For initiation of HAART, following is generally evaluated
Correct Answer: All of the above
Description: (D) All of the above > The indication for antiretroviral therapy is based on the clinical assessment, CD4+ T-cell count, and viral load. These three important factors determine whether therapy should be started or if it can still be deferred, starting therapy in asymptomatic patients> Below 200 CD4+ T-cells/pl treatment should be started as soon as possible.> "As soon as possible" does not mean "immediately": one should still take the time to get acquainted with the patient, give proper counseling, start prophylaxis in advance, and undergo diagnostic procedures (fundoscopy) - it's not usually a question of having to start within a few days!> Above 200 CD4+ T-cells/pl, there is even more time - the individual course of the CD4+ T-cell count is important. Beware the percentage values!> A decrease of more than 80-100 CD4+ T-cells/pl per year is too much! Don't delay too long in such patients!> Because of considerable variability a single CD4+ T-cell count (especially when in the range of 200-350/pl) should be repeated before starting therapy.> Above 350 CD4+ T-cells/pl: wait, but continue to monitor at least every three months.> The higher the viral load, the more frequent checks ofCD4+ T-cell counts are necessary: > 100,000 copies/ml, testing should be performed at least every two months.> Initiation of treatment may be justified at levels above 350 CD4+ T-cells/pl - if viral load is very high, CD4+ T-cell count is decreasing rapidly or the patient requests it (after careful counseling).> A 25 year-old patient with 100 CD4+ T-cells/pl and a viral load of 100,000 copies/ml has a risk of approximately 10 % for developing AIDS within six months - for a 55 year-old, this level of risk is reached at 150 CD4+ T-cells/pl and a viral load of 30,000 copies/ ml
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