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
Filed under: USMLE Test Prep |
Archer USMLE Step 3 Blog 
b:
Start rx if CD4 50,000
B: Start rx if: CD4 50,000
start rx if CD less than 350 or Viral load more than 50,000