Is That “One Pill” Treatment Enough?

A 61-year-old woman is seen to discuss antiretroviral options. She acquired HIV infection from her husband (who has since died of AIDS) in the early 1990s, if not before. In 1996, with a CD4 count of 550 cells/mm³ and a viral load of 43,000 copies/mL, she started d4T and 3TC. She tolerated the drugs well but experienced mild thinning of the face and extremities. She continued on the regimen until 2002, when it became clear, in retrospect, that she did not meet current criteria for starting therapy. At the time of treatment cessation, she had a viral load of 5000 copies/mL and a CD4 count of 680 cells/mm³; a resistance genotype showed the M184V mutation.

Since this patient stopped treatment, the mild thinning she experienced on therapy has im…