Pyrexia of undetermined origin in the era of HAART

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Abstract
In the past the patient had had hepatitis A in 1990 and was first found to be HIV-1 antibody positive in April 1999, at which time the CD4+ T lymphocyte count was 220 cells ×106/l and HIV viral load was 421 400 copies/ml (Chiron quantiplex b DNA assay v 3.0). An STD screen was negative and he was hepatitis B immune. At the time of diagnosis of HIV infection he had declined HAART as he was asymptomatic but had started co-trimoxazole as primary prophylaxis against Pneumocystis carinii pneumonia. He was subsequently monitored in the outpatient clinic on a regular basis. In late 1999 his CD4+ T lymphocyte count began to fall. By early February 2000 it was 70 cells ×106/l and the HIV viral load was 308 900 copies/ml. The patient began zidovudine 250 mg twice daily, lamivudine 150 mg twice daily, and efavirenz 600 mg at night, 10 days before admission to hospital.