Tim, a 25-year-old man, presents to you with a positive screening test for HIV discovered during a routine pre-employment

health check. He is single, works as an air steward. He denies any history of blood transfusion and intravenous drug use. He admits to having unprotected sex with multiple sexual partners. He denies ever having any symptoms suggestive of acute HIV infection. Question1 Marks: 1 Which of the following is the most likely mode of transmission of HIV infection in this patient? Choose one answer.

a. Contact with an infected persons blood b. From mother to child c. Intravenous drug use d. Unprotected sexual intercourse with an infected person e. Use of infected blood products
Correct

Marks for this submission: 1/1.

Question2 Marks: 1 What is the next step to confirm the diagnosis? Choose one answer.

a. Confirmation is unnecessary as screening test is highly specific and sensitive b. Perform a Western Blot test c. Perform a Combo ELISA and p24 test d. Perform a CD4 cell count e. Perform a HIV viral load
Correct

Marks for this submission: 1/1.

Question3 Marks: 1

Which of the following is not a presentation of acute HIV seroconversion? Choose one answer.

a. Fever b. Flu-like illness c. Jaundice d. Lymphadenopathy e. Rash

Correct

Marks for this submission: 1/1.

Tim left after receiving appropriate counselling regarding his condition and blood were drawn for some baseline investigations. He returns after 3 weeks for review. His Western Blot test result was reactive, CD4 cell count is 560 cells/mm3 and the viral load is 273,600 copies/uL. He says he feels well. Physical examination was unremarkable. Question4 Marks: 1 Which of the following components is not part of the counselling of a newly diagnosed HIV-infected person? Choose one answer.

a. Basic information about HIV infection and associated diseases b. Coping with HIV test results c. Methods of safe sex including condom use d. Need to tell the HIV status of the person to key persons in his life e. The cost of therapy
Correct

Marks for this submission: 1/1.

Question5 Marks: 1 Which of the following is NOT part of the routine investigations of a newly diagnosed HIV infection?

Choose one answer.

a. Hepatitis B antigen b. Hepatitis C antibody c. Serum Cryptococcal antigen d. Sputum for Pneumocystis jiroveci e. VDRL/TPHA
Sputum for Pneumocystis jiroveci is unnecessary in the absence of clinical suspicion. Incorrect

Marks for this submission: 0/1.

Question6 Marks: 1 According to the WHO staging for HIV infections, into which clinical category does this patient fall under? Choose one answer.

a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 This patient is categorized under Stage 1 of the WHO staging for HIV infection (revised 2007) which corresponds category A of the U.S. Centre for Disease Control and Prevention (CDC) as he is asymptomatic and his CD4 cell count is above 500 cells/mm3. Click here to learn more about the WHO and CDC staging of HIV.
Incorrect

Marks for this submission: 0/1.

Question7 Marks: 1 According to the WHO guidelines for initiation of antiretroviral therapy (ART) 2010 for adults and adolescents, at what CD4 cell count level should Highly Active Antiretroviral Therapy (HAART) be offered for this patient?

Choose one answer.

a. 500 or less b. more than 500 c. 350 or less d. less than 250 e. less than 200
Correct

Marks for this submission: 1/1.

Tim subsequently failed to return for review, only to present 5 years later complaining of 2 weeks history of fever, cough and progressive shortness of breath. He has lost significant weight since you last saw him. On examination, his temperature is 38oC, BP 110/60 mmHg, Pulse 110/min, SPO2 84% on room air and respiratory rate is 26/min. There is oral thrush and auscultation of the lungs reveals scattered crepitations. A chest radiograph shows bilateral hilar haziness extending outwards to the peripheral lung field.
Question8 Marks: 1 What is the most likely diagnosis? Choose one answer.

a. Community acquired pneumonia b. Kaposi sarcoma of the lung c. Mycobacterium avium complex pneumonia d. Pneumocystis carinii pneumonia e. Pulmonary tuberculosis
Correct

Marks for this submission: 1/1. Tim was diagnosed with PCP and was administered Co-trimoxazole (Bactrim) for 3 weeks. The oral thrush was successfully treated with Syrup Nystatin, an oral antifungal gargle. He recovered uneventfully from the infection. His CD4 cell count is 164 cells/mm3 and the HIV viral load is 200,684 copies/uL. After pre-HAART initiation counselling, Tim is willing to be start on HAART.

Question9 Marks: 1 According to the WHO staging for HIV infections, into which clinical category does Tim now fall under? Choose one answer.

a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4

The patient now falls into Stage 4 of the WHO classification as he presents with PCP which is an AIDS-defining illness. This corresponds to Category C3 of the CDC classification as his CD4 count is < 200 cells/mm3 and he has an AIDS-defining condition.

Click here to learn more about the WHO and CDC staging of HIV. Click here to learn more about AIDS-defining illnesses:
Incorrect

Marks for this submission: 0/1.

Question10 Marks: 1 What measure can be taken to prevent future PCP infection in this patient? Choose one answer.

a. Ensure hygienic home environment b. Prophylaxis with Co-trimoxazole (Bactrim) c. Recommend exercise and chest physiotherapy d. Vaccination with pneumococcal vaccine e. Vaccination of influenza vaccine Prophylaxis against PCP is recommended for all HIV-infected persons with CD4 cell count of less than 200 cells/mm3. The usual and most effective agent is Co-trimoxazole. Other alternatives such as Dapsone, Atovaquone and Pentamidine can be used when Co-trimoxazole is contraindicated.

Click here to learn more about PCP prophylaxis.

Incorrect

Marks for this submission: 0/1.

Question11 Marks: 1 Which of the following classes of drugs is not part of Highly Active Antiretroviral Therapy (HAART)? Choose one answer.

a. Entry inhibitors b. Exit inhibitors c. Non-nucleoside reverse transcriptase inhibitors (NNRTI) d. Nucleoside and nucleotide reverse transcriptase inhibitors (NRTI) e. Protease inhibitors
Correct

Marks for this submission: 1/1.

Question12 Marks: 1 Which of the following is NOT a part of pre-HAART counselling? Choose one answer.

a. Adherence is the key to successful therapy b. Emphasis that HAART is not a cure c. HAART does not prevent transmission of HIV d. HAART has benefits, risks and side effects e. Treatment of opportunistic infections Click here to download a Word document by the Family Health International 2004 to learn more about the various issues in pre-HAART counselling:
Incorrect

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Question13 Marks: 1 Which of the following investigations are performed to monitor HIV-infected patients on HAART? Choose one answer.

a. CD4 cell count to look for increasing trend b. FBC to look for anemia caused by HAART c. HIV viral load to look for successful viral suppression d. Liver function test to look for evidence of hepatitis due to HAART e. All of these
Correct

Marks for this submission: 1/1.

Question14 Marks: 1 Which of the following is the single most important factor in ensuring successful viral suppression in HIV-infected patients on HAART? Choose one answer.

a. Adherence b. Combination drugs taken once daily c. Education level d. Socio-economic stability e. Supportive peers
Correct

Marks for this submission: 1/1. Tim, who has been on HAART for the last 6 months presents for his scheduled review. He is well and claim to be adherent to his medications. His CD4 cell count is 350 cells/mm3 and the viral load is < 20 copies/uL. He has gained 5 kg in weight since initiating HAART and is very pleased with is progress. In 2011, the WHO released a guideline recommending intensified screening for tuberculosis and preventive therapy for HIV-infected patients.

Question15 Marks: 1 Which of the following symptoms is not part of the algorithm for screening for tuberculosis? Choose one answer.

a. Current cough b. Fever c. Hemoptysis d. Loss of weight e. Night sweats

Click here to read and download the WHO guideline for intensified screening for tuberculosis and isoniazid preventive therapy for HIV infected patients in resourceconstrained settings: Incorrect

Marks for this submission: 0/1.

Question16 Marks: 1 Which of the following drugs is used for preventive therapy against tuberculosis recommended by the WHO guideline? Choose one answer.

a. Ethambutol b. Isoniazid c. Pyrazinamide d. Rifampicin e. Rifabutin

Correct

Marks for this submission: 1/1.

Question17 Marks: 1 What is duration of preventive therapy against tuberculosis recommended by the WHO guideline?

Choose one answer.

a. 3 months b. 4 months c. 6 months d. 9 months e. 12 months

Click here to read and download the WHO guideline for intensified screening for tuberculosis and isoniazid preventive therapy for HIV infected patients in resourceconstrained settings: Incorrect

Marks for this submission: 0/1.

18 Marks: 1 Which of the following vaccines is NOT recommended for Tim? Choose one answer.

a. Hepatitis A vaccine b. Hepatitis B vaccine c. Influenza vaccine d. Oral Polio Vaccine e. Tetanus toxoid Oral polio vaccine, which is a live attenuated vaccine, is not recommended in patients with HIV infection because of increased risk of paralytic polio. Instead, the inactivated polio vaccine should be used. Click here to read more about vaccination in HIV-infected patients. Click here to download the PDF document on recommended immunisations for HIV infected adults.
Incorrect

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