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  FIRST POST      

Kaposi sarcoma though rare, is one of the most common malignancies associated with HIV and typically develops under immunocompromised circumstances (Tso et al., 2017). Mr. Hohner was found to have HIV and herpes simplex virus, two conditions that compromise the body’s immune response. Tso et al. (2017) states that there is a link between herpes simplex virus and Kaposi sarcoma. Under normal circumstances, the body would fight off a herpes infection however with HIV the immune system is compromised and unable to fight off the infection. Mr. Hohner likely developed Kaposi Sarcoma due to prolonged herpes simplex virus and a compromised immune system. Mr. Hohner’s CD4+ count is so low because he has advanced HIV which indicates a severe compromise of the immune system. Lebelonyane et al. (2020) states that a CD4+ count lower than 200 is indicative of advanced HIV infection. Mr. Hohner falls into this category because his CD4+ count was found to be 180. This low CD4+ count meaning a compromise in the immune system is the reason he developed pneumocystis pneumonia. Pneumocystis pneumonia is a pneumonia caused by a fungal infection of the lungs (Charles & Shellito, 2016). Again, under normal circumstances, the human body would fight this off but given the state of depressed immune system, Mr. Hohner was not able to fight this off. Mr. Hohner has probably had HIV for a long time, likely years. A low CD4+ count, Kaposi sarcoma and pneumocystis pneumonia are all conditions that develop with a severely compromised immune system and indicate an untreated HIV infection has been present for a long time (Charles & Shellito, 2016). Mr. Hohner most likely had HIV well before it was discovered because in a lot of cases symptoms do not present until the disease has progressed (Lebelonyane et al., 2020). Mr. Hohner was also in a long-term relationship with a partner who was HIV negative so he may not have considered that he could have it. Overall, untreated HIV has left Mr. Hohner with a compromised immune system and multiple other related complications.

Charles, T. P., & Shellito, J. E. (2016). Human immunodeficiency virus infection and host defense in the lungs. Seminars in Respiratory & Critical Care Medicine, 37(2), 147-156. https://doi.org/10.1055/s-0036-1572553

Lebelonyane, R., Mills, L. A., Mogorosi, C., Ussery, F., Marukutira, T., Theu, J., Kapanda, M., Matambo, S., Block, L., Raizes, E., Makhema, J., Lockmang, S., Bachanas, P., Moore, J., Jarvis, J. N., & Lockman, S. (2020). Advanced HIV disease in the Botswana combination prevention project: Prevalence, risk factors, and outcomes. AIDS, 34(15), 2223-2230. https://doi.org/10.1097/QAD.0000000000002627

Tso, F. Y., Sawyer, A., Kwon, E. H., Mudensa, V., Langford, D., Zhou, Y., West, J., & Wood, C. (2017). Kaposi’s sarcoma- associated herpes virus infection of neurons in HIV positive patients. Journal of Infectious Disease, 215(12), 1898-1907. https://doi.org/10.1093/infdis/jiw545 

SECOND POST  

Although a rare cancer, Kaposi sarcoma was developed by the patient due to the infiltration of malignant tumor cells. This cancer type has been associated with human herpesvirus 8 (HHV8) (Liu et al., 2018). Kaposi sarcoma has been closely linked to HIV infection. Individuals diagnosed are immunocompromised hence why Mr. Hohner has contracted pneumonia frequently within the last year.

Studies have shown those affected by HIV who had a higher CD4 count were at lesser risk of contracting KS, however those with lower CD4 counts were at a higher risk. Mr. Hohner’s lab results showed a decrease in CD4 cell count and was unaware of his diagnoses for a period of time (Liu et al., 2018). According to the World Health Organization, CD4 aides in staging, a CD4 cell count <200cells/µl or WHO stage 3 or a 4 event.><200cells/microliter, may indicate a stage 3 or 4 prognosis (Bacchus-Souffan et al., 2021).

Individuals who are immunocompromised are unable to fight serious infections. Pneumocytosis pneumonia is caused by a fungus known as pneumocytosis jirovecii, and those who have HIV/AIDS are at a greater risk of contraction (Kolls, 2017). Given Mr. Hohners diagnoses, his CD4 T cells were unable to drive a response in clearance of the pneumocytocisis pneumonia (Otieno-Odhiambo et al., 2019).

With the information presented and the resulted lab findings, Mr. Hohner has most likely been infected with HIV for 5 + years.

Antiretroviral therapies have been largely beneficial to individuals diagnosed with HIV/AIDs. ART has led to a decrease in mortalities and has provided a better quality of life. At times, patients can be unaware of their HIV status as symptoms do not suddenly appear. This unawareness is caused by the virus multiplying at very low levels not causing symptoms known as the latency period (Bacchus-Souffan et al., 2021).

References

Bacchus-Souffan, C., Fitch, M., Symons, J., Abdel-Mohsen, M., Reeves, D. B., Hoh, R., Stone, M., Hiatt, J., Kim, P., Chopra, A., Ahn, H., York, V. A., Cameron, D. L., Hecht, F. M., Martin, J. N., Yukl, S. A., Mallal, S., Cameron, P. U., Deeks, S. G., . . . Hunt, P. W. (2021). Relationship between CD4 T cell turnover, cellular differentiation and HIV persistence during ART. PLOS Pathogens, 17(1), e1009214. https://doi.org/10.1371/journal.ppat.1009214

Kolls, J. K. (2017). An emerging role of B cell immunity in susceptibility toPneumocystisPneumonia. American Journal of Respiratory Cell and Molecular Biology, 56(3), 279–280. https://doi.org/10.1165/rcmb.2016-0360ed

Liu, Z., Fang, Q., Zuo, J., Minhas, V., Wood, C., & Zhang, T. (2018). The world?wide incidence of Kaposi’s sarcoma in the HIV / AIDS era. HIV Medicine, 19(5), 355–364. https://doi.org/10.1111/hiv.12584

Otieno-Odhiambo, P., Wasserman, S., & Hoving, J. C. (2019). The contribution of host cells to pneumocystis immunity: An Update. Pathogens, 8(2), 52. https://doi.org/10.3390/pathogens8020052