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George G. is a 48-year-old gay man known to be HIV positive for seven years. In the past he has responded well to monotherapy with antiretroviral medications and has a lifetime CD4 count nadir of 340/mm3. He is now on HAART with a viral load below 500 copies/ml and a CD4 count of 540.
Recently Mr. G. presented to the emergency room complaining of six hours of abdominal pain. He stated that the pain was generalized and associated with anorexia, nausea, and some dry heaves. He had moved his bowels normally on the previous day.
Mr. G. was examined by the emergency physician, who ordered some laboratory tests and flat plate and upright x-rays of the abdomen. The chemistries were normal, the WBC count was 7,000/ml, hemoglobin was 15 g/dl, no diffe…