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In the given scenario, Mr. H who is a thirty-seven-year-old male with a known history of unprotected homosexual sex with men and no recorded history of an HIV test within the past six years related to being in a stable relationship developed an unusual type of cancer known as, Kaposi sarcoma. Given that Mr. Hs viral load was substantial and had diminished levels of CD4+ T cell counts at 180 cells/microliter, he is more than likely in stage III defined as AIDS determined by CD4+ T cell count of <200 cells/microliter (McHance & Huether, 2019). Kaposi sarcoma (KS) is mainly associated with immunosuppression among individuals living with HIV (Luo et al., 2021). Rate of KS are higher among males in comparison to females and in younger age groups from aged 35-49 years (Luo et al., 2021). Luo et al. (2021) reviewed cases of Kaposi sarcoma (KS) from thirty-six cancer registries in the US from 2008-2016 from ages 20-59 years old. The authors noted that an increase in younger age groups may be a result of lack of control over immunosuppression due to late HIV diagnosis or possibly delayed treatment with active antiretroviral therapy (ART) (Luo et al., 2021) 

Low CD4+ T cell count 

The CD4+ T cell is low as a result of the HIV virus binding to the surface of the T helper cells and replicating within them. Subsequently, it causes a destruction of the CD4+ T cell by inserting viral integrase where it may remain dormant ( McHance & Huether2019; Vidya et al., 2017). Vidya et al. (2017) described HIV infection as accelerated production and destruction of CD4+ T cells. During the timeframe of HIV Infection, approximately one billion HIV viral particles are produced daily leading to an increased amount of infected CD4+ T cells (Vidya et al., 2017). Following this, infection spreads to memory cells located in the thymus where viral replication is initiated in this lymphoid organ (Vidya et al., 2017).  

Low CD4+ T cell and pneumocystis pneumonia 

Mr. H developed pneumocystis pneumonia (PCP), an opportunistic disease which largely affects individuals with advanced immunosuppression. In the case of his decreased CD+4 T cell count and recent diagnosis of untreated HIV infection; Mr. H. is suffering from an AIDS-related illness varying in degree of severity from mild to moderate presentation based on arterial oxygen levels (Shibata & Kikuchi, 2019) 

Length of HIV status 

In Mr Hs case with a significantly low CD4+ count (180 cells/microliters), he may have been HIV positive for up to five years. McHance & Huether (2019) noted that in Stage III at one to five years, CD+4 T cell counts of < 750, < 500, or < 200 cells/microliters progressed to AIDS.   

Length of time before discovery of status 

The amount of time before Mr H. discovered his HIV status may be the result of the duration of the asymptomatic stage which varies from a few months to as many as a few years with an estimated median of 9.8 years (Vidya et al., 2017). Up to ninety percent of individuals in the initial stages of HIV (stage 0), will experience acute viral symptoms much like an influenza type infection with generalized malaise, headache, fever and a rash (McHance & Huether, 2019). The individual may believe he/she has the flu, and it resolves on its own. Nonetheless, HIV viral particles remain active in body fluids (McHance & Huether, 2019).  

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