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HIV AIDS Clinical Care Guidelines

Abnormalities of Body-Fat Distribution

1. The pathogenesis of fat abnormalities in HIV-infected individuals is not well understood, but research to date suggests that it is multifactorial and is associated with which of the following?

A. HIV-related immune depletion and immune recovery

B. ARV medications

C. Disregulation of fatty acid metabolism

D. All of the above

2. The most common morphologic changes seen in lipohypertrophy are all of the following, except:

A. A firm enlarged abdomen caused by central or visceral fat accumulation.

B. Breast enlargement in both men and women.

C. The gain of subcutaneous fat in the buttocks.

D. Development of a dorsocervical fat pad.

3. When lipohypertrophy and lipoatrophy occur together, the affected individuals show a mixed picture of abdominal obesity with thinning in the face, arms, and legs.

A. True

B. False

4. Both lipoaccumulation and lipoatrophy can be disfiguring, can damage self-image and quality of life, and can negatively influence ARV adherence.

A. True

B. False

5. Differential diagnosis of lipoatrophy includes which of the following?

A. Weight loss and wasting

B. Ascites

C. Cushing syndrom

D. All of the above

6. Treatment for lipohypertrophy and lipoatrophy have reliably reversed body shape changes once these changes have occurred.

A. True

B. False

7. Which of the following are most closely associated with lipoatrophy?

A. Stavudine

B. Didanosine

C. Zidovudine

D. All of the above

8. Tesamorelin has been shown to reduce central fat accumulation by about 18% over the course of 12 months without adverse effects on glucose or lipid parameters, and patients do not regain visceral fat when tesamorelin is discontinued.

A. True

B. False


9. Dyslipidemia is a well-described independent risk factor for coronary heart disease and it occurs in a high proportion of persons with HIV infection.

A. True

B. False

10. HIV-infected individuals who are not on antiretroviral medications often have elevations in which of the following?

A. Triglyceride (TG) levels

B. High-density lipoprotein (HDL) cholesterol

C. Low-density lipoprotein (LDL) cholesterol

D. Total cholesterol (TC)

11. All of the following are CHD risk equivalents, except for:

A. Diabetes mellitus

B. Angina

C. Peripheral vascular disease

D. Abdominal aortic aneurysm

12. Which of the following is the main indicator for treatment, and the main target for lipid-lowering therapy?




D. All of the above

13. A fasting lipid panel should be checked at baseline, before patients start ART.

A. True

B. False

14. The LDL cholesterol calculation is unreliable for patients with serum TG levels of:

A. Greater than 150 mg/dL

B. Greater than 400 mg/dL

C. Greater than 800 mg/dL

D. Greater than 1000 mg/dL

15. Of the statin drugs, _____ is the least affected by most PIs and is the recommended statin for most patients with hypercholesterolemia without hypertriglyceridemia.

A. Pravastatin

B. Atorvastatin

C. Lovastatin

D. Simvastatin

Insulin Resistance, Hyperglycemia, and Diabetes on Antiretroviral Therapy

16. Disorders of glucose metabolism may present as which of the following?

A. Insulin resistance

B. Impaired glucose tolerance

C. Impaired fasting glucose

D. Any of the above

17. HbA1c values may overestimate glycemia in HIV-infected patients, especially in the setting of elevated red blood cell mean corpuscular volume or anemia.

A. True

B. False

18. Which of the following is true with regard to metformin?

A. It can worsen lipoatrophy and should be avoided in the presence of significant lipoatrophy.

B. It increases the risk of lactic acidosis.

C. It should not be used for patients with elevated serum creatinine, hepatic impairment, or metabolic acidosis.

D. All of the above are true.

Coronary Heart Disease Risk

19. Epidemiologic studies suggest that the incidence of myocardial infarction or hospitalization for CHD is increased up to threefold in HIV-infected individuals compared with age-matched controls without HIV infection.

A. True

B. False

20. Several studies have suggested that low CD4 cell counts are associated with myocardial infarction and stroke.

A. True

B. False

21. Exposure to ARVs has been linked to risk of myocardial infarction in large cohort studies, in particular, the risk has been associated with the use of regiments that are based on nonnucleoside reverse transcriptase inhibitors, rather than protease inhibitors.

A. True

B. False

Renal Disease

22. Risk factors for renal disease in HIV-infected patients include all of the following, except for:

A. CD4 count of less than 200 cells/uL

B. HIV viremia, particularly RNA levels greater than 4,000 copies/mL

C. Hispanic race

D. Hepatitis C

23. Chronic hepatitis C, seen in 30% - 40% of HIV-infected individuals in the United States, is associated with which type of chronic kidney disease?

A. Progressive secondary glomerulonephropathy

B. Membranoproliferative glomerulonephropathy

C. Mixed cryoglobulinemia

D. All of the above

24. For patients with HIV-associated nephropathy, ART is the primary treatment.

A. True

B. False

25. Screening for kidney disease in HIV-infected persons consists of all of the following tests, except for:

A. Serum creatinine and calculated estimate of renal function.

B. Kidney biopsy.

C. Urinalysis, for proteinuria, hematuria.

D. Quantitative test for proteinuria.

26. The clinical presentation of HIVAN includes all of the following, except:

A. Nephrotic syndrome or nonnephrotic proteinuria.

B. Elevated blood pressure.

C. Elevated Cr, often with rapid progression to end-stage renal disease.

D. Renal biopsy shows a collapsing FSGS.

27. If present with hematuria, proteinuria is highly suspicious for a glomerular disease.

A. True

B. False

28. For patients with hypertension and proteinuria, the target blood pressure is:

A. 120 / 80 mm Hg

B. <120 / 75 mm Hg

C. <125 / 80 mm Hg

D. 125 / 75 mm Hg

29. Protease inhibitors and nonnucleoside reverse transcriptase inhibitors both require dosage adjustment in persons with CKD.

A. True

B. False

Immune Reconstitution Inflammatory Syndrome

30. A large percentage of patients develop inflammatory disease in response to specific opportunistic pathogens within a few weeks or months after initiating ART.

A. True

B. False

31. Which of the following must be excluded in order to make a diagnosis of immune reconstitution inflammatory syndrome?

A. Presence of a new opportunistic infection or concomitant illness.

B. Failure of treatment for HIV infection.

C. Failure of treatment for a known opportunistic infection.

D. All of the above.

32. Uveitis is painless and primarily involves inflammation in all of the following, except for:

A. The vitreous humor

B. The iris

C. The ciliary body

D. The choroid layers

33. Because of the risk of vision loss, there should be a high index of suspicion for CMV uveitis.

A. True

B. False

34. The majority of cases of IRIS reported in the medical literature are not life-threatening and appear to have resolved within a matter of weeks to months with which of the following?

A. Continuing the current ART regimen.

B. Treating any newly identified, untreated OI.

C. If indicated, administering anti-inflammatory medications to suppress the inflammatory process.

D. All of the above.

35. The risk of IRIS is highest for patients who start ART with low CD4 counts (<50-100 cells/uL) and those for whom ART is initiated soon after OI treatment is begun.

A. True

B. False

36. ART should be deferred until after TB treatment for patients with a CD4 count of 50-200 cells/uL.

A. True

B. False

Anal Dysplasia

37. Anal cancer is a squamous cell cancer associated with human papillomavirus (HPV), the same virus that is associated with cervical cancer.

A. True

B. False

38. Advanced immunosuppression, as demonstrated by lower CD4 cell counts, appears to increase the risk of anal intraepithelial neoplasia (AIN), a precursor to cancer, and anal cancer.

A. True

B. False

39. Receptive anal intercourse is a prerequisite for anal HPV and dysplasia.

A. True

B. False

40. Current guidelines from the HIV Medicine Association of the Infectious Diseases Society of America recommend anal pap tests for:

A. Men who have sex with men.

B. Women with a history of abnormal cervical Pap tests or a history of anal receptive sex.

C. HIV-infected persons with genital warts.

D. All of the above.

41. Which of the following is the most severe, according to the Bethesda 2001 system?

A. Low-grade squamous intraepithelial lesion.

B. High-grade squamous intraepithelial lesion.

C. Atypical squamous cells of undetermined significance.

D. Atypical squamous cells - cannot exclude HSIL.

42. All individuals with abnormal anal cytology, defined as _____ or higher, should be referred for HRA and biopsy to grade the lesion.

A. Low-grade squamous intraepithelial lesion.

B. High-grade squamous intraepithelial lesion.

C. Atypical squamous cells of undetermined significance.

D. Atypical squamous cells - cannot exclude HSIL.

Candidiasis, Oral and Esophageal

43. In the absence of other known causes of immunosuppression, oral thrush in an adult is highly suggestive of HIV infection.

A. True

B. False

44. Which of the following clinical presentations of thrush is common in people with HIV?

A. Pseudomembranous cheilitis

B. Erythematous cheilitis

C. Angular cheilitis

D. All of the above

Candidiasis, Vulvovaginal

45. Although refractory vaginal Candida infections by themselves should not be considered indicators of HIV infection, they may be the first clinical manifestation of HIV infection and can occur early in the course of disease, at CD4 counts of >500 cells/uL.

A. True

B. False

46. Risk factors for candidiasis include all of the following, except:

A. Diabetes mellitus

B. The use of oral contraceptives

C. The use of ART

D. The use of antibiotics

Cervical Dysplasia

47. Effective antiretroviral therapy with immune reconstitution has been shown to prevent the progression of CIN.

A. True

B. False

Cryptococcal Disease

48. The Cryptococcus neoformans organism is found in all of the following, except:

A. Soils enriched with bird droppings

B. On the outer shell of eggs

C. Fruit skins or juices

D. Unpasteurized milk

49. In HIV-infected patients, Cryptococcus can infect almost all organs in the body, but most commonly causes:

A. Meningitis

B. Pneumonia

C. Cystic fibrosis

D. Skin lesions


50. Patients at greatest risk of acquiring cryptosporidiosis are those with CD4 counts of:

A. <50 cells/uL

B. <100 cells/uL

C. <200 cells/uL

D. <500 cells/uL

51. Scrupulous handwashing can prevent the spread of cryptosporidiosis, and HIV-infected patients should be advised to wash their hands after potential contact with human feces (diapering small children, handling pets, gardening, and before and after sex).

A. True

B. False

Cytomegalovirus Disease

52. Approximately _____% of patients with previously treated CMV retinitis may experience CMV-related immune reconstitution uveitis (IRU) after starting successful ART.

A. 20

B. 40

C. 60

D. 80

53. Which of the following is contraindicated for use by patients with renal insufficiency or proteinuria?

A. Valganciclovir

B. Ganciclovir

C. Cidofovir

D. Foscarnet

Gonorrhea and Chlamydia

54. Infection with GC or CT may facilitate transmission of HIV to HIV-uninfected sex partners.

A. True

B. False

55. The CDC recommends rescreening all patients _____ after GC or CT treatment (for possible reinfection).

A. 4 weeks

B. 3 months

C. 6 months

D. 12 months

Hepatitis B Infection

56. Chronic HBV can cause necroinflammation and over time can cause hepatic fibrosis and eventually:

A. Cirrhosis

B. End-stage liver disease

C. Hepatocellular carcinoma

D. All of the above

57. The vaccine series should be given only when CD4 counts are >200 cells/uL and vaccination should be delayed for persons with lower CD4 counts.

A. True

B. False

58. Factors associated with increased rates of cirrhosis include all of the following, except:

A. Male gender

B. Coinfection with HIV

C. Alcohol consumption

D. Smoking

59. Several of the nucleoside analogues (NRTIs) used against HIV also are active against HBV, and these should be included in an ART regimen to treat both HIV and HBV for coinfected persons.

A. True

B. False

60. Because of the complexity of HBV diagnosis and test interpretation, it is important to test for which of the following?

A. HBsAg

B. HBcAb

C. HBsAb

D. All of the above

Hepatitis C Infection

61. HIV/HCV-coinfected patients have all of the following, except:

A. Lower rates of spontaneous HCV clearance.

B. Greater risk of developing liver decompensation, end-stage liver disease, and hepatocellular carcinoma.

C. Increased HIV- and AIDS-related complications.

D. Lower rates of successful HCV treatment with interferon and ribavirin.

62. Monitoring of ALT can be useful for all of the following reasons, except:

A. Assess acute infection.

B. Assess the degree of fibrosis due to ALT always correlating.

C. Assess chronic liver inflammation.

D. Assess response to HCV treatment.

63. HCV protease inhibitors and other DAAs may have significant interactions with certain HIV ARVs, particularly with:

A. Protease inhibitors

B. Nonnucleoside reverse transcriptase inhibitors

C. The pharmacokinetic booster cobicistat

D. All of the above

Herpes Simplex, Mucocutaneous

64. HSV facilitates HIV transmission.

A. True

B. False

Molluscum Contagiosum

65. In which of the following ways does molluscum contagiosum transmission occur?

A. Sexual activity

B. Sharing towels

C. Sharing shaving utensils

D. All of the above

Mycobacterium avium Complex Disease

66. Like Mycobacterium tuberculosis, Mycobacterium avium is transmitted via person-to-person contact.

A. True

B. False

Mycobacterium tuberculosis

67. Even with immune reconstitution through antiretroviral therapy and a normalized CD4 cell count, HIV-infected patients remain at elevated risk of reactivation TB, compared with the background community risk of TB.

A. True

B. False

68. Appropriate use of modern chemotherapy with rifampin-containing TB treatment applied to drug susceptible MTB disease cures at least _____ of these patients, including those with HIV coinfection.

A. 95%

B. 70%

C. 50%

D. 30%

69. A positive TST or IGRA result confirms TB infection and proves active disease.

A. True

B. False

Pneumocystis Pneumonia

70. More than 90% of PCP cases occur in patients with CD4 counts of:

A. <50 cells/uL

B. <100 cells/uL

C. <200 cells/uL

D. <500 cells/uL

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