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HIV — RACP Adult Medicine MCQ

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EasyInfectious DiseasesHIVRACP Adult Medicine

A 35-year-old man is diagnosed with HIV with a CD4 count of 180 cells/µL and viral load of 150,000 copies/mL. He has no opportunistic infections. According to Australian guidelines, when should antiretroviral therapy (ART) be commenced?

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Correct answer: A — Immediately (same day or within days)

Current Australian (ASHM) and international guidelines recommend immediate (same-day) ART initiation for all people living with HIV, regardless of CD4 count. The START and TEMPRANO trials demonstrated benefit of early ART even at high CD4 counts. Rapid ART initiation improves engagement in care and reduces transmission. OI prophylaxis (trimethoprim-sulfamethoxazole for PJP/toxoplasma at CD4 <200) should be commenced concurrently.

Reference: ASHM – 2024 – Antiretroviral Guidelines; eTG – 2025 – Antibiotic Guidelines