Medical Emergencies · patient case question
Which laboratory finding is most significant for the management of this extraction?
Patient case: Two chronic conditions and a set of labs
Patient: Male, 47 years old
Chief Complaint: Presents for extraction of a non-restorable molar.
Background: HIV diagnosed nine years ago, on antiretroviral therapy. Type 2 diabetes for six years, on metformin. BMI 34.
Laboratory: CD4+ count 302 cells/µL · HbA1c 9.0% · Viral load undetectable
Vital Signs: BP 138/86 mmHg · HR 80 bpm
Show answer and explanation
Correct answer: B. The HbA1c of 9.0%, indicating poorly controlled diabetes
- A. Severe immunosuppression begins below 200. There is no basis to defer treatment on immunological grounds here.
- B. CORRECT. A CD4 count of 302 is ABOVE the 200 cells/µL threshold and the viral load is undetectable — this patient's HIV is well controlled and routine dental care proceeds without modification. The HbA1c of 9.0% is the number that actually changes management: it reflects an average glucose around 212 mg/dL over the preceding two to three months, meaning impaired neutrophil function, delayed wound healing and a raised risk of post-extraction infection.
- C. AIDS is defined by a CD4 count BELOW 200 cells/µL, or by the presence of an AIDS-defining illness. At 302 with an undetectable viral load, this patient does not meet that definition.
- D. An undetectable viral load is the goal of therapy and reassuring. It is not an indication for prophylaxis; HIV status alone never is.
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