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Updated August 1, 2011

Case 3: Laboratory Monitoring after Initiating Antiretroviral Therapy

Author: David H. Spach, MD

A 47-year-old HIV-infected woman was recently diagnosed with HIV infection, and initial labs have shown a CD4 count of 238 cells/mm3 and HIV RNA level of 112,000 copies/ml. After several visits to the clinic and repeat laboratory studies that show similar results, she starts on an antiretroviral therapy regimen of tenofovir DF (Viread) plus lamivudine (Epivir) plus lopinavir-ritonavir (Kaletra).

According to the January 2011 DHHS antiretroviral guidelines, which of the following is TRUE regarding laboratory monitoring after starting this patient on antiretroviral therapy.

A The CD4 cell count is the most important laboratory test to obtain at 1 month after starting antiretroviral therapy.
B A follow-up HIV RNA value should first be checked 10 to 12 weeks after starting therapy.
C A follow-up HIV RNA value should first be checked 2 to 8 weeks after starting therapy.
D A decrease in the patient's baseline HIV RNA value of 112,000 copies/ml to 55,000 copies/ml 4 weeks after starting therapy would indicate an excellent early response to antiretroviral therapy.