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HIV AIDS Clinical Care Treatment

Antiretroviral Therapy

1. ART with virologic suppression appears to:

A. Reduce immune activation and protect against many morbidities.

B. Restore immune system function to normal.

C. Fully reverse disease processes.

D. All of the above.


2. The failure of an ARV regimen when accompanied by drug resistance may mean that subsequent regimens are less likely to succeed, despite the availability of second-line ARV combinations.

A. True

B. False


3. ART does not reduce the risk of transmission of HIV between serodiscordant heterosexual partners.

A. True

B. False


4. Regardless of CD4 count, ART is strongly recommended for persons with which of the following conditions?

A. Pregnancy

B. HIVAN

C. Acute HIV infection

D. All of the above


5. A genotype should be performed as early in the course of infection as possible for all patients before initiating ART because mutations may revert to wild-type.

A. True

B. False


6. Successful approaches to supporting patients’ adherence to the ART regimen include which of the following?

A. Extensive patient education.

B. Telephone contact with office staff members who can answer questions about adverse effects or other difficulties.

C. Peer support.

D. All of the above.


7. The HIV RNA level and creatinine clearance (CrCl) should be reviewed if which of the following medications is being considered?

A. Abacavir

B. Maraviroc

C. Rilpivirine

D. All of the above


8. For initial therapy in patients with wild-type HIV virus, the HHS Guidelines recommend the use of two nucleoside reverse transcriptase inhibitors in combination with which of the following?

A. A nonnucleoside reverse transcriptase inhibitor

B. A ritonavir-boosted protease inhibitor

C. An integrase inhibitor

D. Any of the above


9. Ritonavir is used at low doses in combination with most other PIs to enhance or “boost” the serum level and prolong the half-life of the PI.

A. True

B. False


10. Due to the potential for development of resistance, ARV medications should only be given as single agents.

A. True

B. False


11. Patients who start a new ARV regimen should ideally be seen how many times within the first month to allow for an assessment of their adherence to therapy and the tolerability and adverse effects of the regimen?

A. At least once

B. At least twice

C. At least three times

D. At least four times


12. New or recurrent symptoms of opportunistic illness occurring in the first weeks to months after starting ART reflects a failure of ART.

A. True

B. False


13. Inadequate adherence to ART is a common reason for regimen failure.

A. True

B. False


14. Although ART sometimes causes immune reconstitution inflammatory syndromes if initiated in the setting of acute opportunistic infections, clinical data suggest improved outcomes, including better survival, if ART is started early, with the exception of which of the following?

A. Pneumocystis jiroveci pneumonia

B. Tuberculosis

C. Cryptococcal meningitis

D. All of the above


15. Making the decision to start ART is rarely an emergency situation.

A. True

B. False


16. If ARVs must be discontinued, it is usually best to gradually taper off, rather than stopping all ARVs at once.

A. True

B. False


Reducing Perinatal HIV Transmission

17. Antiretroviral therapy is highly effective in reducing the risk of perinatal transmission of HIV to as low as:

A. Less than 1%

B. 16%

C. 25%

D. 50%


18. Recent studies have shown that ART given to the nursing mother and/or her infant eliminates the risk of HIV transmission to the infant through breast feeding.

A. True

B. False


19. Women at risk of HIV infection should be referred for more extensive counseling because some research indicates that pregnancy may place them at greater risk of acquiring HIV infection, and acute HIV infection may confer greater risk of transmission to the fetus.

A. True

B. False


20. Which of the following women should receive HIV testing during labor?

A. Those who have had little or no prenatal care.

B. Those who declined previously.

C. Those whose HIV test results are not available at the time of labor.

D. All of the above.


21. Low-level cervical-vaginal HIV shedding has been found even in women on ART with undetectable plasma HIV RNA, particularly in the presence of genital infections.

A. True

B. False


22. All of the following are factors that influence the risk of perinatal transmission from mother to infant, except for:

A. The mother’s HIV RNA level (viral load).

B. Alcohol consumption.

C. Cigarette smoking.

D. Active genital herpes during labor.


23. The mode of delivery, whether vaginal or cesarean, does not influence the risk of HIV transmission.

A. True

B. False


24. In the United States, where safe, affordable replacement feeding and clean water routinely are available, women with HIV should not breast-feed.

A. True

B. False


25. NVP generally should not be started for treatment-naive women with CD4 counts of _____ because of an increased risk of symptomatic and potentially fatal hepatic and rash toxicity.

A. >450 cells/uL

B. >350 cells/uL

C. >250 cells/uL

D. >150 cells/uL


26. Efavirenz should not be used at any point during pregnancy because of concern for potential teratogenicity.

A. True

B. False


27. In addition to receiving ZDV for 6 weeks, the infant should also be given NVP at all of the following time points in the first week of life, except for:

A. At birth

B. 24 hours after the first dose

C. 48 hours after the first dose

D. 96 hours after the second dose


28. If cesarean delivery is planned for standard obstetrical indications, and the woman has a viral load of <1,000 copies/mL, it should be scheduled for _____ weeks’ gestation.

A. 40

B. 39

C. 38

D. 37


29. Because NNRTIs have shorter half-lives than other agents, if ART is being discontinued, NNRTIs should be discontinued after other ARVs, in order to avoid a period of monotherapy and the development of resistance mutations.

A. True

B. False


30. All of the following are true for HIV-exposed neonates at greater than or equal to 35 weeks’ gestation, except for:

A. They should be given ZDV syrup at a 4 mg/kg/dose PO BID.

B. They should be given ZDV syrup as soon as possible after birth, preferably within 6-12 hours.

C. They should continue to be given ZDV syrup for 12 weeks.

D. All of the above are true.


Care of HIV-Infected Pregnant Women

31. The first task in caring for an HIV-infected woman who is pregnant or considering pregnancy is to:

A. Provide counseling that will allow her to make informed reproductive choices.

B. Provide optimal ART to preserve or restore her immune system and suppress viral replication.

C. Offer interventions that decrease the risk of perinatal HIV transmission.

D. Take a careful reproductive history.


32. Because vaccinations may cause a transient increase in the HIV viral load and theoretically may increase the risk of perinatal HIV transmission, vaccination should be given after pregnant women are on ART.

A. True

B. False


33. Which of the following may be attributable to HIV-related illness rather than to pregnancy?

A. Fatigue

B. Back pain

C. Weight loss

D. All of the above


34. Which of the following inhibits the synthesis of metabolically active folic acid and thus increases the risk of folate deficiency and congenital anomalies?

A. Trimethoprim

B. Abacavir

C. Maraviroc

D. Rilpivirine


35. Women with HIV infection are more likely than HIV-uninfected women to experience outbreaks of genital herpes, and if HSV is transmitted to the infant, neonatal infection can be severe, even if it is detected and treated early.

A. True

B. False


36. Lactic acidosis is a rare but life-threatening complication that has been reported in pregnant women taking nucleoside reverse transcriptase inhibitors, particularly didanosine and stavudine.

A. True

B. False


Health Care of HIV-Infected Women Through the Life Cycle

37. Compared to HIV-uninfected women, HIV-infected women:

A. Have higher rates of intimate partner violence.

B. Have higher rates of sexual coercion.

C. Have more frequent and more severe abuse.

D. All of the above.


38. Which of the following are more common in women with HIV infection, especially among women with low CD4 counts?

A. The incidence, prevalence, and persistence of human papillomavirus.

B. Cervical, vaginal, and vulvar dysplasia.

C. Anal dysplasia.

D. All of the above.


Palliative Care and HIV

39. Which of the following is part of palliative care?

A. End-of-life care

B. Psychosocial support

C. Management of symptoms

D. All of the above


Adherence

40. Patients with suboptimal adherence are at risk for:

A. HIV progression

B. The development of drug resistance

C. Narrowing of options for future treatment

D. All of the above


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