when should antiretroviral therapy be initiated in an asymptomatic HIV-infected individual?
This is new.
The latest edition of the DHHS guidelines, published in February 2001, proposes that treatment should be delayed until the CD4+ cell count is less than 350 cells/mm3 or viral load is greater than 55,000 (by reverse transcriptase-polymerase chain reaction [RT-PCR]) or 30,000 copies/mL (by branched DNA).
Sources:www.medscape.com and https://hivatis.org
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A 64-year-old white man comes to the clinic
because of chest pain for the past 2 months. He has had intermittent episodes
of substernal pain that occur at various times of the day and last 5 to 10
minutes. Physical examination is normal as is an
electrocardiogram. The next step in evaluating his symptoms should be to order
(A) chest x-ray film
(C) exercise stress test
(D) upper gastrointestinal endoscopy
(E) 24-hour monitoring of cardiac rhythm
This question is from usmle booklet.
An exercise stress test is a valuable diagnostic and screening procedure primarily used to detect coronary artery disease. Exercise may induce ischemia (inadequate supply of blood) due to coronary artery disease that is not present at rest. It is usually done for one of the following reasons:
* to screen for the presence of undiagnosed coronary heart disease, especially in individuals with one or more unfavorable coronary risk factors (cigarette smoking, hypertension, elevated cholesterol, family history of coronary heart disease at a young age, or diabetes), or in an individual with other known atherosclerotic impairments
* to evaluate an individual with chest pain
An 18-year-old woman comes to the clinic because
she has missed two menstrual periods. She says she has not been sexually
active. The pelvic examination is difficult because she is tense and complains
of pain throughout the examination. The most appropriate next step is to
(A) arrange pelvic ultrasonography
(B) do urine pregnancy test
(C) determine serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) concentrations
(D) prescribe medroxyprogesterone, 10 mg orally every day for 10 days
(E) reassure her that this is normal for her age, but she should return in 3 months if her periods do not resume
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