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Updated December 10, 2007

Case 1: Indications for Resistance Testing

Authors: Christopher Behrens, MD David H. Spach, MD

Learning Objectives

In which one of the following situations would HIV resistance testing NOT usually be recommended?

A A 28-year-old man who has just been diagnosed with primary (acute) HIV infection.
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 zidovudine plus lamivudine (Combivir) plus nelfinavir (Viracept) whose last four HIV RNA measurements were 256, 865, 1838, and 3298 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.