E.J. is a 27-year-old man who presents to your clinic with new complaints of fevers, night sweats, weight loss, and a white exudate in his

mouth. He states that these symptoms have been present for the past 4 to 6 weeks. On physical examination, it is concluded that E.J. has thrush

caused by Candida Albicans. E.J. admits to intravenous drug use in the past; however, he states that he has been “clean” for 3 years. HIV is

suspected and consent for an HIV test is obtained. Why is HIV suspected and how is it confirmed?
1. E.J.’s ELISA and Western Blot tests both return positive, and he is informed of his HIV status the next week at his follow-up

examination. Before making any decisions regarding therapeutic options, what additional laboratory tests should be obtained? What cautions

should be used when interpreting these values?
2. E.J.’s T-cell count and viral load measurement (two separate levels obtained within the past 2 weeks) return at 225 cells/mm3 and

145,000 copies/mL. Should antiretroviral therapy be initiated?
3. After careful discussion, E.J. agrees to initiate therapy. What should be the goals of therapy? What other factors or information needs

to be considered in selecting an appropriate regimen?
4. On questioning, E.J. states that he has had two bouts of alcohol-induced pancreatitis in the past. The last episode was approximately 1

year ago. He admits to occasional binge drinking even though he knows it is not good for him. E.J. has no known drug allergies and is currently

taking only temazepam periodically to help him sleep. He is employed as a construction worker and during the day hours is extremely busy. His

CBC, CMP, all return WNL. E.J. has no particular preferences for a specific regimen and appears highly motivated to take control of his disease.

What factors should be considered when selecting an appropriate antiretroviral regimen?
5. What initial antiretroviral regimen should E.J. receive?
6. E.J. has remained on FTC, TDF, and efavirenz for more than a year. To date, his T-cell counts have remained stable at 550 cells/mm3, and

his viral load measurements have remained below the limit of assay detection. He presents with new complaints of fevers and malaise. E.J.

reports that he has been compliant with therapy and has not started any new medications. Repeat lab tests now show E.J.’s viral load is 3,000

copies/mL and his T-cell count is 375 cells/mm3. Should E. J.’s regimen be changed?
7. What potential antiretroviral regimen(s) can be considered for E.J.?

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