AIIMS CRE 2025
Medical & Surgical Nursing
Easy
Which opportunistic infection is strongly associated with CD4 count below 200?
Appeared in: AIIMS CRE 2025
Explanation
- Pneumocystis jirovecii pneumonia (PJP) is the opportunistic infection most strongly and specifically associated with a CD4 count dropping below 200 cells/mm³.
- According to clinical guidelines, this threshold is the primary indicator to begin prophylaxis (preventive treatment) against PJP, typically with trimethoprim-sulfamethoxazole.
- Data shows that 95% of PJP cases in patients with HIV occur when their CD4 count is below 200, making this a critical and defining marker.
Why Other Options Were Wrong
- Option A: The risk for Toxoplasmosis becomes most significant at a lower level of immunosuppression, with prophylaxis typically recommended when the CD4 count falls below 100 cells/mm³.
- Option C: Tuberculosis can reactivate or cause a new infection at any CD4 count in a person with HIV. There is no specific CD4 threshold, like 200, that defines the risk for TB.
- Option D: Kaposi's sarcoma is a virus-induced cancer, not a classic infection. While it is an AIDS-defining illness, it can appear at various CD4 levels and is not exclusively tied to the 'below 200' threshold.
Related Visual
- Visual 1: Chart: A diagram illustrating the progression of HIV and the corresponding CD4 count thresholds for various opportunistic infections (PJP at <200, Toxoplasmosis at <100, MAC at <50).
Clinical Relevance
- Nursing practice connection: Knowing CD4 count thresholds for opportunistic infections in HIV/AIDS helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
- Nurses play a vital role in educating patients about the importance of adhering to antiretroviral therapy (ART) to keep their CD4 count high and prevent opportunistic infections.
- Monitoring a patient's CD4 count is a key nursing assessment to anticipate risks, recognize early signs of infection, and ensure timely initiation of prophylaxis.
- What if? If a patient's CD4 count dropped to 90 cells/mm³, the nurse should recognize the risk for both PJP and Toxoplasmosis, and ensure the patient is on appropriate prophylaxis, likely trimethoprim-sulfamethoxazole, which covers both.
How to Approach the Question
- First, identify the key terms in the question: 'opportunistic infection' and 'CD4 count below 200'.
- This is a factual recall question that tests your knowledge of HIV/AIDS management.
- Recall the specific CD4 thresholds that trigger prophylaxis for major opportunistic infections.
- The 'below 200' mark is the most famous threshold, specifically for initiating prophylaxis against Pneumocystis jirovecii pneumonia (PJP).
- Evaluate the other options: Toxoplasmosis is associated with a lower count (<100), while TB and Kaposi's sarcoma are not defined by this specific threshold.
- This process of elimination confirms that PJP is the most accurate answer.
Concept Tested & Keywords
- Concept Tested: CD4 count thresholds for opportunistic infections in HIV/AIDS.
- Stem keywords: opportunistic infection, CD4 count, below 200
- Lead-in keywords: Which
- Clinical cues: CD4 count below 200 cells/mm³ is a key diagnostic criterion for AIDS and a trigger for specific prophylactic treatments.
Question ID
Q60jJlZ0FMcjNp2OfLC_WG
Reference Book
Lewis Medical Surgical Nursing p. 1035-1056
Practise the full AIIMS CRE 2025
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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