10-07-2006, 12:30 AM
A 37-year-old, HIV-positive man comes for evaluation of generalized weakness, diffuse muscle pain, and frequent headaches that began eight weeks after the start of new HIV medications. He has never had any symptoms from his HIV infection, and he has a CD4 of 255/μL and an HIV RNA viral load of 25,000 (by PCR). He was recently started on zidovudine, lamivudine, and ritonavir/lopinavir. His past medical history is significant for hypertension and hypercholesterolemia. His medications include simvastatin and metoprolol. His physical examination is significant for diffuse muscle tenderness of the extremities. The range of motion is decreased because of pain with movement. His potassium level is 5.4 mEq/L, serum bicarbonate is 16 mEq/L, BUN is 35 mg/dL, creatinine is 1.6 mg/dL, and his viral load is RNA 40,000. The genotyping test result is pending. What will you do while waiting for this result?
(A) Switch zidovudine and lamivudine to didanosine and stavudine, and continue ritonavir
(B) Switch zidovudine, lamivudine, and ritonavir/lopinavir to didanosine, stavudine, and indinavir, and stop simvastatin
© Continue all medications but stop simvastatin
(D) Continue zidovudine and lamivudine, and switch ritonavir/lopinavir to efavirenz
(E) Switch to didanosine, stavudine, and efavirenz, and stop simvastatin
(A) Switch zidovudine and lamivudine to didanosine and stavudine, and continue ritonavir
(B) Switch zidovudine, lamivudine, and ritonavir/lopinavir to didanosine, stavudine, and indinavir, and stop simvastatin
© Continue all medications but stop simvastatin
(D) Continue zidovudine and lamivudine, and switch ritonavir/lopinavir to efavirenz
(E) Switch to didanosine, stavudine, and efavirenz, and stop simvastatin