As a member of a national preexposure prophylaxis (PrEP) guideline committee, you are asked to include a paragraph about PrEP in individuals who have had bariatric surgery. Which of the following do you advise?

Correct answer is C. All pharmacokinetic data for daily dosing of TDF/FTC, both as part of combination antiretroviral therapy and as PrEP, show comparable exposure compared with individuals without bariatric surgery. Such data are lacking for on-demand PrEP, and there is theoretical concern about the rate of absorption. Available data do not suggest a preference for TAF/FTC over TDF/FTC. Theoretically, parenteral PrEP has advantages in individuals who have had bariatric surgery, but this form of PrEP is much more expensive and at this moment should not be recommended to all patients.

To learn more about this topic, watch the on-demand presentation, Drug-Drug Interactions, Dosing, Formulations, and Other Pharmacologic Issues in HIV Treatment, presented by David Burger, PharmD, PhD, and moderated by Betty J. Dong, PharmD.

A 26-year-old bisexual man has been newly diagnosed with HIV. He does not have any known illnesses, uses urgent care when sick, and does not take any medication. He has never heard of preexposure prophylaxis. Which of the following baseline laboratory tests do you obtain?

Correct answer is D. Protease and reverse transcriptase genotypic resistance testing should be performed, but integrase genotyping is not currently recommended for all people due to low rates of transmitted resistance. Anal Pap test with HPV genotyping is not recommended because he is younger than 35 years. People who have receptive vaginal intercourse should undergo a urine trichomoniasis NAAT, but it is not indicated in this case. Tuberculin skin test with interferon gamma release assay is not recommended simultaneously.

To learn more about this topic, watch the on-demand presentation, Screening for the “Big Cs” in HIV Care: Coinfections and Cancers, presented by Melanie A. Thompson, MD, at the 2025 Ryan White HIV/AIDS Program CLINICAL CONFERENCE.

Which of the following is TRUE regarding conserved epitope cellular HIV vaccines?

Correct answer is C. Conserved epitope cellular vaccines are being developed to target epitopes related by structure or sequence and are highly relevant to combination cure strategies. They have not yet shown efficacy.

To learn more, watch HIV Vaccines in 2026 and Beyond: Promise and Persistence, presented by Katharine J. Bar, MD, at the IAS–USA Annual Virtual Course Update: Emerging Challenges in HIV Medicine, now available on-demand.

A 27-year-old man was recently diagnosed with syphilis. An HIV test was negative. He was also recently exposed to a person with active tuberculosis and presents to care with cough and shortness of breath. He worries about his risk for HIV, sexually transmitted infections, and other infections and is interested in HIV prevention. Which of the following statements is correct and can inform this patient’s care?

Correct answer is D. Among 119 patients with confirmed tuberculosis by composite microbiologic reference standard (CMRS), stool Ultra resulted in additional cases detected compared with sputum Ultra (23%), sputum culture (29%), and lipoarabinomannan tests (33%). Therefore, answer D is correct.

Dynamic choice HIV prevention (DCP) approach (integrating PrEP with daily oral tenofovir disoproxil fumarate/emtricitabine or long-acting injectable cabotegravir, and PEP with self-assessed risk for HIV acquisition) was shown to significantly increase HIV prevention and decrease the incidence of HIV. The intervention is likely to be cost-effective across numerous settings in east, central, southern, and west Africa. Therefore, answer A is incorrect.

Rates of new HIV acquisition remain unacceptably high in most populations in low-, middle-, and high-income settings despite advances in treatment and prevention strategies. Current global efforts are not sufficient to meet 2030 HIV epidemic goals. Therefore, answer B is incorrect.

Although the use of doxycycline for PrEP would substantially decrease this patient’s risk for syphilis and chlamydia, it has also led to a marked increase in tetracycline-resistant Neisseria, Staphylococcus, or Streptococcus. Therefore, answer C is incorrect.

To learn more on this topic, view the on-demand for, No Mo’ FOMO — In Case You Missed It: Recent Changes in Guidelines, New Publications, and Updates From Recent Conferences, to be presented by Roger J. Bedimo, MD, MS, and moderated by Constance A. Benson, MD.

Which of the following statements about the risk of cancers in people with HIV is correct?

Correct answer is D. People with HIV are at an increased risk of cancers caused by infections. This is due to an impaired ability to control oncogenic infections because of HIV-associated immunosuppression. It is true that the prevalence, or cancer burden, of many age-associated cancers (eg, breast cancer, colorectal cancer) is increasing among PWH. However, that is due to more individuals reaching ages where those cancers are common; they are not necessarily at a higher risk of developing them than the general population.

To learn more, view the on-demand course, Medical Management of People With HIV as They Age: A Course for Non-Geriatricians, for the presentation, Aging in the Context of HIV and Cancer: What Does “Age” Actually Mean, and Can It Impact Cancer Survivorship?, by Dr Anna E. Coghill, PhD, MPH.

An infant is born to a person with a plasma HIV RNA level of 1240 copies/mL at 24 weeks of gestation. The mother had missed numerous doses of emtricitabine/tenofovir disoproxil fumarate plus dolutegravir (DTG), and subsequently resuppressed to less than 50 copies/mL at 32 and 36 weeks of gestation. Which of the following approaches is recommended by current US guidelines?

Correct answer is C. Current US guidelines recommend the initiation of either 3-drug presumptive therapy (after collecting a birth HIV nucleic acid test) or zidovudine alone for infant prophylaxis.

To learn more about this topic, read the latest issue of Topics in Antiviral Medicine™, November/December 2025, which is available for 4.75 AMA PRA Category 1 Credits™ credits.

In which of the following scenarios should the use of long-acting injectable cabotegravir/rilpivirine (LAI CAB/RPV) NOT be considered?

Correct answer is E. Doxycycline is commonly used as initial therapy to reduce bacterial load, but eradication rates are poor. Azithromycin resistance is high (44%–90%), fluoroquinolone resistance is increasing (now ~10%-15%), and routine screening of asymptomatic persons is not recommended.

To learn more about this topic, watch the on-demand course, The IAS–USA Annual Virtual Course Update: Emerging Challenges in HIV Medicine.

In which of the following scenarios should the use of long-acting injectable cabotegravir/rilpivirine (LAI CAB/RPV) NOT be considered?

Correct answer is D. A 34-year-old with perinatally acquired HIV whose most recent genotype testing showed K101E, K103N, Y181C, and G140R/S mutations should not be considered for LAI CAB/RPV. These mutations indicate substantial resistance to the CAB/RPV regimen, increasing the risk of virologic failure and the potential for developing further drug resistance.

To learn more about this topic, read the latest Issue of Topics in Antiviral Medicine™, November/December 2025.

Which of the following regimens is the US Centers for Disease Control and Prevention (CDC)-recommended first-line therapy for uncomplicated urogenital Chlamydia trachomatis in a male adult with HIV?

Correct answer is D. The CDC-recommended first-line therapy for uncomplicated urogenital Chlamydia trachomatis in a male adult with HIV is doxycycline 100 mg taken orally twice daily for 7 days.

To learn more about this topic, view the on-demand webinar, Chlamydia Management Updates: Advances and Vaccine Development for STI Prevention, presented by Jodie A. Dionne, MD, MSPH, and moderated by Jason E. Zucker, MD, on December 11, 2025.

Hours ago, a child was stuck by the needle on a discarded insulin syringe he found outside. His mother is worried about HIV infection and brings the syringe to the clinic for testing. She reports that the child has received all recommended childhood vaccinations.

Which of the following is the most appropriate next step?

Correct answer is A. Neither HBV nor HIV PEP is recommended in this situation. Reassure his mother that there is negligible risk of infectious exposure in this circumstance and that her son, who has completed the pediatric vaccination series, is protected.

HBV is substantially more infectious than HIV and HCV and has persisted and remained infectious for days in controlled studies. However, despite numerous prospective exposures, there has been only 1 case report of HBV transmission from a discarded needle in the community. It is exceptionally uncommon.

Testing the syringe for viruses would delay taking action with PEP if needed, and there are no methods for testing discarded syringes found in the open environment that have been standardized and widely adopted, making it challenging to reliably interpret any results, which are likely to be negative.

See also: Res S, Bowden FJ. Acute hepatitis B infection following a community-acquired needlestick injury. J Infect. 2011;62(6):487-489.

 To learn more about this topic, watch the IAS–USA Annual Virtual Course Update: Emerging Challenges in HIV Medicine, available on demand at https://www.iasusa.org/courses/on-demand-hiv-virtual-updates-2025-dc/

Which statement about individuals with HIV who achieved HIV cure after stem cell transplant is FALSE?

Correct answer is B. This statement is false because although HIV cure has mostly occurred in people who received delta32 homozygous donor cells, HIV cure after heterozygous and wild-type donor cells has also been reported. Stem cell transplant remains a high-risk procedure that is only undertaken in people with cancer, so statements A and D are true. Cure is associated with chemoablation, graft versus host disease, immunotherapy, and HIV-resistant cells, so statement C is true.

To learn more about this topic, view the IAS–USA on-demand webcasts, The IAS–USA Annual Update on HIV Management in Chicago, Illinois, for Dr Katharine J. Bar’s presentation, Update on the Cure: From In Between Days to Just Like Heaven.

A 24-year-old patient designated male sex at birth presents for follow-up regarding well-controlled HIV. Diagnosed 1 year ago and treated with bictegravir/emtricitabine/tenofovir alafenamide, the patient currently has a plasma HIV RNA level below the limits of detection and a CD4+ count of 892 cells/µL. The patient reports a gender identity of female. She is eager to start gender-affirming hormone therapy (GAHT) but is concerned about interactions between GAHT and her antiretroviral therapy (ART). Which of the following best describes what to expect if the patient initiates estrogen?

Correct answer is D. There are real pharmacokinetic interactions between ART and GAHT. Nonnucleoside reverse transcriptase inhibitors may decrease hormone levels; most other ART options may increase hormone levels. Clinically, these differences are of low magnitude. Because hormone levels are monitored, these interactions would simply lead to slight adjustments in the hormone dose (within the usual dose range) and effectiveness would be maintained. Generally, there is no significant impact of GAHT on the effectiveness of ART. Data do not clearly show increased risk of atherosclerotic cardiovascular disease from estrogen GAHT and bone density is maintained.

To learn more about this topic, view the on-demand webinar, Gender-Affirming Hormone Initiation and Antiretroviral Therapy Considerations in People With HIV, to be presented by Ole-Petter R. Hamnvik, MBBCH, and moderated by Tonia C. Poteat, PhD, MPH, PA-C.

In a patient with HIV planning to undergo solid organ transplantation, which of the following antiretroviral therapy regimens should be changed prior to transplant?

Correct answer is B. This regimen contains cobicistat, a potent cytochrome P450 3A4 (CYP3A4) inhibitor, which causes problematic drug-drug interactions with posttransplant medications.

To learn more about this topic, view the on-demand webinar, Practice Updates in Solid Organ Transplantation for People With HIV, presented by Christine M. Durand, MD, and moderated by Peter Chin-Hong, MD, on November 13, 2025.

A 50-year-old woman with HIV (CD4+ count, 500 cells/µL; plasma HIV RNA level, 500,000 copies/mL; no resistance mutations shown with pretreatment genotype testing) and gastroesophageal reflux disease is treated with bictegravir/emtricitabine (FTC)/tenofovir alafenamide (TAF). At week 12, her plasma HIV RNA level declines to 100 copies/mL. Over the next 12 months, her plasma HIV RNA level fluctuates between 50 and 100 copies/mL. How should she be managed?

Correct answer is C. This patient has low-level viremia on antiretroviral therapy (ART). The most common cause of low-level viremia in this setting is drug-drug interactions, such as use of multivalent cations (iron, calcium, magnesium, zinc) around the time of integrase strand transfer inhibitor-based ART use. Adding an antiretroviral drug (intensifying therapy) has not been shown to reduce low-level viremia, nor has changing to a protease inhibitor-based regimen. A proviral genotype test has not been validated for the management of low-level viremia, and there are concerns about its sensitivity for drug resistance mutations.

To learn more about this topic, watch the IAS–USA Annual Update on HIV Management, available on demand at https://www.iasusa.org/courses/on-demand-hiv-update-2025-chicago/

Which is NOT true of the current US Centers for Disease Control and Prevention (CDC) guidelines for postexposure prophylaxis (PEP) for HIV?

Correct answer is D. The current CDC guidelines do NOT recommend that final HIV testing be done at 6 months. The CDC updated its occupational and nonoccupational PEP guidelines in 2025. The current guidelines recommend that PEP be started within 72 hours of exposure with either a bictegravir- or dolutegravir-based regimen, administered for 4 weeks. Final HIV testing should consist of an HIV antigen/antibody laboratory test at 12 weeks.

References:
Kofman AD, Struble KA, Heneine W, et al. 2025 US public health service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis in healthcare settings. Infect Control Hosp Epidemiol. Published online 2025 September 15. doi:10.1017/ice.2025.10254

Tanner MR, O’Shea JG, Byrd KM, et al. Antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV – CDC recommendations, United States, 2025. MMWR Recomm Rep. 2025;74(1):1-56. Published 2025 May 8. doi:10.15585/mmwr.rr7401a1

To learn more about this topic, watch the IAS–USA Annual Update on HIV Management, available on demand at https://www.iasusa.org/courses/on-demand-hiv-update-2025-chicago/

The clinic where you practice recently prioritized retention in care for a quality improvement (QI) initiative. The medical director has asked you to spearhead a team to make recommendations for possible evidence-based approaches to improve retention in care. After reviewing the literature and HIV treatment guidelines, your team suggests that the following approaches might be considered for the QI initiative, EXCEPT:

Correct answer is C. Guidelines set forth by the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) and the United States Department of Health and Human Services (DHHS) include sections on engagement and retention in care. The DHHS guidelines indicate that evidence does not support the use of financial incentives to engage people with HIV in ongoing routine care. The guidelines recommend consideration to deploying evidence-based interventions, including enhanced personal contacts and telehealth services; therefore, options A and B are incorrect. Although there is currently a paucity of rigorously tested effective interventions for retention in care, the guidelines highlight the importance of systematically monitoring retention in care; therefore, option D is incorrect.

To learn more about this topic, register for the upcoming IAS-USA webinar, Patient Adherence and Engagement in Care in People With HIV, to be presented by Michael J. Mugavero, MD, MHSc, and moderated by Susan P. Buchbinder, MD, on Tuesday, October 28, 2025, at 11:00 AM – 12:15 PM PT (12:00 PM – 1:15 PM MT, 1:00 PM – 2:15 PM CT, 2:00 PM – 3:15 PM ET).

Which of the following best describes why transdermal estrogen is the preferred method of menopausal hormone therapy for women with HIV?

Correct answer is B. Transdermal estrogen preparations (eg, patches, gels) are released directly into the bloodstream and bypass liver metabolism. This potentially reduces the risk of blood clots and gallbladder disease.

To learn more about this topic, register for Clinical Considerations for Women With HIV During Menopause, to be presented by Sara E. Looby, PhD, ANP-BC, and moderated by Eileen Scully, MD, PhD, on October 16, 2025 at 11:00 AM – 12:15 PM PT (12:00 PM – 1:15 PM MT, 1:00 PM – 2:15 PM CT, 2:00 PM – 3:15 PM ET).

Which of the following mechanisms best explains how cytomegalovirus (CMV) contributes to morbidity in people with HIV despite suppressive antiretroviral therapy?

Correct answer is A. CMV is highly immunogenic, eliciting massive expansion of CD8+ T cells. In people with HIV, this chronic activation is linked to higher levels of inflammatory markers, comorbidities (eg, cardiovascular disease, cancer, neurocognitive decline), and larger HIV reservoirs. Although CMV influences many organ systems, the best-described mechanism is its effect on systemic immune activation and inflammation.

For more about this topic, register for Cytomegalovirus Suppression: Improving Immunologic and Functional Aging Outcomes in Populations Undergoing HIV Treatment, to be presented by Sara Gianella Weibel, MD, and moderated by Kristine M. Erlandson, MD, MS, on October 9, 2025, at 11:00 AM – 12:15 pm PT (12:00 PM – 1:15 PM MT, 1:00 PM – 2:15 PM CT, 2:00 PM – 3:15 PM ET)

What is the correct definition of a refugee?

Correct answer is A. One who flees their country because of a well-founded fear of persecution is termed a “refugee.” One who has already fled their country and whose application for protection is in process is termed an “asylum-seeker” and one who is displaced within one’s own country is termed “internally displaced.”

To learn more about this topic, register for the upcoming webinar, HIV Care for Displaced Persons in the US, with presenter and moderator Carlos del Rio, MD, and panelists Amir Mohareb, MD, Bill Burman, MD, and Angel Desai, MD, MPH.

Which of the following statements is CORRECT regarding recommended baseline testing for people with newly diagnosed HIV?

Correct answer is C. Updated 2025 US Department of Health and Human Services (HHS) guidelines on opportunistic infections among people with HIV highlight data indicating that among people with low CD4+ cell counts, the prevalence of cryptococcal antigenemia, which is a harbinger of disease, suggests an opportunity to intervene through broader screening to identify people who should undergo timely cerebral spinal fluid evaluation and be considered for treatment. Therefore, HHS guidelines recommend that asymptomatic people with newly diagnosed HIV with CD4+ counts of 200 cells/µL or less undergo routine surveillance testing for serum CrAg. The 2025 IAS-USA guidelines recommend using a CD4+ count threshold of 100 cells/µL or less.

References:

Clinicalinfo.HIV.gov. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. National Institutes of Health, HIV Medicine Association, and Infectious Diseases Society of America. Accessed September 16, 2025. Available at https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-infection

Gandhi RT, Landovitz RJ, Sax PE, et al. Antiretroviral drugs for treatment and prevention of HIV in adults: 2024 recommendations of the International Antiviral Society-USA Panel. JAMA. 2025;333(7):609-628. doi:10.1001/jama.2024.24543

To learn more about this topic, view the on-demand IAS-USA webinar, HIV 101: Foundations of Management of People Who Are Newly Diagnosed With HIV, presented by Michael S. Saag, MD, Carolyn Chu, MD, MSc, and Roy M. Gulick, MD, MPH.

A 34-year-old man has been intermittently adherent to HIV preexposure prophylaxis (PrEP) with cabotegravir (CAB) administered every other month. He tests positive for HIV. His initial CD4+ count is 470 cells/µL and repeat CD4+ count is 395 cells/µL. His initial plasma HIV RNA level is 13,000 copies/mL and repeat plasma HIV RNA level is 62,000 copies/mL. His routine complete blood cell count and chemistry panel results are normal. Initial genotypic resistance testing is pending.
Which antiretroviral regimen would you recommend?

Correct answer is D. Acquisition of HIV on a PrEP regimen with CAB can occur due to emergence of an integrase strand transfer inhibitor (InSTI)-resistant viral strain. Current International Antiviral Society-USA Panel guidelines suggest an integrase genotypic resistance test and starting a DRV-based regimen while awaiting the result. If no InSTI resistance is found, the antiretroviral regimen can be adjusted.

Reference: Gandhi RT, Landovitz RJ, Sax PE, et al. Antiretroviral drugs for treatment and prevention of HIV in adults: 2024 recommendations of the International Antiviral Society-USA Panel. JAMA. 2025;333(7):609-628. doi:10.1001/jama.2024.24543

To learn more about this topic, watch the on-demand webinar, HIV 101: Foundations of Management of People Who Are Newly Diagnosed With HIV, to be presented by Michael S. Saag, MD, Carolyn Chu, MD, MSc, and Roy M. Gulick, MD, MPH, on September 25, 2025, from 12:00 PM to 1:30 PM PT.

A 50-year-old woman with HIV reported to her physician and inquired about statin use, citing the results of the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) study. Her low-density-lipoprotein (LDL) level was 105 mg/dL, and her predicted 10-year risk for a cardiovascular event was 5.5%. She had already implemented a lifestyle program and was attentive to her diet and other cardiovascular risks. What is the most appropriate advice regarding statin use for this patient?

Correct answer is D. The REPRIEVE study showed that the use of a moderate-intensity statin reduced LDL level by about 30%, which was strongly associated with, and accounted for, a significant reduction in major adverse cardiovascular events. Option A is incorrect because statin therapy was shown to be efficacious in REPRIEVE even among those with relatively well-controlled LDL. Her LDL of 105 mg/dL should therefore not dissuade her caregiver from recommending statin therapy, with a moderate dose statin, if there is no other contraindication. Option B is incorrect because risk algorithms under-predict cardiovascular risk in women; therefore, her actual risk is likely greater than predicted. Option C is incorrect because the REPRIEVE study addressed the use of a single, moderate-intensity statin strategy, which decreased cardiovascular risk by 36%. REPRIEVE did not study the question of whether additional LDL decrease with a second agent would be beneficial in this population, so this question remains unanswered.

To learn more on this topic, listen to the latest episode of the IAS-USA Going anti-Viral podcast, The Management of Cardiovascular Health in Patients With HIV, hosted by Dr Michael Saag and featuring guest Dr Steven Grinspoon.

Subscribe now to Going anti-Viral on Spotify or Apple Music and stay in the know! Episodes are released at 4 AM PT every other Tuesday. Visit https://www.iasusa.org/going-anti-viral-podcast/ for instructions on how to subscribe.

Which of the following statements about breakthrough infections in the PURPOSE 1 (Preexposure Prophylaxis Study of Lenacapavir and Emtricitabine/Tenofovir Alafenamide in Adolescent Girls and Young Women at Risk of HIV Infection) and PURPOSE 2 (Study of Lenacapavir for HIV Preexposure Prophylaxis in People Who Are at Risk for HIV Infection) trials is TRUE?

Correct answer is C. Functional cure means that there is no evidence of active hepatitis B virus (HBV) replication or protein production. Clearance of covalently closed circular DNA (cccDNA) is not a component of functional cure as this can be “silent” in hepatocytes. A so-called “sterilizing cure” would encompass the loss of cccDNA as well as integrated HBV DNA in cells.

To learn more about this topic, watch the on-demand webinar, Update on Hepatitis B Cure, to be presented by David L. Wyles, MD, and moderated by Debika Bhattacharya, MD, MS.

Which of the following statements about breakthrough infections in the PURPOSE 1 (Preexposure Prophylaxis Study of Lenacapavir and Emtricitabine/Tenofovir Alafenamide in Adolescent Girls and Young Women at Risk of HIV Infection) and PURPOSE 2 (Study of Lenacapavir for HIV Preexposure Prophylaxis in People Who Are at Risk for HIV Infection) trials is TRUE?

Correct answer is A. Both documented LEN preexposure prophylaxis (PrEP) failures in PURPOSE 2 were characterized by high viral loads (more than 900,000 copies/mL in 1 case and 14,000 copies/mL in the other) and the N74D capsid mutation, conferring LEN resistance. One of the documented LEN PrEP failures in PURPOSE 2 occurred in a cisgender man who has sex with men, and 1 occurred in a transgender woman; no incident HIV infections have been seen in PURPOSE 1 to date. Integrase strand transfer inhibitor resistance was not observed.

To learn more about HIV PrEP, watch Preexposure Prophylaxis for HIV Infection: PrEP-Aring for The Next Decade, presented by Raphael J. Landovitz, MD, MSc, from the recent IAS-USA virtual course, Keeping Up with the Guidelines: Recommendations and Controversies in Sexually Transmitted Infection Management. https://www.iasusa.org/courses/on-demand-2025-virtual-sti-and-hiv-treatment/

Also available on-demand, watch Complicated Issues in the Management of PrEP: Part 1, presented by Raphael J. Landovitz, MD, MSc, and moderated by Michael S. Saag, MD.

And don’t miss Complicated Issues in the Management of PrEP: Part 2, now open for registration and scheduled for August 28, 2025, at 10:00 AM PT, which will continue the discussion on challenging cases and highlight important new data and PrEP options.

Which of the following statements is TRUE about the pathogenesis of long COVID?

Correct answer is A. Data from the Test Us At Home cohorts presented at the 2025 Conference for Retroviruses and Opportunistic Infections (CROI) demonstrated that, compared with people who fully recovered, those who went on to develop long COVID had a longer time from peak viral load to clearance and that those who experienced viral rebound had dramatically higher odds of developing long COVID.

Option B is incorrect because the data on SARS-CoV-2 persistence are mixed. Option C is incorrect because numerous studies have now failed to identify a shared autoimmune signature. Option D is incorrect because numerous studies have identified objective differences in people with and without long COVID, including studies presented at the 2025 Conference on Retroviruses and Opportunistic Infections (CROI).

To learn more about this topic and other Selected Highlights from CROI 2025, read the latest issues of Topics in Antiviral Medicine™ (TAM™):
May 2025 Issue: https://www.iasusa.org/tam/may-2025/
June 2025 Issue: https://www.iasusa.org/tam/june-2025/

In the BREATHER Plus trial (Short-Cycle HIV Therapy [5 Days On/2 Days Off] in Young People [12-19 Years] With Chronic HIV Infection in Sub-Saharan Africa), which compared intermittent to continuous antiretroviral therapy with tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD), which of the following was found?

Correct answer is C. Unlike a previous study of short-cycle therapy in young people on efavirenz-based antiretroviral therapy (BREATHER), as well as other studies included in the meta-analysis presented at IAS 2025, BREATHER Plus showed that short-cycle therapy with TLD was INFERIOR to continuous therapy. The reasons for this finding are not entirely clear and did not seem to relate to lower adherence (self-reported and MEMS cap adherence >90% in both arms) or demographic characteristics of study participants. No InSTI genotypic resistance was seen among virologic failures (with available resistance testing) in the intermittent arm.

To learn more about this topic, watch the on-demand webinar, Review of Data Presented at the 13th International AIDS Society Conference on HIV Science (IAS 2025), presented by Marina Klein, MD, MSc, and moderated by Roy M. Gulick, MD, MPH, on Tuesday, August 12, 2025.

How often should patients who are administered lenacapavir (LEN) every 6 months be monitored for breakthrough HIV infection?

Correct answer is D. The IAS–USA guidelines recommend testing before the initiation of lenacapavir, every 6 months thereafter, and at quarterly intervals, if sexually transmitted infection testing is performed at those intervals. The US Food and Drug Administration package insert requires that testing be done before initiating lenacapavir (and includes RNA testing at that point), at 6-month intervals (either antigen/antibody or rapid test plus a more sensitive test), and “as clinically indicated.” On-treatment testing for HIV breakthrough infection is critically important to monitor for the nonperfect protection afforded by preexposure prophylaxis (PrEP), even though breakthrough infections are expected to be extremely infrequent.

To learn more about HIV PrEP, watch Complicated Issues in the Management of PrEP: Part 1, presented by Raphael J. Landovitz, MD, MSc, and moderated by Michael S. Saag, MD, and now available on-demand. This webinar elicited a rich discussion and vibrant audience participation, and we were therefore not able to complete the portion of the agenda that focused on some of the important new advances in PrEP. Part 2, now open for registration and scheduled for August 28, 2025, at 10:00 AM PT, will therefore continue the discussion on challenging cases and highlight important new data and PrEP options.

A 52-year-old male presents for evaluation of a newly diagnosed HIV infection. His CD4+ count is 125 cells/µL and his HIV viral load is 34,000 copies/mL. Which of the following vaccines would be contraindicated at this time?

Correct answer is C. All live, replicating vaccines are contraindicated in people with HIV whose CD4+ count is less than 200 cells/µL. These include the MMR vaccine, the varicella vaccine, and the yellow fever vaccine. Oral typhoid vaccine and the live attenuated influenza vaccine are also not given to people with HIV, regardless of CD4+ cell count, and there are alternative vaccines for both diseases. The Jynneos mpox vaccine is a live, nonreplicating vaccine that can be safely administered at any CD4+ cell count.

To learn more about this topic, register for the August 6, 2025, webinar, 2025 Update on Routine and Special Immunizations for People With HIV, to be presented by Steven C. Johnson, MD, and moderated by Melanie A. Thompson, MD.

Which of the following is a common contributor to poorer quality of life among people with HIV?

Correct answer is A. Common contributors to poorer quality of life (QOL) in people with HIV are pain, fatigue, mood disturbance, sleep disturbance, and cognitive impairment. Higher socioeconomic status and engagement in a spiritual practice would be expected to improve QOL. Psychosis may occur and could reduce QOL, but it is far less common than pain. Isolation (ie, low social network density) is a far more common problem among people aging with HIV than stress related to high social network density.

To learn more about this topic, view the on-demand webinar, The True Meaning of Palliative Care: Maximizing Function in the Setting of Disability in People With HIV, to be presented by Jessica Robinson-Papp, MD, MS, and moderated by Michael S. Saag, MD.

Which of the following antiviral drugs has shown efficacy for postexposure prophylaxis (PEP) of SARS-CoV-2?

Correct answer is B. The phase III SCORPIO-PEP (Stopping COVID-19 Progression With Early Protease Inhibitor Treatment – Postexposure Prophylaxis) clinical trial results¹ were presented at the 2025 Conference for Retroviruses and Opportunistic Infections (CROI). The ensitrelvir group had a significantly lower proportion of participants develop symptomatic COVID-19 compared with the placebo group (2.9% vs 9.0%, respectively; risk ratio, 0.33; P<.0001), providing evidence for the efficacy of ensitrelvir in PEP. Nirmatrelvir/ritonavir was studied in a phase II-III double-blind trial of intrahousehold PEP, and although there were risk reductions seen with 5 and 10 days of nirmatrelvir/ritonavir, these were not significant. Molnupiravir for intrahousehold PEP was studied in the phase III MOVe-AHEAD (Study of MK-4482 for Prevention of Coronavirus Disease 2019 [COVID-19] in Adults [MK-4482-013]) trial, and although again a risk reduction was seen, molnupiravir did not meet the prespecified superiority criterion. There are no human data on remdesivir for PEP. 1. Fukushi A, Shinkai M, Clark TW, et al. Ensitrelvir to prevent COVID-19 in households: SCORPIO-PEP phase III placebo-controlled trial results. [CROI Abstract 200]. In Special Issue: Abstracts From the CROI 2025 Conference on Retroviruses and Opportunistic Infections. Top Antivir Med. 2025;33(1):54.

To learn more about this topic and to read other Selected Highlights from the 2025 Conference on Retroviruses and Opportunistic Infections, read the June 2025 issue of Topics in Antiviral Medicine™ (TAM).

This issue offers up to 8.0 CME credits.

Which of the following positive hepatitis B virus (HBV) serologies indicates a risk of HBV reactivation?

Correct answer is C. A randomized, double-blind phase IIb clinical trial of complex S aureus bacteremia conducted by Armata Pharmaceuticals demonstrated that those who received phage in addition to optimized antibiotics had more rapid bacterial clearance and improved clinical outcomes. Option A is incorrect because phase IIb clinical trials have demonstrated antimicrobial activity of phages directed at P aeruginosa in the sputum and E coli in the urine. Option B is incorrect because properly prepared phage preparations can be given safely intravenously over 2 to 3 minutes without toxicity. Option D is incorrect because a randomized, double-blind, phase IIb clinical trial of E coli urinary infections comparing an anti-E coli phage cocktail with placebo (both in addition to trimethoprim sulfamethoxazole) demonstrated clearance of E coli in the urine in more than 80% of patients receiving phages regardless of whether their isolates were susceptible to trimethoprim sulfamethoxazole.

To learn more about this topic, watch the on-demand webinar, An Introduction to Bacteriophages: Basic Science and Clinical Applications, presented by Graham F. Hatfull, PhD, and Robert T. Schooley, MD.

For a deeper dive into this topic, join us for the inaugural 2025 Conference on Bacteriophages: Biology, Dynamics, and Therapeutics, taking place in person from October 12–14 at the Washington Hilton in Washington, DC. This scientific meeting will bring together researchers from around the world to explore cutting-edge advances in bacteriophage biology, phage-host dynamics, and therapeutic applications.

Additionally, to enrich your understanding ahead of the conference, listen to the Going anti-viral Podcast, Episode 45 – Bacteriophages for the Treatment of Antimicrobial-resistant (AMR) Bacterial Infections, hosted by Michael S. Saag, MD, and featuring Graham F. Hatfull, PhD.

Which of the following positive hepatitis B virus (HBV) serologies indicates a risk of HBV reactivation?

Correct answer is C. Core antibody is a serologic marker of prior infection and thus the presence of covalently closed circular DNA (cccDNA) in the nucleus. This is transcriptionally competent DNA that can be transcribed to pregenomic RNA and thus to the nucleocapsid.

To learn more about this topic, view Dr Susanna Naggie’s presentation, Updates on Hepatitis B Coinfection: Challenging Serology and Treatment Approaches, from the virtual course, Keeping Up with the Guidelines: Recommendations and Controversies in Sexually Transmitted Infection Management, on May 20, 2025.

What is the most important feature of a therapeutically useful bacteriophage?

Correct answer is C. The most important feature of a therapeutically useful bacteriophage is that the phage kills the specific clinical isolate of bacteria efficiently. Bacteriophages are small, but size is not an important parameter in therapeutic utility. Temperate bacteriophages are not therapeutically useful, unless they are engineered to be lytic. Bacteriophage genomes often carry 100 or more genes, but the gene number is not relevant for therapeutic use. Many bacteriophages, but not all, look like lollipops, and shape is not a determinant in therapeutic choice.

To learn more about this topic, view the on-demand IAS-USA webinar, An Introduction to Bacteriophages: Basic Science and Clinical Applications, to be co-presented by Graham F. Hatfull, PhD, and Robert T. Schooley, MD.

A 32-year-old man presents to care with a single, painless ulcer on the ventral shaft of the penis. He does not have a prior rapid plasma reagin (RPR) test result, and he reports recent condomless sex with a new partner. Which of the following is the most appropriate treatment?

Correct answer is A. This patient with a painless chancre would be staged as primary syphilis. Benzathine penicillin G 2.4 million units intramuscularly in a single dose is the recommended first-line treatment for primary syphilis in nonpregnant adults.

Doxycycline 100 mg orally twice daily is an accepted alternative regimen, but it should be given for 14 days, not 7. More importantly, penicillin is the preferred treatment when there is no contraindication.

The 3-week penicillin regimen is used for late latent syphilis or syphilis of unknown duration, not for primary syphilis.

Clinical diagnosis of primary syphilis can and should prompt empiric treatment, even before reactive plasma reagin test results are available, due to the high risk of transmission and progression.

To learn more about this topic, view the on-demand webinar, Syphilis Resurgent: Addressing the Growing Epidemic From Prevention to Perinatal Impact, presented by Jason E. Zucker, MD, and moderated by Connie L. Celum, MD, MPH.

Which of the following statements is TRUE about the challenges of developing vaccines to prevent bacterial sexually transmitted infections (STIs)?

Correct answer is B. Ritonavir reduces atovaquone-proguanil levels, but no clinically important interactions have been demonstrated between antimalarial drugs and primary antiretroviral regimens, including integrase strand transfer inhibitor/nucleoside reverse transcriptase inhibitor combinations and cabotegravir. Mefloquine is the antimalarial drug most likely to interact with antiretroviral regimens.

To learn more about this topic, watch the on-demand webinar, Update on Pretravel Medical Preparation for Persons With HIV and Immunocompromised Travelers, presented by Dr David O. Freedman, MD, and moderated by Judith S. Currier, MD.

Which of the following statements is TRUE about the challenges of developing vaccines to prevent bacterial sexually transmitted infections (STIs)?

Correct answer is A. It is difficult to design an effective vaccine when the immune response is not known. If the correlate of protection is defined (eg, a certain antibody threshold for a key antigen related to C trachomatis binding of the host cell or T pallidum dissemination), rationale vaccine design principles can be used to focus on eliciting that targeted immune response. STI reinfection with C trachomatis, Neisseria gonorrhoeae, or T pallidum is quite common, so Option B is incorrect. Models demonstrate a significant impact of an STI prevention vaccine with 30% to 40% efficacy on population-level STI rates, so Option C is incorrect. Bacterial STIs do not lead to sterilizing immunity or protection against reinfection. Principles of STI management include diagnosis and treatment to prevent adverse outcomes in the patient and onward transmission to partners or during pregnancy, so Option D is incorrect.

To learn more about this topic, watch the on-demand presentation by Jodie A. Dionne, MD, MSPH, Chlamydia Management Updates: Advances and Vaccines Developments for STI Prevention

And don’t miss the other informative presentations from this on-demand activity, Keeping Up with the Guidelines: Recommendations and Controversies in Sexually Transmitted Infection Management.

Which of the following statements is TRUE regarding tenofovir alafenamide (TAF)/emtricitabine (FTC) for pericoital preexposure prophylaxis (PrEP)?

Which of the following is the most appropriate approach at 6 months following treatment for early syphilis?

Correct answer is B. Live-attenuated virus vaccines should not be administered for at least 6 but likely 12 months after rituximab. The risk of yellow fever, a fatal disease in the immunocompromised, is too high in the Amazon to travel there unprotected.

To learn more about this topic, view the on-demand webinar, Update on Pretravel Medical Preparation for Persons With HIV and Immunocompromised Travelers, presented by Dr David O. Freedman, MD, and moderated by Judith S. Currier, MD.

Which of the following statements is TRUE regarding tenofovir alafenamide (TAF)/emtricitabine (FTC) for pericoital preexposure prophylaxis (PrEP)?

Which of the following is the most appropriate approach at 6 months following treatment for early syphilis?

A 42-year-old heterosexual man presents to the clinic with a 4-day history of urethral discharge and dysuria. He reports having sexual intercourse with a woman 3 days prior to symptom onset while he was traveling in Thailand. He has genital discharge, which shows Gram-negative diplococci on stain.

Which of the following is the most appropriate next step in management?

Correct answer is D. When evaluating a patient with urethral discharge, sending for NAAT for N gonorrhoeae and C trachomatis is recommended. If the patient history is concerning for potential antimicrobial resistance (eg, an infection occurring in a region with a high prevalence of resistance), then obtaining a urethral swab for culture is recommended. The recommended treatment for gonococcal infections of the urethra is ceftriaxone 500 mg intramuscularly once. When providing treatment for gonorrhea, and chlamydia has not been excluded, treating for chlamydia coinfection with doxycycline 100 mg twice per day for 7 days is recommended.

To learn more about this topic, register for the virtual course, Keeping Up with the Guidelines: Recommendations and Controversies in Sexually Transmitted Infection Management, chaired by Raphael J. Landovitz, MD, MSc, and Susanna Naggie, MD, MHS.

A 46-year-old man with HIV (plasma HIV RNA <20 copies/mL; CD4+ count, 1100 cells/µL) presented to care with low-grade fever, hair loss, and a rash involving his palms and soles. His treponemal enzyme immunoassay was reactive, as was his serum rapid plasma reagin (RPR) with a titer of 1:64. He was diagnosed with secondary syphilis and treated with 2.4 million units of long-acting benzathine penicillin G intramuscularly. At 3 months, his RPR titer was 1:32. Now, at 6 months, his RPR titer is still 1:32. He denies any symptoms or new exposures since his treatment 6 months ago.

Which of the following is the most appropriate approach at 6 months following treatment for early syphilis?

Correct answer is A. When following RPR titers after therapy for early syphilis, and in the absence of reinfection or treatment failure, the recommendation is to allow for at least 12 months (and up to 24 months in persons with HIV) for the RPR titers to decline 4-fold. The patient has not been reinfected and is clinically well without any evidence of treatment failure. As such, no intervention is warranted at this time.

To learn more about this topic, register for the virtual course, Keeping Up with the Guidelines: Recommendations and Controversies in Sexually Transmitted Infection Management, chaired by Raphael J. Landovitz, MD, MSc, and Susanna Naggie, MD, MHS.

Which of the following was TRUE in studies comparing switching participants to islatravir (ISL) plus doravirine (DOR) with either continuing their baseline antiretroviral therapy (ART) regimen or continuing bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC)?

Correct answer is D. Viral suppression in study participants switching to islatravir plus doravirine was noninferior to continuing baseline antiretroviral therapy. There was no change in weight compared with those continuing BIC/TAF/FTC. Lymphocyte counts remained stable in both studies.

To learn more about this topic, view the on-demand webinar, 2025 and Beyond: Exciting Times For the HIV Treatment Pipeline! presented by Melanie A. Thompson, MD, and moderated by Rajesh T. Gandhi, MD.

Which of the following is a substantial limitation to the broad use of bacteriophages for therapy of nontuberculous mycobacterium (NTM) infections?

Correct answer is D. There are some phages available for some NTM infections, and bacteriophages that kill NTM strains do exist. Bacteriophages can (and are) used in combination with antibiotics. Answer D is correct because the bacteriophages available for treating NTM infections have narrow host preferences and only infect subsets of NTM clinical isolates, imposing a constraint on broadening therapeutic use.

To learn more about this topic, join us for the inaugural 2025 Conference on Bacteriophages: Biology, Dynamics, and Therapeutics, taking place in person from October 12–14 at the Washington Hilton in Washington, DC. This scientific meeting will bring together researchers from around the world to explore cutting-edge advances in bacteriophage biology, phage-host dynamics, and therapeutic applications.

Additionally, to enrich your understanding ahead of the conference, listen to the Going anti-viral Podcast, Episode 45 – Bacteriophages for the Treatment of Antimicrobial-resistant (AMR) Bacterial Infections, hosted by Dr Michael S. Saag and featuring Dr Graham F. Hatfull.

Of the 47 participants in the HIV Prevention Trials Network (HPTN) 083 (Injectable Cabotegravir Compared to TDF/FTC For PrEP in HIV-Uninfected Men and Transgender Women Who Have Sex With Men) who were exposed to long-acting cabotegravir (CAB-LA) who became infected with HIV, what proportion achieved viral suppression on their first antiretroviral regimen?

Correct answer is C. Overall, among those with breakthrough infections who had received CAB-LA in HPTN 083, 77% achieved viral suppression on their initial regimen, including 71% of those started on an integrase strand transfer inhibitor (InSTI)-based regimen and 81% who started on a non-InSTI-based regimen.

To learn more about this topic, view the on-demand webinar, The ART of HIV and STI Prevention: Update From the 2025 Conference on Retroviruses and Opportunistic Infections (CROI), presented by Susan P. Buchbinder, MD, and moderated by Albert Y. Liu, MD, MPH, on April 15, 2025.

According to the BEeHIVe (B-Enhancement of HBV Vaccination in Persons Living With HIV: Evaluation of HEPLISAV-B) study of CpG-adjuvanted hepatitis B vaccine (HepB-CpG) for people with HIV and prior hepatitis B vaccine nonresponse, which of the following statements is FALSE?

Correct answer is B. Two-dose and 3-dose series of HepB-CpG vaccinations were each superior to the control, but a 3-dose series was not superior to a 2-dose series.

To learn more about this topic, view the on-demand course, The Scott M. Hammer Annual Update on HIV Management in New York, New York, for Dr Melanie A. Thompson’s presentation, Update on HIV Primary Care: New Data, New Guidelines.

In studies like the Last Gift Program, what is the primary benefit of using a participatory research model?

Correct answer is A. A participatory research model is essential in studies like the Last Gift Program because it ensures that participants and their families are actively involved in shaping the research process from the very beginning. This approach is particularly important in end-of-life studies where ethical considerations, trust, and community engagement are paramount.

To learn more about this topic, watch the on-demand webinar, The Last Gift Program: Lessons Learned From Altruistic Participants Enrolled in HIV Cure Research at the End of Life, presented by Sara Gianella Weibel, MD, and moderated by Davey M. Smith, MD.

A 44-year-old individual with HIV is currently well controlled with emtricitabine/tenofovir alafenamide and dolutegravir and asks your opinion regarding initiation of gender-affirming hormone treatment (GAHT). She was designated male sex at birth but identifies as a transgender woman. She has discussed her gender incongruence with her primary care physician,who is experienced in providing GAHT, but this physician has also expressed concern due to the patient’s HIV infection and antiretroviral therapy (ART) regimen. Which of the following is the best recommendation?

Correct answer is E. With current ART regimens, there is negligible interaction between ART and GAHT. There is therefore no need to adjust either the ART or the GAHT regimen, and she can proceed with standard GAHT. The standard of care is to adjust the GAHT dose to ensure adequate, but not excessive, hormone levels. Monitoring of hormone levels would also alleviate any issues related to ART-induced changes in hormone levels.

Recommended readings:

Coleman E, Radix AE, Bouman WP, et al. Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgend Health. 2022;23(Suppl 1):S1-S259. Published 2022 Sep 6. doi:10.1080/26895269.2022.2100644

Safer JD, Tangpricha V. Care of transgender persons. N Engl J Med. 2019;381(25):2451-2460. doi:10.1056/NEJMcp1903650

Senneker T. Drug-drug interactions between gender-affirming hormone therapy and antiretrovirals for treatment/prevention of HIV. Br J Clin Pharmacol. 024;90(10):2366-2382. doi:10.1111/bcp.16097

van Zijverden LM, Wiepjes CM, van Diemen JJK, Thijs A, den Heijer M. Cardiovascular disease in transgender people: a systematic review and meta-analysis. Eur J Endocrinol. 2024;190(2):S13-S24. doi:10.1093/ejendo/lvad170

Iwamoto SJ, Grimstad F, Irwig MS, Rothman MS. Routine screening for transgender and gender diverse adults taking gender-affirming hormone therapy: a narrative review J Gen Intern Med. 2021;36(5):1380-1389. doi:10.1007/s11606-021-06634-7

Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society Clinical Practice Guideline [published correction appears in J Clin Endocrinol Metab. 2018 Feb 1;103(2):699. doi: 10.1210/jc.2017-02548.] [published correction appears in J Clin Endocrinol Metab. 2018 Jul 1;103(7):2758-2759. doi: 10.1210/jc.2018-01268.]. J Clin Endocrinol Metab. 2017;102(11):3869-3903. doi:10.1210/jc.2017-01658

To learn more about this topic, view the The Scott M. Hammer Annual Update on HIV Management in New York, New York, that happened on March 24, 2025, and watch Dr Ole-Petter R. Hamnvik’s presentation, Gender-Affirming Hormone Initiation and Antiretroviral Therapy Considerations.

Which human papillomavirus (HPV)-related cancer occurs more frequently in men than women in the general population?

Correct answer is C. The rates of oral and oropharyngeal cancer (OPC) in men now exceed the rates of cervical cancer in women. In the general population, men are 5-times more likely than women to develop OPC.^1-3 The rates of OPC continue to climb; meanwhile, cervical cancer rates are dropping.

1. Marur S, D’Souza G, Westra WH, Forastiere AA. HPV-associated head and neck cancer: a virus-related cancer epidemic. Lancet Oncol. 2010;11(8):781-789. doi:10.1016/S1470-2045(10)70017-6

2. Kreimer AR, Villa A, Nyitray AG, et al. The epidemiology of oral HPV infection among a multinational sample of healthy men. Cancer Epidemiol Biomarkers Prev. 2011;20(1):172-182. doi:10.1158/1055-9965.EPI-10-0682

3. Gillison ML, Broutian T, Pickard RK, et al. Prevalence of oral HPV infection in the United States, 2009-2010. JAMA. 2012;307(7):693-703. doi:10.1001/jama.2012.101

To learn more about this topic, register for The Scott M. Hammer Annual Update on HIV Management in New York, New York, on March 24, 2025.

Watch Dr Timothy J. Wilkin’s presentation, Comprehensive Overview: Latest Guidelines for Screening and Treatment for Human Papillomavirus and Anal Cancer, available on-demand from The Annual IAS-USA Washington, DC, Virtual Course: Update on HIV Medicine Emerging Challenges

A 44-year-old Black man who has sex with men has been on HIV preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) for the past 2 years. He has heard about new options for prevention with injectable antiretrovirals and also asks about options for prevention of sexually transmitted infections. Which of the following statements is correct?

*PURPOSE-1 (Pre-Exposure Prophylaxis Study of Lenacapavir and Emtricitabine/Tenofovir Alafenamide in Adolescent Girls and Young Women at Risk of HIV Infection)

**PURPOSE-2 (Study of Lenacapavir for HIV Pre-Exposure Prophylaxis in People Who Are at Risk for HIV Infection)

Correct answer is D. In both PURPOSE-1 and PURPOSE-2, HIV incidence with lenacapavir was significantly lower than background HIV incidence and HIV incidence with F/TDF. Therefore, option A is incorrect.^1,2 Analysis of a Kaiser Permanente Northern California Retrospective Cohort from 2022-2023 showed that among doxycycline postexposure prophylaxis (doxy-PEP) recipients, quarterly chlamydia and syphilis positivity both decreased by 80% after starting doxy-PEP. However, rectal, and urethral gonorrhea positivity also decreased only modestly (20% and 40%, respectively) and pharyngeal gonorrhea did not decrease.³ Also, in San Francisco, monthly cases of chlamydia and early cases of syphilis decreased by 50% each following implementation of a preexposure prophylaxis program. Therefore, option B is incorrect.⁴ According to the IAS-USA guidelines for persons who acquired HIV after exposure to cabotegravir for preexposure prophylaxis, if therapy is desired before genotype results are available or if resistance to integrase strand transfer inhibitors is present or suspected, ritonavir- or cobicistat-boosted darunavir and tenofovir alafenamide or tenofovir disoproxil fumarate (TXF) plus emtricitabine or lamivudine (XTC) should be used. Therefore, option C is incorrect and option D is correct.⁵

1. Bekker LG, Das M, Abdool Karim Q, et al. Twice-yearly lenacapavir or daily F/TAF for HIV prevention in cisgender women. N Engl J Med. 2024;391(13):1179-1192. doi:10.1056/NEJMoa2407001

2. Kelley CF, Acevedo-Quiñones M, Agwu AL, et al. Twice-yearly lenacapavir for HIV prevention in men and gender-diverse persons. N Engl J Med. Published online November 27, 2024. doi:10.1056/NEJMoa2411858

3. Traeger MW, Leyden WA, Volk JE, et al. Doxycycline postexposure prophylaxis and bacterial sexually transmitted infections among individuals using HIV preexposure prophylaxis. JAMA Intern Med. Published online January 6, 2025. doi:10.1001/jamainternmed.2024.7186

4. Sankaran M, Glidden DV, Kohn RP, et al. Doxycycline postexposure prophylaxis and sexually transmitted infection trends. JAMA Intern Med. Published online January 6, 2025. doi:10.1001/jamainternmed.2024.7178

5. Gandhi RT, Landovitz RJ, Sax PE, et al. Antiretroviral drugs for treatment and prevention of HIV in adults: 2024 recommendations of the International Antiviral Society-USA Panel. JAMA. Published online December 1, 2024. doi:10.1001/jama.2024.24543

To learn more about this topic, watch the on-demand webinar, No Mo’ FOMO 2025—In Case You Missed It: Recent Changes in Guidelines, New Publications, and Updates From Recent Conferences, presented by Roger J. Bedimo, MD, MS, and moderated by Constance A. Benson, MD.

A 68-year-old man who has been vaccinated 4 times with the mRNA COVID-19 vaccine comes down with his third episode of COVID-19 disease. His most recent vaccination was 6 months ago. His underlying medical conditions include hypertension, hyperlipidemia, and type 2 diabetes mellitus. Which of the following is true regarding this current episode of COVID-19 disease?

Correct answer is D. Several studies now show that the risk of developing long COVID increases with each episode of COVID-19 disease. Multiple pathways can lead to long COVID, which ranges from exaggeration or persistence of symptoms related to the COVID-19 episode to the development of autoimmunity triggered by the SARS-CoV-2 infection.

Answer A is incorrect because for those who have had a prior episode of COVID-19 disease, the risk of hospitalization is lower for individuals who have received at least 1 COVID-19 vaccine than those who have never received a COVID-19 vaccine.

Answer B is incorrect because humoral immunity following both COVID-19 disease and COVID-19 vaccination wanes quickly over the 3- to 6-month interval from the infection or vaccine. This is one of the reasons individuals can be infected numerous times, even if they have had infection previously or have been vaccinated. Cellular immunity, on the other hand, persists for years. Cellular immunity likely helps protect against serious adverse outcomes, including hospitalization and death, but not reinfection.

Answer C is incorrect because among individuals who have had prior episodes of COVID-19 disease, symptoms and adverse outcomes (eg, hospitalization or death) are worse for those who have never received a vaccination versus those who have been vaccinated in the past.

To learn more about this topic, listen to the Going anti-viral podcast, Update on COVID-19 – with Dr Andrew T. Pavia, moderated by Dr Michael S. Saag.

A 68-year-old man who has sex with men was diagnosed with HIV 20 years ago. He is virologically suppressed on stable antiretroviral therapy. His CD4+ count is 640 cells/µL. His comorbidities include type 2 diabetes mellitus, hypertension, atherosclerotic cardiovascular disease with acute myocardial infarction 3 years ago, and prostate cancer. He leads a very sedentary lifestyle and has noticed increasing weakness and falls. Which of the following statements is correct?

Correct answer is C. Age-related comorbidity burden is higher in people with HIV (PWH) compared with the general population. Recent forecasting indicates that by 2030, 45% of PWH will be living with 2 or more physical comorbidities, and 64% with 1 or more mental comorbidities.^1,2 Therefore, option A is incorrect. Epigenetic aging did not accelerate in a cohort of aviremic HIV-infected adults after 4 years of follow-up, independently of the antiretroviral regimen and CD4+ cell count changes.³ Therefore, option B is incorrect. Investigators looked at associations between phenotypic measures of cognition, frailty, and 7-year survival with epigenetic age estimates derived from the modification of DNAm in a population of older PWH. They found that epigenetic age advancement is associated with greater mortality after adjusting for chronologic age.⁴ Therefore, option C is correct. PWH have increased incidence of several age-related complications, but median age of onset appears to be the same as those without HIV. This has been observed in the VA Aging Cohort Study for cardiovascular diseases and cancer.^5,6 Therefore, option D is incorrect.

1. Kong AM, Pozen A, Anastos K, Kelvin EA, Nash D. Non-HIV comorbid conditions and polypharmacy among people living with HIV age 65 or older compared with HIV-negative individuals age 65 or older in the United States: a retrospective claims-based analysis. AIDS Patient Care STDS. 2019;33(3):93-103. doi:10.1089/apc.2018.0190

2. Althoff KN, Stewart C, Humes E, et al. The forecasted prevalence of comorbidities and multimorbidity in people with HIV in the United States through the year 2030: a modeling study. PLoS Med. 2024;21(1):e1004325. Published 2024 Jan 12. doi:10.1371/journal.pmed.1004325

3. Esteban-Cantos A, Rodriguez-Centeno J, Saiz-Medrano G, et al. Epigenic aging changes in a cohort of aviremic HIV-infected adults. In Special Issue: Abstracts From the CROI 2021 Conference on Retroviruses and Opportunistic Infections. Top Antivir Med. 2021;29(1):201.

4. Johnston C, Pang AP, Siegler E, et al. Epigenetic age advancement is associated with cognition, frailty, and mortality in older PWH. [CROI Abstract 595]. In Special Issue: Abstracts From the CROI 2024 Conference on Retroviruses and Opportunistic Infections. Top Antivir Med. 2024;32(1):161.

5. Althoff KN, McGinnis KA, Wyatt CM, et al. Comparison of risk and age at diagnosis of myocardial infarction, end-stage renal disease, and non-AIDS-defining cancer in HIV-infected versus uninfected adults. Clin Infect Dis. 2015;60(4):627-638. doi:10.1093/cid/ciu869

6. Sigel K, Park LS, Justice AC, et al. Prostate cancer characteristics and outcomes for veterans with HIV in the antiretroviral era. [CROI Abstract 154]. In Special Issue: Abstracts From the CROI 2024 Conference on Retroviruses and Opportunistic Infections. Top Antivir Med. 2024;32(1):34.

To learn more about this topic, register for the webinar No Mo’ FOMO 2025—In Case You Missed It: Recent Changes in Guidelines, New Publications, and Updates From Recent Conferences presented by Roger J. Bedimo, MD, MS, and moderated by Constance A. Benson, MD, on February 11, 2025.

Which of the following statements is TRUE about immunologic aging in people with HIV?

Correct answer is B. Levels of systemic inflammation and immune activation in the blood increase with advancing age, which has been described as “inflamm-aging.” This increase in inflammation is associated with an increased risk for age-related diseases (eg, cardiovascular disease, cancer, multimorbidity, and frailty). HIV-associated immunosuppression does not reduce inflamm-aging. In fact, HIV is associated with greater inflammation, including increases among people with HIV at older ages (eg, over age 50 years) despite continuous antiretroviral therapy use with viral suppression and a very low risk of opportunistic infections.

To learn more about this topic, read HIV and Inflamm-Aging: How Do We Reach the Summit of Healthy Aging? by Kerry Sheets, MD, MS, and Jason V. Baker, MD, MS, in the latest issue of Topics in Antiviral Medicine™.

A 28-year-old man newly diagnosed with HIV presents for an initial visit to establish care at your infectious diseases primary care practice. You discuss the option to initiate antiretroviral therapy (ART) to control HIV and review potential adverse effects of the medication. You plan to start bictegravir/emtricitabine/tenofovir alafenamide. Which of the following is a risk factor for greater magnitude of weight gain on ART?

Correct answer is A. The return-to-health phenomenon has been shown to contribute to greater weight gain for individuals with a greater HIV disease burden pretreatment. Observational data show that women and older individuals are also at higher risk of weight gain. Alcohol use is not a typically associated risk factor for weight change with antiretroviral therapy.

To learn more about this topic, watch the on-demand webinar Comprehensive Review of Weight Management in People With HIV presented by Selvi Rajagopal, MD, MPH, and moderated by Roger J. Bedimo, MD, MS.

A 52-year-old woman with HIV presents for routine follow-up care. She has an undetectable plasma HIV RNA level and currently takes aspirin 81 mg daily, rosuvastatin 20 mg daily, lisinopril 20 mg daily, and tirzepatide 10 mg weekly. Over the past 3 months, she has achieved 10% weight loss through a combination of lifestyle changes and medication support. Her current weight is 216 lb, with a body mass index of 34 kg/m2. Her last hemoglobin A1c level was 6.0%. She would like to achieve an additional 8% weight loss to reach a goal weight of 200 lb or lower. She experiences nausea after each weekly tirzepatide dose and has trouble eating 3 meals per day due to significant appetite suppression. Which of the following is the best response?

Correct answer is B. After 10% weight loss from baseline, there is a decline in resting metabolism that makes additional weight loss more difficult. Weight training done in conjunction with adequate protein intake (approximately 1 to 1.2 g/kg/day) can support lean muscle mass, help to preserve metabolism, and improve body composition. Increasing the dose of tirzepatide is not appropriate given the level of appetite suppression she already feels and adverse effect of nausea. Adding metformin may not be adequate to support her additional weight loss goals. She is unlikely to be a candidate for bariatric surgery given a weight loss goal of 8% and well-controlled diabetes with a lower body mass index.

To learn more about this topic, view the on-demand webinar Comprehensive Review of Weight Management in People With HIV to be presented by Selvi Rajagopal, MD, MPH, and moderated by Roger J. Bedimo, MD, MS.

Which of the following is TRUE about the results of the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) study?

Correct answer is B. The oldest cohort in the REPRIEVE study benefited the most from pitavastatin treatment, with a hazard ratio of 0.3 for development of major adverse cardiovascular events in the 5.1-year period. The upper age limit of inclusion criteria was 75 years of age, and there are no data for this age group. The authors supported the use of other statins: “For persons who are living in areas where pitavastatin is not available, the use of other statins that do not interact with antiretroviral therapy may be a reasonable choice.”

To learn more about this topic, register for the IAS-USA webinar Optimizing Care for Older People With HIV to be presented by Eugenia L. Siegler, MD, and moderated by Carrie D. Johnston, MD, MS, on Tuesday, January 14, 2025, at 10:00 AM – 11:15 AM PT.

A 26-year-old man originally from Brazil presents to care for an initial evaluation after being diagnosed with HIV during routine testing. He is asymptomatic, with no past medical history or prior opportunistic infections. He has a CD4+ count of 540 cells/µL and a plasma HIV RNA level of 120,000 copies/mL. Routine screening for latent tuberculosis with an interferon gamma release assay is positive, and his chest radiograph is normal. He denies any symptoms of active tuberculosis.
When you explain he will need to be treated for latent tuberculosis infection, the patient expresses concern about pill burden and adherence, emphasizing the need for a simple and manageable treatment regimen. Which of the following regimens do you recommend, considering both antiretroviral therapy (ART) and latent tuberculosis infection?

Correct answer is B. This person with latent tuberculosis is asking for a simple treatment. Simultaneous initiation of 3HP and once-daily DTG in ART-naive patients achieves and maintains adequate and rapid viral suppression. The other acceptable option would be DTG twice daily with 1HP but this may present a challenge for adherence, as it is a twice-daily regimen.

To learn more about this topic, watch presentation, Co-Infections in the Setting of ART: TB, OIs, and Others, presented by Brenda Crabtree, MD, at the 2024 IAS-USA Guidelines Virtual Update: Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults on December 12, 2024.

Which of the following is the most appropriate initial treatment for disseminated Mycobacterium avium complex (MAC) disease in persons with HIV who are not receiving effective antiretroviral therapy (ART)?

Correct answer is B. Based on the National Institutes of Health (NIH)/Centers for Disease Control and Prevention (CDC)/Infectious Diseases Society of America (IDSA) Guidelines for the Treatment and Prevention of Opportunistic Infections, ART should be started as soon as possible after the diagnosis of MAC disease, preferably at the same time as initiation of antimycobacterial therapy in people with HIV who are not receiving effective ART. Initial treatment of MAC disease should consist of 2 or more antimycobacterial drugs to prevent or delay the emergence of resistance; clarithromycin or azithromycin are the preferred first agents. Ethambutol is the recommended second drug for the initial treatment of MAC disease based on randomized clinical trials that indicate its use in the regimen is associated with lower rates of relapse. Rifabutin can be added as a third drug with a fluoroquinolone (eg, levofloxacin or moxifloxacin) or an injectable aminoglycoside (eg, amikacin or streptomycin) as a fourth drug if more severe disease is present, the risk of mortality is high, the emergence of drug resistance is likely, or in the setting of advanced immunosuppression (ie, CD4+ count of less than 50 cells/µL), high mycobacterial loads (ie, greater than 2log₁₀ colony-forming units/mL of blood), or absence of effective ART.

To learn more about this topic, watch the Key Opportunistic Infections: Not Gone and Not Forgotten – Cases from the Clinic and Panel Discussion, presented by Constance A. Benson, MD, at the 2024 Ryan White HIV/AIDS Program CLINICAL CONFERENCE on November 19, 2024.

A 32-year-old Black woman with HIV started antiretroviral therapy (ART) with dolutegravir (DTG)/abacavir (ABC)/lamivudine (3TC) 2 years ago. She has since gained 25 lb. At the follow-up visit, her blood pressure is 140/90 mm Hg and her body mass index is 34 kg/m2. Physical examination is otherwise unremarkable. Recent laboratory values include a plasma HIV RNA level of less than 20 copies/mL, a CD4+ count of 430 cells/µL, and a hemoglobin A1c (HbA1C) level of 6.2%. Her atherosclerotic cardiovascular disease (ASCVD) risk score is 6%. She is concerned about her weight gain and the potential metabolic complications of ART. Which of the following statements is TRUE?

Correct answer is B. In the data presented to date, statins appear to lower LDL-C in people with HIV but do not seem to lower inflammation.

To learn more about this topic, view the presentation, Strategies to Reduce Cardiovascular Disease in Persons With HIV in 2024 – Where Do We Go From Here?, presented by Priscilla Y. Hsue, MD, at the Washington, DC, virtual course, on December 3, 2024.

In the general population, individuals on lipid-lowering therapy achieve the most clinical benefit when they are able to lower both low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP). Which of the following does statin use achieve among persons with HIV?

Correct answer is B. In the data presented to date, statins appear to lower LDL-C in people with HIV but do not seem to lower inflammation.

To learn more about this topic, view the presentation, Strategies to Reduce Cardiovascular Disease in Persons With HIV in 2024 – Where Do We Go From Here?, presented by Priscilla Y. Hsue, MD, at the Washington, DC, virtual course, on December 3, 2024.

Diamond is 52 years old and was diagnosed with HIV at age 25 years. At age 15 years, she started injecting gender-affirming hormones acquired from friends, but she switched to prescribed hormone therapy once she engaged in HIV care. She has a past medical history of syphilis. Her most recent laboratory values include a low-density lipoprotein level of 75 mg/dL. Her physical examination is normal, with a blood pressure reading of 132/80 mm Hg. Her estimated atherosclerotic cardiovascular disease risk score is 5.5%. She takes dolutegravir/rilpivirine daily, oral estradiol 4 mg daily, and spironolactone 100 mg twice daily. She quit smoking cigarettes 4 years ago and drinks 1 or 2 beers per week. Her father died of an acute myocardial infarction at age 55 years. Based on current guidelines, which of the following is the best option for reducing Diamond’s atherosclerotic cardiovascular disease risk?

Correct answer is C. Department of Health and Human Services guidelines recommend statin therapy for primary prevention of atherosclerotic cardiovascular disease in people with HIV who are age 40 years or older and have low to intermediate risk, regardless of lipid levels. Reducing Diamond’s low alcohol intake is less likely to reduce her risk than statin therapy. Injectable estradiol may have a lower risk of venous thromboembolism than oral estradiol but has not been shown to reduce the risk of atherosclerotic cardiovascular disease.

To learn more about this topic, view the on-demand IAS-USA webinar, Gender-Affirming Hormone Care for People With HIV, to be presented by Tonia C. Poteat, PhD, MPH, PA-C, and moderated by Asa Radix, MD, PhD, MPH, on Wednesday, December 11, 2024, at 10:00 AM – 11:15 AM PT.

Which of the following statements is TRUE?

Correct answer is A. American Indian/Alaska Native men have the highest rates of primary/secondary syphilis in the US. Pneumococcal conjugate vaccine (PCV15) should be given with pneumococcal polysaccharide vaccine (PPSV23) to complete the pneumococcal vaccine series. Both 2 and 3 doses of HepB-CpG (Heplisav-B®) vaccine were superior to control in prior hepatitis B vaccine nonresponders. According to the new US Preventive Services Task Force guidelines, there is no age for stopping cervical Pap screening in people with HIV.

To learn more about this topic, view the on-demand webinar, Update on HIV Primary Care Guidelines, presented by Melanie A. Thompson, MD, and moderated by Steven C. Johnson, MD, on Wednesday, December 4, 2024, at 10:00 AM – 11:15 AM PT.

Which of the following antiretroviral strategies is not currently under clinical investigation?

Correct answer is C. There are a number of weekly oral antiretroviral treatment regimens under clinical study, including lenacapavir/islatravir, ulonivirine/islatravir, and GS-4182 (lenacapavir prodrug)/GS-1720 (an integrase strand transfer inhibitor). Although the investigational nucleoside reverse transcriptase translocation inhibitor (nRTTI) islatravir will no longer be developed as monthly oral PrEP, a second nRTTI, MK-8527 is currently under study with that strategy. Injectable antiretrovirals with longer half-lives, including a newer formulation of cabotegravir, are now in clinical development, as are every 6-month infusions of combinations of broadly neutralizing monoclonal antibodies. There are no current monthly oral treatment regimens under clinical study.

To learn more about this topic, register for the virtual course, The Annual IAS-USA Washington, DC, Virtual Course: Update on HIV Medicine Emerging Challenges, and view the presentation, Advancements in Long-Acting Drugs for HIV Treatment and Prevention, Including Emerging Therapies, presented by Roy M. Gulick, MD, MPH, on December 3, 2024.

Which of the following groups is recommended to receive mpox vaccination by the Advisory Committee on Immunization Practices?

Correct answer is C. The Advisory Committee on Immunization Practices recommends vaccination for gay, bisexual, and other men who have sex with men with a diagnosis of a sexually transmitted infection in the past 6 months.

To learn more about this topic:

• • Watch the on-demand webinar, Mpox Updates Amidst the Ongoing Global Public Health Emergency, presented by Jason E. Zucker, MD, and moderated by Judith S. Currier, MD: https://www.iasusa.org/courses/on-demand-webinar-2024-zucker-2/
• • Listen to the Going antiViral podcast, featuring a discussion on the latest information about mpox with Jason E. Zucker, MD, and host Michael S. Saag, MD: https://www.iasusa.org/going-anti-viral-podcast/

What is the targeted decrease in the incidence of hepatitis C virus (HCV) infection put forth in the 2016 World Health Organization mandate for the elimination of HCV by 2030?

Correct answer is B. In the guidance developed in 2016, the World Health Organization specifies an 80% decrease in hepatitis C incidence by 2030 as the target for hepatitis C elimination. Other components of the mandate include diagnosis of 90% of persons with hepatitis C, treatment of 80%, and realizing a 65% decrease in hepatitis C-related mortality.

To learn more about this topic, register for Where Are We With Hepatitis C Elimination?, to be presented by David L. Wyles, MD, and moderated by Kara W. Chew, MD, MS, on November 22, 2024, at 10:00 AM – 11:15 AM PT.

Which of the following antiviral treatments has been shown to be effective against mpox in humans in a randomized clinical trial?

Correct answer is E. The PALM 007 (Tecovirimat for Treatment of Monkeypox Virus) trial did not show a benefit of tecovirimat. To date, no antiviral treatment has been shown to be effective in a randomized clinical trial.

To learn more about this topic:

• • Register for the webinar, Mpox Updates Amidst the Ongoing Global Public Health Emergency, to be presented by Jason E. Zucker, MD, and moderated by Judith S. Currier, MD, on November 13, 2024, at 10:00 AM – 11:15 AM PT.
• • Stay tuned for the Going antiViral podcast on November 5, 2024, featuring a discussion on the latest information about mpox. Jason E. Zucker, MD, will join host Michael S. Saag, MD: https://www.iasusa.org/going-anti-viral-podcast/

A 62-year-old man had a 23-valent pneumococcal polysaccharide vaccine (PPSV23) as his first pneumococcal vaccine at age 50 years. He had a 13-valent pneumococcal conjugate vaccine (PCV13) vaccine at age 55 years and a PPSV23 vaccine at age 60 years. What vaccine should he receive at age 65 years?

Correct answer is D. A PPSV23 could be given at age 65 years, which would be 5 years after his last PPSV23; however, there is no recommendation for an additional vaccine 5 years later. An additional PCV13 is not recommended, since he had a previous PCV13. PCV15 followed by an additional PPSV23 at 5 years is not recommended. A single dose of PCV20 or PCV21 would complete his vaccine series.

To learn more about this topic, watch the on-demand webinar, HIV 101: Core Principles of HIV Management for People Who Are Newly Diagnosed With HIV, presented by Michael S. Saag, MD, Judith S. Currier, MD, and Melanie A. Thompson, MD.

A 23-year-old woman is 3 weeks pregnant. An HIV test is positive, her HIV RNA level is 12,000 copies/mL, and her CD4+ count is 456 cells/µL. She has no underlying medical conditions and no concomitant medications. Which of the following regimens is the best option for antiretroviral treatment?

Correct answer is B. RPV is best taken with meals and has interactions with proton pump inhibitors that the patient is taking. Also, TDF/ FTC has been associated with decreased bone mineral density. So, RPV/FTC/TDF would not be ideal given the patient’s comorbidities. Therefore, answers A and D are incorrect. Similarly, it would be best to avoid an ABC-containing regimen in this patient with increased cardiovascular risk, so answer C is incorrect. DRV/ cobicistat-containing regimens have also been associated with increased cardiovascular disease risk. There is also the potential for increased steroid exposure in this patient taking fluticasone. Therefore, answer E is incorrect.

See also:

Clinicalinfo. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Updated September 12, 2024. Accessed October 4, 2024. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/non-nucleoside-reverse-transcriptase

Ryom L, Lundgren JD, El-Sadr W, et al. Cardiovascular disease and use of contemporary protease inhibitors: the D:A:D international prospective multicohort study. Lancet HIV. 2018;5(6);E291-E300. doi:10.1016/S2352-3018(18)30043-2

Jaschinski N, Greenberg L, Neesgaard B, et al. Recent abacavir use and incident cardiovascular disease in contemporary-treated people with HIV. AIDS. 2023;37(3):467-475. Epub 2022 Aug 23. doi:10.1097/QAD.0000000000003373

To learn more about this topic, be sure to view the on-demand webinar, HIV 101: Core Principles of HIV Management for People Who Are Newly Diagnosed With HIV, presented by Michael S. Saag, MD, Judith S. Currier, MD, and Melanie A. Thompson, MD.

A 23-year-old woman is 3 weeks pregnant. An HIV test is positive, her HIV RNA level is 12,000 copies/mL, and her CD4+ count is 456 cells/µL. She has no underlying medical conditions and no concomitant medications. Which of the following regimens is the best option for antiretroviral treatment?

Correct answer is B. The use of bictegravir is acceptable if a pregnant patient is already on this regimen; however, tenofovir alafenamide (TAF)/emtricitabine (FTC)/dolutegravir (DTG) is a preferred regimen (see below). Elvitegravir requires cobicistat, which is contraindicated in pregnancy. There are insufficient data to support the use of doravirine. In preliminary cohort studies, DTG was associated with neural tube defects in children born to mothers who were on DTG in the first trimester of pregnancy. Follow-up data with larger numbers demonstrated no significant difference in neural tube defects, early-term labor, or low birth weight in infants when the mother used DTG during pregnancy compared with other approved regimens. Of note, efavirenz, too, had early data suggesting neural tube problems among fetuses exposed to the drug in the first trimester; follow-up data showed no association. TAF-based regimens now have sufficient data to warrant use during pregnancy; indeed, this is now a preferred nucleoside combination to be used during pregnancy. While ritonavir-boosted atazanavir is a fine choice as the ”anchor” drug for a TAF/FTC, tenofovir disoproxil fumarate/FTC, or abacavir/lamivudine regimen, these choices were not listed. Therefore, answer B is the correct choice.

To learn more about this topic, be sure to register for the webinar, HIV 101: Core Principles of HIV Management for People Who Are Newly Diagnosed With HIV, presented by Michael S. Saag, MD, Judith S. Currier, MD, and Melanie A. Thompson, MD.

A 48-year-old patient with well-controlled HIV and diabetes mellitus has been feeling sick for 4 days with myalgia, headache, cough, and fever. He develops tachypnea and is admitted to the hospital for low oxygen saturation. Chest radiography show diffuse, hazy infiltrates. Which of the following is the best next step?

Correct answer is D. It is impossible to discriminate between COVID-19 and influenza at initial presentation, so testing for both is important. Oseltamivir would be indicated in this hospitalized and at-risk patient. The earlier oseltamivir is started the more effective it is, so it should be started without waiting for test results. Benefit from antivirals for hospitalized patients has been demonstrated for up to 6 days after symptom onset.

Because the patient’s HIV is well-controlled, Pneumocystis jiroveci pneumonia is relatively unlikely. Viral pneumonias are as common a cause of community-acquired pneumonia as bacterial pneumonia. The chest radiography suggests viral infection, so testing for viruses is key, especially when influenza and SARS-CoV-2 are treatable.

To learn more about this topic, be sure to view the on-demand webinar, Prevention and Treatment of Influenza in People With HIV, presented by Andrew T. Pavia, MD, and moderated by Michael S. Saag, MD.

Which of the following was reported to be associated with worse Veterans Aging Cohort Study (VACS) index values in research presented at CROI 2024?

Correct answer is B. Abstracts 601 and 602 compared the VACS index with indicators of brain health, identifying that a higher VACS index value was associated with smaller brain volume on magnetic resonance imaging (VACS index version 1.0 or 2.0), worse cognitive performance (VACS index version 2.0 only), and higher cytomegalovirus immunoglobulin G concentration in the blood (VACS index version 1.0 only). Epstein-Barr viral DNA concentration correlated with cytomegalovirus immunoglobulin G concentration but not VACS index value.

To learn more about this topic, be sure to read the latest issue of Topics in Antiviral Medicine™, which features 3 articles reviewing information from the 2024 Conference on Retroviruses and Opportunistic Infections and is currently available for 6.0 CME credits.

Which human papillomavirus (HPV)-related cancer occurs more frequently in men than women in the general population?

Correct answer is C. The rates of oral and oropharyngeal cancer (OPC) in men now exceed the rates of cervical cancer in women. The rates of OPC continue to climb, and cervical cancer rates are dropping. Although men with HIV experience higher rates of anal cancer than women with HIV, this is not true in the general population (anal cancer risk in women is about 1.5 times the risk in men).

For more information on this topic, be sure to watch the on-demand webinar, Screening and Prevention of Anal, Cervical, and Oral/Oropharyngeal Cancers in People With HIV, to be presented by Grant Ellsworth, MD, MS and moderated by Ruanne V. Barnabas, MD, PhD.

At which of the following ages does the updated National Institutes of Health (NIH)/Centers for Disease Control and Prevention (CDC) opportunistic infections guidelines recommend initiating anal cancer screening in women with HIV?

Correct answer is C. Anal cancer risk increases with age, and the risk of anal cancer in women with HIV surpasses 10 times the risk of the general population around age 45 years. It is not clear whether screening younger women will lead to a meaningful reduction in anal cancer incidence. The efficacy and cost-effectiveness of this strategy needs to be evaluated.

For more information on this topic, be sure to check out our on-demand webinar, Screening and Prevention of Anal, Cervical, and Oral/Oropharyngeal Cancers in People With HIV, to be presented by Grant Ellsworth, MD, MS and moderated by Ruanne V. Barnabas, MD, PhD.

Which of the following tests has the best diagnostic performance to exclude cryptococcal infection?

Correct answer is E. Cryptococcal infection infections starts with asymptomatic subclinical dissemination from the lungs into the bloodstream, eventually disseminating throughout the body. During this initial dissemination, the Cryptococcus spp polysaccharide capsule (ie, cryptococcal antigen [CrAg]) is detectable in blood. This is termed asymptomatic cryptococcal antigenemia. People who present to care early (eg, with their initial headache) can have positive serum CrAg tests and negative CSF studies. These persons with “symptomatic antigenemia” can be missed, but with repeat CSF diagnostics, CSF CrAg will turn positive first, then CSF culture second, PCR test third, and lastly India ink by microscopy.

Commercial PCR has poor sensitivity at low fungal burdens (eg, less than 100 yeasts/mL), but can be diagnostically useful for second episodes of meningitis to distinguish culture-positive relapse (with a positive PCR test) from probable paradoxical immune reconstitution inflammatory syndrome (IRIS) with a negative PCR.

The CrAg LFA is approximately 5 times more sensitive as well as more specific than the traditional latex agglutination test. In immunocompromised hosts, we recommend testing both blood and CSF for cryptococcal antigen. Therefore, the best answer is E. Serum (or plasma) CrAg LFA testing is the best way to exclude all stages of cryptococcal infection (eg, asymptomatic, early symptomatic antigenemia, and late cryptococcal meningitis).

To learn more about this topic, view the on-demand virtual course, Opportunistic Infections: Forgotten But Not Gone – A Case-Based Discussion of Key OIs and Real Cases From the Clinic.

Which of the following classes of diabetes medications is preferred for a patient with a history of heart failure?

Correct answer is D. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have clearly shown a benefit for people with heart failure, including those with a preserved ejection fraction and those with a reduced ejection fraction. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) also can improve physical function and clinical outcomes in patients with heart failure, regardless of heart failure type; however, GLP-1 RAs are not listed among the choices.

See also: See also: Deanfield J, Verma S, Scirica BM, et al. Semaglutide and cardiovascular outcomes in patients with obesity and prevalent heart failure: a prespecified analysis of the SELECT trial. Lancet. 2024;404(10454):773-786. doi:10.1016/S0140-6736(24)01498-3; Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084. doi:10.1056/NEJMoa2306963

To learn more about this topic, view the on-demand webinar Diagnosis, Treatment, and Complications of Diabetes in People With HIV, presented by Todd T. Brown, MD, PhD and moderated by Grace McComsey, MD, on August 27, 2024.

Which of the following antiretroviral medications interacts with metformin, such that with concomitant use, the dose of metformin should not exceed 1000 mg daily?

Which of the following is the most appropriate initial treatment for disseminated Mycobacterium avium complex (MAC) disease in people with HIV who are not receiving effective antiretroviral therapy (ART)?

Correct answer is B. Based on the National Institutes of Health (NIH)/Centers for Disease Control and Prevention (CDC)/Infectious Diseases Society of America (IDSA) Guidelines for the Treatment and Prevention of Opportunistic Infections, ART should be started as soon as possible after the diagnosis of MAC disease, preferably at the same time as initiation of antimycobacterial therapy in people with HIV who are not receiving effective ART. Initial treatment of MAC disease should consist of 2 or more antimycobacterial drugs to prevent or delay the emergence of resistance; clarithromycin or azithromycin are the preferred first agents. Ethambutol is the recommended second drug for the initial treatment of MAC disease based on randomized clinical trials that indicate its use in the regimen is associated with lower rates of relapse. Rifabutin can be added as a third drug with a fluoroquinolone (eg, levofloxacin or moxifloxacin) or an injectable aminoglycoside (eg, amikacin or streptomycin) as a fourth drug if more severe disease is present, the risk of mortality is high, the emergence of drug resistance is likely, or in the setting of advanced immunosuppression (CD4+ count <50 cells/µL), high mycobacterial loads (>2 log₁₀ colony-forming units/mL of blood), or absence of effective ART.

To learn more about this topic, register for the virtual course, Opportunistic Infections: Forgotten But Not Gone – A Case-Based Discussion of Key OIs and Real Cases From the Clinic, on September 10, 2024.

Which of the following statements is TRUE about the H56:IC31 tuberculosis (TB) vaccine?

Correct answer is C. A phase IIb trial presented at the 2024 Conference on Retroviruses and Opportunistic Infections showed that 5.8% of participants receiving the H56:IC31 vaccine had recurrent TB disease compared with 3.4% in the placebo group, which was associated with a vaccine efficacy of -74% (95% CI, -247 to 10; P=.10).

To learn more about this topic, be sure to read the June/July issue of Topics in Antiviral Medicine™, which feature 4 articles reviewing the latest information from the 2024 Conference on Retroviruses and Opportunistic Infections and is currently available for 7.0 CME credits.

A 25-year-old woman with a past medical history of opioid use disorder (OUD) has recently initiated methadone for OUD. After 2 months, she stabilized at 120 mg of methadone per day. Urine drug screens are consistent with methadone dispensed and negative for all other substances. Urine pregnancy test is positive. She is surprised and slightly dismayed. She asks if she will have to stop methadone if she continues the pregnancy. Which of the following statements is correct?

A 32-year-old cisgender asymptomatic man newly diagnosed with HIV is screened for syphilis using the reverse sequence algorithm. The results revealed a reactive treponemal enzyme immunoassay (EIA), a nonreactive rapid plasma reagin (RPR), and a reactive Treponema pallidum particle agglutination (TPPA). Which of the following interpretations of the serological tests does NOT apply to this patient?

Correct answer is B. Two different reactive treponemal antibody tests with a nonreactive rapid plasma reagin (RPR) suggest syphilis infection, NOT false-positive treponemal antibodies. One of the following interpretations of the serological tests may apply to this patient:

• • Treated syphilis
• • Old untreated syphilis
• • Early syphilis (treponemal antibodies can become reactive before nontreponemal antibodies)
• • Prozone reaction (usually seen in secondary syphilis)

To learn more about this topic, watch the presentation, Treatment and Prevention of Syphilis in People With HIV, presented by Khalil G. Ghanem, MD, PhD, and moderated by Meredith E. Clement, MD.

A person with HIV has just initiated antiretroviral therapy with a CD4+ count of 25 cells/µL and plasma HIV RNA level of 300,000 copies/mL. Which of the following immunizations is contraindicated?

Correct answer is A. Live attenuated vaccines (eg, measles, mumps, and rubella [MMR] vaccine, live typhoid vaccine, yellow fever vaccine, and nasal spray influenza vaccines) are contraindicated for people with HIV with CD4+ counts less than 200 cells/µL (and probably those with measurable viral loads). The JYNNEOS mpox vaccine is safe in this population because it is a nonreplicating live attenuated vaccine.

To learn more about this topic, watch the on-demand webinar, Prevention and Treatment of Opportunistic Infections in People With HIV, presented by Henry Masur, MD, and moderated by Judith S. Currier, MD, or register now for our upcoming virtual course, Opportunistic Infections: Forgotten But Not Gone, scheduled for September 10, 2024, at 8:00 AM – 1:00 PM PT.

Which of the following is NOT a consideration for long-acting antiretroviral implementation?”

Correct answer is C. Patient gender is not a consideration for long-acting antiretroviral implementation. Implementation considerations include site-level, payer-level, and program-level factors. Patient-level factors (eg homelessness, transportation, etc) can sometimes be implementation considerations but demographics, such as gender, should not be a factor for long-acting antiretroviral implementation.

To learn more about this topic, view the July 23, 2024, webinar, Implementation of Long-Acting Drugs for the Treatment and Prevention of HIV, presented by Joshua P. Havens, PharmD, and moderated by Betty J. Dong, PharmD.

What is the most sensitive test to detect Cryptococcus in the cerebrospinal fluid?

Correct answer is A. The most sensitive “rapid” test for cryptococcal disease is the cryptococcal antigen test. The polymerase chain reaction (PCR) test for Cryptococcus that is used in some cerebrospinal fluid (CSF) PCR panels is slightly less sensitive than the cryptococcal antigen test. If there is a high suspicion of cryptococcal meningitis and the CSF panel is negative for Cryptococcus or other plausible/likely pathogens, starting therapy for cryptococcal meningitis is appropriate while awaiting the CSF cryptococcal antigen test.

To learn more about this topic, check out the webinar, Prevention and Treatment of Opportunistic Infections in People With HIV, presented by Henry Masur, MD, and moderated by Judith S. Currier, MD.

Glycoprotein-1 receptor agonists (GLP-1RAs) have shown several potential off-target effects. Which of the following has been demonstrated in randomized clinical trials?

Correct answer is A. The SELECT (Semaglutide Effects on Heart Disease and Stroke in Patients With Overweight or Obesity) trial evaluated cardiovascular outcomes among those with obesity without diabetes mellitus and demonstrated a 20% risk reduction with semaglutide subcutaneous weekly versus placebo. The SELECT trial enrolled only those with preexisting cardiovascular disease (CVD). The benefit to those without known CVD remains unclear at this time.

In the Step-HFpEF (Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity) trial, treatment with semaglutide among those with heart failure with preserved ejection fraction and obesity resulted in a large reduction in symptoms and in improvements in exercise function. The study was not powered to assess heart failure events and further studies are needed.

Preclinical studies have investigated GLP-1RAs to treat addiction disorders and showed preliminary benefits to decrease substance use and drug-seeking behavior related to alcohol, nicotine, opioids, and simulants. Clinical studies have not thoroughly investigated GLP-1RA use for addiction disorders to date.

References: Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563; Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084. doi:10.1056/NEJMoa2306963; Jerlhag E. The therapeutic potential of glucagon-like peptide-1 for persons with addictions based on findings from preclinical and clinical studies. Front Pharmacol. 2023;14:1063033. Published 2023 Mar 30. doi:10.3389/fphar.2023.1063033

To learn more about this topic, watch the presentation, “Weighing In” on GLP-1 Receptor Agonists for People With HIV, presented by Suman Srinivasa, MD, MS, at the 2024 The IAS–USA Annual Update on HIV Management in Chicago, Illinois.

Which one of the following is an implementation outcome according to Proctor and colleagues?

Correct answer is D. Sustainability is one of Proctor’s 8 implementation outcomes. The other 7 are reach, cost, fidelity, appropriateness, feasibility, adoption/uptake, and acceptability.

To learn more about this topic, watch the presentation, Implementation Science From an HIV Clinician’s Perspective, presented by Nwora Lance Okeke, MD, MPH, and moderated by Ellen F. Eaton, MD, on Tuesday, May 14, 2024.

Which of the following anatomical sites is most likely to contain the bulk of the HIV reservoir in a person with HIV on antiretroviral therapy who initiated treatment some time after the acute phase?

Correct answer is C. The International Antiviral Society–USA (IAS–USA) guidelines were recently updated to recommend consideration of LA CAB/RPV in patients who, despite maximal efforts to optimize adherence, still had significant barriers to oral therapy AND the following features:

• High risk of HIV disease progression
• Virus susceptible to CAB and RPV
• Intensive follow-up and case management

Patients with RPV resistance were excluded from the LATITUDE (Long-Acting Therapy to Improve Treatment Success in Daily Life) trial. From posthoc analyses of FLAIR (First Long-Acting Injectable Regimen), ATLAS (Antiretroviral Therapy as Long-Acting Suppression), and ATLAS-2M (Antiretroviral Therapy as Long-Acting Suppression Every 2 Months), the biggest predictor for virologic failure on CAB/RPV was the presence of baseline resistance mutations to RPV. Neither RPV nor CAB are considered to have a high genetic barrier to resistance. If a patient has an RPV resistance mutation and they are started on CAB/RPV, they are likely to develop virologic failure and could develop failure with resistance to CAB. Elevated BMI was initially hypothesized to potentially increase the risk of virologic failure; however, when elevated BMI was the only risk factor present, the risk of failure was the same as risk in individuals without any risk factors. With the use of longer 2-inch needles and appropriate injection technique to ensure therapeutic levels, elevated BMI alone should not be considered a contraindication to CAB/RPV. A plasma HIV RNA level of 5000 copies/mL is not a contraindication to CAB/RPV. Almost 20% of individuals in LATITUDE were viremic, and many individuals from both LATITUDE and the observational studies of CAB/RPV in patients with viremia had viral loads in the tens of thousands. Initially, in the posthoc analysis of ATLAS, FLAIR, and ATLAS-2M, infection with HIV-1 subtype A1 or A6 was thought to be associated with a slight increase in the risk of virologic failure. In the CARES (Cabotegravir and Rilpivirine: Efficacy and Safety Study) trial, more than half the study participants had subtype A1 and almost 100% of study participants maintained virologic suppression on CAB/RPV. This supports our understanding that infection with subtype A1 is NOT associated with an increased risk of virologic failure; the initial results were likely driven by subtype A6.

To learn more about this topic, view the presentation, State of the ART: Hot Antiretroviral Updates from CROI 2024 and Beyond, presented by Darcy A. Wooten, MD, on Thursday, May 16, 2024.

Which of the following anatomical sites is most likely to contain the bulk of the HIV reservoir in a person with HIV on antiretroviral therapy who initiated treatment some time after the acute phase?

Correct answer is D. Gut lymphoid tissues are very depleted in chronic infection. Thus, even though the gut reservoir of virus starts off very large, the bulk of the virus in chronic infection resides in all the lymphoid tissues, including the spleen and lymph nodes.

To learn more about this topic, register for the upcoming webinar, HIV Cure: Where Are We and Do We Have a Map?, presented by Daniel C. Douek, MD, PhD, on Wednesday, June 19, 2024.

Is starting treatment for HIV earlier sufficient to achieve a functional cure?

Correct answer is A. Post-treatment control can occur in less than 10% of people who start antiretroviral therapy very early but this approach alone is not a reasonable option.

To learn more about this topic, register for the upcoming webinar, HIV Cure: Where Are We and Do We Have a Map?, presented by Daniel C. Douek, MD, PhD, on Wednesday, June 19, 2024.

You are seeing a patient who has gained 15 pounds on bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide fumarate (TAF) over the past 2 years. The patient is otherwise tolerating the therapy well and remains virologically suppressed. The patient asks if their antiretroviral therapy (ART) should be changed to help address the weight they have gained.
They have a complete blood cell count within normal limits; glomerular filtration rate greater than 115 mL/min/1.73 m2; low-density lipoprotein level of 113 mg/dL; hemoglobin A1C level of 5.1%; CD4+ count of 500 cells/µL; plasma HIV RNA level of less than 20 copies/mL; and body mass index of 27 kg/m2. They are hepatitis B immune, and baseline HIV genotype testing indicates wildtype virus.

Which of the following would you recommend regarding the patient’s ART?

Correct answer is D. There are currently no data to support a switch to the regimens listed in options A to C, as there was no difference in weight outcomes when patients were switched to the regimen options listed in A to C compared with patients who remained on their baseline regimen. A switch to a tenofovir disoproxil fumarate(TDF)-containing regimen would likely lead to some reduction in weight, as was seen in the CHARACTERISE (A Cross-sectional, Observational Study to Characterise the Transition to Dolutegravir-based Regimens in South Africa in Terms of the Emergence of Obesity, Viral Re-suppression and Integration Into Routine Programme Care) study; however, the risks and benefits of switching to TDF (including renal and bone toxicity) might not be worth the small benefit of modest weight loss. None of the specific answer choices include a TDF-containing regimen. Because the virus is well-controlled and it is unclear how much their ART is contributing to their weight gain, the current regimen should be continued and other interventions to address the weight should be pursued.

To learn more about this topic, watch the presentation, State of the ART: Hot Antiretroviral Updates from CROI 2024 and Beyond, presented by Darcy A. Wooten, MD, on Thursday, May 16, 2024.

Which of the following scenarios can be addressed by a hybrid effectiveness-implementation study?

Correct answer is D. The mechanistic substudy of REPRIEVE showed a marked reduction of ox-LDL and Lp-PLA2 levels. Oxidized low-density lipoprotein can trigger inflammation through the activation of macrophages and other cells. Lp-PLA2 is a biomarker for vascular wall inflammation that circulates in the blood bound to both low-density lipoprotein and high-density lipoprotein and promotes vascular inflammation. However, the mechanistic study did not demonstrate a reduction in CRP or IL-6 levels, which are biomarkers indicative of more generalized inflammation and tissue injury.

To learn more about this topic, watch the presentation, Statins: Young at Heart, presented by Judith A. Aberg, MD, on Thursday, May 16, 2024.

Which of the following scenarios can be addressed by a hybrid effectiveness-implementation study?

Correct answer is B. Option B is an example of the measurement of the implementation measure, acceptability. Acceptability is one of the 8 core Proctor implementation outcomes and is a valid outcome to be measured in a hybrid effectiveness-implementation study. Option A still looks to measure the efficacy of a drug in a segment of the population and option C is primarily an operational determination that varies from setting to setting, neither of which can be addressed by a hybrid effectiveness-implementation study.

To learn more about this topic, watch the on-demand webinar, Implementation Science From an HIV Clinician’s Perspective, presented by Nwora Lance Okeke, MD, MPH, and moderated by Ellen F. Eaton, MD, on Tuesday, May 14, 2024.

A 38-year-old man is sexually active with several male partners (including receptive anal and oral intercourse). He has a history of secondary and early latent syphilis 2 years ago. Rapid plasma regain (RPR) testing 11 months ago was 1:2. Physical examination is notable for a macular rash on his chest and scrotum. Gonorrhea/chlamydia (GC/CT) testing in the throat and anus are negative. HIV antibody is negative. The patient has been counseled on HIV preexposure prophylaxis, but he is not ready to start PrEP. RPR is now 1:128, and a treponemal enzyme immunoassay is positive. He is treated with doxycycline 100 mg twice daily for 14 days due to benzathine penicillin shortage. He presents for a clinical visit 11 months after treatment. He does not remember if he took all 14 days, as he had been sharing doxycycline with sexual partners for postexposure prophylaxis. Examination reveals several painless perianal ulcers, generalized lymphadenopathy, and resolving penile ulcer. GC/CT testing is negative, herpes simplex virus polymerase chain reaction assay is also negative, and RPR is 1:2. HIV antibody testing is positive, with an initial CD4+ cell count of 280 cells/µL and plasma HIV RNA levels of 10 million copies/mL. He started on antiretroviral therapy and was treated with benzathine penicillin 2.4 million IU once intramuscularly.

Which reason for an inadequate serologic response after treatment of early syphilis is NOT correct?

In clinical trials, latency-reversing agents (eg, vorinostat, romidepsin) have been shown to affect measures of the HIV reservoir by causing which of the following?

Which of the following statements about prevention of bacterial sexually transmitted infections (STIs) is TRUE?

Which of the following statements about long-acting injectable cabotegravir (CAB-LA) for HIV preexposure prophylaxis is TRUE?

Correct answer is C. The high positive and negative predictive values of concordant rapid and antigen/antibody test results suggest this testing may be sufficient for follow-up long-acting cabotegravir (CAB-LA) visits.

To learn more about this topic, be sure to register for our upcoming webinar, presented by Susan P. Buchbinder, MD, and moderated by Albert Y. Liu, MD, MPH, The ART of HIV and STI Prevention: Update From the 2024 Conference on Retroviruses and Opportunistic Infections (CROI).

Which of the following is TRUE about the LATITUDE (Long-Acting Therapy to Improve Treatment Success in Daily Life) study (CROI Abstract 5359)?

Correct answer is D. There was a lower rate of virologic and treatment-related failure in those randomized to LA CAB/RPV, which led to the premature termination of the LATITUDE study. A, B, and C are not true, respectively, because the study was a randomized, clinical trial, approximately 15% of the study participants had detectable virus at the time the study regimen was initiated, and the timing of LA CAB/RPV dosing was on time more than 90% of the time.

To learn more about this topic, register for webinar, Antiretroviral Management of HIV: New Data From the 2024 Conference on Retroviruses and Opportunistic Infections (CROI), to be presented by Eric S. Daar, MD, and moderated by Judith S. Currier, MD, on April 12, 2024.

For more information on this topic, be sure to listen to the latest episode of the Going anti-Viral podcast: 

Episode 14 – HIV Treatment with Long-Acting Injectables with Dr Aadia Rana Recorded Live at CROI 2024 on March 4, 2024
(https://www.iasusa.org/going-anti-viral-podcast/)

And read more here:

Sax PE, Thompson MA, Saag MS, IAS–USA Treatment Guidelines Panel. Updated treatment recommendation on use of cabotegravir and rilpivirine for people with HIV from the IAS–USA Guidelines Panel. JAMA. 2024;331(12):1060-1061. doi:10.1001/jama.2024.2985

Rana AI, Bao Y,  Zheng L, et al. Long-acting injectable CAB/RPV is superior to oral ART in PWH with adherence challenges: ACTG A5359 [CROI Abstract 212]. In Special Issue: Abstracts From the CROI 2024 Conference on Retroviruses and Opportunistic Infections. Top Antivir Med. 2024;32(1):57.

Which of the following statements is TRUE?

Which statement accurately contrasts acute HIV infection (AHI) with long-acting early viral inhibition (LEVI) in the context of HIV?

Which of the following is a potential mechanism of weight suppression observed with tenofovir disoproxil fumarate (TDF) presented at this year’s CROI?

Is it reasonable to begin a patient who was virally suppressed on tenofovir alafenamide fumarate/emtricitabine/bictegravir with a history of K103N on genotyping (only) on cabotegravir/rilpivirine?

A patient who previously had mpox asks about their vaccination options. Which of the following is the current recommendation by the Advisory Committee on Immunization Practices (ACIP)?

Which of the following antiviral treatments has been shown to be effective against mpox in humans in a randomized clinical trial (RCT)?

According to recently released guidance by the Centers for Disease Control and Prevention, doxycycline postexposure prophylaxis (doxyPEP) is recommended for which of the following populations?

You are treating a 28-year-old man who was recently hospitalized for osteomyelitis resulting from injection drug use (IDU) of opioids and stimulants. He has posttraumatic stress disorder, opioid use disorder, stimulant use disorder, and HIV. He lives in a rural area with limited access to substance use disorder (SUD) treatment. He is doing well on antiretroviral therapy through your clinic but is still struggling with IDU. He has done well on sublingual buprenorphine (SL-bup) in the past but struggled with weekly appointments and filling weekly scripts at the pharmacy because of transportation problems. What do you recommend for his SUD treatment?

Which of the following statements is TRUE about lenacapavir?

Correct answer is B. The M66I capsid mutation was the most frequently observed mutation in highly treatment-experienced patients in whom lenacapavir failed.

To learn more about the principles of HIV drug resistance mutations and what is currently known about resistance to antiretroviral drugs and products, including new and long-acting medications, watch the on-demand webinar, Basic Principles and Clinical Relevance of the IAS–USA 2022 Update of the Drug Resistance Mutations in HIV-1, presented by Francesca Ceccherini Silberstein, PhD, Annemarie M. Wensing, MD, PhD, and moderated by Douglas D. Richman, MD, on January 31, 2024.

In which demographic group has the rate of syphilis increased dramatically in recent years?

Correct answer is A. There has been a substantial increase in syphilis rates among heterosexual women in recent years. From 2020 to 2021, the rate of primary and secondary syphilis among women increased by more than 50%. This increase is associated with a corresponding escalation in the rate of congenital syphilis, which has increased each year since 2013.

To learn more about this topic, subscribe now to the IAS–USA podcast, Going anti-Viral, hosted by Dr Michael S. Saag, and listen to, Episode 5 – An In-depth Discussion on Syphilis with Dr Meredith Clement, Associate Professor at Louisiana State University Health Sciences Center. Don’t miss out on upcoming episodes, where Dr Saag interviews an expert in infectious diseases or emerging pandemics about their area of specialty and current developments in the field – subscribe now!

Which of the following is true about long-acting injectable buprenorphine (LAI-bup) formulations?

Correct answer is A. There are weekly and monthly doses of long-acting injectable buprenorphine (LAI-bup), and the 300 mg dose of RBP-6000 can be administered to patients on 100 mg monthly maintenance doses if they are going to be away for more than a month and would miss their scheduled 100 mg dose. Although there are scant data on the use of LAI-bup with preexposure prophylaxis and long-acting injectable HIV medications, there is no contraindication to giving both to the same patient. Patients receiving LAI-bup should never have this medication in their possession. The medication should be directly administered to the patient by the clinician.

For more information on this topic, view the on-demand webinar, (Part 6 of 6) Substance Use Disorder:

Future Directions Focusing on Long-Acting Injectable Buprenorphine, presented by Michelle R. Lofwall, MD, and moderated by Ellen F. Eaton, MD.

What is the most effective public health intervention to prevent the development of long COVID, according to current evidence?

Correct answer is B. Current evidence shows that the risk of developing long COVID is consistently 30% to 60% lower in people who are correctly vaccinated with at least 2 to 3 doses of SARS-CoV-2 vaccine.

To learn more about this topic, watch the on-demand webinar, Pathogenesis of Long COVID, presented by Roger Paredes, MD, PhD, and moderated by Michael J. Peluso, MD, on January 16, 2024.

Which of the statements following is true regarding the pathogenesis of long COVID?

Correct answer is C. There is solid and cumulative evidence of early and persistent organ and tissular damage in subjects with long COVID, which is also supported by animal models and in vitro studies. Most patients do not have altered mental test results when they are diagnosed with long COVID, although anxiety, depression, and other mental health concerns may develop or aggravate during the course of the disease, particularly when patients realize that their symptoms will not remit easily. Considering long COVID a “mental disease” is stigmatizing for patients with long COVID and with mental disorders. Although plasma antigenemia is promising, it still requires further technical and clinical validation. Finally, viruses are different in many ways (antigenically, mechanistically, in terms of tropism, etc), so the different postviral syndromes do not necessarily share the same intimate pathogenic mechanisms.

To learn more about this topic, watch the on-demand webinar, Pathogenesis of Long COVID, presented by Roger Paredes, MD, PhD, and moderated by Michael J. Peluso, MD, on January 16, 2024.

Which of the following is a US Food and Drug Administration (FDA)-approved medication for addiction?

Correct answer is C. Extended-release naltrexone is approved for the treatment of opioid use disorder and alcohol use disorder.

Although topiramate is supported by the American Society of Addiction Medicine (ASAM) practice guidelines for treating cocaine use disorder, especially when combined with extended-release mixed amphetamine salts, this medication is not US Food and Drug Administration (FDA)-approved for an addiction indication.

Similarly, although mirtazapine and extended-release naltrexone/bupropion combination have strong evidence for use to treat methamphetamine use disorder, none of these drugs are FDA-approved for an addiction indication.

To learn more about stimulant use disorder in patients with HIV, view the on-demand webinar: (Part 5 of 6) Substance Use Disorder: Stimulant Use Disorder, Harm Reduction, and Contingency , presented by Steven J. Shoptaw, PhD, and moderated by Sandra A. Springer, MD.