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Case 4: Antiretroviral Therapy for Acute (Primary) HIV

You answered:

A Fewer than 30% of persons with acute HIV infection treated with HAART will achieve an HIV RNA level less than 400 copies/ml, mainly as a result of the very high HIV RNA levels and the weak immune response at this stage.

This answer is incorrect. Although HIV RNA levels are typically very high with acute HIV infection, available data suggest that treatment of primary infection with a 3- or 4-drug combination regimen generally reduces HIV RNA levels at least as well as with treatment of chronic infection.

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B Transmission of antiretroviral-resistant HIV has been documented through sexual, parenteral, and vertical routes. Persons who acquire antiretroviral resistant HIV are more likely to have failures with antiretroviral therapy.
C More than 90% persons with acute HIV who initiate 4-drug antiretroviral therapy prior to seroconversion (and continue therapy for 24 months) will eventually maintain long-term virologic control without antiretroviral therapy.
D Antiretroviral therapy initiated within 180 days of acquiring HIV clearly provides long-term clinical benefit when compared with deferred antiretroviral therapy (given for chronic HIV when the CD4 count has deceased to less than 500 cells/mm3).

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