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Updated September 29, 2012

Case 1: Indications for Initiating Antiretroviral Therapy

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A 25-year-old HIV-infected man with a CD4 count of 560 cells/mm3 and HIV RNA level of 86,000 copies/ml visits the clinic for a routine follow-up appointment. His laboratory studies obtained 3, 6, and 12 months prior showed CD4 counts of 610, 686, and 736 cells/mm3 and HIV RNA levels of 84,000, 68,000, and 72,000 copies/ml. He has no HIV-related symptoms and has not had any AIDS-defining illnesses. He has several male sexual partners and uses condoms most of the time. The patient is very interested in taking antiretroviral therapy and there are no major concerns with adherence.

According to the March 2012 HHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents, which of the following would you recommend regarding initiating antiretroviral therapy in this treatment-naive patient.

A Initiate antiretroviral therapy.
B Defer antiretroviral therapy until the patient's CD4 count decreases to less than 500 cells/mm3.
C Defer antiretroviral therapy until the patient's CD4 count decreases to less than 350 cells/mm3.
D Defer antiretroviral therapy until the patient's CD4 count decreases to less than 200 cells/mm3 or the patient develops HIV-related clinical symptoms.