I read with interest the recent NEJM Case Records of the Massachusetts General Hospital, entitled “A 39-Year-Old Zimbabwean Man with a Severe Headache.”
This patient presented with AIDS, a CD4 count of 31, and cryptococcal meningitis, and fortunately survived despite a lack of flucytosine (due to cost) and an antiquated HIV regimen which included stavudine and neviripine.
My main comment is that the patient was lucky to survive. I’ve taken care of many similar patients in Mozambique, Botswana, and other settings who have died. His late presentation with a CD4 of 31 implies that he was outside the health system for a long period of time. Everyone who lives in settings with high HIV prevalence needs regular HIV testing.
Colleagues and I recently published a research paper, “Knowledge of Human Immunodeficiency Virus Status and Seropositivity After a Recently Negative Test in Malawi.” Our study demonstrated the need for repeat HIV testing in people at high risk for infection.
Global HIV programs put in place by PEPFAR, ministries of health, and other partners are at risk of failing. These programs need our support.