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    usmlemate is offline Junior Member
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    Indications for Initiating Antiretroviral Therapy

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    A 29-year-old HIV-infected man with a CD4 count of 260 cells/mm3 and HIV RNA level of 42,000 copies/ml visits the clinic for a routine follow-up appointment. His recent laboratory studies taken 3 and 6 months prior showed CD4 counts of 274 and 310 cells/mm3 and HIV RNA levels of 45,000 and 39,000 copies/ml. He has no HIV-related symptoms and has not had any AIDS-defining illnesses. The CD4 count of 260 cells/mm3 is his lowest CD4 cell count. The patient is very interested in antiretroviral therapy and there are no major concerns with adherence.

    According to the March 2004 DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents, which of the following is TRUE regarding the timing of initiating antiretroviral therapy.

    A. Antiretroviral therapy is recommended for patients who have a CD4 count less than 200 cells/mm3, regardless of clinical symptoms.

    B. Antiretroviral therapy is recommended for patients who have a CD4 count less than 200 cells/mm3, but only if they have an AIDS-defining clinical illness.

    C. Antiretroviral therapy is recommended for patients who have an AIDS-defining clinical illness, but only if their CD4 count is less than 350 cells/mm3.

    D. Antiretroviral therapy should not be offered to an asymptomatic patient with a CD4 cell count between 200-350 cells/mm3, unless their HIV RNA level is greater than 100,000 copies/ml.

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    Asclepius1 is offline Ultimate Member 537 points
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    C. Antiretroviral therapy is recommended for patients who ha

    My guess is C. Antiretroviral therapy is recommended for patients who have an AIDS-defining clinical illness, but only if their CD4 count is less than 350 cells/mm3.

  3. #3
    usmlemate is offline Junior Member
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    Re: Indications for Initiating Antiretroviral Therapy

    Quote Originally Posted by usmlemate
    A 29-year-old HIV-infected man with a CD4 count of 260 cells/mm3 and HIV RNA level of 42,000 copies/ml visits the clinic for a routine follow-up appointment. His recent laboratory studies taken 3 and 6 months prior showed CD4 counts of 274 and 310 cells/mm3 and HIV RNA levels of 45,000 and 39,000 copies/ml. He has no HIV-related symptoms and has not had any AIDS-defining illnesses. The CD4 count of 260 cells/mm3 is his lowest CD4 cell count. The patient is very interested in antiretroviral therapy and there are no major concerns with adherence.

    According to the March 2004 DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents, which of the following is TRUE regarding the timing of initiating antiretroviral therapy.

    A. Antiretroviral therapy is recommended for patients who have a CD4 count less than 200 cells/mm3, regardless of clinical symptoms.

    B. Antiretroviral therapy is recommended for patients who have a CD4 count less than 200 cells/mm3, but only if they have an AIDS-defining clinical illness.

    C. Antiretroviral therapy is recommended for patients who have an AIDS-defining clinical illness, but only if their CD4 count is less than 350 cells/mm3.

    D. Antiretroviral therapy should not be offered to an asymptomatic patient with a CD4 cell count between 200-350 cells/mm3, unless their HIV RNA level is greater than 100,000 copies/ml.
    The correct answer is A. For patients who have a CD4 count less than 200 cells/mm3, the 2004 DHHS antiretroviral guidelines recommend starting antiretroviral therapy, regardless of the HIV RNA level, clinical symptoms, or whether they have developed an AIDS-defining clinical illness.


    Answer B is incorrect. According to the 2004 DHHS guidelines, antiretroviral therapy is recommended for patients who have a CD4 count less than 200 cells/mm3, regardless of whether they have ever developed an AIDS-defining clinical illness and regardless of their HIV RNA level.

    Answer C is incorrect. According to the 2004 DHHS antiretroviral therapy guidelines, any AIDS-defining clinical illness, such as Pneumocystis pneumonia or Kaposi's sarcoma, would be an indication to start antiretroviral therapy, regardless of the patient's CD4 cell count or HIV RNA level.


    Answer D is incorrect. The 2004 DHHS antiretroviral therapy guidelines recommend that antiretroviral treatment should generally be offered to an asymptomatic patient with a CD4 count between 200-350 cells/mm3, regardless of their HIV RNA level. The guidelines state the majority of clinicians would offer therapy at a CD4 threshold less than 350 cells/mm3. These guidelines, however, acknowledge this threshold of 350 cells/mm3 is controversial.

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