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Age: HIV knows no boundary

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Clinical record

A 66-year-old retired man was referred to a regional hospital for investigation of a prolonged illness characterised by a 9-month history of profound lethargy, loss of appetite, episodic explosive watery diarrhoea without blood or mucus, and weight loss of 45 kg, resulting in a body mass index of 19 kg/m2. His functional status had deteriorated such that he was mostly bed-bound and required a walking stick to mobilise. The patient’s syndrome had been extensively investigated in the outpatient setting by other clinicians in the region without any causative abnormality identified.

The patient described intermittent fevers and sweats and reported a propensity to pick up “every common infection going around”. He had a background of two coronary angioplasties, mild depression, hypertension and dyslipidaemia, for which he was receiving appropriate treatment. His regular medications included citalopram, aspirin, simvastatin and metoprolol, and he had no history of medication allergies. He was married and had adult children from a previous marriage. He denied a history of smoking or use of recreational drugs, and reported drinking alcohol on social occasions.

On physical examination, he was cachectic and afebrile, with normal vital signs and mildly dry mucous membranes. Results of a clinical examination were otherwise unremarkable, with no organomegaly,…