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Updated September 16, 2011

Case 4: Antiretroviral Therapy for Acute (Primary) HIV

Author: David H. Spach, MD

A 22-year-old man presents with a 3-day history of a mononucleosis-like illness that began 9 days after a high-risk sexual exposure with an HIV-infected contact. Laboratory studies subsequently show a negative HIV antibody ELISA test and a HIV RNA level of 868,000 copies/ml. Further testing shows a CD4 cell count of 568 cells/mm3. This newly infected individual receives extensive counseling regarding his new diagnosis of HIV and, in the process of this discussion, the patient asks whether he should now start treatment for his HIV disease.

Which of the following statements is TRUE regarding antiretroviral therapy for acute (primary) HIV infection?

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.
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).