Case: Ms Y

Ms Y is a 54-year-old woman originally from Guinea-Bissau who moved to Cape Verde as a teenager to escape civil war. She lived and worked as a phlebotomist in Cape Verde until she fell ill with unremitting fevers, fatigue, and arthralgia. She moved to the United States to seek care. She was tested using an HIV-1/2 antigen/antibody immunoassay and the result was positive.

Clinical Decision Point A

Which test(s) should be performed next?

The results of the patient’s HIV-1/2 differentiation assay are positive for HIV-2 antibodies. Her HIV-2 RNA level is 2420 copies/mL and her CD4+ cell count is 290/µL. She reports experiencing weight loss, and it is discovered on examination that she has thrush. A thorough review of systems and the remainder of the examination are otherwise unrevealing. Routine baseline testing, including blood chemistry panels, renal and liver function tests, and a complete blood cell count, yields normal results.

Clinical Decision Point B

What is the best next step for this patient?

Clinical Decision Point C

Which initial antiretroviral regimen is appropriate for this patient? For this question, “tenofovir” refers to either tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF).

Decision Point D

The patient is treated with tenofovir, emtricitabine, and ritonavir-boosted darunavir. How should she be monitored while she is taking therapy?