Case 1: 23-year-old Male Student Clinical Director, Division of Infectious Diseases Brigham and Women’s Hospital Professor of Medicine Harvard Medical School Boston, MA Paul E. Sax, MD

23-year-old Male Student 23-year-old male student newly diagnosed with HIV Tested as part of screening for an HIV vaccine study at local academic medical center Past medical history notable for 1 episode of rectal gonorrhea at age 18; otherwise negative Since entering college, has had annual HIV antibody tests, which have been negative to date Does not recall any illness consistent with acute HIV

23-year-old Male Student Takes no medications Drinks alcohol on weekends socially and uses no illicit drugs He is sexually active with other men, uses condoms irregularly, and does not know from whom he acquired HIV

23-year-old Male Student Baseline evaluation: Normal physical examination CD4 cell count = 740 HIV RNA = 4,000 A resistance genotype has K103N and no other mutations

23-year-old Male Student Question to consider: How do you decide with which patients PrEP should be discussed?

23-year-old Male Student Questions to consider: What is the urgency? What is the optimal regimen?