From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.
At Medical Grand Rounds in April 1998, Dr Harvey Makadon discussed the
care of Mr K, a 41-year-old self-employed man with asymptomatic human immunodeficiency
virus (HIV) infection that was likely contracted in 1990.1
At the time of diagnosis, Mr K started taking zidovudine, 200 to 300 mg/d.
Frequent CD4 cell counts have been 500/mm3(0.50 × 109) or higher, and several measures of HIV viral load, including ultrasensitive
RNA studies, were unable to detect any virus. Fighting clinical depression
that started with his diagnosis and was exacerbated in late 1997 by his partner's
death from acquired immunodeficiency syndrome, Mr K began to drink increasing
amounts of wine and discontinued zidovudine 6 months prior to the Rounds.
Dr Makadon discussed current indications for multiple drug therapy in patients
with asymptomatic disease and suggested that even in the absence of symptoms
or increasing viral load, therapy with a combination of drugs including protease
and reverse transcriptase inhibitors may prove beneficial. He addressed the
psychosocial impact of infection and evolving models of HIV care.
Delbanco T, Hartman E. An Asymptomatic 41-Year-Old Man With HIV Infection, 1 Year Later. JAMA. 1999;282(12):1176. doi:10.1001/jama.282.12.1176