HIV

Question 1

What prophylaxis should be given on an HIV patient with a CD4 count<200?

Answer 1

Cotrimoxazole for Pneumocystis jirovecii

Question 2

At what CD4 count level should the cryptococcal antigen test be tested and what should be done if positive?

Answer 2

CD4 <200: If positive lumbar puncture should be done

Question 3

List 7 investigations that should be done at diagnosis of HIV

Answer 3

Sputum: TB NAAT
Urine: Dipstix and pregnancy test
Bloods: CD4 count, creatinine and if CD4<200 Cryptococcal antigen
Cervical screening with a PAP smear

Question 4

How frequently should cervical smear be done in HIV patients?

Answer 4

Every 3 years

Question 5

Who should get routine TB NAAT while asymptomatic?(5)

Answer 5

HIV patients yearly
People who had TB in the last 2 years yearly for 2 years
Pregnant woman at first antenatal visits
Abnormal TB screening CXR even if there is no known exposure
When excluding TB disease during the TB preventative therapy work up

Question 6

Which investigations should be done if a patient is on TLD?

Answer 6

Tenofovir: Creatinine at 1 month of regimen, 4 months of regimen and yearly
Lamivudine: Nothing as it has no side effects
Dolutegravir: Nothing as it only have self limiting side effects and no long term effects

Question 7

What is the adverse effect of tenofovir?

Answer 7

Kidney failure

Question 8

What is the adverse effect of lamivudine?

Answer 8

Uncommon

Question 9

What is the adverse effect of dolutegravir?

Answer 9

Uncommon too

Question 10

What is the adverse effect of zidovudine?

Answer 10

Symptomatic anemia and neutropenia

Question 11

What is the most important adverse effect of abacavir?

Answer 11

Allergic hypersensitivity reaction

Question 12

What is the long term effect of . zidovudine?

Answer 12

Lipoatrophy(fat loss)in the face, limbs and buttocks

When it happens switch to another drug

Question 13

What is the long term effect of efavirenz?

Answer 13

Gynaecomastia

Switch to Dolutegravir

Question 14

What are the short term side effects of dolutegravir?

Answer 14

Headaches, nausea and diarrhoea and insomnia

Question 15

Why must a dolutegravir drug be taken in the morning?

Answer 15

To reduce the likelihood of having insomnia

Question 16

What is the adverse effect of protease inhibitors?

Answer 16

Liver injury

Check ALT and review within 24 hours if symptoms occur

Question 17

What is the long term complication of lopinavir/ritonavir?

Answer 17

Dyslipidemia ( Total chol>6 and trigs>5)

Question 18

Name two HIV drugs that lead to diarrhoea.

Answer 18

Dolutegravir
Lopinavir/ritonavir(Switch drug if intolerable and last>6 weeks)

Question 20

Name two HIV drugs that lead to sleep problems.

Answer 20

Efavirenz and dolutegravir

Question 21

Contraindications of lopinavir ritonavir (3)

Answer 21

Chronic diarrhoea
CVD risk>20%
High total cholesterol and triglycerides

Question 22

What is the contraindication of tenofovir?

Answer 22

Kidney disease with eGFR<=50 (creatinine>85 for pregnant patients)

Question 23

Contraindications of zidovudine (3)

Answer 23

On linezolid
Anemia with Hb<8
Neutrophils<=1

Question 24

Which investigation should be done routinely if on zidovudine?

Answer 24

FBC and differential count

Question 25

Which investigation should be done routinely if on lopinavir ritonavir

Answer 25

Total cholesterol and triglycerides

Question 26

What should be done if ALT>=200 on an HIV patient using TLD?

Answer 26

Stop all medications and refer

Question 29

When to give HIV patients TB preventative therapy?(3)

Answer 29

If they never had one or if they were in contact with someone with TB.

Question 30

Contraindications of TB preventative therapy(4)

Answer 30

Previous RR TB, liver disease and alcohol abuse/misuse and neuropathy

Question 31

What is TB preventative therapy?

Answer 31

Isoniazid/rifapentine(3 HP) with pyridoxine(B6) for 3 months(used when VL<50) Or Isoniazid for 12 months with B6(used VL>50)

Question 32

Can Prednisone be used for rifampicin resistant TB?

Answer 32

Nope only used in DS TB with improving symptoms and CD4<100 Stop at 4 weeks

Question 33

When should ART be started on a patient with known TB meningitis or brain tuberculoma?

Answer 33

After 4-8 weeks of TB treatment

Question 34

When should you start ART if the patient is known with pulmonary TB?

Answer 34

Start ART after 8 weeks of TB treatment

Question 35

When should ART be started if a patient has TB and CD4<50?

Answer 35

DS-TB: Within 2 weeks of TB treatment RR-TB: After 2 weeks of TB treatment Pregnant/breastfeeding: within 2 weeks of starting TB treatment

Question 36

When should ART be started in a patient known with Cryptococcal meningitis?

Answer 36

After 4-6 weeks of meningitis treatment

Question 37

What is meant by virological failure?

Answer 37

When a patient is on TLD and adherent but the viral load is>=1000 for at least 2 times after starting TLD and has been using it for >2 years

Question 39

What are two adverse side effects of tenofovir disoproxil fumarate

Answer 39

Bone demineralisation and hypochloremic metabolic acidosis(RTA)