Question:

Hilda was a 55-year-old Hispanic woman with advanced AIDS when she presented in April 2003, noting 1 week of word-finding difficulty. She was well known to the clinic for her multiple psychiatric admissions, her substance abuse, and her nonadherence to medications. Hilda’s HIV infection was diagnosed in 1995, and she had a long history of bipolar disease and schizoaffective disorder. Her medical history included mild type 2 diabetes, syphilis, and chronic low back pain with mild degenerative joint disease evident on MRI. She was a heavy smoker and frequently used benzodiazepines or painkillers that she bought on the street. She had recurrent oral candidiasis that responded to fluconazole. At this presentation, she was again admitted to the hospital. When Hilda first presented in 2000, her CD4+ cell count was 42/

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