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November 2000

Case of the Month: Alex is a 12-year-old, perinatally infected with HIV. He was diagnosed with HIV at the age of three years. On his last visit to clinic, Alex’s plasma HIV RNA concentration (viral load) had increased from undetectable to 20,000 copies/mL (<1.4 to 4.3 log copies/mL). His CD4+ lymphocyte count had decreased from 612/uL (27%) to 480/uL (22%). When Alex was first diagnosed with HIV, he was given ddI monotherapy. At age five, Alex’s therapy was changed to AZT plus 3TC. At age nine, indinavir was added to Alex’s regimen. Alex and his family always have been adherent with appointments and medical treatments, and his mother insists that she has continued to monitor his medications closely. After repeating the viral load and CD4+ lymphocyte count, and determining that these changes are not transient, what would be your next step?

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