A.S., age 28, is infected with HIV. She weighs 48 kg. Her boyfriend was an IV drug user who died of AIDS 2 years ago. She presents with a fever (103?F) and a 2-week history of “splitting headaches.” Laboratory test results include the following: Hemoglobin, 11.2 g/dL WBC count, 4,100 cells/?L Platelets, 73,000/L SCr, 0.9 mg/dL Glucose, 94 mg/dL CD4+ count, 47 cells/?L A.S. is highly nonadherent and has not been to the clinic in more than a year, at which time she was prescribed AZT, lamivudine, fosamprenavir, and ritonavir. Physical examination reveals no nuchal rigidity. With the exception of moderate lethargy, her neurologic examination is unremarkable. Her chest radiograph and three sets of blood cultures for bacteria and fungi are negative. A computed tomography scan is nondiagnostic. Lumbar puncture reveals the following CSF findings: Glucose, 45 mg/dL Protein, 90 mg/dL WBC count, 10 cells/?L Cryptococcal antigen titer, 1:2,048I Intracranial pressure (ICP), 24 cm H2O (normal, 8–22 cm H2O) How is A.S.’s clinical presentation typical of a patient with AIDS and cryptococcal meningitis? What is her likely prognosis?
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