When to initiate treatment in patients with HIV

March 21, 2018

Figure 1 Quiz of the Week

A 60-year-old man who is HIV positive presents with fever, dyspnea, and inflammatory lesions on the skin. A biopsy reveals a diagnosis of histoplasmosis. 

At what threshold should antiretroviral therapy (ART) be initiated in adults with HIV? 

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Image credit: @BiBiRamos. #AIDS15.


Answer: Any CD4 count

The WHO now recommends ART should be started at any CD4 count. Early initiation of ART can help to prevent AIDS-defining conditions such as histoplasmosis, one of the most common mycoses in patients with HIV. Spores can be present in bird and bat droppings and, if inhaled from the soil, can lead to infection. Histoplasmosis typically occurs in patients with a CD4 count less than 200 cells/mm3, producing flu-like respiratory symptoms.

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