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Case 1: Indications for Resistance Testing

You answered:

A A 28-year-old man who has just been diagnosed with primary (acute) HIV infection.

This answer is incorrect. The December 2007 DHHS antiretroviral therapy guidelines recommend performing resistance testing prior to initiating antiretroviral therapy in persons with acute HIV infection, regardless of whether the decision is made to initiate therapy. The recommendation to obtain resistance testing even when the decision in made to defer therapy is based on the greater likelihood of detecting transmitted resistant early in the course of HIV infection. Thus, obtaining a resistance test soon after acute infection may provide the best opportunity to determine whether or not this patient has acquired drug-resistant HIV.

Choose another answer:

B A 32-year-old woman has a CD4 count of 284 cells/mm3 and a HIV RNA level of 61,000 copies/ml. She has never taken antiretroviral therapy, but is planning to start on her first antiretroviral regimen within the next 3-4 months.
C A 41-year-old man on tenofovir plus emtricitabine (Truvada) plus ritonavir (Norvir) plus atazanavir (Reyataz) whose last four HIV RNA measurements were 281, 765, 1532, and 3036 copies/ml.
D A 35-year-old woman who previously had an HIV RNA level of 16,700 copies/ml while taking the regimen of stavudine (Zerit) plus lamivudine (Epivir) plus efavirenz (Sustiva). She admits to spotty adherence while taking that regimen and she discontinued all of her antiretroviral medications 24 weeks ago. She now wants to restart antiretroviral therapy and states she is highly motivated to have excellent adherence.

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