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NBME 20 Answers

nbme20/Block 1/Question#23

A 34-year-old man who is HIV positive is brought to ...

CD4+ T lymphocytes

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CD4+ cells activate B-cells which form follicles and cause enlargement of lymph nodes. Therefore, in an AIDS patient, to enlarge the lymph nodes, the CD4+ dysfunction must be resolved.

breis  Yea i get that, but if the patients CD4 was ~35, how in the world did the CD4 count rise enough to stimulate B cell proliferation...? I don't get it +1  
namira  The only thing i can think of is that: the cd4 count that is given was taken prior to having started the antiretroviral therapy. Since the question asks about "improved function", maybe its referring to the therapy actually being effective and its managed to increase cd4 count and function so as to be able to contribute to lymph node enlargement due to myco. avium +7  
kamilia20  I though it transfer to a lymphoma,OMG +  

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submitted by hayayah(525),

Mycobacterium avium complex infections are a common opportunistic infection in patients with advanced AIDS (CD4 count <50).

realfakedreams  @hayayah you were being lazy.. smh.. Homie started anti-retroviral therapy. HIV infects CD4 T-Cells through either CCR5 or more commonly CXCR4. Because of anti-retrovirals start working, HIV isnt able to infect anymore CD4 T cells. Thus CD4 t lymphocytes levels start to rise and are able to active B cells. +5  
myf1991  Why can't it be monocyte? macrophage eat MAC and interact with CD4 +