A 27-year-old HIV-positive man comes to the clinic for a periodic health maintenance examination. He contracted the disease 5 years ago from a former partner. He has been followed in the community health clinic since that time. He has no other medical history and takes only diazepam orally for anxiety. His last visit was 11 months ago. His temperature is 37.0 C (98.6 F), blood pressure is 140/85 mm Hg, pulse is 78/min, and respirations are 12/min. He has clear lung fields bilaterally, his skin is free of rashes or excoriations, and his abdomen is soft and nontender. Blood work drawn a few weeks ago reveals a CD4 count of 98 cells/mm3 and a hematocrit of 34% with an MCV of 95 fl. His last tuberculin skin test was 3 months ago and was read as 4mm and flat. In addition to initiating vitamin B12 and folate therapy for his patient, the most appropriate intervention at this time is
A. antibiotic prophylaxis for PCP pneumonia
B. antibiotic prophylaxis for tuberculosis
C. a skin test for tuberculosis
D. treatment for active tuberculosis infection
E. none is indicated based upon his CD4 count at this time
|