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After completing this case study, the reader should be able to:

  • Describe when antiretroviral therapy should be initiated in patients living with HIV.

  • List the treatment goals of antiretroviral therapy.

  • Design an appropriate antiretroviral regimen for an antiretroviral-naïve person living with HIV based on patient-specific data.

  • Provide patient education on recommended antiretroviral agents to ensure adherence and minimize adverse effects.


Chief Complaint

“I am here for regular care. It hurts to swallow.”


Jenny Baird is a 34-year-old woman diagnosed with HIV infection 2 years ago during a routine exam. She was asymptomatic at the time of diagnosis. She is currently antiretroviral therapy (ART) naïve, and since her diagnosis she has been following up regularly every 6 months. However, up to this point, she has not been ready to commit to ART. Today she returns to the HIV Specialty Clinic for a follow-up visit and reports painful and difficult swallowing over the past 2–3 weeks.


HIV positive, diagnosed 2 years ago; risk factor heterosexual contact






History of crack cocaine use, last use 1 month ago; smokes marijuana once per month, mainly as an appetite enhancer; cigarette smoking, 0.5 ppd; EtOH, one to two drinks on weekends; unemployed, lives with partner; sexually active with stable partner, 100% condom use; partner is HIV (–) and is aware of her HIV status


Multivitamin with minerals one tablet PO once daily

Albuterol HFA two puffs Q 6 H PRN SOB

Calcium carbonate antacid one to two tablets PRN heartburn

Oral contraceptive one tablet PO daily


TMP/SMX (rash)


Difficulty and pain on swallowing

Physical Examination


Thin, well-developed black woman in NAD, alert and oriented × 3


BP 110/64 mm Hg, P 80 bpm, RR 18, T 35.9°C; Wt 58 kg, Ht 5′5″


Anicteric, has large tattoo on back, no other skin lesions noted


(+) Oral lesions and white plaques, sinuses nontender, PERRLA, ears and nose clear

Neck/Lymph Nodes

Supple, no thyromegaly, (+) ...

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