A 25-Year-Old Woman at 10 Weeks Gestation Comes to the Office

question 871

Multiple Choice

A 25-year-old woman at 10 weeks gestation comes to the office for a consultation regarding a positive HIV-1 enzyme-linked immunosorbent assay and a confirmatory Western blot that were ordered as part of routine prenatal care.  She has never been tested before and does not know when she was exposed to HIV.  She has no other chronic medical conditions and has had no prior surgeries.  The patient takes a daily prenatal vitamin but no other medication.  She does not use tobacco or illicit drugs.  The patient is a college student and lives with her boyfriend.
Physical examination is within normal limits.  A complete blood count, basic metabolic panel, lipid panel, and hepatic function panel are all normal.  HIV viral load is 3,240 copies/mL and CD4 count is 473 cells/mm³.
Which of the following is the best next step in management of this patient?

• A)Initiate therapy at delivery
• B)Initiate therapy if CD4 count is <350 cells/mm³
• C)Initiate therapy if viral load is >100,000 copies/mL
• D)Initiate therapy immediately
• E)Initiate therapy in the third trimester

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