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Author: Laura Kogelman, M.D.

A 46y/o man is referred to your clinic for advice on management of his HIV infection. He was diagnosed HIV positive in 1992.

His CD4 count 25 cells/mm3 and his plasma HIV-1 viral load is 100,000 copies/mL

  • Does this man have AIDS?
  • What opportunistic events can occur in individuals with < 50 CD4 cells/mm3

He is taking a protease inhibitor (indinavir) and two NRTIs, 3TC and d4T. He has previously tried many antiHIV medications and has taken drugs from each of the available classes of HIV medications.

  • What are the classes of approved HIV medications?

He says that over the years he has tried to take his medications fairly regularly but he often misses doses. He states that he has only taken 70-80% of the prescribed doses of his antivirals.

  • How might antiviral adherence impact treatment of HIV disease?

He says has never had a viral load that has been ‘undetectable’.

  • Why might it be important to know that his viral load has never been undetectable?

Although he continues to work he states that he has lost approximately 20lbs in the last 6 months.

  • Is recent accelerated weight loss of concern?

A sample of blood is taken to test for HIV drug resistance. This test shows high level resistance to all available antivirals. He is not eligible for trials of unapproved antivirals and is reluctant to change his current HIV medications.

  • What might it be important of knowing that the virus is drug resistant?

The patient returns four weeks later with difficulty swallowing and weakness in his left leg. An brain magnetic resonance imaging (MRI) study shows patches of demyelination. He is diagnosed with Progressive Multifocal Leukoencephalopathy. Over the next 4 weeks he experiences rapid progression of his neurologic deficit, becoming unable to eat, drink or get out of bed. He requires 24 hour nursing and tube feedings. He develops a severe aspiration pneumonia and expires two weeks later.

  • Is the number of deaths from AIDS continuing to decrease?