Advanced human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) continues to occur in those with social, educational, and cultural barriers to accessing healthcare. A 27-year-old Ecuadorian man presented with vomiting, epigastric pain, fever, weakness, and weight loss. He had advanced AIDS, with opportunistic infections including disseminated histoplasmosis, cerebral toxoplasmosis, and JC virus brain infection. Despite prior repeated contact with local, US-based healthcare, sexual history and HIV screening were never performed. Missed opportunities to identify HIV infection led to potentially preventable opportunistic infections, despite our current era of widely available, effective antiretroviral therapy.
Alappan et al. (Fri,) studied this question.