112)
A 30-year-old HIV-infected man presents to your office for evaluation regarding starting of Anti-retroviral therapy. The patient’s most recent CD4 count was 460 cells/mm3 and HIV RNA level of 20,000 copies/ml. He has a history of Intravenos drug abuse. The patient was also noted to have elevated liver enzymes twice the upper limit of normal. During the work-up for his liver abnormalities, his Hepatitis C is negative but Hepatitis B surface antigen returns positive consistent with hepatitis B active infection. He has no HIV-related symptoms and has not had any AIDS-defining illnesses. The patient requests that he be started on Highly Active Anti-Retrovial therapy (HAART). Which of the following is the most appropriate indication for starting HAART in a HIV infected patient?
A) CD4 count of less than 500
B) HIV viral load greater than 50,000
C) Initiation of treatment for Hepatitis B co-infection
D) Renal Insufficiency with out proteinuria
E) All Reproductive age group HIV + women
B
Dr Red what is the answer?
B,>50,000-From Premier Review
b
bbb
HAART started when CD4 50000 by kaplan so B
cd4 less than 350 and viral load more than 50 thousand so B
ans C
cd4100k
dual infection hcv or hbv etc
ref CMDT -antiretroviral rx
The decision to initiate antiretroviral therapy can be based either on symptoms or on CD4 count.
In the US, HAART is recommended in the following: [31]
History of an AIDS-defining illness
CD4 count less than 500 cells/microlitre
All pregnant women, regardless of clinical stage, viral load, or CD4 cell count [45]
Hepatitis B infection requiring treatment
HIV nephropathy.
C. Check out US HIV/AIDS treatment guidelines :”The progression of chronic HBV to cirrhosis, end-stage liver disease, and/or hepatocellular carcinoma is more rapid in HIV-infected persons than in persons with chronic HBV alone.” Basically, if a pt has HIV and HBV and they need treatment for at least 1 of these diseases (recall HIV treatment indications), then HAART should be started.