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Clinical Crossroads Update
September 22/29, 1999

An Asymptomatic 41-Year-Old Man With HIV Infection, 1 Year Later

Author Affiliations

From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.

JAMA. 1999;282(12):1176. doi:10.1001/jama.282.12.1176

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 Ă— 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.