Internal Medicine

0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54

Coma Complications of Human Immunodeficiency Virus Type 1 371

specific therapy

■Treat underlying disorder

follow-up

N/A

complications and prognosis

■Depends on cause

➣Good for drug-induced coma, w/ supportive care

➣Poor when structural lesions responsible

➣Poor outcome from anoxic encephalopathy if pupillary

responses absent after 24 hrs

➣Will not recover if findings indicate brain death

COMPLICATIONS OF HUMAN IMMUNODEFICIENCY

VIRUS TYPE 1 (HIV-1) INFECTION

MALCOLM D.V. JOHN, MD, MPH

history & physical

History

Fungi

■Pneumocystis carinii: ubiquitous; pneumonia (PCP) occurs in

20–40% of patients with AIDS today (rarely in those with CD4 >200–

250/mm^3 ); rare cases of person-to-person transmission among

immunosuppressed reported (some authorities recommend that

HIV+persons at risk for PCP not share a hospital room with a patient

who has PCP)

■Candida species: common on mucosal surfaces and skin; recovered

from soil, hospital environments, inanimate objects, and food; no

special measures to reduce exposure to these fungi

■Cryptococcus neoformans: cannot completely avoid exposure; no evi-

dence exists that exposure to pigeon droppings is associated with an

increased risk for acquisition

■Histoplasma capsulatum: endemic to the Mississippi-Ohio River

Valley area and parts of Latin America; activities associated with

increased risk (e.g., creating dust when working with surface soil;

cleaning chicken coops that are heavily contaminated with drop-

pings; disturbing soil beneath bird-roosting sites; cleaning, remod-

eling, or demolishing old buildings; and exploring caves)