October 3, 2022: Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infections (STIs)

Previous Questions

Which of the following statements is true regarding current COVID-19 antiviral therapy?

Responses
A. Current oral antiviral treatments include nirmatrelvir-ritonavir (Paxlovid), molnupiravir, and remdesivir 32% (312)
B. Nirmatrelvir-ritonavir is the only preferred oral antiviral therapy in the National Institutes of Health (NIH) treatment guidelines 42% (412)
C. Nirmatelvir-ritonavir and molnupiravir are each preferred oral antiviral therapies in the NIH treatment guidelines 23% (225)
D. The Omicron BA.5 variant is resistant to all oral antivirals 3% (36)
  • A. Current oral antiviral treatments include nirmatrelvir-ritonavir (Paxlovid), molnupiravir, and remdesivir
  • B. Nirmatrelvir-ritonavir is the only preferred oral antiviral therapy in the National Institutes of Health (NIH) treatment guidelines
  • C. Nirmatelvir-ritonavir and molnupiravir are each preferred oral antiviral therapies in the NIH treatment guidelines
  • D. The Omicron BA.5 variant is resistant to all oral antivirals

Correct answer is B. Remdesivir is not an oral antiviral, and molnupiravir is not a preferred antiviral; it is an alternative treatment. Both available oral antivirals are active against the Omicron BA.5 variant.

To learn more about this topic, click the button below to watch Advancements in Oral Antiviral Therapy for COVID-19, presented by Jonathan Li, MD, MMSc, on September 13, 2022. Or click the button below to watch the September 15 COVID-19 Dialogue, Continued Discussion on Urgent Virus Outbreaks: COVID-19, Monkeypox, and the Resurgence of Vaccine-Preventable Diseases.

A 45-year-old woman with HIV was diagnosed in 2005 and started ART in 2012. Her CD4+ at diagnosis was 245cells/µL. She now has controlled hypertension, an HIV RNA of less than 50 copies/mL, a current CD4+ count of 560 cells/µL, and hepatitis C virus that she will soon begin treatment for. Her ACC/AHA (American College of Cardiology/American Heart Association) Pooled Cohort Equation score is 7.0%. What factor does NOT affect your decision about whether she needs a statin?

Responses
A. Current undetectable viral load 46% (325)
B. Nadir CD4+ of 245 cells/µL 19% (133)
C. Hepatitis C virus coinfection 18% (129)
D. Prolonged viremia in the past 17% (121)
  • A. Current undetectable viral load
  • B. Nadir CD4+ of 245 cells/µL
  • C. Hepatitis C virus coinfection
  • D. Prolonged viremia in the past

Correct answer is A.  A currently undetectable viral load does not compensate for a history of prolonged uncontrolled viremia, which, like B, and C, are HIV risk-enhancing factors that increase the risk of cardiovascular disease.

To learn more about this topic, click the link below to watch “Aging and HIV: If I knew I’d Live This Long I Would Have Moisturized,” presented by Melanie A. Thompson, MD, on September 8 in Los Angeles, California.

M.S. is a 70-year-old man diagnosed with HIV 30 years ago. He has been on efavirenz (EFV)/lamivudine (3TC)/tenofovir disoproxil fumarat (TDF) for the past 10 years. Recalling how he struggled through multiple regimens in the past, he has been very reluctant to change a regimen that “saved his life.” However, he is now willing to do so due to persistent insomnia and depressive disorder. His CD4+ count is 700 cells/µL, and his viral load is less than 20 copies/mL. He has multiple comorbidities, including type 2 diabetes, cardiovascular disease, chronic obstructive pulmonary disease, and osteoporosis. Contrary to his HIV disease, these comorbidities are poorly controlled. Which of the following statements are true?

Responses
A. The burden of comorbidities is increasing among aging people with HIV (PWH). Compared to 2005-2009, the cumulative incidence of myocardial infarction among PWH has declined and is no longer higher than compared to the uninfected population 15% (108)
B. Non-AIDS complications are largely due to antiretrovirals. Patients with spontaneous control of HIV (without ART) have a lower risk of non-AIDS events compared to PWH on suppressive ART 4% (28)
C. The life expectancy of PWH has significantly improved in the modern ART era and is now similar to that of the general population 51% (362)
D. Among PWH, age greater than 65 years is a significant risk factor for both non-communicable diseases and in-hospital mortality from COVID-19
30% (211)
  • A. The burden of comorbidities is increasing among aging people with HIV (PWH). Compared to 2005-2009, the cumulative incidence of myocardial infarction among PWH has declined and is no longer higher than compared to the uninfected population
  • B. Non-AIDS complications are largely due to antiretrovirals. Patients with spontaneous control of HIV (without ART) have a lower risk of non-AIDS events compared to PWH on suppressive ART
  • C. The life expectancy of PWH has significantly improved in the modern ART era and is now similar to that of the general population
  • D. Among PWH, age greater than 65 years is a significant risk factor for both non-communicable diseases and in-hospital mortality from COVID-19

Correct answer is D. The burden of comorbidities is expected to continue to increase significantly in the aging population with HIV. While life expectancy has significantly improved, there remains a survival gap among PWH compared to the general population. A recent analysis has suggested that the cumulative incidence of myocardial infarctions is increasing in PWH over the past decade compared to the general population. Among PWH, age greater than 65 years, low CD4+ cell count, chronic kidney disease, and diabetes mellitus have been shown to be factors of increased in-hospital mortality with COVID-19.

To learn more about comorbidities in older people with HIV, click the link below to watch the on-demand recording, “In Case You Missed It: The latest in HIV Literature and Monkeypox,” presented by Roger J. Bedimo, MD, MS, at the September 8 course in Los Angeles.

You have a patient who presents with Human Monkeypox Virus, which has been confirmed by assay. Which of the following medications is recommended as the first-line treatment for this patient during the 2022 outbreak?

 

Responses
A. Acyclovir 5% (37)
B. Cidofovir 4% (33)
C. Brincidofovir 5% (36)
D. Tecovirimat 77% (608)
E. Vaccinia immunoglobulin 9% (72)
  • A. Acyclovir
  • B. Cidofovir
  • C. Brincidofovir
  • D. Tecovirimat
  • E. Vaccinia immunoglobulin

Correct answer is D. Tecovirimat is recommended as the first-line treatment during this 2022 Human Monkeypox Virus outbreak. However, there is limited safety data and no human efficacy data to date. Acyclovir is not recommended due to its need for phosphorylation by viral kinases and is much more effective against herpes virus infections than poxvirus infections. Cidofovir is not recommended because, although it is likely to have activity against orthopoxviruses, concerns about nephrotoxicity limit generalized use. Brincidofovir is not recommended because, although it is likely to have activity against orthopoxviruses, concerns about hepatotoxicity limit generalized use. Vaccinia immunoglobulin is not recommended because it has no proven benefit, but it may be used for postexposure prophylaxis in individuals who cannot receive the vaccine.

To learn more information about Human Monkeypox Virus, click the button below to watch the August 30, 2022, webinar, What You Need to Know About the Diagnosis and Treatment of Human Monkeypox Virus, presented by Jason E. Zucker, MD.

Which of the following ways does long-acting early viral inhibition (LEVI) differs from acute HIV infection (AHI)?

 

Responses
A. LEVI is often asymptomatic or protean 49% (517)
B. LEVI is briefer than AHI 10% (101)
C. LEVI is often associated with acute opportunistic infections 10% (109)
D. LEVI is associated with HIV acquisition within 12 months of a long-acting cabotegravir injection 31% (330)
  • A. LEVI is often asymptomatic or protean
  • B. LEVI is briefer than AHI
  • C. LEVI is often associated with acute opportunistic infections
  • D. LEVI is associated with HIV acquisition within 12 months of a long-acting cabotegravir injection

Correct answer is A. LEVI is often asymptomatic or protean.

To learn more about this topic, click the button below to register for the 30th Annual Update on HIV Management in Los Angeles.

TRUE or FALSE: In a study by Diggins and colleagues, the primary hypothesis was that teduglutide may improve immune activation and downstream arterial inflammation in people with HIV by preserving the intestinal epithelial barrier.

 

Responses
A. True 84% (622)
B. False 16% (117)
  • A. True
  • B. False

Correct answer is A. Disruption of the intestinal epithelial barrier is seen in people with HIV, and the proof-of-concept study by Diggins and colleagues was designed to determine whether teduglutide, a GLP-2 agonist, may have a beneficial effect on the intestinal epithelial barrier in people with HIV, thereby by reducing immune activation and downstream arterial inflammation.

To learn more about this topic, click the button below to read the TAMTM article, CROI 2022: Metabolic and Other Complications of HIV Infection or COVID-19, written by Sudipa Sarkar, MD, and Todd T. Brown, MD, PhD.

Which of the following findings was reported in the Tsepamo study, in which birth outcome surveillance was conducted among women in Botswana who were routinely screened for COVID-19 at delivery?

Responses
A. Maternal mortality was higher, with an age-adjusted risk ratio of 31.6, in women with COVID-19 than in women without COVID-19 47% (142)
B. Maternal mortality was higher during pre-Delta COVID-19 variant waves than during the Delta wave 10% (29)
C. Rates of any adverse birth outcome (defined as preterm delivery, small for gestational age, stillbirth, and neonatal death) were similar among infants born to women with COVID-19 and women without COVID-19 20% (62)
D. Rates of any adverse birth outcome were similar among infants born to women with HIV and who had COVID-19 and among infants born to women in the other comparison groups 23% (70)
  • A. Maternal mortality was higher, with an age-adjusted risk ratio of 31.6, in women with COVID-19 than in women without COVID-19
  • B. Maternal mortality was higher during pre-Delta COVID-19 variant waves than during the Delta wave
  • C. Rates of any adverse birth outcome (defined as preterm delivery, small for gestational age, stillbirth, and neonatal death) were similar among infants born to women with COVID-19 and women without COVID-19
  • D. Rates of any adverse birth outcome were similar among infants born to women with HIV and who had COVID-19 and among infants born to women in the other comparison groups

Correct answer is A. In the Tsepamo study, which conducted birth outcomes surveillance among women in Botswana, maternal mortality was higher, with an age-adjusted risk ratio of 31.6, in women with COVID-19 than in women without COVID-19. Maternal mortality was higher during the wave of the Delta COVID-19 variant than during pre-Delta waves. Rates of any adverse birth outcome were significantly higher among infants born to women with COVID-19 than among women without COVID-19. Rates of any adverse birth outcome were highest among infants born to women with HIV and who also had COVID-19.

For more information, click the link below to read the TAM article, CROI 2022: Advances in Antiviral Therapy for HIV, COVID-19, and Viral Hepatitis, written by Shauna H. Gunaratne, MD, MPH, Hong-Van Tieu, MD, MS, Timothy J. Wilkin, MD, MPH, and Barbara S. Taylor, MD, MS.

Which of the following groups would be eligible for simplified treatment regimens for hepatitis C virus (HCV)?

Responses
A. Persons with HIV 36% (278)
B. Pregnant persons 9% (73)
C. Patients with compensated cirrhosis 40% (308)
D. Patients with a positive hepatitis B surface antigen 15% (112)
  • A. Persons with HIV
  • B. Pregnant persons
  • C. Patients with compensated cirrhosis
  • D. Patients with a positive hepatitis B surface antigen

Correct answer is C. Direct-acting antiviral regimens are available for people with HCV, whether they have no evidence of cirrhosis or compensated cirrhosis. HIV coinfection requires attention to potential drug interactions. Data for the treatment of pregnant persons are few. If hepatitis B virus (HBV) coinfection is present, there is a need for additional monitoring due to the risk of HBV reactivation.

To learn more about hepatitis C virus treatment, click the button below to watch the on-demand webinar, Simplifying Treatment of Hepatitis C and Overcoming Barriers to Cure, presented by Arthur Y. Kim, MD, on August 2, 2022.

Drug interactions between rifampin and integrase strand transfer inhibitors occur because rifampin is which of the following?

Responses
A. Uridine glucuronosyltransferases (UGT1A) substrate 6% (49)
B. Cytochrome P450 3A (CYP3A) inhibitor 47% (362)
C. UGT1A inducer 48% (294)
D. P-glycoprotein (p-gp) inhibitor 9% (68)
  • A. Uridine glucuronosyltransferases (UGT1A) substrate
  • B. Cytochrome P450 3A (CYP3A) inhibitor
  • C. UGT1A inducer
  • D. P-glycoprotein (p-gp) inhibitor

Correct answer is C. Rifampin is a potent inducer of CYP3A4, UGT1A, and p-gp. Since bictegravir is a substrate of CYP3A, UGT1A1, and p-gp, rifampin-induced induction will reduce bictegravir levels leading to a loss of virologic suppression and risk of resistance. Rifampin does not inhibit CYP3A or p-gp.

To learn more about the drug-drug interactions of antiretroviral therapy and tuberculosis, click the button below to watch the on-demand webinar, Key Antiretroviral Drug-Drug Interactions With Mycobacterium tuberculosis Infection in Persons With HIV: A Case-Based Presentation, presented by Betty J. Dong, PharmD, on July 26, 2022.

Which of the following groups should be considered for a 3-dose primary SARS-CoV-2 vaccination series rather than the standard 2-dose series?

Responses
A. Current CD4+ count greater than 350 cells/µL and older than 65 years 7% (39)
B. Current CD4+ count less than 500 cells/µL and older than 65 years 7% (40)
C. Current CD4+ count less than 200 cells/µL or unsuppressed HIV viral load 48% (280)
D. Current CD4+ count less than 200 cells/µL and unsuppressed HIV viral load 17% (103)
E. Current CD4+ count less than 200 cells/µL and older than 65 years 21% (127)
  • A. Current CD4+ count greater than 350 cells/µL and older than 65 years
  • B. Current CD4+ count less than 500 cells/µL and older than 65 years
  • C. Current CD4+ count less than 200 cells/µL or unsuppressed HIV viral load
  • D. Current CD4+ count less than 200 cells/µL and unsuppressed HIV viral load
  • E. Current CD4+ count less than 200 cells/µL and older than 65 years

Correct answer is C. For PWH who have a current CD4+ count of less than 200 cells/µL or have a detectable HIV viral load, a 3-dose primary SARS-CoV-2 vaccination series should be considered.

To have more of your difficult COVID-19 questions answered, click the below button to watch the on-demand course, COVID-19 Prevention and Management: HIV Coinfection, Outpatient Management, Hospitalization, and Post-COVID-19 Complications.

Which of the following initial HIV treatment regimens containing hepatitis B virus (HBV) active agents is not appropriate for HBV therapy in people with HIV?

 

Responses
A. Bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF) 8% (69)
B. Dolutegravir (DTG) plus TAF/FTC 4% (39)
C. DTG/abacavir (ABC)/lamivudine (3TC) 59% (540)
D. DTG plus tenofovir disoproxil fumarate (TDF)/3TC 7% (66)
E. All are acceptable regimens to treat both HBV and HIV 22% (206)
  • A. Bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF)
  • B. Dolutegravir (DTG) plus TAF/FTC
  • C. DTG/abacavir (ABC)/lamivudine (3TC)
  • D. DTG plus tenofovir disoproxil fumarate (TDF)/3TC
  • E. All are acceptable regimens to treat both HBV and HIV

Correct answer is C. Although 3TC and FTC each some have activity against HBV, using either these anti-HBV agents alone (monotherapy ) for HBV infection is considered suboptimal due to high rates of resistance emergence over time and less potent HBV DNA suppression compared with TAF, TDF, or entecavir (ETV) regimens. HIV regimens for someone with HBV coinfection should include TAF or TDF, or include ETV if TAF or TDF cannot be used.

For more information about HIV and HBV co-infection, click the link below to watch the the July 19 webinar, Unique Issues in People With HIV and Hepatitis B/D Coinfections, presented by David L. Wyles, MD.

Which of the following recommended therapies has the least clinical evidence to support its use for high-risk outpatients with COVID-19?

Responses
A. Bebtelovimab 45% (348)
B. Molnupiravir 22% (167)
C. Nirmatrelvir-ritonavir 12% (93)
D. Remdesivir 21% (163)
  • A. Bebtelovimab
  • B. Molnupiravir
  • C. Nirmatrelvir-ritonavir
  • D. Remdesivir

Correct answer is A. Recommendation for its use is based on in vitro activity against current omicron variants; clinical data are very limited, and thus bebtelovimab has not been shown to reduce hospitalizations in a randomized controlled trial. Remdesivir, nirmatrelvir-ritonavir, and molnupiravir were each shown to reduce hospitalizations in placebo-controlled randomized trials.

To learn more about COVID-19, click the button below to watch the latest COVID-19 Dialogue from July 7, 2022. For an in-depth review of in-patient and outpatient care, click the button below to register for the virtual CME activity, COVID-19 Prevention and Management: HIV Coinfection, Outpatient Management, Hospitalization, and Post-COVID-19 Complications. This CME activity is scheduled for July 20, 2022.

Which of the following PrEP regimens are recommended for coverage for a missed long-acting injectable cabotegravir visit?

 

Responses
A. Daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) 37% (178)
B. Daily oral tenofovir alafenamide/emtricitabine (TAF/FTC) 14% (70)
C. Daily oral cabotegravir (CAB) 38% (186)
D. On-demand tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) 11% (54)
  • A. Daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC)
  • B. Daily oral tenofovir alafenamide/emtricitabine (TAF/FTC)
  • C. Daily oral cabotegravir (CAB)
  • D. On-demand tenofovir disoproxil fumarate/emtricitabine (TDF/FTC)

Correct answer is A. The package insert for cabotegravir recommends oral cabotegravir for up to 2 months after a missed injection visit. After 2 months, an alternative form of PrEP should be used. Oral cabotegravir has not been studied as an oral PrEP option. Therefore, based on the data for daily oral TDF/FTC, as well as cost and implementation considerations, TDF/FTC would be the best option for covering missed injection visits.

To learn more about long-acting injectable CAB, click the link below to watch Implementation of Long-Acting PrEP: Case-Based Panel Discussion With Clinicians, presented by Colleen Kelley, MD, MPH, Kim Scarsi, PharmD, and Hyman Scott, MD, MPH, on June 28, 2022.

Which of the following statements regarding the pharmacokinetic (PK) and PK-pharmacodynamics (PD) of nirmatrelvir/ritonavir is CORRECT?

 

Responses
A. Nirmatrelvir is highly protein bound 12% (62)
B. The protein-adjusted 90% effective concentration (EC90) for nirmatrelvir is 292 ng/mL 28% (139)
C. Race, weight, and renal function influence nirmatrelvir PK 23% (112)
D. In the EPIC-SR (Evaluation of Protease Inhibition for COVID-19 in Standard-Risk Patients) and EPIC-HR (Evaluation of Protease Inhibition for COVID-19 in High-Risk Patients) trials in persons with COVID-19, those with a nirmatrelvir trough above 1000 ng/mL had faster time to symptom resolution 37% (186)
  • A. Nirmatrelvir is highly protein bound
  • B. The protein-adjusted 90% effective concentration (EC90) for nirmatrelvir is 292 ng/mL
  • C. Race, weight, and renal function influence nirmatrelvir PK
  • D. In the EPIC-SR (Evaluation of Protease Inhibition for COVID-19 in Standard-Risk Patients) and EPIC-HR (Evaluation of Protease Inhibition for COVID-19 in High-Risk Patients) trials in persons with COVID-19, those with a nirmatrelvir trough above 1000 ng/mL had faster time to symptom resolution

Correct answer is B.  The protein-adjusted EC90 for nirmatrelvir is 292 ng/mL. Option A is incorrect because nirmatrelvir is 69% bound. Option C is incorrect because no population PK studies have been reported to date that evaluate clinical or demographic factors associated with nirmatrelvir PK. Option D is incorrect because no PK-PD associations have been reported with nirmatrelvir in persons with COVID-19 to date.

To learn more about the PK-PD of antivirals, click the button below to watch the on-demand webinar Optimizing Antiviral Outcomes Through Clinical Pharmacology, presented by Jennifer J. Kiser, PharmD, PhD, on June 21, 2022.

Which of the following antiretroviral therapy (ART) regimens is now recommended for all pregnancy-related clinical categories for people with HIV (PWH)?

 

Responses
A. Bictegravir/tenofovir
alafenamide/emtricitabine
18% (139)
B. Doravirine/tenofovir disoproxil
fumarate/lamivudine
8% (60)
C. Dolutegravir/tenofovir
alafenamide/emtricitabine
60% (456)
D. Cabotegravir/rilpivirine 3% (27)
E. Dolutegravir/lamivudine 11% (84)
  • A. Bictegravir/tenofovir alafenamide/emtricitabine
  • B. Doravirine/tenofovir disoproxil fumarate/lamivudine
  • C. Dolutegravir/tenofovir alafenamide/ emtricitabine
  • D. Cabotegravir/rilpivirine
  • E. Dolutegravir/lamivudine

Correct answer is C. Dolutegravir/tenofovir alafenamide/emtricitabine is the preferred regimen for people who are pregnant or trying to become pregnant.

To learn more about ART during pregnancy, along with other clinical situations, click the button below to watch, Challenging Cases in Antiretroviral Therapy and Panel Discussion, presented by Paul E. Sax, MD, at the IAS–USA 30th Annual Scott M. Hammer Update on HIV Management on June 13, 2022, in New York, NY.

Which of the following statements is true regarding comorbidities among adolescents with HIV?

 

Responses
A. Adolescents with HIV have lower rates of mental health disorders than adolescents without HIV 2% (13)
B. Untreated mental health disorders result in nonadherence and increased risk of morbidity 91% (538)
C. Adolescents do not experience the same weight gain with integrase strand transfer inhibitors (InSTIs) that adults do 3% (16)
D. Adolescents and young adults with HIV are less likely to be sexually active than those without HIV 2% (12)
E. Human papillomavirus (HPV) vaccination cannot be given to adolescents with HIV 2% (10)
  • A. Adolescents with HIV have lower rates of mental health disorders than adolescents without HIV
  • B. Untreated mental health disorders result in nonadherence and increased risk of morbidity
  • C. Adolescents do not experience the same weight gain with integrase strand transfer inhibitors (InSTIs) that adults do
  • D. Adolescents and young adults with HIV are less likely to be sexually active than those without HIV
  • E. Human papillomavirus (HPV) vaccination cannot be given to adolescents with HIV

Correct answer is B. There is a known association between unaddressed mental health and nonadherence and poor outcomes.

To learn more about HIV-related comorbidities in adolescents, click the button below to read the TAM™ article, Preventing and Diagnosing HIV-Related Comorbidities in Adolescents, written by Hasiya Eihuri Yusuf, MD, MPH; David Griffith, MD; and Allison Lorna Agwu, MD, ScM.

Which antiretroviral medication interacts with metformin so that the dose of metformin should not exceed 1000 mg daily with concomitant use?

 

Responses
A. Doravirine 20% (266)
B. Dolutegravir 68% (926)
C. Start ART at end of TB treatment (6 months) 4% (49)
D. Raltegravir 8% (116)
  • A. Doravirine
  • B. Dolutegravir
  • C. Start ART at end of TB treatment (6 months)
  • D. Raltegravir

Correct answer is B. Coadministration of dolutegravir and metformin increases metformin concentrations by about 80%. As a result, the maximum daily dose of metformin in the setting of dolutegravir should be 1000 mg daily.

To learn more about managing diabetes in people with HIV, click the button below to watch the May 31, 2022, webinar, Management of Diabetes in People With HIV, presented by Todd T. Brown, MD, PhD.

A 54-year-old woman is admitted to your hospital with a cough, a fever, and weight loss. She is diagnosed with HIV on admission and is found to have a CD4+ count of 70 cells/μL and her HIV RNA is 120,000 copies/mL. Chest X-ray shows pleural thickening, and diffuse infiltrates. A bronchoscopy is performed, and the smear microscopy is negative for acid-fast bacilli. Gene Xpert Mycobacterium tuberculosis (Mtb)/rifampicin subsequently confirms tuberculosis (TB); the sputum culture is pending. She is started on treatment for TB with isoniazid, rifampin, ethambutol, and pyrazinamide. When should you start her on antiretroviral therapy (ART)?

Responses
A. Start ART as soon as possible (within 2 weeks) 59% (389)
B. Start ART within 8 weeks 37% (247)
C. Start ART at end of TB treatment (6 months) 4% (25)
  • A. Start ART as soon as possible (within 2 weeks)
  • B. Start ART within 8 weeks
  • C. Start ART at end of TB treatment (6 months)

Correct answer is B. Based on a number of clinical trials (CAMELIA [Early vs Late Introduction of Antiretroviral Therapy in HIV-infected Patients With Tuberculosis], SAPIT [Starting Antiretroviral Therapy at Three Points in Tuberculosis], STRIDE [Strategies to Reduce Injuries and Develop Confidence in Elders]), there is now clear evidence that early ART initiation is safe and associated with reduced mortality. There is no increased risk of adverse events; however, earlier ART initiation is associated with an increase in the risk of immune reconstitution inflammatory syndrome (IRIS). Therefore, the American Thoracic Society (ATS), the US Department of Health and Human Services (DHHS), and the International Antiviral Society–USA (IAS–USA) all recommend early ART initiation in patients with TB (early is defined as within 2 weeks for those with a CD4+ count below 50 cells/μL) and within 8 weeks for those with a CD4+ count greater than 50 cells/μL. The exception to early initiation is in cases of TB meningitis, where increased rates of adverse events and death have been reported with early ART initiation. The correct answer for this case, in which the patient has a CD4+ count of 70 cells/μL, is option B.

To learn more about treating HIV and tuberculosis, follow the link below to read the new Topics in Antiviral Medicine™ article, Update on Tuberculosis/HIV Coinfections: Across the Spectrum From Latent Infection Through Drug- Susceptible and Drug-Resistant Disease, written by Elisa H. Ignatius, MD, MSc, and Susan Swindells, MBBS.

A 38-year-old man diagnosed with HIV comes to the office expressing passive suicidal ideation. During the past 6 weeks, he has experienced fatigue, loss of interest in usual activities, a 7-kg (15-lb) weight loss, and insomnia. He is diagnosed with a major depressive episode. Which of the following is NOT true regarding his depression treatment?

Responses
A. Beginning a low dose of antidepressant reduces the risk of adverse effects 9% (53)
B. Escalating the dose of an antidepressant medication should be avoided 54% (304)
C. Accepting treatment with antidepressants is associated with greater adherence to antiretroviral medications 21% (117)
D. More than one antidepressant trial may be needed to achieve remission from depression 16% (87)
  • A. Beginning a low dose of antidepressant reduces the risk of adverse effects
  • B. Escalating the dose of an antidepressant medication should be avoided
  • C. Accepting treatment with antidepressants is associated with greater adherence to antiretroviral medications
  • D. More than one antidepressant trial may be needed to achieve remission from depression

Correct answer is B. If the patient can tolerate the adverse effects of an antidepressant, it may be necessary to gradually increase the dose to achieve a therapeutic response.

For more information on treating depression in people with HIV, follow the link below to read the new Topics in Antiviral Medicine™ article, Addressing Depressive Disorders Among People With HIV, written by Andres Fuenmayor, MD, and Francine Cournos, MD.

Long-acting (LA) therapy with cabotegravir plus rilpivirine (CAB/RPV) as a switch therapy in adults with HIV suppressed on therapy has been studied in 3 large randomized controlled trials. Which of the following is a common result across these studies?

Responses
A. LA CAB/RPV was superior to continued oral therapy in maintaining suppression of HIV RNA 16% (118)
B. Virologic failure occurred in less than 3% of participants treated with LA CAB/RPV in each study 54% (395)
C. When virologic failure occurred, only nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance mutations emerged 8% (56)
D. LA CAB/RPV therapy was always preceded by oral lead-in therapy 20% (147)
E. Injection site reactions increased in severity over time 2% (19)
  • A. LA CAB/RPV was superior to continued oral therapy in maintaining suppression of HIV RNA
  • B. Virologic failure occurred in less than 3% of participants treated with LA CAB/RPV in each study
  • C. When virologic failure occurred, only nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance mutations emerged
  • D. LA CAB/RPV therapy was always preceded by oral lead-in therapy
  • E. Injection site reactions increased in severity over time

Correct answer is B. Across all studies (FLAIR [First Long-Acting Injectable Regimen] and ATLAS [Antiretroviral Therapy as Long Acting Suppression]), LA CAB/RPV was noninferior to continued oral therapy, virologic failure, and an HIV viral load of greater than 50 copies/mL occurred 1% to 3% of the time depending on the study. When resistance occurs, there is typically resistance to NNRTIs and to integrase strand transfer inhibitors (InSTIs). In FLAIR crossover from oral therapy at week 96, participants were randomized to CAB/RPV oral lead or to direct to intramuscular (IM) injection of LA CAB/RPV. Finally, in each study, injection site reaction severity decreased over time.

To learn more about LA CAB for treatment, click the button below to watch NEW ANTIRETROVIRALS AND THE FUTURE OF HIV TREATMENT AND PREVENTION presented by Chloe M. Orkin, MBBCH, MSC, from Queen Mary University of London on February 16, 2022, at CROI 2022.

Nirmatrelvir/ritonavir has United States Food and Drug Administration (FDA) Emergency Use Authorization to treat mild-to-moderate COVID-19 in patients at high risk of progression to severe disease, who are 12 years of age and older, and weigh 40 kg or more. In such patients, nirmatrelvir/ritonavir should be initiated within 5 days of symptom onset. Given the coformulation with ritonavir, there is some risk of drug interactions. Which of the following treatments is absolutely contraindicated (ie, cannot be temporarily discontinued or the dose adjusted) while taking nirmatrelvir/ritonavir?

Responses
A. Atorvastatin 23% (133)
B. Bictegravir/emtricitabine/tenofovir alafenamide 21% (127)
C. Salmeterol 33% (199)
D. Bupropion 6% (38)
E. Risperidone
17% (179)
  • A. Atorvastatin
  • B. Bictegravir/emtricitabine/tenofovir alafenamide
  • C. Salmeterol
  • D. Bupropion
  • E. Risperidone

Correct answer is C. Coadministration of salmetrol and nirmatrelvir/ritonavir may increase cardiac effects, and nirmatrelvir/ritonavir should be avoided. Nirmatrelvir/ritonavir may increase bictegravir drug levels, but this has no clinical significance, and no dose modification is needed. Nirmatrelvir/ritonavir increases the levels of most statins. Atorvastatin and all other statins can be withheld during nirmatrelvir/ritonavir treatment and for 5 days thereafter. Nirmatrelvir/ritonavir increases drug levels of risperidone. No dose adjustment is recommended, but monitoring for adverse events is necessary.

Sources: IDSA, Liverpool, and the IAS–USA May 6 COVID-19 Dialogue

To learn more about nirmatrelvir/ritonavir, click the button below to watch the May 6, 2022, IAS–USA COVID-19 Dialogue titled, Detailed Discussion on the Most Current Issues in COVID-19 Therapeutics, 2nd Booster, Variants of Variants, and COVID-19 in Children, moderated by Dr Paul A. Volberding with discussants Drs Yvonne Maldonado, Peter Chin-Hong, and Carlos del Rio.

In a male patient who has treated HIV and primary syphilis, which one of the following is recommended by the Centers for Disease Control and Prevention (CDC) sexually transmitted infections (STIs) guidelines panel?

Responses
A. Lumbar puncture to evaluate for neurosyphilis 5% (29)
B. Repeat non-specific syphilis serology (ie, rapid plasma reagin [RPR]) at 6, 9, 12, and 24 months after treatment 48% (270)
C. Penicillin G benzathine 2.4 million units (MU) intramuscularly (IM) weekly for 3 weeks 15% (81)
D. Thorough ocular and otic examination 32% (179)
  • A. Lumbar puncture to evaluate for neurosyphilis
  • B. Repeat non-specific syphilis serology (ie, rapid plasma reagin [RPR]) at 6, 9, 12, and 24 months after treatment
  • C. Penicillin G benzathine 2.4 million units (MU) intramuscularly (IM) weekly for 3 weeks
  • D. Thorough ocular and otic examination

Correct answer is D. The CDC sexually transmitted infections guidelines panel recommends that all persons with HIV infection and primary and secondary syphilis have a thorough neurologic, ocular, and otic examination.

For more information on screening for and managing STIs, click the button below to watch “Controversies in Managing Sexually Transmitted Infections: A Case-Based Panel Discussion,” presented by Jeffrey L. Lennox, MD, at the 30th Annual Update on HIV Management course in Atlanta, Georgia.

Which of the following is true regarding the incidence rate of anal cancer among persons with HIV?

Responses
A. They are low among women with HIV 5% (40)
B. They are approximate to the rates of common cancers that screening guidelines exist for 27% (192)
C. They continue to rise despite the widespread use of ART 52% (378)
D. They are only high in those with a history of anoreceptive sex 16% (114)
  • A. They are low among women with HIV
  • B. They are approximate to the rates of common cancers that screening guidelines exist for
  • C. They continue to rise despite the widespread use of ART
  • D. They are only high in those with a history of anoreceptive sex

Correct answer is B. Anal cancer rates for women with HIV approximate the historic cervical cancer rates prior to widespread cervical cancer screening. Among men who have sex with men (MSM) with HIV, the rates approximate or exceed the rates of lung, colon, and prostate cancer.

For more information on screening for anal cancer, click the button below to watch “Screening for Anal Cancer: When to Screen and What to Do With the Results,” presented by Grant Ellsworth, MD, at the 30th Annual Update on HIV Management course in Atlanta, Georgia.

Which of the following is NOT true?

Responses
A. Gait speed alone predicts disability and death 25% (112)
B. Frailty predicts risk for diabetes 17% (78)
C. American College of Cardiology (ACC) and the American Heart Association (AHA) cardiovascular risk of greater than or equal to 7.5% is associated with an increased risk of frailty 15% (69)
D. A short Physical Performance Battery score of less than 10 predicts a higher risk of death 14% (63)
E. The Clinical Frailty Score requires a timed walk 29% (129)
  • A. Gait speed alone predicts disability and death
  • B. Frailty predicts risk for diabetes
  • C. American College of Cardiology (ACC) and the American Heart Association (AHA) cardiovascular risk of greater than or equal to 7.5% is associated with an increased risk of frailty
  • D. A short Physical Performance Battery score of less than 10 predicts a higher risk of death
  • E. The Clinical Frailty Score requires a timed walk

Correct answer is E. The clinical frailty scale is a quick “eyeball” test of frailty that is completed in less than a minute and does not include a timed walk.

To learn more about assessing frailty in older adults with HIV, click the button below to watch “Frailty: Screening, Preventing, and Intervening,” presented by Melanie Thompson, MD, at the 30th Annual Update on HIV Management in Atlanta, Georgia.

Which of the following statements about long-acting cabotegravir (CAB-LA) is FALSE?

Responses
A. In the first year of unblinded data, it was still shown to be 66% more effective than tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) at preventing HIV 14% (91)
B. There have been no cases of breakthrough infections in the participants who received injections on time 49% (318)
C. Some people with breakthrough infections developed integrase strand transfer inhibitor (InSTI) resistance 20% (112)
D. RNA testing is recommended at baseline and every 2 months 17% (81)
  • A. In the first year of unblinded data, it was still shown to be 66% more effective than tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) at preventing HIV
  • B. There have been no cases of breakthrough infections in the participants who received injections on time
  • C. Some people with breakthrough infections developed integrase strand transfer inhibitor (InSTI) resistance
  • D. RNA testing is recommended at baseline and every 2 months

Correct answer is B. There have been 7 reported cases of breakthrough infections in participants who received injections on time.

To learn more about CAB-LA and other preventative strategies, click the button below to watch “CROI 2022 Update: Highlights in HIV and COVID-19 Epidemiology and Prevention​,” presented on March 31, 2022, by Susan P. Buchbinder, MD.

In people who inject drugs (PWID), PrEP uptake falls in the range of:

Responses
A. 0%-3% 42% (373)
B. 5%-10% 28% (252)
C. 10%-15% 20% (178)
D. 20%-25% 10% (81)
  • A. 0%-3%
  • B. 5%-10%
  • C. 10%-15%
  • D. 20%-25

Correct answer is A. Despite high awareness and willingness, PrEP uptake has been extremely low in PWID (0%-3%). Declines in engagement are observed through the PrEP care continuum, and there is a paucity of data on sexual minority men who inject drugs.

For more information on HIV prevention in special populations, click the button below to watch the HIV PREVENTION IN SPECIAL POPULATIONS symposium presented on February 24, 2022, at CROI 2022.

What is the recommended timing for hepatitis C virus (HCV) treatment initiation in the setting of acute/recent infection or documented reinfection? .

Responses
A. After waiting 3 to 6 months to evaluate for spontaneous clearance 26% (179)
B. Immediately or as soon as feasible 52% (362)
C. Only once chronic infection is established (more than 6 months) 11% (73)
D. After 1 month to ensure acute hepatic failure does not develop 4% (25)
E. Once resistance testing results are back 7% (51)
  • A. After waiting 3 to 6 months to evaluate for spontaneous clearance
  • B. Immediately or as soon as feasible
  • C. Only once chronic infection is established (more than 6 months)
  • D. After 1 month to ensure acute hepatic failure does not develop
  • E. Once resistance testing results are back

Correct answer is B. The major guidelines and guidance documents recommend expedited or immediate treatment of acute HCV infection without waiting for spontaneous clearance assessment. This also applies to the setting of documented HCV reinfection. This recommendation is rooted in the public health benefit with prevention of onward transmission as well as the benefit to the individual. Baseline resistance testing is not routinely recommended.

To learn more about liver disease and hepatitis B, C, and D, click the button below to watch the CASE-BASED LIVER WORKSHOP presented on February 13, 2022, at CROI 2022.

True or false: The new PrEP Guidelines from the Centers for Disease Control and Prevention (CDC) recommend all sexually active adults and adolescents should receive information about PrEP.

Responses
A. True 93% (1225)
B. False 7% (86)
  • A. True
  • B. False

Correct answer is A. The new recommendation for clinicians is to inform all sexually active adults and adolescents about PrEP, and providers to offer PrEP to anyone who requests it, even if they do not report specific risk behaviors. This recommendation is intended to increase awareness and make PrEP available to people who may be apprehensive about sharing potentially stigmatizing HIV risk behaviors with their clinician.

To learn more about the new PrEP guidelines, be sure to watch the March 22, 2022, webinar, CDC PrEP Clinical Practice Guideline and Strategies for Ending the HIV Epidemic in the US, presented by Demetre C. Daskalakis, MD, MPH, and Dawn K. Smith, MD, MS, MPH.

At CROI 2022, the 3rd case of HIV cure was reported in a woman with well-controlled HIV who developed acute myeloid leukemia (AML). Which of the following is TRUE?

Responses
A. The participant was of mixed race and lived in a developing country 6% (43)
B. The participant received systemic chemotherapy, but NOT total body irradiation 8% (57)
C. The participant received a bone marrow transplant from a donor with the delta 32 deletion in the gene coding for the CCR5 recepto 52% (387)
D. The participant never experienced graft vs host disease
34% (248)
  • A. The participant was of mixed race and lived in a developing country
  • B. The participant received systemic chemotherapy, but NOT total body irradiation
  • C. The participant received a bone marrow transplant from a donor with the delta 32 deletion in the gene coding for the CCR5 receptor
  • D. The participant never experienced graft vs host disease

Correct answer is D. The participant never experienced graft vs host disease. Like the first 2 documented cases of HIV cure, this participant, a woman of mixed race living in New York, was living with well-controlled HIV when she developed aggressive AML. She enrolled in the IMPAACT P1007 study and following systemic chemotherapy (but NOT total body irradiation) for her AML, she received an umbilical cord blood transplant that was pre-screened and harbored the delta 32 deletion. She engrafted the cord blood cells but NEVER developed graft vs host disease, which was hypothesized to play a role in the first 2 documented cases of HIV cure. Following discontinuation of antiretroviral therapy for more than a year, she remains HIV-free and is considered cured.

To learn more about this cure patient, as well as other CROI 2022 updates, be sure to watch the March 15, 2022, on-demand webinar, CROI 2022 Update: Highlights in Clinical Research With a Focus on Antivirals, presented by Roy M. Gulick, MD, MPH.

As a reminder, CROI 2022 content will become public on the CROI website on March 25, 2022.

AB is a 32-year-old Black woman who has been virologically suppressed on efavirenz (EFV)/tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) since 2012. She developed progressively worsening insomnia and was diagnosed with depressive disorder. Her antiretroviral therapy (ART) regimen was switched to abacavir (ABC)/lamivudine (3TC)/dolutegravir (DTG) 2 years ago. She has since then gained 25 lbs. She is not concerned about her appearance, but you would like to counsel her about potential metabolic complications of weight gain on ART. Which of the following are metabolic complications of weight gain on ART?

Responses
A. DTG is associated with significant worsening of lipid profile with correlate with the weight gain 9% (55)
B. There is no risk for metabolic complications. Most of the weight gain is lean, not fat mass 4% (24)
C. Weight gain on ART is associated with an increased risk of cardiovascular disease (CVD) 14% (86)
D. Weight gain on ART is associated with an increased risk of metabolic syndrome 73% (438)
  • A. DTG is associated with significant worsening of lipid profile with correlate with the weight gain
  • B. There is no risk for metabolic complications. Most of the weight gain is lean, not fat mass
  • C. Weight gain on ART is associated with an increased risk of cardiovascular disease (CVD)
  • D. Weight gain on ART is associated with an increased risk of metabolic syndrome

Correct answer is D. Previous studies have shown that obesity disproportionately increases diabetes risk in people with HIV compared to HIV-uninfected controls. In the D:A:D (Data Collection on Adverse Events of Anti-HIV Drugs) study cohort, a higher body mass index (BMI) was not associated with an increased risk of CVD, but such changes were consistently associated with an increased risk of diabetes mellitus (DM). Weight gain was also associated with an increased risk of metabolic syndrome in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) trial. DTG is not associated with an increased risk of dyslipidemia.

To learn more about weight gain and ART, click the Watch Webcast button below to view the our March 8th webinar on Weight Gain: A Growing Issue in Antiretroviral Therapy, presented by Roger J. Bedimo, MD, MS.

By what percentage did new HIV infections decline in the United States from 2015 to 2019?

Responses
A. No decline 13% (128)
B. 8% 44% (443)
C. 16% 22% (227)
D. 24% 16% (162)
E. 32% 5% (49)
  • A. No decline
  • B. 8%
  • C. 16%
  • D. 24%
  • E. 32%

Correct answer is B. There was only an 8% decline in the United States from 2015 to 2019, despite scale-up of testing and treatment. Preexposure prophylaxis (PrEP) scale-up could have a substantial impact on reducing new infections nationally, and getting us toward the Ending the HIV Epidemic goal of a 75% reduction in new infections by 2025, and a 90% reduction in new infections by 2030.

To learn more about how PrEP can be utilized in meeting the Ending the HIV Epidemic goals, click the Watch Webcast button below to view the presentation, “Ending the HIV Epidemic: The Impact of PrEP,” presented by Susan P. Buchbinder, MD, at the November 19, 2021, virtual course, PrEParing for PrEP: From Policy to Implementation.

Which of the following statements is FALSE?

 

Responses
A. Treating depression may require considerable trial and error 11% (108)
B. Mood stabilizers tend to have more interactions with antiretroviral medications than antidepressants 16% (146)
C. More than 10% of patients diagnosed with major depression in a primary care setting have bipolar depression 16% (145)
D. Antidepressants are a good first-line treatment for bipolar depression 44% (405)
E. Ketamine is now being used for refractory depression 13% (127)
  • A. Treating depression may require considerable trial and error
  • B. Mood stabilizers tend to have more interactions with antiretroviral medications than antidepressants
  • C. More than 10% of patients diagnosed with major depression in a primary care setting have bipolar depression
  • D. Antidepressants are a good first-line treatment for bipolar depression
  • E. Ketamine is now being used for refractory depression

Correct answer is D. Antidepressants are not the recommended treatment for bipolar depression and can precipitate mania.

For more information, click the Watch Webcast button below to view the presentation, Addressing Depression in Patients with HIV, presented by Francine Cournos, MD, at the virtual 2021 Ryan White HIV/AIDS Program CLINICAL CONFERENCE on October 5, 2021.

Chronic pain can be influenced by a variety of diseases and environmental factors. Which of the following is NOT indicative of the potential worsening of chronic pain?

Responses
A. Frequent psychiatric follow-up visits 39% (136)
B. Inadequate housing 28% (98)
C. A high HIV viral load 30% (106)
D. Insomnia 3% (12)
  • A. Frequent psychiatric follow-up visits
  • B. Inadequate housing
  • C. A high HIV viral load
  • D. Insomnia

Correct answer is A. Undertreated mental health conditions can worsen chronic pain. However, having regular, frequent psychiatric follow-ups can improve the care of mental health conditions and help reduce chronic pain. Inadequate housing and insomnia can lead to increased physical and psychologic stress levels, and a high viral load may contribute to HIV-induced nerve damage. These latter factors can lead to a worsening in chronic pain.

For more information on chronic pain and HIV, follow the link below to read the new Topics in Antiviral Medicine™ article, Chronic Pain and Opioid Use in Older People With HIV, written by Vasudev C. Mandyam, MD, and R. Douglas Bruce, MD, MA, MS.

Which of the following is/are the most commonly identified risk factor(s) of cognitive decline in people with HIV on suppressive antiretroviral therapy (ART)?

 

Responses
A. A history of HIV-associated neurocognitive disorder (HAND) or cognitive impairment pre-ART, and older age
83% (679)
B. Asymptomatic cerebral spinal fluid (CSF) viral escape 4% (34)
C. Reversed CD4+/CD8+ cell ratio 5% (37)
D. Low central nervous system penetration effectiveness (CPE) ART regimens 8% (66)
  • A. A history of HIV-associated neurocognitive disorder (HAND) or cognitive impairment pre-ART, and older age
  • B. Asymptomatic cerebral spinal fluid (CSF) viral escape
  • C. Reversed CD4+/CD8+ cell ratio
  • D. Low central nervous system penetration effectiveness (CPE) ART regimens

Correct answer is A. Longitudinal studies and a meta-analysis suggest that older people with HIV and those with a pre-existing cognitive impairment before ART had a higher risk of cognitive decline than those without these risk factors. Although CSF samples in asymptomatic CSF viral escape demonstrated higher levels of immune activation markers than those without escape, it remains unclear if the former poses a substantial negative impact on long-term cognitive function. Reversed CD4+/CD8+ ratio is common among people with HIV who are virally suppressed and is associated with noncommunicable comorbidities, although its association with long-term cognitive function is unclear. The use of low CPE ART regimens may be associated with a higher risk of CSF viral escape. However, low CPE ART regimens appear safe in uncomplicated cases and are not associated with cognitive decline.

For more information on cognition and HIV, follow the link below to read the new Topics in Antiviral Medicine™ article, Neurocognition and the Aging Brain in People With HIV: Implications for Screening, written by Philip Chan, MBChB, PhD, and Victor Valcour, MD, PhD.

Long-term opioid treatment (LTOT) for chronic non-malignant pain in people with HIV increases retention in HIV treatment by what percent?

 

Responses
A. Does not increase retention 34% (249)
B. Increases retention by 10% 11% (76)
C. Increases retention by 15% 15% (105)
D. Increases retention by 20% 21% (153)
E. Increases retention by 25% 19% (140)
  • A. Does not increase retention
  • B. Increases retention by 10%
  • C. Increases retention by 15%
  • D. Increases retention by 20%
  • E. Increases retention by 25%

Correct answer is A. Although patients with chronic pain and not on LTOT had twice the rate of virologic failure than those on LTOT, LTOT did not impact retention in HIV treatment in patients with pain.

For more information on opioid use, follow the link below to view the presentation, “Chronic Pain and Opioid Use in Older People with HIV,” presented by R. Douglas Bruce, MD, MA, MS, at the June 25, 2021, virtual course, Aging and HIV: Issues, Screening, and Management in Individuals with HIV as They Age.

This topic will also be covered in the next issue of Topics in Antiviral Medicine. This article will be released soon; check the IAS–USA website for updates.

Which of the following is a Centers for Disease Control and Prevention (CDC) preferred treatment approach for latent tuberculosis (TB) infection?

Responses
A. Isoniazid daily for 9 months 32% (205)
B. Rifampin and isoniazid weekly for 3 months 51% (325)
C. Close monitoring of the patient’s health status and treatment only if TB disease develops 9% (60)
D. Rifampin and pyrazinamide for 6 months 8% (54)
  • A. Isoniazid daily for 9 months
  • B. Rifampin and isoniazid weekly for 3 months
  • C. Close monitoring of the patient’s health status and treatment only if TB disease develops
  • D. Rifampin and pyrazinamide for 6 months

Correct answer is B. Rifampin and isoniazid weekly for 3 months is the CDC’s preferred approach for treating latent TB. Isoniazid on its own is no longer a preferred regimen because the CDC only lists shorter course regimens. Watchful waiting is not recommended. Rifampin with pyrazinamide is not on the CDC’s list and was associated with increased mortality.

For more information, click the Watch Webinar button below to view the presentation, Update on Tuberculosis/HIV Coinfection: Across the Spectrum From Latent Infection Through Drug-Susceptible and Drug-Resistant Disease, presented by Susan Swindells, MBBS, on November 16, 2021.

TB will also be addressed at the CROI 2022 symposium, TUBERCULOSIS: NEW STRATEGIES IN THE TREATMENT OF THE WORLD’S OLDEST EPIDEMIC, on Wednesday, February 23, 2022. Content from CROI 2022 will be available to the public 1 month following the conference.

How does the risk of myocardial infarction (MI) for people with HIV compare with the risk for people without HIV?

Responses
A. The risk is the same 9% (54)
B. 10% to 20% lower for people with HIV
4% (27)
C. 20% to 100% higher for people with HIV
78% (466)
D. 200% to 400% higher for people with HIV 9% (54)
  • A. The risk is the same
  • B. 10% to 20% lower for people with HIV
  • C. 20% to 100% higher for people with HIV
  • D. 200% to 400% higher for people with HIV

Correct answer is C. People with HIV have approximately 1.5-fold (150%) higher risk for MI than people without HIV. There is some variation in studies, depending on the cohorts and control populations, but the vast majority have demonstrated people with HIV have anywhere from 20% to 100% higher MI risk than people without HIV.

For more information, click the Read Article button below to read the article, “HIV and Cardiovascular Disease: From Insights to Interventions,” authored by Matthew J. Feinstein, MD, MSc, which was published in the October/November 2021, Volume 29, Issue 4 of Topics in Antiviral Medicine.

A 32-year-old cisgender woman with HIV on effective antiretroviral therapy who you have been following for 10 years is diagnosed with primary syphilis. Her rapid plasma reagin (RPR) titer is 1:256. She is treated with 2.4 μL of intramuscular benzathine penicillin. At 3 months, her titer is 1:256; at 6 months, her titer is 1:128; and at 9 months (currently), her titer is 1:128. Her examination is normal, and she denies any re-exposures. What is the most appropriate management approach at this time?

 

Responses
A. Benzathine penicillin G 2.4 μL intramuscular 1 time 7% (31)
B. Benzathine penicillin G 2.4 μL intramuscular 3 times 27% (122)
C. Continue to observe 43% (197)
D. Cerebrospinal fluid examination 23% (109)
  • A. Benzathine penicillin G 2.4 μL intramuscular 1 time
  • B. Benzathine penicillin G 2.4 μL intramuscular 3 times
  • C. Continue to observe
  • D. Cerebrospinal fluid examination

Correct answer is C. The current Sexually Transmitted Infection (STI) Treatment Guidelines recommend waiting a full 12 months for persons with early syphilis and a full 24 months for persons with late latent syphilis before anticipating what to do with serological titers following therapy. In this situation, the patient was treated 9 months ago for early syphilis. Her titer has declined 2-fold (or 1 dilution) so far. She denies any re-exposures. The most appropriate approach is to continue to observe for at least a full 12 months. Interestingly, titers in persons with HIV may decline more slowly. The STI Treatment Guidelines acknowledge this and suggest that clinicians may wish to wait for a full 24 months for people with HIV treated for early syphilis.

“Challenging Diagnostic and Management Questions in Syphilis: A Case-Based Approach,” “Leveraging Administrative and Governmental Policies to Improve PrEP Utilization,” presented by Khalil G. Ghanem, MD, PhD, on November 2, 2021.

In the United States, the rate of people with HIV who are uninsured compared with the general adult population is approximately which of the following?

 

Responses
A. The same 24% (59)
B. Higher
54% (133)
C. Lower 22% (55)
  • A. The same
  • B. Higher
  • C. Lower

Correct answer is A. Since the Patient Protection and Affordable Care Act (PPACA) was enacted, the rate of people with HIV who are uninsured is roughly equal to the rest of the adult population.

To learn more about the relationship between policy and access to care, click the below link to watch the webinar, “Leveraging Administrative and Governmental Policies to Improve PrEP Utilization,” presented by Jeffrey Crowley, MPH, at the November 19, 2021, virtual course, PrEParing for PrEP: From Policy to Implementation.

Which statement regarding interactions with contemporary antiretrovirals is FALSE?

Responses
A. Oral absorption of integrase strand transfer inhibitors is significantly reduced by polyvalent cations such as aluminum, calcium, magnesium, iron, and zinc that frailty in one clinic is assessed the same in another clinic 13% (16)
B. Potent enzyme and transporter inducers reduce cabotegravir/rilpivirine exposures when cabotegravir/rilpivirine is given orally, but not when given intramuscularly
46% (58)
C. Several antiretroviral drugs inhibit membrane transporters resulting in higher exposures of transporter substrates 28% (36)
D. Iatrogenic Cushing’s syndrome may occur when inhaled, intranasal, intra-articular, or ocular corticosteroids are used in people with HIV on antiretroviral regimens that contain ritonavir or cobicistat 13% (17)
  • A. Oral absorption of integrase strand transfer inhibitors is significantly reduced by polyvalent cations such as aluminum, calcium, magnesium, iron, and zinc
  • B. Potent enzyme and transporter inducers reduce cabotegravir/rilpivirine exposures when cabotegravir/rilpivirine is given orally, but not when given intramuscularly
  • C. Several antiretroviral drugs inhibit membrane transporters resulting in higher exposures of transporter substrates
  • D. Iatrogenic Cushing’s syndrome may occur when inhaled, intranasal, intra-articular, or ocular corticosteroids are used in people with HIV on antiretroviral regimens that contain ritonavir or cobicistat

Correct answer is B. Potent enzyme and transporter inducers reduce cabotegravir/rilpivirine exposures both when given orally and when administered intramuscularly.

For more information on how to manage drug-drug interactions and polypharmacy in your clinic, follow the link below to view the presentation, “Managing Polypharmacy and Drug-Drug Interactions,” presented by Jennifer J. Kiser, PharmD, PhD, at the virtual 2021 Ryan White HIV/AIDS Program CLINICAL CONFERENCE.

Which of the following statements is true regarding assessments for frailty or functional limitations?

Responses
A. The Frailty Phenotype and Index have clear-cut points and components that ensure that frailty in one clinic is assessed the same in another clinic 23% (36)
B. The Short Physical Performance Battery can be collected retrospectively
7% (11)
C. The Frailty Phenotype provides a wide range of scores 16% (26)
D. The Frailty Index can be easily determined using just a few variables 15% (24)
E. The Clinical Frailty Scale requires less than a minute to complete 39% (61)
  • A. The Frailty Phenotype and Index have clear-cut points and components that ensure that frailty in one clinic is assessed the same in another clinic
  • B. The Short Physical Performance Battery can be collected retrospectively
  • C. The Frailty Phenotype provides a wide range of scores
  • D. The Frailty Index can be easily determined using just a few variables
  • E. The Clinical Frailty Scale requires less than a minute to complete

Correct answer is E. The Frailty Phenotype and Index have different-cut points or components depending on the cohort; the Short Physical Performance Battery must be collected in real-time, and the Frailty Phenotype scores range from 0 to 5. Assessments such as the 400-meter walk can take less than 240 seconds to more than 900 seconds to administer. A Frailty Index typically includes at least 50 variables. The Clinical Frailty Scale is a quick “eye ball” test of frailty that is completed in less than a minute.

For more information on how to conduct these assessments in your clinic, follow the link below to view the presentation, “Assessing Frailty in Older People With HIV,” presented by Kristine M. Erlandson, MD, MS, at the June 25, 2021, virtual course, Aging and HIV: Issues, Screening, and Management in Individuals with HIV as They Age.

The recombinant herpes zoster vaccine is recommended for which group of people with HIV?

Responses
A. All people with HIV age 50 years and older 43% (150)
B. All people with HIV age 18 years and older 26% (89)
C. People with HIV and a CD4+ count greater than 200 cells/μL 19% (65)
D. People with HIV who have not had a prior episode of herpes zoster 4% (14)
E. None of the above 8% (27)
  • A. All people with HIV age 50 years and older
  • B. All people with HIV age 18 years and older
  • C. People with HIV and a CD4+ count greater than 200 cells/μL
  • D. People with HIV who have not had a prior episode of herpes zoster
  • E. None of the above

Correct answer is B. Herpes zoster is a common infection in people with HIV, and the infection may be severe and recurrent. The Advisory Committee on Immunization Practices (ACIP) and the US Department of Health and Human Services (DHHS) Opportunistic Infection Guidelines have recently been updated to recommend the recombinant herpes zoster vaccine in all adults with HIV infection.

For more information, click the Read Article button below to read the article, “Primary Care Concerns for the Aging Population With HIV”, authored by Steven C. Johnson, MD, which was published in the October/November 2021, Volume 29, Issue 4 of Topics in Antiviral Medicine.

Responses
A. Virologic suppression was not achieved in treatment-experienced patients with low CD4+ count (<200 cells/μL) when they were switched to dolutegravir (DTG) vs darunavir/ritonavir (DRV/r) each with tenofovir/emtricitabine (TDF/FTC) or zidovudine (ZDV)/3TC 10% (40)
B. After NNRTI therapy failure, DTG or DRV boosted with ritonavir (RTV) plus TDF/FTC would be efficacious, regardless of the amount of nRTI resistance 57% (222)
C. Virologic suppression was not achieved in treatment-experienced patients with high baseline viremia (>100,000 copies/mL) when switched to DTG vs DRV/r each with TDF/FTC or ZDV/3TC 13% (51)
D. There should be a minimum of 1 predicted active nRTI for her to achieve virologic suppression on DTG plus TDF/FTC 20% (77)
  • A. Virologic suppression was not achieved in treatment-experienced patients with low CD4+ count (<200 cells/μL) when they were switched to dolutegravir (DTG) vs darunavir/ritonavir (DRV/r) each with tenofovir/emtricitabine (TDF/FTC) or zidovudine (ZDV)/3TC
  • B. After NNRTI therapy failure, DTG or DRV boosted with ritonavir (RTV) plus TDF/FTC would be efficacious, regardless of the amount of nRTI resistance
  • C. Virologic suppression was not achieved in treatment-experienced patients with high baseline viremia (>100,000 copies/mL) when switched to DTG vs DRV/r each with TDF/FTC or ZDV/3TC
  • D. There should be a minimum of 1 predicted active nRTI for her to achieve virologic suppression on DTG plus TDF/FTC

Correct answer is B. The NADIA trial showed that after NNRTI therapy failure, DTG or DRV/r plus TDF/FTC were efficacious, regardless of the amount of nRTI resistance. Baseline low CD4+ cell count or high viral load were not significant predictors of failure after switching. This study complements the findings of previous trials in treatment-experienced patients such as SECOND LINE (Ritonavir-Boosted Lopinavir Plus Nucleoside or Nucleotide Reverse Transcriptase Inhibitors Versus Ritonavir-Boosted Lopinavir Plus Raltegravir for Treatment of HIV-1 Infection in Adults With Virological Failure of a Standard First-Line ART Regimen) and EARNEST (Nucleoside Reverse-Transcriptase Inhibitor Cross-Resistance and Outcomes from Second-Line Antiretroviral Therapy in the Public Health Approach), which showed that first-line NNRTI failures could be treated with regimens containing an older protease inhibitor (lopinavir/ritonavir [LPV/r]) with 2 or 3 nRTIs or LPV/r plus raltegravir (RAL).

For more information, click the Watch On-Demand Recording button below to view the presentation, “In Case You Missed It: Updates From Recent Publications and Meetings”, presented by Roger J. Bedimo, MD, MS, at the November 5, 2021, virtual course, HIV, COVID-19, and Sexually Transmitted Infections: Update and Implications for Practice.

Responses
A. Start postexposure prophylaxis (PEP) 11% (60)
B. Check HIV viral load and start PrEP today 49% (261)
C. Check HIV viral load and delay starting PrEP 37% (197)
D. Start 3-drug antiretroviral treatment twice daily 3% (16)
  • A. Start postexposure prophylaxis (PEP)
  • B. Check HIV viral load and start PrEP today
  • C. Check HIV viral load and delay starting PrEP
  • D. Start 3-drug antiretroviral treatment twice daily

Correct answer is B. This patient has been off PrEP for several months, and he reports ongoing potential HIV exposures. He has some symptoms concerning for possible acute HIV (chills, subjective fevers, sore throat), but he has a cough and several sick contacts, which is suggestive of a respiratory infection. The rapid HIV test has a longer window period, so he would be false negative in the setting of acute HIV infection. It would be important to evaluate for acute HIV, and restarting PrEP would be reasonable given the symptoms are most consistent with an upper respiratory infection.

For more information, click the Watch Webcast button below to view the presentation, “Assessing and Monitoring Persons Interested in Starting and Continuing PrEP”, presented by Hyman Scott, MD, MPH, at the November 19, 2021, virtual course, PrEParing for PrEP: From Policy to Implementation.

Responses
A. Raltegravir 1200 mg daily 16% (90)
B. Bictegravir 50 mg daily 14% (83)
C. Lopinavir 400 mg/ritonavir 100 mg twice daily 10% (58)
D. Efavirenz 600 mg daily 60% (342)
  • A. Raltegravir 1200 mg daily
  • B. Bictegravir 50 mg daily
  • C. Lopinavir 400 mg/ritonavir 100 mg twice daily
  • D. Efavirenz 600 mg daily

Correct answer is D. Standard TB treatment includes rifampin, so multiple drug-drug interactions are possible. Raltegravir should be dosed at 800 mg twice daily; single daily dosing results in unacceptable decreases in concentration. Bictegravir and lopinavir/ritonavir should not be coadministered because of large decreases in antiretroviral concentrations. In contrast, rifampin only leads to modest reduction in efavirenz concentrations at most, so no dose adjustment is needed.

For more information, click the Watch Webinar button below to view the presentation, Update on Tuberculosis/HIV Coinfection: Across the Spectrum From Latent Infection Through Drug-Susceptible and Drug-Resistant Disease, presented by Susan Swindells, MBBS, on November 16, 2021.

Responses
A. A 40-year-old smoker with a 15-pack-year history 19% (148)
B. A 60-year-old with a 40-pack-year history and no other pulmonary issues 40% (309)
C. A 55-year-old with a 35-pack-year history and complaints of chronic cough with occasional hemoptysis 35% (273)
D. A 70-year-old with a 30-pack-year history who quit smoking 20 years prior 6% (50)
  • A. A 40-year-old smoker with a 15-pack-year history
  • B. A 60-year-old with a 40-pack-year history and no other pulmonary issues
  • C. A 55-year-old with a 35-pack-year history and complaints of chronic cough with occasional hemoptysis
  • D. A 70-year-old with a 30-pack-year history who quit smoking 20 years prior

Correct answer is B. The USPSTF screening recommendations are for people 50- to 80-years-old with a history of at least 20-pack-years, who are current smokers or have quit within the past 15 years, and currently have no signs of lung cancer.

For more information, click the Watch On-Demand Session button below to view the presentation, “Non-AIDS Cancers,” presented by Timothy J. Wilkin, MD, on October 5, 2021, for the Ryan White HIV/AIDS Program CLINICAL CONFERENCE.

Responses
A. The drug inhibits HIV replication via 2 different mechanisms making resistance less likely 57% (369)
B. The drug obtains high levels in plasma that are maintained over time 12% (81)
C. The drug has a long intracellular half-life 21% (135)
D. None of the above 10% (65)
  • A. The drug inhibits HIV replication via 2 different mechanisms making resistance less likely
  • B. The drug obtains high levels in plasma that are maintained over time
  • C. The drug has a long intracellular half-life
  • D. None of the above

Correct answer is A. Islatravir has a dual mechanism of action, inhibiting translocation and chain termination. These properties are expected make it more difficult for resistant viruses to emerge with this antiretroviral drug.

For more information, click the Watch On-Demand Session button below to view the presentation, “New and Investigational ART Drugs and Strategies,” presented by Judith S. Currier, MD, on October 3, 2021, for the Ryan White HIV/AIDS Program CLINICAL CONFERENCE.

Responses
A. Oral absorption of integrase strand transfer inhibitors is significantly reduced by polyvalent cations such as aluminum, calcium, magnesium, iron, and zinc 13% (131)
B. Potent enzyme and transporter inducers reduce cabotegravir/rilpivirine exposures when cabotegravir/rilpivirine is given orally, but not when given intramuscularly 43% (417)
C. Several antiretroviral drugs inhibit membrane transporters resulting in higher exposures of transporter substrates 25% (243)
D. Iatrogenic Cushing’s syndrome may occur when inhaled, intra-nasal, intraarticular, or ocular corticosteroids are used in people with HIV on antiretroviral regimens that contain ritonavir or cobicistat 19% (182)
  • A. Oral absorption of integrase strand transfer inhibitors is significantly reduced by polyvalent cations such as aluminum, calcium, magnesium, iron, and zinc
  • B. Potent enzyme and transporter inducers reduce cabotegravir/rilpivirine exposures when cabotegravir/rilpivirine is given orally, but not when given intramuscularly
  • C. Several antiretroviral drugs inhibit membrane transporters resulting in higher exposures of transporter substrates
  • D. Iatrogenic Cushing’s syndrome may occur when inhaled, intra-nasal, intraarticular, or ocular corticosteroids are used in people with HIV on antiretroviral regimens that contain ritonavir or cobicistat

Correct answer is B. Potent enzyme and transporter inducers reduce cabotegravir/rilpivirine exposures both when given orally and when administered intramuscularly.

For more information, click the Watch On-Demand Session button below to view the presentation, “Managing Polypharmacy and Drug-Drug Interactions,” presented by Jennifer J. Kiser, PharmD, PhD, on October 4, 2021, for the Ryan White HIV/AIDS Program CLINICAL CONFERENCE.

Responses
A. Trichomonas can cause urethritis in men who have sex with other men, likely acquired through receptive anal intercourse 16% (107)
B. N. meningitidis has a similar colony morphology appearance on culture and cannot be distinguished from N. gonorrhoeae on Gram stain 27% (178)
C. Herpes simplex virus (HSV)-2 is a more common etiology of urethritis than HSV-1 6% (39)
D. M. genitalium urethritis has been associated with chronic complications among men, including epididymitis, prostatitis, or infertility 51% (339)
  • A. Trichomonas can cause urethritis in men who have sex with other men, likely acquired through receptive anal intercourse
  • B. N. meningitidis has a similar colony morphology appearance on culture and cannot be distinguished from N. gonorrhoeae on Gram stai
  • C. Herpes simplex virus (HSV)-2 is a more common etiology of urethritis than HSV-1
  • D. M. genitalium urethritis has been associated with chronic complications among men, including epididymitis, prostatitis, or infertility

Correct answer is B. N. meningitidis has a similar colony morphology appearance on culture and cannot be distinguished from N. gonorrhoeae on Gram stain.

T. vaginalis can cause urethritis among heterosexual men. However, the prevalence varies substantially by US geographic region, age, sexual behavior, and within specific populations.

N. meningitidis has similar colony morphology appearance on culture and cannot be distinguished from N. gonorrhoeae on Gram stain. Identification of N. meningitidis as the etiologic agent with presumed gonococcal urethritis on the basis of Gram stain but negative nucleic acid amplification testing (NAAT) for gonorrhea requires a confirmation by culture. Meningococcal urethritis is treated with the same antimicrobial regimens as gonococcal urethritis.

Nongonococcal urethritis (NGU) can be caused by herpes simplex virus, Epstein-Barr virus, or adenovirus acquired by oral-penile contact. Herpes simplex virus (HSV)-1 infections are usually the most common and may be associated with meatitis or genital ulcerations.

Associations between urethritis and insertive anal and oral exposure among heterosexual men with urethritis have been reported with Leptotrichia or Sneathia species. These studies increase concern for possible undetected infectious rectal or vaginal pathogens, or alternatively, a transient reactive dysbiosis after exposure to a new microbiome or even a noninfectious reactive etiology.

Data are insufficient to implicate M. genitalium infection with chronic complications among men, including epididymitis, prostatitis, or infertility.

For more information, click the Watch Webinar button below to view the presentation, “Exploration of the Latest Update to the Sexually Transmitted Infection (STI) Treatment Guidelines,” presented by Kimberly A. Workowski, MD, on October 19, 2021.

Responses
A. Inflammation 7% (90)
B. Metabolism of antiretroviral drugs 29% (354)
C. C. difficile infection 59% (717)
D. Epithelial barrier damage 5% (60)
  • A. Inflammation
  • B. Metabolism of antiretroviral drugs
  • C. C. difficile infection
  • D. Epithelial barrier damage

Correct answer is C. Inflammation, metabolism of antiretroviral drugs, and epithelial barrier damage have been shown to increase HIV transmission. Although C. difficile infection has been associated with and has been shown in some studies to increase HIV pathogenesis, it has never been shown to increase HIV transmission.

For more information, click the Watch Webinar button below to view the webinar, “The Role of the Microbiome in Modulation of Inflammation and Impact on Disease in HIV and COVID-19,” presented by Nichole Klatt, PhD, on July 27, 2021.

Responses
A. Increased weight 28% (340)
B. Lower CD4+ count 34% (408)
C. Mood disturbance 4% (47)
D. HIV disease progression 19% (222)
E. Increased cardiovascular mortality 15%(176)
  • A. Increased weight
  • B. Lower CD4+ count
  • C. Mood disturbance
  • D. HIV disease progression
  • E. Increased cardiovascular mortality

Correct answer is A. There are studies that suggest poor sleep in people with HIV is associated with a lower CD4+ count, HIV disease progression, increased cardiovascular mortality, and mood disturbance. However, it is not evident that increased weight is associated with poor sleep in people with HIV.

To learn more about sleep disorders in people with HIV, click the Watch Webinar button below to view the webinar, “Sleep Disorders and Sleep Assessment in People with HIV,” presented by Ana C. Krieger, MD, MPH, on September 21, 2021.

Responses
A. Azithromycin 1 g orally once 11% (66)
B. Azithromycin 1 g orally once a week for 3 consecutive weeks 4% (22)
C. Ceftriaxone 500 mg intramuscularly once 5% (32)
D. Doxycycline 100 mg orally twice daily for 1 week 28% (171)
E. Doxycycline 100 mg orally twice daily for 3 weeks 52%(315)
  • A. Azithromycin 1 g orally once
  • B. Azithromycin 1 g orally once a week for 3 consecutive weeks
  • C. Ceftriaxone 500 mg intramuscularly once
  • D. Doxycycline 100 mg orally twice daily for 1 week
  • E. Doxycycline 100 mg orally twice daily for 3 weeks

Correct answer is E. This patient has Chlamydia trachomatis proctitis, which may be caused by the D-K serovars or the lymphogranuloma venereum (LGV) serovars. There is no way to know because additional testing to determine the serovar is not available. The best antibiotic to treat chlamydia proctitis is doxycycline. The treatment duration depends on symptoms when LGV testing is not available. For mild symptoms, 1 week of doxycycline is sufficient. For severe symptoms, 3 weeks is necessary. The patient has severe symptoms of proctitis, and she would need a 3-week course of therapy.

The 2021 CDC STI screening recommendations can be read on the CDC website.

Dr Khalil G. Ghanem will give an in-depth update on STIs and HIV in a presentation titled, “Diagnosing and Managing Sexually Transmitted Infections,” which will be available for on-demand viewing approximately 2 weeks following the virtual Ryan White HIV/AIDS CLINICAL CONFERENCE.

Which statement is true regarding screening or treatment of hyperlipidemia in people with HIV?

Responses
A. A CD4+ count of less than 200 cells/µL is as strong a risk factor for cardiovascular disease as hypertension 10% (141)
B. All people with HIV should be on a statin, regardless of low-density lipoprotein (LDL) cholesterol level 4% (64)
C. Lovastatin and simvastatin are preferred statins with protease inhibitors 7% (101)
D. Prolonged HIV viremia increases cardiovascular risk, requiring adjustment of risk calculator score 79% (1152)
  • A. A CD4+ count of less than 200 cells/µL is as strong a risk factor for cardiovascular disease as hypertension
  • B. All people with HIV should be on a statin, regardless of low-density lipoprotein (LDL) cholesterol level
  • C. Lovastatin and simvastatin are preferred statins with protease inhibitors
  • D. Prolonged HIV viremia increases cardiovascular risk, requiring adjustment of risk calculator score

Correct answer is D. Prolonged HIV viremia is a potential HIV-related cardiovascular disease (CVD) risk-enhancing factor and is a consideration for increasing a patient’s risk calculator score.

To learn more about the latest recommendations for preventing and managing CVD in people with HIV, as well as other important updates on primary care for people with HIV, click the Watch Webinar button below to view the webinar, “HIV 101: Fundamentals of HIV Medicine, Initiation of Antiretroviral Therapy, and Primary Care for People With HIV,” which was presented by Melanie A. Thompson, MD, on September 28, 2021.

For an in-depth update on CVD and HIV, click the Watch Webcast to view “Cardiovascular Disease in HIV: Moving From Insights to Interventions,” presented by Matthew J. Feinstein, MD, MSc, on June 25, 2021.

Approximately what proportion of people with HIV experience sleep disturbances compared with the general public?

Responses
A. About half as many 5% (57)
B. About the same 9% (101)
C. About twice as many 72% (779)
D. About 3 times as many 14% (151)
  • A. About half as many
  • B. About the same
  • C. About twice as many
  • D. About 3 times as many

Correct answer is C. Approximately 70% of people with HIV experience some type of sleep disturbance impacting their overall health. This is more than twice the rate of the general public, which is approximately 30%. Sleep problems in people with HIV are associated with lower treatment adherence, lower quality of life, impaired metabolic control, and depression.

For more information, click the Watch Webinar button below to watch the webinar, “Sleep Disorders and Sleep Assessment in People with HIV,” presented by Ana C. Krieger, MD, MPH, on September 21, 2021.

Which HIV preexposure prophylaxis (PrEP) regimen or formulation is NOT under clinical investigation?

 

Responses
A. Daily oral tenofovir alafenamide/emtricitabine (TAF/FTC) 30% (203)
B. Weekly tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) patch 36% (246)
C. Monthly oral islatravir 14% (95)
D. Injectable cabotegravir administered every 2 months 7% (48)
E. Subcutaneous lenacapavir administered every 6 months 13% (90)
  • A. Daily oral tenofovir alafenamide/emtricitabine (TAF/FTC)
  • B. Weekly tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) patch
  • C. Monthly oral islatravir
  • D. Injectable cabotegravir administered every 2 months
  • E. Subcutaneous lenacapavir administered every 6 months

Correct answer is B. There is no antiretroviral patch for HIV prevention currently in clinical trials, but several are in pre-clinical development. All of the other PrEP regimens and formulations listed have reached clinical trials.

For more information, click the Watch Webcast button below to watch Rapid Review of New Scientific and Clinical Data Presented at the International AIDS Society (IAS) 2021 Conference, presented by Roy M. Gulick, MD, MPH, on September 7, 2021.

Regarding screening for cognitive impairment in older patients with HIV, which of the following recommendations is shared across commonly used guidelines?

Responses
A. All patients with HIV should have a baseline cognitive screening and repeat screening annually 29% (281)
B. No cognitive screening is recommended 3% (29)
C. There is substantial controversy across guidelines in terms of regular cognitive screening 33% (321)
D. The United States Preventative Service Task Force (USPSTF) recommends cognitive screening for all patients over the age of 60 years regardless of HIV status
35% (342)
  • A. All patients with HIV should have a baseline cognitive screening and repeat screening annually
  • B. No cognitive screening is recommended
  • C. There is substantial controversy across guidelines in terms of regular cognitive screening
  • D. The United States Preventative Service Task Force (USPSTF) recommends cognitive screening for all patients over the age of 60 years regardless of HIV status

Correct answer is C. There is substantial inconsistency across major guidelines, including that of the International Antiviral Society-USA (IAS–USA), the United States Department of Health and Human Services (DHHS), the European AIDS Clinical Society, and the Infections Disease Society of America (IDSA). Recommendations from some groups include frequent screening and others suggest screening in symptomatic patients. Although the USPSTF does not offer recommendations specific to people with HIV, their general guidance on screening for cognitive impairment in the general population states that “the evidence is insufficient to balance the benefits and harms.”

For more information, click the Watch Webcast button below to watch “Neurocognition and the Aging Brain,” presented by Victor G. Valcour, MD, PHD, at June 25, 2021, virtual course, Aging and HIV: Issues, Screening, and Management in Individuals with HIV as They Age.

A 25-year-old transgender woman has just been diagnosed with anal chlamydia in your clinic. You advise her to consider preexposure prophylaxis (PrEP) with daily tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) to reduce her risk for HIV acquisition. She takes oral spironolactone 100 mg twice daily and oral estradiol 2 mg twice daily as part of her gender-affirming hormone regimen. Baseline test results are HIV antigen/antibody negative, hepatitis B surface antigen (HBsAg) negative, and an estimated glomerular filtration rate (eGFR) of 90. She is concerned about the possibility of drug-drug interactions between her hormones and PrEP. Which statement is true regarding the use of PrEP among transgender women?

Responses
A. TDF/FTC has been demonstrated in clinical trials to be as effective in preventing HIV acquisition among transgender women as in cisgender men 53% (344)
B. TDF/FTC is associated with a 10 to 15% reduction in estradiol levels among transgender women receiving gender-affirming hormones 14% (89)
C. Feminizing hormones significantly reduce levels of TDF/FTC and therefore PrEP should be avoided in this population 3% (16)
D. Stricter adherence to daily TDF/FTC in transgender women may be needed to prevent HIV infection 30% (197)
  • A. TDF/FTC has been demonstrated in clinical trials to be as effective in preventing HIV acquisition among transgender women as in cisgender men
  • B. TDF/FTC is associated with a 10 to 15% reduction in estradiol levels among transgender women receiving gender-affirming hormones
  • C. Feminizing hormones significantly reduce levels of TDF/FTC and therefore PrEP should be avoided in this population
  • D. Stricter adherence to daily TDF/FTC in transgender women may be needed to prevent HIV infection

Correct answer is D. Daily oral TDF/FTC is effective in preventing HIV in transgender women when taken as prescribed. There are no known drug-drug interactions between TDF/FTC and gender-affirming hormones, nor are there any known contraindications to concomitant use of PrEP with gender-affirming hormone therapy. There are indications that TDF levels are lower in the presence of estrogen, but the clinical significance is not known. Transgender women on hormone therapy may need to have better adherence to TDF/FTC to be sufficiently protected.

For more information, click the Watch Webinar button below to watch Management and Prevention of HIV Infection Among Transgender Adults, presented by Asa E. Radix, MD, PhD, MPH, on August 18, 2020.

Which of the following is a potential toxic effect of bacteriophage therapy?

Responses
A. Induction of septic shock by accelerated lysis of bacterial pathogens
27% (124)
B. Induction of bacteriophage-specific adaptive immune responses
21% (99)
C. Urine NAATs for gonorrhea and chlamydia, and pharyngeal NAAT for gonorrhea only 17% (77)
D. Inadvertent administration of endotoxin or other impurities in bacteriophage preparations 35% (159)
  • A. Induction of septic shock by accelerated lysis of bacterial pathogens
  • B. Induction of bacteriophage-specific adaptive immune responses
  • C. Massive disruption of the host microbiome
  • D. Inadvertent administration of endotoxin or other impurities in bacteriophage preparations

Correct answer is D. Toxic effects of bacteriophage therapy could theoretically include inadvertent administration of endotoxin or other impurities in bacteriophage preparations. However, very sensitive endotoxin assays are now available and if used during the preparation of the phage for administration, prevent this from being an issue.

To learn more about the potential clinical niches for bacteriophage therapy, click the Watch Webinar button below to watch Bacteriophage Therapy: The Enemy of My Enemy is My Friend, presented by Robert T. Schooley, MD, on August 24, 2021.

A 38-year-old man with HIV has been on antiretroviral therapy for the past 2 years and has had a viral load of less than 200 copies/mL for the last 18 months. He is in a relationship but occasionally has sexual encounters outside of his primary relationship with other men, using condoms for anal sex but not oral. He is asymptomatic of any problems suggestive of sexually transmitted infections (STIs). The appropriate recommendation for STI testing for this individual, based on the United States Department of Health and Human Services (DHHS) and Centers for Disease Control and Prevention (CDC) guidelines, would be:

 

Responses
A. No testing is needed since he has an undetectable HIV viral load and is asymptomatic 2% (18)
B. Urine nucleic acid amplification tests (NAATs) for gonorrhea and chlamydia only 2% (19)
C. Urine NAATs for gonorrhea and chlamydia, and pharyngeal NAAT for gonorrhea only 5% (33)
D. Urine NAATs for gonorrhea and chlamydia, rectal NAATs for gonorrhea and chlamydia, and pharyngeal NAAT for gonorrhea only 8% (54)
E. Urine NAATs for gonorrhea and chlamydia, rectal NAATs for gonorrhea and chlamydia, pharyngeal NAAT for gonorrhea, and syphilis serology testing 83% (592)
  • A. No testing is needed since he has an undetectable HIV viral load and is asymptomatic
  • B. Urine nucleic acid amplification tests (NAATs) for gonorrhea and chlamydia only
  • C. Urine NAATs for gonorrhea and chlamydia, and pharyngeal NAAT for gonorrhea only
  • D. Urine NAATs for gonorrhea and chlamydia, rectal NAATs for gonorrhea and chlamydia, and pharyngeal NAAT for gonorrhea only
  • E. Urine NAATs for gonorrhea and chlamydia, rectal NAATs for gonorrhea and chlamydia, pharyngeal NAAT for gonorrhea, and syphilis serology testing

Correct answer is E. The updated CDC STI treatment guidelines recommend regular (at least once annually, or 3 to 6 times if at greater risk) testing for gonorrhea, chlamydia, and syphilis for those at higher risk, including people with HIV and men who have sex with men (MSM). For gonorrhea, it is recommended that sites of contact for MSM (urine, rectal, and pharyngeal) be tested regardless of condom use. For chlamydia, it is recommended that sites of contact for MSM (urine and rectal) be tested regardless of condom use. For syphilis, it is recommended that those who are asymptomatic and at higher risk be tested at least once annually.

The 2021 CDC STI screening recommendations can be read on the CDC website.

Which of the following statements is true regarding the HIV reservoir in elite controllers?

Responses
A. Their HIV reservoir is extremely large 6% (37)
B. Integrated proviruses from elite controllers are often transcriptionally active 28% (177)
C. Most intact proviruses accumulate at non-genic and satellite DNA 45% (283)
D. Immune pressure has likely no impact on the reservoir in elite controllers 21% (138)
  • A. Their HIV reservoir is extremely large
  • B. Integrated proviruses from elite controllers are often transcriptionally active
  • C. Most intact proviruses accumulate at non-genic and satellite DNA
  • D. Immune pressure has likely no impact on the reservoir in elite controllers

Correct answer is C. Clonally-expanded intact proviral genomes in exceptional elite controllers accumulate at satellite DNA in centromeric regions and KRAB-ZNF genes on chromosome 19. Elite controllers usually carry a very small frequency of infected cells, most proviruses in elite controllers are integrated in regions of the chromatin that repress gene transcription, and the reservoir of elite controllers is under the pressure of a potent cytotoxic T lymphocyte (CTL) response.

Click the Watch Webcast button to view “Elite Controllers: A Model for a Functional Cure of HIV-1 Infection,” presented by Xu Yu, MD, at vCROI 2021 on March 8, 2021.

Most of the individuals who responded that they were going to “wait and see” when asked if they were planning to get a COVID-19 vaccine in January 2021 have now been vaccinated.

 

Responses
A. True 50% (616)
B. False 50% (607)
  • A. True
  • B. False

Correct answer is A. In January 2021, the Kiser Family Foundation COVID-19 Vaccine Monitor asked individuals if they were going to get a COVID-19 vaccine once they were eligible. In a new poll published on July 13, 2021, of the individuals that responded that they were going to “wait and see,” 54% have now reported that they are vaccinated.

Click the Watch Webinar button to view COVID-19 Vaccine Hesitancy, Crucial Conversations, and Effective Messaging for Patients and Healthcare Teams, presented by Marie T. Brown, MD, and moderated by Constance A. Benson, MD, IAS-USA Webinar, on August 3, 2021.

As highlighted in the NA-ACCORD (North American AIDS Cohort Collaboration on Research and Design) study, which of the following was associated with an increased risk for hepatocellular carcinoma (HCC) in people with HIV/HBV coinfection?

 

Responses
A. Detectable HIV viral load 17% (171)
B. Low CD4+ cell percentage 14% (146)
C. Hepatitis B virus (HBV) DNA level above 200 IU/mL 50% (505)
D. Hepatitis delta infection 12% (126)
E. Race 7% (71)
  • A. Detectable HIV viral load
  • B. Low CD4+ cell percentage
  • C. Hepatitis B virus (HBV) DNA level above 200 IU/mL
  • D. Hepatitis delta infection
  • E. Race

Correct answer is C. Even a low level of HBV viral replication was associated with an increased risk of HCC. Undetectable HBV for more than a year was associated with lower HCC rate, compared with detectable HBV or undetectable for less than a year. This highlights the importance of monitoring for HBV suppression in HIV/HBV coinfection as the data suggests sustained suppression of HBV replication may be key to reducing HCC risk, rather than simply getting HBV below a certain threshold.

Click the Read Article button to read “CROI 2021: Viral Hepatitis and Other Forms of Liver Injury Impacting People with HIV,” authored by Anne F. Luetkemeyer, MD, and David L. Wyles, MD, in IAS-USA Topics in Antiviral Medicine, Volume 29, Issue 3.

Which of the following statements is true?

 

Responses
A. Anal cancer screening has been shown to reduce the rates of anal cancer in people with HIV (PWH) 42% (269)
B. Rates of anal cancer in PWH approximate or exceed the rates of lung, colon, and cervical cancer in the general population 47% (302)
C. Among women with HIV, only those with certain risk factors should be screened for anal cancer precursors or anal high grade squamous intraepithelial lesions (HSIL) 11% (72)
  • A. Anal cancer screening has been shown to reduce the rates of anal cancer in people with HIV (PWH)
  • B. Rates of anal cancer in PWH approximate or exceed the rates of lung, colon, and cervical cancer in the general population
  • C. Among women with HIV, only those with certain risk factors should be screened for anal cancer precursors or anal high grade squamous intraepithelial lesions (HSIL)

Correct answer is B. Among men who have sex with men with HIV, the rates of anal cancer match or exceed those of colon, lung, and possibly prostate cancer. Among women with HIV, the rate of anal cancer approximates historic cervical cancer rates prior to widespread cervical cancer screening.

Click the Watch Webinar button to view Prevention of HPV-Related Anal Cancer in Persons With HIV: How Should We Screen and Will Vaccines Make a Difference?, presented by Grant Ellsworth, MD, MS, at the July 13, 2021, IAS-USA webinar.

Which of the following is a valid reason to check for SARS-CoV-2 spike antibody levels in a vaccinated patient?

Responses
A. To find out if they are protected 18% (177)
B. To find out if a booster shot is needed 16% (150)
C. For research purposes only 63% (609)
D. Because your patient wants to know 3% (26)
  • A. To find out if they are protected
  • B. To find out if a booster shot is needed
  • C. For research purposes only
  • D. Because your patient wants to know

Correct answer is C. More research is needed to determine if spike binding antibodies can be useful for determining if a patient is immune-protected or needs a booster. This is currently unknown. Both the United States Center for Disease Control and Prevention (CDC) and United States Federal Drug Administration (FDA) do not recommend that post-vaccination antibody levels be routinely checked, since we do not know how to interpret that information, how to act on it, and the commercial antibody assays are not authorized for that use.

Commercial spike antibody assays are not authorized (nor are they proven to have predictive value) by the FDA for determining if a person has immune-protection against SARS-CoV-2 and variants, and may or may not need a booster shot. The authorized COVID-19 vaccines induce functional antibody (Ab) and cellular responses. Commercial assays are qualitative or semi-quantitative measures of binding antibodies only, not measures of functional antibodies (eg, neutralizing Ab, antibody-dependent cellular cytotoxicity [ADCC]) and/or cellular immunity.

Healthcare practitioners can educate their patients who want to know their antibody levels and request post-vaccination testing about the above facts; and, where available, refer them to research studies currently investigating the duration of immunity post-vaccination and the utility of booster shots.

Click the Watch Webinar button to view “COVID-19 Vaccines and the Viral Variants: New Aspects of Vaccine Research,” presented by Mark J. Mulligan, MD, at the June 29, 2021, IAS-USA webinar.

As of July 5, 2021, which of the following individuals is eligible for monoclonal antibody treatment under the Emergency Use Authorization (EUA)?

Responses
A. A 66-year-old woman with a positive SARS-CoV-2 polymerase chain reaction (PCR) but no symptoms and a body mass index (BMI) of 30 but no comorbidities 11% (53)
B. A 66-year-old woman with a positive SARS-CoV-2 PCR, a mild cough starting 2 days prior, and no comorbidities, but lives with her husband who has diabetes 14% (69)
C. A 66-year-old man with diabetes who was exposed to his wife who has a positive SARS-CoV-2 PCR but his PCR was negative 9% (43)
D. An 86-year-old man with a positive SARS-CoV-2 PCR, is hospitalized with COVID-19 pneumonia, and has a cough, but is not requiring oxygen 35% (171)
E. An 86-year-old man with no comorbidities and a positive SARS-CoV-2 PCR with mild fatigue starting 2 days prior 31% (153)
  • A. A 66-year-old woman with a positive SARS-CoV-2 polymerase chain reaction (PCR) but no symptoms and a body mass index (BMI) of 30 but no comorbidities
  • B. A 66-year-old woman with a positive SARS-CoV-2 PCR, a mild cough starting 2 days prior, and no comorbidities, but lives with her husband who has diabetes
  • C. A 66-year-old man with diabetes who was exposed to his wife who has a positive SARS-CoV-2 PCR but his PCR was negative
  • D. An 86-year-old man with a positive SARS-CoV-2 PCR, is hospitalized with COVID-19 pneumonia, and has a cough, but is not requiring oxygen
  • E. An 86-year-old man with no comorbidities and a positive SARS-CoV-2 PCR with mild fatigue starting 2 days prior

Correct answer is E as of the posting of the question on July 5, 2021.The EUA of monoclonal antibodies is for the treatment of COVID-19 in people who are at high risk of disease progression (people who are older and have comorbidities) and not already hospitalized.

Please note, the field of COVID-19 changes rapidly and the half-life of information is short.

Click the Watch Webcast button to view “Preventing Severe COVID-19: The Role of Monoclonal Antibodies and Beyond,” presented by Davey Smith, MD, at the May 20, 2021, virtual course, Unique Issues in HIV Prevention, Treatment, and Care in the COVID-19 World

For asymptomatic individuals with HIV at average risk for colon cancer, what age group does the United States Preventive Services Task Force (USPSTF) recommend routine colon cancer screening?

Responses
A. 50-85 years 9% (62)
B. 45-85 years 13% (88)
C. 50-75 years
18% (122)
D. 45-75 years 39% (263)
E. Beginning at 50 years with no upper age limit 21% (138)
  • A. 50-85 years
  • B. 45-85 years
  • C. 50-75 years
  • D. 45-75 years
  • E. Beginning at 50 years with no upper age limit

The correct answer is D. In May 2021, the USPSTF broadened the age range that adults should be routinely offered colon cancer screening. For individuals 50 to 75 years old, the recommendation strength is “A,” and for individuals 45 to 49 years old, the recommendation strength is “B.” The USPSTF continues to recommend selective screening for individuals 76 to 85 years old, taking into consideration the patient’s overall health, prior screening history, and preferences, with a recommendation strength of “C.” The HIV Medicine Association (HIVMA)/Infectious Diseases Society of America (IDSA) HIV Primary Care Guidance recommends following the USPSTF recommendations for colon cancer screening for persons with HIV.

Which of the following drugs could cause postural hypotension in an elderly HIV-infected patient?

Responses
A. Dolutegravir 7% (74)
B. Efavirenz 9% (82)
C. Tamsulosin
70% (687)
D. Fexofenadine 5% (46)
E. Sertraline 9% (89)
  • A. Dolutegravir
  • B. Efavirenz
  • C. Tamsulosin
  • D. Fexofenadine
  • Sertraline

The correct answer is C. Tamsulosin is an alpha1 antagonist, and can cause postural hypotension. Use caution whenever prescribing alpha antagonists in the elderly, who may have greater risk for cardiovascular instability.

The course presentation covering this topic, along with other presentations that cover some of the key issues unique to management and care of older patients with HIV, will be available for viewing on demand on the IAS–USA website. Those who did not participate in the live activity can earn continuing education credits for viewing the on-demand webcasts.

To learn more about this topic and other issues unique to managing the care of older patients with HIV, watch webinars of June 25, 2021, course, Aging and HIV: Issues, Screening, and Management in Individuals with HIV as They Age.

A 33-year-old man with well-controlled HIV infection was diagnosed with gonococcal infection by his primary HIV practitioner. STI testing had been ordered by the patient’s primary HIV practitioner at a telehealth visit. However, the primary practitioner’s office is not open for in-person visits, and so the patient is referred to your sexual health center for treatment. He brings the results of gonorrhea and chlamydia nucleic acid amplification testing, which show positive oropharyngeal testing for gonorrhea and negative chlamydia oropharyngeal testing. Also negative are rectal and urine gonorrhea and chlamydia testing, as well as syphilis treponemal testing. How do you manage this patient according to the updated Centers for Disease Control and Prevention (CDC) recommendations from December 2020?

Responses
A. Ceftriaxone 250 mg, followed by a test of cure in 7 to 14 days 7% (57)
B. Ceftriaxone 250 mg, no subsequent test of cure but retesting in 3 months to assess for reinfection 8% (69)
C. Ceftriaxone 500 mg, followed by a test of cure in 7 to 14 days 54% (453)
D. Ceftriaxone 500 mg, no subsequent test of cure but retesting in 3 months to assess for reinfection 31% (255)
  • A. Ceftriaxone 250 mg, followed by a test of cure in 7 to 14 days
  • B. Ceftriaxone 250 mg, no subsequent test of cure but retesting in 3 months to assess for reinfection
  • C. Ceftriaxone 500 mg, followed by a test of cure in 7 to 14 days
  • D. Ceftriaxone 500 mg, no subsequent test of cure but retesting in 3 months to assess for reinfection

Correct answer is C. The updated CDC recommendations for treatment of uncomplicated gonococcal infection of the pharynx is ceftriaxone 500 mg, administered as a single intramuscular dose for those weighing less than 150 kg (or 300 lbs). For those weighing more, 1 gm of ceftriaxone should be administered. If chlamydia infection has not been excluded, treatment should also include doxycycline 100 mg twice daily for 7 days (unless the patient is pregnant, and then 1 gm of azithromycin should be administered for chlamydia treatment). A test of cure, using culture or nucleic acid amplification testing, is recommended at 7 to 14 days after treatment for pharyngeal infection. Test-of-cure is not thought to be necessary after treatment for uncomplicated urogenital or rectal gonorrhea when a recommended regimen is used.

Click the Watch Webcast button to view “Management and Prevention of Sexually Transmitted Infections,” presented by Meredith Clement, MD, at the April 30, 2021, virtual course, Annual Update on HIV Management: State-of-the-Art Updates on HIV, STIs, and COVID-19.

A 52-year-old man with HIV is seen in clinic for a routine visit. He received his second dose of COVID-19 vaccine (Moderna product) 4 days ago with only a mild reaction and currently is asymptomatic. He is scheduled to get a dose of pneumococcal polysaccharide vaccine (PPSV-23) at this visit. What would you recommend regarding administering the PPSV-23 vaccine for this man?

Responses
A. He must wait at least 14 days after the most recent COVID-19 vaccine dose 40% (419)
B. He must wait at least 6 weeks after the most recent COVID-19 vaccine dose 6% (66)
C. He must wait at least 12 weeks after the most recent COVID-19 vaccine dose 3% (36)
D. He can receive the PPSV-23 vaccine at this clinic visit
51% (540)
  • A. He must wait at least 14 days after the most recent COVID-19 vaccine dose
  • B. He must wait at least 6 weeks after the most recent COVID-19 vaccine dose
  • C. He must wait at least 12 weeks after the most recent COVID-19 vaccine dose
  • D. He can receive the PPSV-23 vaccine at this clinic visit

Correct answer is D. Prior to May 14, 2021, the Centers for Disease Control and Prevention (CDC) recommended that no vaccines be coadministered within 14 days (before or after) any dose of the COVID-19 vaccine. These recommendations changed on May 14, 2021, and the CDC guidance now provides the following guidance (verbatim) regarding coadministering vaccines with COVID-19 vaccines:

  • COVID-19 vaccines and other vaccines may now be administered without regard to timing.
  • COVID-19 vaccines and other vaccines on the same day, as well as coadministration within 14 days.
  • If multiple vaccines are administered at a single visit, administer each injection in a different injection site.

This guidance does not mean that a practitioner cannot elect to defer a vaccine, which may be prudent in some situations, such as coadministering a dose of non-COVID-19 vaccine with the COVID-19 vaccine on the same day if the non-COVID-19 vaccine has a potent conjugate or adjuvant (eg, recombinant zoster vaccine or CPG-HepB) that may enhance the reactogenicity to the COVID-19 vaccine (or create highly uncomfortable/problematic combined postvaccine symptoms). Also, some practitioners may elect to delay the non-COVID-19 vaccine if it can easily be delayed and there is no eminent threat from that pathogen. In general, given the current state of the COVID-19 epidemic, the COVID-19 vaccine should always have priority for administration over a non-COVID-19 vaccine.

Click the Watch Webcast button to view “Vaccine Prevention for Individuals With HIV in the Era of COVID-19,” presented by David H. Spach, MD, at the May 20, 2021, virtual course, Unique Issues in HIV Prevention, Treatment, and Care in the COVID-19 World.