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Case 5: Discordant CD4 Cell Count and Viral Load Responses to Antiretroviral Therapy

You answered:

B Switch the atazanavir plus ritonavir to lopinavir-ritonavir (Kaletra).

This answer is incorrect. The patient has achieved an excellent and sustained virologic response with a regimen that she has tolerated well. There are no data suggesting that switching the protease inhibitor component of this regimen would substantially increase the patient’s CD4 cell count.

Choose another answer:

A Give subcutaneous interleukin-2 twice daily for 5 consecutive days every 8 weeks until the CD4 count is greater than 200 cells/mm3.
C Discontinue antiretroviral therapy, since it appears the patient has not had a good CD4 cell count recovery.
D Continue the current antiretroviral regimen and Pneumocystis prophylaxis, but discontinue azithromycin.

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