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Quiz: How Much Do You Know About HIV?

Nicholas J. Bennett, MBBCh, PhD, MA(Cantab)

April 07, 2015

According to the most recent statistics from the Centers for Disease Control and Prevention (CDC), more than 1.2 million Americans are estimated to be living with HIV infection. More than 160,000 of those persons (14%) remain undiagnosed. With numerous advances in treatment and patient education, individuals with HIV are living longer lives. Are you familiar with the associated conditions to watch for and best treatment to initiate? Test your knowledge with our short quiz.

Which of the following is not considered an opportunistic infection or condition commonly found in patients with HIV?

Candidiasis

Chlamydia

Encephalopathy

Toxoplasmosis

Many opportunistic infections and conditions are used to mark when HIV infection has progressed to AIDS. The general frequency of these infections and conditions varies from rare to common, but all are uncommon or mild in immunocompetent persons. Opportunistic infections and conditions include the following:

·         Candidiasis of bronchi, trachea, or lungs

·         Candidiasis, esophageal

·         Cervical cancer, invasive

·         Coccidioidomycosis, disseminated or extrapulmonary

·         Cryptococcosis, extrapulmonary

·         Cryptosporidiosis, chronic intestinal (duration > 1 mo)

·         Cytomegalovirus disease (other than liver, spleen, or nodes)

·         Cytomegalovirus retinitis (with vision loss)

·         Encephalopathy, HIV-related

·         Herpes simplex: chronic ulcer or ulcers (duration > 1 mo) or bronchitis, pneumonitis, or esophagitis

·         Histoplasmosis, disseminated or extrapulmonary

·         Isosporiasis, chronic intestinal (duration > 1 mo)

·         Kaposi sarcoma

·         Lymphoma, Burkitt (or equivalent term)

·         Lymphoma, immunoblastic (or equivalent term)

·         Lymphoma, primary, of the brain

·         Mycobacterium avium complex or Mycobacterium kansasii infection, disseminated or extrapulmonary

·         Mycobacterium tuberculosis infection, any site (pulmonary or extrapulmonary)

·         Mycobacterium infection with other species or unidentified species, disseminated or extrapulmonary

·         Pneumocystis pneumonia

·         Pneumonia, recurrent

·         Progressive multifocal leukoencephalopathy

·         Salmonella septicemia, recurrent

·         Toxoplasmosis of the brain

·         Wasting syndrome due to HIV infection

Sexually transmitted infections, such as chlamydia, may be found in people with HIV who acquired their HIV infection via sexual transmission or who are not practicing safe sex, but are not considered opportunistic infections.

For more on the pathophysiology of HIV and its relationship to opportunistic conditions, read here.

Which of the following is considered a secondary HIV test?

Proviral DNA polymerase chain reaction

Enzyme-linked immunoabsorbent assay

CD4+ T-cell count

Viral culture

In June 2014, the CDC issued new recommendations for HIV testing in laboratories that are aimed at reducing the time needed to diagnose HIV infection by as much as 3-4 weeks over previous testing approaches. The new testing algorithm is performed as follows:

·         Diagnosis starts with a fourth-generation test that detects HIV in the blood earlier than previous-generation tests can; in addition to HIV antibody testing, it identifies the viral protein HIV-1 p24 antigen, which appears in the blood before antibodies do.

·         If this test is positive, an immunoassay that differentiates HIV-1 from HIV-2 antibodies should be performed; results from such assays can be obtained faster than they can from the Western blot test.

·         In patients with positive results on the initial antigen test but with negative or indeterminate results on the antibody differentiation assay, HIV-1 nucleic acid testing should be performed to determine whether infection is present.

Viral culture is expensive and time-consuming and is less sensitive in patients with low viral loads. Viral culture may be performed as part of phenotypic drug-resistance testing.

For more on the work-up of HIV, read here.

Prophylaxis against which of the following is most important in patients with HIV?

Candidiasis

Mucormycosis

Tularemia

Pneumocystis jiroveci

Prophylaxis for Pneumocystis jiroveci (a normally harmless commensal organism) is most important because this causes a common, preventable, serious infection. In patients with CD4 counts less than 200/μL, prophylaxis with trimethoprim/sulfamethoxazole (Bactrim™) has been shown to prevent Pneumocystis pneumonia.

For more on prophylaxis against opportunistic infections, read here.

Which of the following regimens is preferred in men and nonpregnant women with HIV?

Lopinavir/ritonavir

Zidovudine/lamivudine

Efavirenz/tenofovir/emtricitabine

Dolutegravir/abacavir/tenofovir

Current guidelines list the following regimens as preferred in treatment-naive patients:

·         Efavirenz/tenofovir/emtricitabine (EFV/TDF/FTC);

·         Ritonavir-boosted atazanavir + tenofovir/emtricitabine (ATV/r + TDF/FTC);

·         Ritonavir-boosted darunavir + tenofovir/emtricitabine (DRV/r + TDF/FTC); and

·         Raltegravir + tenofovir/emtricitabine.

The guidelines consider lopinavir/ritonavir-based regimens as alternative rather than preferred, except in pregnant women, in whom twice-daily lopinavir/ritonavir plus zidovudine/lamivudine remains preferred.

For more about the treatment of HIV, read here.

Which of the following is recommended for long-term monitoring of patients with HIV receiving antiretroviral therapy?

Fasting lipid profile monthly

Fasting glucose profile annually

CD4+ T-cell count every 2 months

Basic chemistry profile and complete blood count (CBC) every 3 months

Guidelines from the US Department of Health and Human Services (DHHS) recommend performing the following tests every 3 months in patients on antiretroviral therapy:

·         Basic chemistry profile

·         Liver function studies

·         CBC with differential

The basic chemistry studies should include serum sodium, potassium, bicarbonate, chloride, blood urea nitrogen, creatinine, and glucose (preferably fasting), plus an estimate of creatinine clearance. Fasting glucose measurement is repeated every 3-6 months if abnormal at the last measurement, or every 6 months if normal at the last measurement.

A fasting lipid profile is measured every 6 months if abnormal at the last measurement, or every 12 months if normal at the last measurement.

In a clinically stable patient on an antiretroviral regimen whose viral load is suppressed and whose CD4+ T-cell count is well above the threshold for opportunistic infection risk, 2011 DHHS guidelines recommend that the CD4+ T-cell count may be monitored every 6-12 months (instead of every 3-6 months), unless there are changes in the patient's clinical status, such as new HIV-associated clinical symptoms or initiation of treatment with interferon, corticosteroids, or antineoplastic agents.

For more on the long-term monitoring of HIV, read here.

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Cite this article: Nicholas J. Bennett. Quiz: How Much Do You Know About HIV? Medscape. Apr 07, 2015.