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Case 3: Laboratory Monitoring after Initiating Antiretroviral Therapy

You answered:

C A follow-up HIV RNA value should first be checked 2 to 8 weeks after starting therapy.

This answer is correct. According to the 2011 DHHS antiretroviral therapy guidelines, patients should have an HIV RNA value checked 2 to 8 weeks (preferably 2 to 4 weeks) after starting (or changing antiretroviral therapy. The first post-treatment HIV RNA value should indicate a substantial decrease in the HIV RNA level (at least a 1.0 log decrease compared with baseline). Repeat testing of HIV RNA levels should occur every 4 to 8 weeks until the HIV RNA has decreased to undetectable levels, then monitored every 3 to 4 months. Some experts recommend extending the monitoring interval to every 6 months in adherent patients who have maintained a suppressed HIV RNA level for at least 2 years, assuming they have a stable clinical and immunologic status. The CD4 count should be monitored every 3 months after initiating or changing therapy. In selected highly stable patients (clinically and immunologically stable, CD4 counts well above the threshold level for major opportunistic infection risk, and consistently suppressed HIV RNA levels), the CD4 count can be monitored every 6 to 12 months.


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