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

You answered:

C Discontinue antiretroviral therapy, since it appears the patient has not had a good CD4 cell count recovery.

This answer is incorrect. Although the patient has not had a good immunologic response, her CD4 cell counts are significantly higher than they were before she started antiretroviral therapy. Maintaining long-term virologic control provides clinical benefit in this setting, independent of the CD4 cell count response.

A Give subcutaneous interleukin-2 twice daily for 5 consecutive days every 8 weeks until the CD4 count is greater than 200 cells/mm3.
B Switch the atazanavir plus ritonavir to lopinavir-ritonavir (Kaletra).
D Continue the current antiretroviral regimen and Pneumocystis prophylaxis, but discontinue azithromycin.

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