Vision-Related Patient-Reported Outcomes in Randomized Controlled Trials of Age-Related Macular Degeneration: A Systematic Review.

Human immunodeficiency virus (HIV) infection is characterised by progressive immune dysfunction that predisposes affected individuals to a wide spectrum of complications, which may arise from direct HIV-mediated damage, opportunistic infections ranging from typical to rare, treatment-related effects, and inflammatory processes . Patients with advanced HIV may therefore present with multisystem involvement reflecting the simultaneous unfolding of disparate aetiologies — a clinical tableau of competing diagnoses rather than a single unifying condition. Particularly in tuberculosis-endemic regions, tuberculosis remains a primary and often sole diagnostic consideration. However, the aetiological spectrum for complications such as neurological dysfunction, cytopenias, and renal disease is exceptionally broad. Neurological manifestations in HIV encompass opportunistic infections and primary HIV-associated conditions such as HAND and myelopathy — the latter being diagnoses of exclusion. Among haematological complications, parvovirus B19 — a common childhood pathogen — is a well-recognised cause of life-threatening bone marrow suppression in HIV, often underdiagnosed because impaired humoral immunity may result in absent serological responses , . Renal involvement in patients with HIV have higher risk of complicated urinary tract infections that may progress to destructive pathology . Non-tuberculous mycobacteria, though uncommon causes of genitourinary disease, are increasingly recognised as extrapulmonary pathogens — yet data on genitourinary NTM infection specifically in this population remain scarce . Attributing multisystem disease to a single unifying aetiology, thus risk overlooking concurrent or alternative pathologies with distinct management implications, underscoring the importance of rigorous parallel diagnostic evaluation. The approach of single unifying etiology may thus risk overlooking concurrent or alternative pathologies with distinct management implications. Rigorous parallel diagnostic evaluation carries profound therapeutic consequences compared with conventional attribution of multisystem disease to a single unifying aetiology. We present a case that illustrates this principle: a patient with advanced HIV, persistent pancytopenia, progressive neuropsychiatric symptoms, and pyelonephritis, in whom comprehensive evaluation identified not a unifying diagnosis but three distinct concurrent aetiologies — parvovirus B19-associated myelosuppression, xanthogranulomatous pyelonephritis due to co-infection with carbapenem-resistant and , and direct HIV-mediated neurological disease. To our knowledge, pyelonephritis caused by has not been previously described in patients with HIV infection, expanding the recognised spectrum of non-tuberculous mycobacterial disease in advanced HIV. This case further illustrates the diagnostic challenges and clinical consequences of pursuing diagnoses beyond the obvious presumption. A 35-year-old male daily-wage worker was referred for evaluation of multisystem complaints following diagnosis of HIV-1 infection at an outside facility approximately three months prior, with a baseline CD4 count of 60 cells/µL. He was a reformed alcoholic (abstinent for two years, previous intake 30–60 mL of country liquor daily for three years) and tobacco chewer, with no other substance use. He was initiated on antiretroviral therapy (ART) consisting of tenofovir, lamivudine, and dolutegravir after clinical exclusion of active pulmonary tuberculosis. Despite reported full adherence to ART, newer complaints emerged along with persistence of existing symptoms, thus prompting admission for further evaluation.