Document 3090
 DOCN  M94A3090
 TI    Opportunistic infections in patients with CD4 counts above 300.
 DT    9412
 AU    Stool E; Piot D; Gathe J Jr; Najjar A; Edwards S; Park Plaza Hospital,
       Special Diseases Unit, Houston, Texas.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):156 (abstract no. PB0049). Unique
       Identifier : AIDSLINE ICA10/94369485
 AB    OBJECTIVE: To detail the presentation of opportunistic infection (OI) in
       patients with CD4 counts > 300. METHODS: Retrospective review of five
       homosexual males, non-IV drug abusers who were followed by the authors
       prospectively. RESULTS: Patient 1: 33 yo male HIV positive for 64
       months, on AZT for 30 months evaluated for 4 weeks of headaches. CD4
       count was 830 prior to admission. MRI brainscan was negative, lumbar
       puncture revealed organisms consistent with toxoplasmosis under oil
       immersion. Peripheral and CSF toxo titers were positive. The patient
       improved on anti-toxo meds and 2 months later his CD4 count was 585.
       Patient 2: 48 yo male HIV positive for 20 months and on AZT for 20
       months, was admitted with bronchoscopy proven PCP. One week prior his
       CD4 was 541, during his illness CD4 count declined to 300 and rebounded
       to 520 after recovery. Patient 3: 41 yo male HIV positive for 18 months,
       on AZT for 12 months, evaluated for headaches. A lumbar puncture
       revealed acute cryptococcal meningitis. CD4 2 weeks prior to diagnosis
       was 320. He responded well to therapy, 18 months later CD4 count was
       764. Patient 4: 44 yo male HIV positive for 5 years on AZT for 21 months
       admitted with bronchoscopy proven PCP. Ten weeks prior to admission CD4
       count was 418, responded well to treatment, a week after discharge CD4
       count was 403. Patient 5: 41 yo male HIV positive for 2 years on AZT for
       two years admitted with bronchoscopy proven PCP and also toxoplasmosis.
       Thirty days prior to admission, CD4 count was 370. During
       hospitalization CD4 dropped to 279. He responded well to treatment, and
       2 months after discharge CD4 was 260. CONCLUSIONS: 1. While OI's are
       common in patients with CD4 < 300, we describe 5 patients with OI's and
       CD4 counts > 300. 2. Although uncommon, the possibility of opportunistic
       pathogens must remain in the differential diagnosis of infections in HIV
       patients, independent of absolute CD4 count. 3. This illustrates that
       despite laboratory markers, a detailed medical history and clinical
       finding are of paramount importance.
 DE    Adult  AIDS-Related Opportunistic Infections/BLOOD/*IMMUNOLOGY  Case
       Report  Human  HIV Seropositivity/BLOOD/DRUG THERAPY/*IMMUNOLOGY
       Leukocyte Count  Male  Meningitis, Cryptococcal/*IMMUNOLOGY  Pneumonia,
       Pneumocystis carinii/*IMMUNOLOGY  Toxoplasmosis/*IMMUNOLOGY  *T4
       Lymphocytes  Zidovudine/THERAPEUTIC USE  MEETING ABSTRACT

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