What is your approach to work up and management of a patient with advanced HIV and poor adherence to therapy presenting with dysphagia and fever?

I would first do an HPI (is the dysphagia for both liquids and solids?), then a quick physical exam, with a full set of vital signs. In terms of basic blood work, I would get a CBC and BMP, liver function tests, a set of blood cultures, a chest x-ray, along with a viral load and CD4 T cell count, wh...

Having a sense of a recent CD4 value would help. After a thorough H&P to assess for localizing symptoms beyond the dysphagia and no available CD4 data, I would approach this patient as someone with a CD4 count of <100 and possibly <50. It is highly likely that they have candida esophagitis, for whic...

First I have to get over being irritated about the nonadherence and then do my job. The dysphagia is probably Candida esophagitis. HSV is possible, but I would cover Candida, not HSV. The fever is probably not from the esophagitis. In advanced AIDS, I worry first about cryptococcus and PCP. Serum cr...