International AIDS Society-USA

Presentation

The Use of Preexposure and Postexposure Prophylaxis for HIV Prevention
Raphael J. Landovitz, MD

Level: Advanced


You must answer at least 8 of 10 questions correctly (≥80%) to receive a passing score and earn continuing medical education credit.

1. A 57-year-old African-American man would like to know if the availability of postexposure prophylaxis (PEP) for HIV means that it is “okay” to not use condoms.

a. Yes, that is correct, although PEP is only 80% protective.

b. Yes, that is correct, because he is not in a high-risk demographic group.

c. No, that is not correct because PEP can cause erectile dysfunction.

d. No, that is not correct because condoms are the most effective HIV-prevention tool available, and PEP is an emergency “back-up” method of HIV prevention.

2. For PEP to be effective, most guidelines recommend that a patient present for treatment within:

a. 72 hours of sexual exposure

b. 36 hours of sexual exposure

c. 24 hours of sexual exposure

d. 12 hours of sexual exposure

3. An HIV-seropositive man and his HIV-seronegative female partner present to your office requesting PEP. The couple had penile-vaginal intercourse with a condom 24 hours ago. The male partner ejaculated, and the condom was intact on withdrawal.

Is PEP indicated for this couple?

a. PEP is indicated because of the ejaculation episode.

b. PEP is not indicated because the condom was intact.

c. PEP is not indicated because they are heterosexual.

d. PEP is indicated because the male partner is HIV-seropositive.

4. Which of the following behavioral interventions is a crucial component of PEP?

Risk-reduction counseling

Aversive conditioning

Medication adherence counseling

Referral to appropriate mental health and substance-use counseling

Select one of the following:

a. 1 and 3

b. 1, 3, and 4

c. 1, 2, and 4

d. 2, 3, and 4

5. The appropriate duration of PEP treatment for HIV, if initiated, is:

a. 7 days

b. 14 days

c. 28 days

d. 6 months

6. A 20-year-old man has presented to your office for his fourth course of PEP for HIV. He asks if he can just take something “all the time.”

This strategy, preexposure prophylaxis (PrEP)

a. has good safety data and is ready for routine use

b. has limited safety data and no efficacy data but is probably ready for routine use

c. has limited safety data and no efficacy data, and it should not be used outside a study context

d. has been shown not to be effective in preventing HIV infection

7. Which of the following is true about HIV titers of genital tract secretions?

a. If the plasma HIV RNA level is undetectable, HIV titers of genital tract secretions will be undetectable.

b. If the HIV RNA level is high, HIV titers of genital tract secretions will be low.

c. If the HIV RNA level is undetectable, HIV cannot be transmitted sexually.

d. If the HIV RNA level is undetectable, HIV titers of genital tract secretions may be unpredictable.

8. A young Vietnamese woman who has been diagnosed with acute, primary HIV infection is referred to your office. She would like to be treated with pills provided by her sister, who brought them from Vietnam. Each pill is fixed-dose, combination stavudine/lamivudine/nevirapine.

Which of the following statements is true?

The most common type of transmitted resistance will confer resistance to nevirapine.

Nevirapine has been associated with central nervous system side effects and, therefore, is not appropriate therapy.

Nevirapine has significant hepatic and cutaneous toxic effects in patients with higher CD4+ counts which may make it impossible for some patients to tolerate.

Nevirapine has numerous drug interactions that may complicate a patient’s treatment.

Select one of the following:

a. 2 and 3

b. 1, 3, and 4

c. 2, 3, and 4

d. 1 and 2

9. In a patient for whom you have a high clinical suspicion of secondary syphilis, a nonreactive rapid plasma reagin (RPR) result rules out the diagnosis. True or false?

a. True.

b. False; an RPR test is the incorrect test.

c. False; an RPR test will not register positive until syphilis has reached its tertiary stage.

d. False; at high titers, the antibodies clump, producing a false-negative result.

10. Acute HIV seroconversion is best characterized by which of the following profiles:

a. A negative HIV ELISA result and a viral load of 6,000,000 copies/mL

b. Positive HIV ELISA and Western Blot results and a viral load of 100,000 copies/mL

c. A positive rapid HIV test result and no further information

d. Negative HIV ELISA and Western Blot results and a viral load of 1000 copies/mL