M.L. is a 26-year-old homosexual man admitted to the hospital for progressive respiratory distress, fever, weakness, and chronic diarrhea. He tested HIV positive about 3 years ago, but his infection has remained asymptomatic until 2 months prior to admission. Pneumocystis jiroveci (carinii) pneumonia was suspected and confirmed by culture. Laboratory analysis demonstrates a low CD4+ count of 185 cells/ml. HAART treatment with the antiretrovirals azidothymidine (AZT), efavirenz (Sustiva), and ritonavir (Norvir) was started 2 months ago.   QUESTIONS:  P. jiroveci pneumonia is an opportunistic infection to which immunocompetent people are immune. What other opportunistic infections are commonly seen in AIDS patients? Are there any data to suggest that M.L. may have one of these?

M.L. is a 26-year-old homosexual man admitted to the hospital for progressive respiratory distress, fever, weakness, and chronic diarrhea. He tested HIV positive about 3 years ago, but his infection has remained asymptomatic until 2 months prior to admission. Pneumocystis jiroveci (carinii) pneumonia was suspected and confirmed by culture. Laboratory analysis demonstrates a low CD4⁺ count of 185 cells/ml. HAART treatment with the antiretrovirals azidothymidine (AZT), efavirenz (Sustiva), and ritonavir (Norvir) was started 2 months ago.

QUESTIONS: 

1. P. jiroveci pneumonia is an opportunistic infection to which immunocompetent people are immune. What other opportunistic infections are commonly seen in AIDS patients? Are there any data to suggest that M.L. may have one of these?
2. A medical student asks you to draw a picture of the HIV virion and a CD4⁺ cell, and to explain the mechanism of intracellular infection and the role of reverse transcriptase. What would you show on the drawing and explain about the process?