A 40-Year-Old Man Comes to the Office with Concern of HIV

question 168

Multiple Choice

A 40-year-old man comes to the office with concern of HIV infection.  The patient had unprotected anal intercourse with a new partner during a business trip a month ago.  A few days after the encounter, the patient learned that the partner was HIV positive.  The patient immediately visited an urgent care clinic and was tested for HIV using a combination p24 antigen/HIV-antibody immunoassay.  Although the test was negative and he has no symptoms, the patient feels anxious about the possibility of infection.  He has no prior medical problems and takes no medication.  The patient drinks alcohol on social occasions but does not use tobacco or illicit drugs.  Temperature is 37.1 C (98.8 F) , blood pressure is 130/70 mm Hg, and pulse is 80/min.  No oropharyngeal erythema, exudate, or ulcers are present.  Lung auscultation is unremarkable and heart sounds are normal.  The abdomen is soft and nontender with no organomegaly.  Bowel sounds are normal.  No anal ulcers are present and genital examination is normal. Repeat testing for HIV antigen and antibody is positive.  The patient's CD4+ count is 320/mm³ and serum HIV RNA (viral load) is 500,000 copies/mL.  The risks and benefits of antiretroviral therapy are discussed, and the decision is made to initiate treatment.  In addition to genotypic drug-resistance testing, what additional laboratory test should be obtained before initiating antiretroviral therapy?

• A)Beta-D-glucan level
• B)Cytomegalovirus PCR
• C)Echocardiogram
• D)Hepatitis B serology
• E)Thyroid function studies

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Definitions:

Centers for Disease Control and Prevention (CDC)

A national public health institute in the United States, dedicated to protecting health and promoting quality of life through the prevention and control of disease, injury, and disability.

Splenectomy

A surgical procedure involving the removal of the spleen, which may be necessary due to conditions like trauma, blood disorders, or cancer.

Immune Function

The series of processes within an organism that protects against disease by identifying and killing pathogens and tumor cells.

Inflammatory Response

The body's defense mechanism against infection or injury involving redness, heat, swelling, and pain.