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Chapter 27. Human Immunodeficiency Virus

YP is a patient recently diagnosed with human immunodeficiecy virus (HIV). The patient presents to your pharmacy to fill a prescription for Triumeq. During the counseling session, YP asks the pharmacist, when is a person living with HIV classified as having acquired immunodeficiency syndrome (AIDS)? Select all that apply.

a. Diagnosis of Pneumocystis jiroveci pneumonia

b. CD4 count of 350 μL

c. HIV viral load of >100,000 copies/mL

d. CD4 count of 150 μL

e. CD4% of 10%

Answer a is correct. P. jiroveci (formerly known as P. carinii) pneumonia is considered an AIDS-defining condition, so an HIV patient with this diagnosis would be considered to have progressed to AIDS. Other AIDS defining conditions include esophageal candidiasis, Kaposi sarcoma, and Mycobacterium avium complex.

Answers d and e are correct. A CD4 count of ≤200 μL, CD4% of <14%, or development of an AIDS-defining condition indicates an AIDS diagnosis.

Answer b is incorrect. A CD4 count of ≤200 μL or development of an AIDS-defining condition indicates an AIDS diagnosis.

Answer c is incorrect. An AIDS classification is independent of viral load.

LF is a 31-year-old male patient recently diagnosed with human immunodeficiency virus (HIV). He presents to the HIV clinic for the first time. He has no other significant medical history but has been having photophobia, fever, malaise and headaches with altered mentation, memory loss, and lethargy. Which of the laboratory results, if positive, would result in delaying the start of antiretroviral therapy (ART) due to concerns for development of immune reconstitution syndrome (IRIS)?

a. Hepatitis panel (screen for A, B, and C), gonorrhea, and syphilis screen

b. Cryptococcal antigen (CrAg)

c. Viral load and CD4 count

d. Anti-toxoplasma gondii IgG

e. HIV viral genotypic resistance test

Answer b is correct. In persons with cryptococcal meningitis or meningeal tuberculosis, immediate initiation of ART increases likelihood for development of immune reconstitution syndrome (IRIS). A short delay in initiating ART until therapy is initiated for treatment of the opportunistic infection is warranted.

Answers c and e are incorrect. HIV resistance test results, baseline viral load and CD4 count are important to be able to assess for ART efficacy but regardless of results, ART can be initiated immediately. Genotypic resistance results, viral load, and CD4 values may influence the specific regimen selection but do not alter the evidence ...

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