Case 1: Indications for Initiating Antiretroviral Therapy

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Case last updated: April 3, 2008

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 January 2008 DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents, which of the following is TRUE regarding initiating antiretroviral therapy.

	Antiretroviral therapy is recommended for patients who are co-infected with hepatitis B virus when treatment for hepatitis B virus is indicated, regardless of the patient's CD4 cell count.
	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.
	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.
	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.