs presenting clinical manifestations are quite relative in the diagnosis of a potential HIV case. The rash on this gentleman's anterior and posterior trunk could signify bacillary angiomatosis or potentially Kaposi’s sarcoma. Kaposi’s sarcoma is described as painless purple lesions that are flat or raised (Swinkles et al., 2024). The consistent illness and the potential oral thrush are established signs and symptoms of an immunocompromised individual. C. Diagnostic tests for an HIV diagnosis include antigen-antibody, nucleic acid testing. These two tests will differentiate a positive vs negative diagnosis. Labs to further evaluate the progression of this potential HIV diagnosis would include CD4+, viral load, CBC, BMP, hepatitis panel, possible STDs, Cxray, and CT scans. Relevant to Wilbur, I would like to see a biopsy of his rash to check for cancer. If identified, additional imaging will be warranted to search for metastasis. Also, a mouth swab can be obtained to identify the causative fungus vs bacteria before initiating an oral solution. D. In the case of Wilbur's indiscriminate symptomology and potential HIV, I would like to compare and contrast the possibility of these symptoms being allergies. To start, the white coating on his tongue could be associated with thrush related to recurrent oral corticosteroid use. Also, his rash could be purpura spread on his posterior and anterior trunk. Wilbur could be thrombocytopenic. Allergies could not explain him being sick a lot lately. But, possibly he has some type of environmental contamination such as mold in his home. I believe the importance of physical examination and patient demographics to be quite relevant in this situation.
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