HESI RN Case Study: HIV/TB
The nurse notices the UAP about to enter Raymond's room to deliver a meal tray without wearing any protective apparel. 4. What information should the nurse provide the UAP
A mask is required for healthcare workers entering the room of someone suspected of having active TB. TB is spread by airborne transmission of droplet nuclei. A specific fit tested, high-efficiency particulate air (HEPA) mask is necessary to filter the mycobacterium tuberculosis bacillus.
The second most common malignancy in people with AIDS is ________________
B-cell lymphomas
A fungal infection in nearly all patients with AIDS is ____________
Candidiasis
A patient with HIV informs the nurse of difficulty eating and swallowing, and shows the nurse white patches in his mouth. What problem related to AIDS does the nurse understand the patient has developed?
Candidiasis
OraQuick ADVANCE
First FDA-approved home based test for HIV antibodies. 99.6% effective in 20 minutes. At home
HIV culture
Identifies retrovirus in blood. Not used much anymore
CD4 T cell count
Normal 500 - 1,500 cells/ mm3
Viral load testing
Quantifies HIV RNA and DNA in plasma. Most important indicator of response to ART.
HIV belongs to a group of viruses known as ___________.
Retroviruses that carry their genetic material in the form of RNA rather than DNA.
A patient is diagnosed with pneumocystis pneumonia. What medication does the nurse anticipate educating the patient about for treatment?
TMP-SMZ (Bactrim)
Drug resistance can be defined as _______________
The ability of pathogens to withstand the effects of medications that are intended to produce toxicity.
Pneumocystis pneumonia (PCP)
The most common life-threatening infection in those living with AIDS. Caused by P. jiroveci. Non-specific symptoms such as nonproductive cough, SOB, fever, chills, dyspnea and occasionally chest pain. If left untreated eventually leads to RF in as little time as 2-3 days.
Western blot assay
Used to confirm a + EIA
A recommended chemotherapeutic agent used in Kaposi's sarcoma is ___________________
Alpha-interferon
A patient develops gastric bleeding from a gastric ulcer and requires blood transfusions. The patient states to the nurse , " I am not going to have a transfusion because I don't want to get AIDS." What is the best response by the nurse?
"I understand your concern, the blood is screened very carefully for different viruses as well as HIV."
A patient is on ART for the treatment of HIV. What does the nurse know would be an adequate CD4+ count to determine the effectiveness of treatment for a patient per year?
50mm3 to 150mm3
What is the difference in the etiology and clinical manifestations of cryptococcal meningitis and cytomegalovirus retinitis?
Cryptococcus is a fungus. It is very common in the soil. It can get into your body when you breathe in dust or dried bird droppings. It does not seem to spread from person to person. Meningitis is the most common illness caused by Cryptococcus. Cytomegalovirus retinitis, also known as CMV retinitis, is an inflammation of the retina of the eye that can lead to blindness. Caused by human cytomegalovirus, it occurs predominantly in people whose immune system has been compromised, 15-40% of those infected with AIDS.
When performing Raymond's morning physical assessment, the nurse discovers that he has a weak, rapid pulse, decreased skin turgor, and dry, sticky, oral mucous membranes. His weight is 2 lbs (0.91 kg) less than it was yesterday morning. What is the highest priority nursing diagnosis for Raymond? Fatigue. Disturbed sleep pattern. Deficit fluid volume. Situational low self-esteem.
Deficit fluid volume. A weak, rapid pulse; decreased skin turgor; dry, sticky, oral mucous membranes; and weight loss are signs of dehydration.
List five types of body fluids that can transmit HIV-1
Blood, vaginal secretions, seminole fluid, amniotic fluid and breast milk
RT - PCR
Measures viral load. Used along with CD4 to assess stage and severity of HIV infection. Used to confirm + EIA and also used to screen neonates
2. What assessment data would indicate to the nurse that brandon may be dehydrated?
poor skin turgor, dry mucous membranes
Describe the clinical manifestations of the immune reconstitution inflammatory syndrome (IRIS)
Complications of ART. A paradoxical worsening of a preexisting opportunistic infection when ART is initiated because of an incensed WBC count, low viral load that attacks dorment pathogens. Since ART leads to an improvement in immune function, an inflammatory reaction may occur at the site of the preexisting infection. Patients at highest risk for IRIS are those with low CD4+ counts and high viral loads.
Immune reconstitution inflammatory syndrome (IRIS)
Fever, respiratory and/ or abdominal symptoms, worsening of an opportunistic infection, or appearance of new manifestations or new opportunistic infections appeared
According to the Centers for Disease control and Prevention (CDC, 2011b), ________________ million people in the Unites States are living with HIV.
1.2 million
After 3 days, the nurse receives the results from Raymond's Tuberculin skin test that was administered at his HCP office. Even though Raymond's reaction to the TB skin test measures only 5mm in diameter, the HCP documents a positive test result. A new graduate nurse finds this confusing. The new graduate nurse thought a 10mm induration was the minimum size for a positive reading and asks the nurse preceptor for clarification. 10. How should the nurse preceptor reply?
" That is not always true. A 5mm induration is considered positive for TB in a person with HIV." The person with HIV has diminished T cell immunity, which compromises their ability to react to skin tests. Therefore, an induration of 5 mm is considered a positive reaction, rather than the standard of 10 to 15 mm for other groups.
The nurse receives a phone call at the clinic from the family of a patient with AIDS They state that the patient has started "acting funny" after complaining of headache, tiredness and a stiff neck. Checking the temperature resulted in a fever of 103.2 F . What should the nurse inform the family member?
" The patient may have crytococcal meningitis and will need to be evaluated by the physician."
Pharmacologic and Parenteral Therapies Before breakfast, the nurse brings Raymond the HIV medicines that are due. Raymond inquires about his other medications,stating, "I take all my HIV medications all at once before breakfast. I don't want to bother with taking medications all day long!" 11. How should the nurse reply?
" To be most effective, HIV medications are prescribed on different schedules. Some HIV inhibitors need to be given on an empty stomach and some need to be given with food for best effectiveness. Many need to be taken around the clock, even if sleep is disrupted, to ensure drug efficacy."
The nurse admits Raymond to a private room at the end of the hall. According to hospital protocol, the nurse put on a mask before starting the admission process. Raymond tells the nurse that his significant other is downstairs and that he would like for him to stay in the room with him. 1. How should the nurse respond?
"He may stay but only if he wears a mask" Raymond's significant other may stay in the room, but he should wear a mask to help decrease the possibility of contracting the TB organism.
8. How should the supervisor respond to the staff LVN who does not want to caee for Raymond?
"I understand you want to protect your children. Please tell me your concerns regarding caring for a client with HIV." This response by the nurse supervisor demonstrates compassion and provides an opportunity to discover if education of the staff LVN is needed.
Raymond responds by agreeing to take his medications as prescribed. He than states, " However, I don't what good they will do. Do you?" 12. The nurse should respond?
"The main purpose of these medications is to block the replication of the HIV virus." The purpose of the antiretroviral and inhibitor medicines is to block the replication of the HIV virus and prevent opportunistic diseases.
The nurse is discussing sexual activity with a patient recently diagnosed with HIV. The patient states, " As long as I have sex with another person who is already infected, I will be okay." What is the best response by this nurse?
"You should avoid having sex with a person who is HIV positive because you can increase the severity of infection in both you and your partner."
A patient is infected with HIV after sharing needles with another IV drug abuser. Upon infection with HIV, the immune system responds by making antibodies against the virus, usually within how many weeks after infection?
3 to 12 weeks
he HCP is notified of Raymond's physical exam findings indicating possible dehydration and vital signs, including a blood pressure of 100/50. It is determined that Raymond could use a bolus of IV fluids. The HCP prescribes 1000 mL of normal saline to run over 6 hours. The drop factor tubing set is 15 drops/mL. How many drops/minute will the IV run? (Enter the numeric value only. If rounding is required, round to the whole number.)
42 1000/360 X 15 = 41.66 = 42 gtts/minute or 42 1000mL/6hr=166.67 166.67x15gtt=2499.99 2499.99/60min=41.67 ~ 42gtt/min
Discuss the safe sexual behavior that a nurse should incorporate into an education plan to prevent HIV/AIDS.
Abstain from sharing sexual fluids (semen nd vaginal secretions) , reduce the number of sexual partners to 1, Always use latex condoms, you can use non-latex if allergic but they won't work to protect against HIV infection, Always use dental dams, don't reuse condoms, don't donate blood, take part in non-penetrative sex activities
Patient with HIV has been on antiretroviral therapy (ART) for 6 months. The patient come to the clinic with home medications and the nurse observes that there are to many pills in the container. What does the nurse know about the factors associated with nonadherance to ART? (SATA)
Active substance use, depression , lack of social support
When planning the care of a patient with HIV encephalopathy, what would the nurse include in the nursing interventions
Assess LOC, Mental status baseline, Assess for sensory deficits ( visual changes, numbness or tingling, headache, in the extremities)Motor involvement , altered gait, paresis, or paralysis , and seizure activity
CD4+ count
Indicates the level of immune dysfunction. It is important to assess the extent of damage to the immune system before initiation of ART and or/prophylactic treatment for opportunistic infections.
RT-PCR test
Measures viral load, is used along with CD4+ count, which indicates the level of immune dysfunction, to assess the stage and severity of HIV infection.
Since Raymond now has thrush, in addition to fatigue and anorexia, which food best contributes to improving Raymond's nutrition? Broiled steak. Milk shake. Tomato soup. Lettuce salad with raw vegetables.
Milk shake. A milk shake is a nutrient-dense food. It provides needed calories, calcium, and protein. Raymond can drink the nutritious snack without using the energy it would take to eat a full meal. Raymond may find that the cool liquid is soothing to his sore mouth.
The nurse notifies the HCP, who prescribes nystatin (Nyamyc) 6 mL PO 4 times per day. What instruction should the nurse give Raymond about the use of liquid nystatin (Nyamyc)? What instruction should the nurse give Raymond about the use of liquid nystatin (Nyamyc)? Place all of the suspension in the mouth, then swish and swallow immediately. Sip the suspension over 5 minutes, swishing and swallowing after each sip. Place the suspension in the mouth, then swish for several minutes before swallowing. Use the applicator to paint the medication on the infected sites and swallow the remaining dose.
Place the suspension in the mouth, then swish for several minutes before swallowing. This "swish and swallow" technique is the proper way to take liquid nystatin (Nyamyc). HCPs also recommend gargling, as well as swishing, prior to swallowing.
A patient with HIV develops a non productive cough,SOB, a fever of 101 degrees F, and an O2 saturation of 92%. What infection caused by pneumocystsis jiroveci does the nurse know could occur with his patients?
Pneumocystis pneumonia
A patient had unprotected sex with an HIV infected person and arrives in the clinic requesting HIV testing. Results determine a negative HIV antibody test and an increased viral load . What stage does the nurse determine the patient is in?
Primary infection
What is the priority nursing diagnosis for Raymond at this time?
Risk for new opportunistic infections related to decreased immune function. Since Raymond's immune system is no longer competent, he is at risk for additional opportunistic infections. Immune problems start when the CD4 cell count drops below 500 cells/mm3. Preventing infections is a basic need and is a high priority in the immunocompromised client.
3. What medication can be affective to manage the chronic diarrhea that Brendan is having?
octreotide acetate (Sandostatin)
The two major means of HIV transmission are _____________ and _______________________.
unprotected sex and sharing of injection drug use equipment. (refer to 37-1)
Brandon is a 39-year old man who has recently been diagnosed with AIDS. He is living with his wife of 7 years who id HIV positive but asymptomatic. Brandon has a previous history of IV drug use but is no longer using drugs. He is having difficulty eating, has diarrhea, and has had a 10lb weight loss in 1 month. 1. The nurse understands that Brandon's anorexia,diarrhea, and GI malabsorption are all factors that identify a significant problem. What problem do these symptoms contribute to?
wasting syndrome
Nursing Process: Plan of Care 9. Which statements by Raymond indicates that he understands why he is risk for TB? (SATA)
"I realize my helper T cells are diminished from HIV. Those are the cells I need to fight TB." HIV attacks the CD4 receptors on the helper T cells that help the body fight off diseases such as TB. " I guess living at a homeless shelter increased my chances of getting TB." The risks of acquiring the infection and of developing clinical disease depends on the infection's existence in the population, especially among persons residing in high-risk environments for the transmission of TB, such as correctional facilities, homeless shelters, hospitals, and nursing homes.
Nursing Process: Evaluation Before Raymond is discharged home, it is important that he understands how to prevent the spread of HIV. When discussing infection control practices with the nurse, Raymond says, "I have heard that condoms don't always prevent HIV."
"If used correctly and consistently, latex condoms are highly effective in preventing the transmission of HIV." Raymond's misinformation and misunderstanding is a common myth regarding the effectiveness of latex condoms. Studies prove that condoms work.
HIV Cycle
1. Attachment: GP120 and GP41 glycoproteins of HIV bind with the hosts uninfected CD4+ receptor and chemokine correctors,usually CCR5, which results in fusion of HIV with the CD4+ T-cell membrane. 2. Uncoating: Only the contents of HIV's viral core(two single strands of viral RNA and three viral enzymes: reverse transcriptase , integrase, and protease) are emptied into the CD4= T-cell. 3. DNA synthesis: HIV changes its genetic material from RNA to DNA through action of reverse transcriptase, resulting in double stranded DNA that carries instruction for viral replication. 4. Integration: New viral DNA enters the nucleus of the CD4+ T-cell and through action of integrase is blended with the DNA of the CD4+ T-cell, resulting in permanent lifelong infection. Prior to this, the uninfected person has only been exposed to, not infected with, HIV. With this step HIV infection is permanent. 5. Transcription: When the CD4+ T-cell is activated, the double stranded DNA forms a single- stranded messenger RNA (mRNA), which binds new viruses. 6. Translation: The mRNA creates chains of new proteins and enzymes (polyproteins) that contain components needed in the construction of the new virus. 7. Cleavage: The HIV enzyme protease cuts the polyprotein chain into individual protein that make up the new virus. 8. Budding: New proteins and viral RNA migrate to the membrane of the infected CD4+ cell, exit from the cell, and start the process all over again.
Raymond assures the nurse that he will use a condom with each sexual encounter. He also expresses concern that he may become dehydrated again.
Access to the services of a registered dietitian. It is essential that the nurse arrange a consult for Raymond with a registered dietitian before Raymond is discharged home. The dietitian will give Raymond specific information on suggested foods and liquids to include in his diet to help prevent dehydration if diarrhea occurs at home. The registered dietitian will provide Raymond with resources, such as a phone number, that will give him access to the dietitian on an outpatient basis.
Describe the clinical symptoms of a patient infected with acute HIV syndrome
Adverse affects associated with all HIV treatment regimens include hepatotoxicity, nephrotoxicity, osteopenia, along with increased risk of cardiovascular disease and MI, Many of the ART agents that prolong life may simultaneously cause fat redistribution syndrome and metabolic alterations such as dyslipidemia and insulin resistance, which put the patient at risk for early onset of heart disease and diabetes. The fat redistribution syndrome (lipodystrophy) consists of lipoatrophy (localized SQ fat loss in the face, arms, legs , and buttocks) and lipohypertrophy (central visceral fat [lipoma] accumulation i the abdomen,although possibly in the beats,dorso-cervical region [buffalo hump] and within the muscle and liver
Explain the procedures that would be used for post exposure prophylaxis for health care providers
Alert supervisor/nursing facility Identify the source patient who may need to be tested for HIV,hep B, C ., Report as quickly as possible to the employee health services, ER, Give consent for baseline testing for HIV, hep B or C, in accordance with CDC. Start medication prophylaxis within 2 hours post exposure. Continue HIV medications for a full 4 weeks after, Combinations may be prescribed for post exposure include zidovudine (ZDV), and lamivudine (3TC) or emtricitbine (FTC) ; stavudine (d4T), and 3TC or FTC; and tenofovir (TDF) and 3TC or FTC., follow up post exposure at 1 month, 3 months and 6 months, and maybe 1 year, document in detail, psychosocial support
EIA (enzyme immunoassay)
Diagnostic screening test that determines the presence of antibodies to HIV.
4. What suggestions could the nurse make to improve Brendan's nutritional status?
Encourage him to rest before eating, limit fluids 1 hour before meals, have 5 to 6 small meals a day
Raymond's significant other,Brandon, arrives. Raymond wants to know why a mask is necessary for people entering his room. 2.What teaching should the nurse implement?
Explain that the Tuberculosis(TB) organism is most often spread through the air. When an infected person coughs or sneezes, they produce infectious droplets that can be breathed in by another person. This answer provides Raymond with the scientific rationale for wearing a mask.
A UAP says, "Now that Raymond's condition has worsened and he has been moved to the HIV Symptomatic stage, shouldn't added precautions be posted on Raymond's door to protect staff members?" What information should the nurse give the UAP? Following standard precautions will minimize the exposure to blood and body fluids. Reverse isolation procedures should be implemented to protect the staff. Respiratory precautions are all that are needed, and those are already posted on the door. Staff members caring for Raymond should begin prophylaxis medications.
Following standard precautions will minimize the exposure to blood and body fluids. Standard precautions are designed to prevent contact with blood or body fluids, which are the mode of transmission for HIV, and are used regardless of the stage classification of the disease.
How can healthcare providers maintain "standard precautions" to prevent HIV transmission?
Hand hygiene, PPE, soiled patient care equipment, Environmental control, textiles and laundry, endless and other sharps, patient resuscitation (use mouthpiece), patient placement, respiratory hygiene/cough etiquette
Nursing Process: Intervention An acid-fast-bacilli (AFB) stain is part of the initial admission prescriptions. Early morning sputum specimens will be collected for three consecutive days and sent onto the lab. 5. Which tasks may the nurse delegate to the UAP? (SATA)
Have the UAP tell Raymond that the specimen must be collected in the early morning. This task may be delegated. Provide Raymond with three sterile specimen cups at his bedside. This task may be delegated. Document the time and date that each sputum specimen was collected. This task may be safely delegated. However, it is the nurse's responsibility to ensure that the documentation is completed and sent with the specimen to the lab.
A patient is in the clinic and states, " My boyfriend told me he went to the clinic and he was treated for gonorrhea." While testing for the sexually transmitted infection (STI), what else should be done for this patient?
Inform the patient that it would be beneficial to test for HIV
Describe the stage of HIV disease known as primary infection
Is that period from infection with HIV to the development of HIV-secific antibodies. IT is the time when the viral burden set point is achieved and includes the symptoms and early infection phases. During primary infection, a window period occurs in which the person is infected but tests negative on the HIV antibody blood test.
While caring for a patient with pneumocystis pneumonia, the nurse assesses flat, purplish lesions on the back and trunk. What does the nurse suspect these lesions indicate?
Kaposi's sarcoma
Raymond is scheduled for several activities the following morning. 6. Which activity should Raymond perform first upon awakening?
Obtain the first of three sputum specimens for laboratory testing. Secretions collecting during the night provide the opportunity for the client to cough and expectorate upon awakening before performing other morning activities.
A patient with AIDS is having a recurrence of 10 - 12 loose stools a day. What medication may help this patient with controlling the chronic diarrhea?
Octreotide (Sandostatin)
The standard new HIV testing used when information about HIV status is needed immediately ( emergency departments, labor, and delivery) is ____________
Ora Quick test
Nursing Process: Intervention Raymond Malone is 5' 11" (180.3 cm) tall. He has a large frame and weighs 152 lbs (68.9 kg). His current body mass index (BMI) is 17.4. Raymond says he realizes he should eat, but he does not have the energy or the appetite, even when he has no oral pain. The nurse identifies the nursing diagnosis of, "Imbalanced Nutrition: less than body requirements."
Request a dietary consultation for Raymond to better assess Raymond's nutritional status and food preferences. Determining Raymond's food preferences is a good first step. It is essential that Raymond be an active participant in his care so he has some control. If a favorite food is not on the menu, it can be requested. Monitor for oral thrush and diarrhea. HIV can cause profuse diarrhea, night sweats and decreased appetite due to yeast. Weigh daily and record signs of wasting syndrome. Clients with HIV/AIDS or TB can lose weight. Wasting syndrome or cachexia can include redistribution of fat (lipodystrophy), hollow cheeks, or buffalo hump.
Raymond's HCP has also prescribed the anti-tuberculosis regimen of rifabutin/isoniazid/pyrazinamide/ethambutol. 13. What information is important to teach Raymond about the use of rifabutin/isoniazid/pyrazinamide/ethambutol? (SATA)
Rifabutin stains urine, stool, saliva, sweat, and tears reddish-orange. This teaching can help Raymond prepare for this side effect without anxiety. Liver function tests should be routinely conducted and monitored. The major side effect of isoniazid, rifabutin, and pyrazinamide is drug-induced hepatitis. Therefore, Raymond must be taught the importance of having blood samples drawn to monitor his liver function. Visual disturbances related to ethambutol therapy may develop during therapy, but may resolve once treatment is discontinued. Ethambutol is generally well tolerated. The most significant adverse effect is optic neuritis.
A new nursing graduate is working at the hospital in the medical-surgical unit. The preceptor observes he nurse emptying a patients wound drain without gloves on. What important information should the preceptor share with the new graduate about standard precautions?
Standard precautions should be used with all patients to reduce the risk of transmission of blood borne pathogens.
Which action should the nurse take first? Hold Raymond's breakfast tray to provide bowel rest. Perform oral care and moisten mucous membranes. Take Raymond's blood pressure to assess for postural hypotension. Notify the HCP of Raymond's weak, rapid pulse.
Take Raymond's blood pressure to assess for postural hypotension. Postural hypotension can result from dehydration. Therefore, it is important for the nurse to obtain this vital information because it directly impacts Raymond's safety.
Safe and Effective Care Environment: Management of Care A licensed vocational nurse (LVN) says to the nurse who is making assignments, " I do not want to be assigned to care for Raymond. I have never cared for a client with HIV and do not want to start now. I have a family at home that needs me." 7. Which information should the nurse base a response about the LVN's right to refuse care for a client with HIV?
The LVN may refuse to care for a client in circumstances in which risk to the nurse outweighs the nurse's responsibility to care for a client, or if the assignment conflicts with the nurse's ethical standards. According to the ANA Code for Nurses, a nurse may morally refuse to participate in care, but only on the grounds of either client advocacy or moral objection to a specific type of intervention. Exceptions may be made when risk of harm outweighs the nurse's responsibility to care for a given client. For example, an immunosuppressed nurse may refuse to care for clients with certain infectious processes. The pregnant nurse may refuse to care for the client with HIV who has secondary infections such as toxoplasmosis or cytomegalovirus, both of which can cause severe damage or death to the fetus.
Safety and Infection Control The unlicensed assistive personnel (UAP) asks why Raymond could not be in an empty semiprivate room closer to the nurses station so that the staff would not have to walk so far to provide care. 3. What information should the nurse provide to the UAP on infection control services?
The implementation of airborne precautions for possible TB requires a private, negative pressure room assignment. According to the Centers for Disease Control (CDC), in addition to isolating Raymond by using a private room, engineering controls can help to prevent the spread of TB. Controlling the direction of the airflow can prevent contamination of air in adjacent areas.
What would the nurse document about the appearance of cutaneous lesions seen with Kapok's sarcoma?
These lesions are usually brownish pink to deep purple. They may be flat or raised and surrounded by hemorrhagic patches and edema.
An older adult widowed woman informs the nurse that she notices vaginal dryness now that she has become sexually active again. She is not using barrier protection because it makes the dryness worse. What education should the nurse provide the patient?
Vaginal dryness is normal in postmenopausal woman, and there are creams that can be used, but she should use a latex condom.
Risk Potential Raymond develops severe diarrhea with occasional incontinence that could be caused by an opportunistic gastrointestinal infection or by one of his medications. While stool cultures are pending, other interventions can be initiated. Which tasks should be delegated to the UAP? Select all that apply Which tasks should be delegated to the UAP? Weigh Raymond each morning before breakfast. Measure the urine output. Count and record the number of watery stools. Assess Raymond's peri-rectal skin during incontinent care. Check Raymond's skin turgor to determine if he is dehydrated.
Weigh Raymond each morning before breakfast. Weights can be obtained by the UAP. Measure the urine output. Measurement of the urine output can be delegated to the UAP, who can then report to the nurse. Count and record the number of watery stools. The UAP can legally count and record the number of watery stools. However, it is the nurse's responsibility to be aware of the client's condition and promptly report any significant changes to the HCP.
The nurse notices that Raymond has left most of his dinner untouched. The nurse offers to order something different for Raymond, but he replies that his mouth is sore and he just doesn't feel like eating. Which assessment finding by the nurse would be indicative of oral candidiasis, a common secondary infection in persons with compromised immune systems? Blisters on the tongue or oral mucosa. Inflammation of the gums. Painless white lesions on the lateral surface of the tongue. White-yellow patches on the tongue or oral mucosa.
White-yellow patches on the tongue or oral mucosa. This sign is indicative of a Candida albicans infection. It is a common finding in people with HIV, and it frequently occurs with a falling CD4 cell cou