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    usmlemate is offline Junior Member
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    Antiretroviral Therapy for Acute (Primary) HIV

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    Case 4: Antiretroviral Therapy for Acute (Primary) HIV
    Author: ***** H. Spach, MD

    Last updated: June 30, 2004

    A 22-year-old man presents with a 3-day history of a mononucleosis-like illness that began 9 days after a high-risk sexual exposure with an HIV-infected contact. Laboratory studies subsequently show a negative HIV antibody ELISA test and a HIV RNA level of 868,000 copies/ml. Further testing shows a CD4 cell count of 568 cells/mm3. This newly infected individual receives extensive counseling regarding his new diagnosis of HIV and, in the process of this discussion, the patient asks whether he should now start treatment for his HIV disease.

    Which of the following statements is TRUE regarding antiretroviral therapy for acute (primary) HIV infection?

    A. Fewer than 30% of persons with acute HIV infection treated with HAART will achieve an HIV RNA level less than 400 copies/ml, mainly as a result of the very high HIV RNA levels and the weak immune response at this stage.

    B. Transmission of antiretroviral-resistant HIV has been documented through sexual, parenteral, and vertical routes. Persons who acquire antiretroviral resistant HIV are more likely to have failures with antiretroviral therapy.

    C. More than 90% persons with acute HIV who initiate 4-drug antiretroviral therapy prior to seroconversion (and continue therapy for 24 months) will eventually maintain long-term virologic control without antiretroviral therapy.

    D. Antiretroviral therapy initiated within 60 days of acquiring HIV clearly provides long-term clinical benefit when compared with deferred antiretroviral therapy (given for chronic HIV when the CD4 count has deceased to less than 350 cells/mm3).

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    usmlemate is offline Junior Member
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    Re: Antiretroviral Therapy for Acute (Primary) HIV

    Quote Originally Posted by usmlemate
    Case 4: Antiretroviral Therapy for Acute (Primary) HIV
    Author: ***** H. Spach, MD

    Last updated: June 30, 2004

    A 22-year-old man presents with a 3-day history of a mononucleosis-like illness that began 9 days after a high-risk sexual exposure with an HIV-infected contact. Laboratory studies subsequently show a negative HIV antibody ELISA test and a HIV RNA level of 868,000 copies/ml. Further testing shows a CD4 cell count of 568 cells/mm3. This newly infected individual receives extensive counseling regarding his new diagnosis of HIV and, in the process of this discussion, the patient asks whether he should now start treatment for his HIV disease.

    Which of the following statements is TRUE regarding antiretroviral therapy for acute (primary) HIV infection?

    A. Fewer than 30% of persons with acute HIV infection treated with HAART will achieve an HIV RNA level less than 400 copies/ml, mainly as a result of the very high HIV RNA levels and the weak immune response at this stage.

    B. Transmission of antiretroviral-resistant HIV has been documented through sexual, parenteral, and vertical routes. Persons who acquire antiretroviral resistant HIV are more likely to have failures with antiretroviral therapy.

    C. More than 90% persons with acute HIV who initiate 4-drug antiretroviral therapy prior to seroconversion (and continue therapy for 24 months) will eventually maintain long-term virologic control without antiretroviral therapy.

    D. Antiretroviral therapy initiated within 60 days of acquiring HIV clearly provides long-term clinical benefit when compared with deferred antiretroviral therapy (given for chronic HIV when the CD4 count has deceased to less than 350 cells/mm3).
    The correct answer is B. Transmission of resistant HIV has clearly been documented with multiple different routes of exposure. Recent studies have shown that persons who acquire resistant HIV are more likely to fail antiretroviral therapy, with a longer time to viral suppression and a shorter time to virologic failure.


    Answer A. is incorrect. Although HIV RNA levels are typically very high with acute HIV infection, available data suggest that treatment of primary infection with a 3- or 4-drug combination regimen generally reduces HIV RNA levels at least as well as with treatment of chronic infection.

    Answer C. is incorrect. Although early data were promising using this approach, long-term follow-up has shown that most of the patients eventually failed to maintain control of HIV.


    Answer D. is incorrect. Based on currently published data, there is no clear evidence that antiretroviral therapy given immediately during or prior to HIV seroconversion provides greater long-term clinical benefit than deferring therapy until indicated during chronic HIV infection.

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