HIV
CME credit can be obtained if questions are completed through the following link: https://www.eeds.com/em/3944
This question module contains 5 questions related to HIV therapeutics.
20%
1 / 5
A 45 y/o male is admitted for unstable angina. He is treated with 3 coronary artery stents. His HIV ELISA is positive, CD4 count is 100, and viral load is 250K. If you were to prescribe a protease inhibitor, which would be most likely to be beneficial?
Explanation : Answer: B – Virtually all of the PIs have been associated with possible increased risk of CV events. This is not true of Atazanavir
40%
2 / 5
Which HAART regimen would be optimal for the above patient?
Explanation : Answer: C – Because of higher rate of virologic failure, patients with CD4 counts less than 200 and viral loads greater than 100K should not be started initially on Rilpivirine based regimens or boosted Darunavir with Raltegravir.
60%
3 / 5
The patient’s wife is tested and found to be HIV positive. She is 8 months pregnant. Her CD4 count is 340 and viral load is 38K. Which HAART regimen below would be most appropriate?
Explanation : Answer: B – In pregnancy, preferred two-NRTI regimens include TDF/FTC and TDF/3TC. ABC/3TC is acceptable but only after verifying that the patient is HLA-B5701 negative. In pregnancy, darunavir and lopinavir must be given twice daily.
80%
4 / 5
A 23 y/o man is diagnosed with HIV. He is taking a one-pill combination of dolutegravir, abacavir and lamivudine. He had CD4 of 230 at time of diagnosis and HIV viral load of 750,000. At 6 months of follow up, his viral load is suppressed and CD4 is 380. His misses 2 appointments out of 4 in the next year. His most recent CD4 is 320 but his viral load is 2800. You send a genotype. Which of the following mutations would predict reduced effectiveness of dolutegravir?
Explanation : Answer: C. Y143C mutation in presence of 148 codon mutation
The mutations Y143C and N155H lead to resistance to Raltegravir and Elvitegravir. Dolutegravir maintains activity when integrase inhibitor mutations Y143C and N155H are present. However, if a 148 codon mutation is also present with Y143C and N155H, dolutegravir will have reduced effectiveness. The M50I mutation results in reduced effectiveness of bictegravir.
100%
5 / 5
The patient in question 4 has the mutation pattern conferring reduced susceptibility to dolutegravir as well as bictegravir. Which of the following is true?
Explanation : Answer C. The patient can take dolutegravir twice daily to improve effectiveness
Patients with predicted reduced susceptibility to dolutegravir based on genotype may still achieve virologic control of HIV replication when dolutegravir is dosed twice daily. There are no specific recommendations for bictegravir, although it also has a very high barrier to resistance. It may be reasonable to switch to bictegravir, but that was not an option provided in the question. No specific recommendations exist for adding darunavir or ibalazimub, although these may be added in some clinical situations. With board-type questions, there are very few absolutes—i.e. “must”; “cannot”; “should”, etc.
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