A 58-year-old cisgender man is seen in follow-up. He has inconsistently taken antiretroviral therapy for the past 2 years, with HIV RNA levels ranging from 1,200 to 34,000 copies/mL. He is started on once-daily trimethoprim-sulfamethoxazole for Pneumocystis pneumonia prophylaxis. One week later, laboratory studies performed at the prior visit show a CD4 count of 28 cells/mm³ and plasma HIV RNA of 26,000 copies/mL. His current antiretroviral regimen is tenofovir alafenamide-emtricitabine plus dolutegravir plus darunavir-cobicistat. Based on his inability to maintain adherence with antiretroviral medications and achieve virologic suppression, the decision is made to start prophylaxis for disseminated Mycobacterium avium complex (MAC) disease. He is currently afebrile and has no systemic symptoms.