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

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

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

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

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

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

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

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

And read more here:

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

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

Which of the following statements is TRUE?

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

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

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

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

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

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

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

Which of the following statements is TRUE about lenacapavir?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A 53-year-old obese woman presents to care with HIV infection. She has been doing well on antiretroviral treatment, and her last plasma HIV RNA level 6 months ago was below the limits of detection. She takes medications for schizophrenia and type 2 diabetes mellitus. Overall, the patient is on 7 different prescribed medications for her 3 conditions. She presents today with a sudden increase in auditory hallucinations. Her vital signs are unchanged from their usual baseline. Which of the following is the most appropriate next step?

Correct answer is C. This patient was initially referred for an increase in her antipsychotic medication. The evaluating psychiatrist first ordered laboratory tests which revealed a blood glucose level of 600 mg/dL. Treatment of the patient’s elevated blood sugar restored the patient to her baseline mental status. Always first look for an urgent medical problem when assessing a change in mental status.

To learn more about how addressing mental health directly reduces morbidity and mortality in people with HIV, view this webcast from 2023 Ryan White CLINICAL CONFERENCE, Beyond Viral Suppression: How Addressing Mental Health Directly Reduces Morbidity and Mortality in People with HIV, presented by Francine Cournos, MD. You may also earn continuing education credits through the on-demand activity here.

Which of the following has the highest signal strength for treating stimulant use disorder?

Correct answer is D. Contingency management has numerous meta-analyses showing the signal strength of the treatment compared with the standard-of-care is in the moderate-to-strong range. As such, this treatment has the highest signal of efficacy compared with all other treatments, behavioral or pharmacological. The largest well-controlled, multisite trial of any medication for methamphetamine use disorder in the broad population with efficacy for reducing methamphetamine use is the combination of extended-release naltrexone plus bupropion, but the strength of signal for the combination medication is much smaller than that of contingency management. Although mirtazapine has 2 replication studies, which is a marker of the consistency of the signal for the medication to reduce methamphetamine use compared with placebo, to date the medication has only been evaluated in clinical samples of men who have sex with men and transgender women. There are no placebo-controlled studies of mirtazapine in broad groups of people with methamphetamine use disorder. Moreover, the size of signal for mirtazapine is far less than that for contingency management. Although cognitive behavior therapy is used widely in addiction care settings, the signal strength for it is far lower than for contingency management.

To learn more about contingency management and stimulant use disorder, register now for our December 20, 2023, webinar, (Part 5 of 6) Substance Use Disorder: Stimulant Use Disorder, Harm Reduction, and Contingency Management in Patients With HIV, presented by Steven J. Shoptaw, PhD, and moderated by Sandra A. Springer, MD.

Glucagon-like peptide-1 receptor agonist (GLP-1RAs) have shown several potential off-target effects. Which of the following has been demonstrated in randomized control trials?

Correct answer is C. The STEP 1 (Effect and Safety of Semaglutide 2.4 mg Once-weekly in Subjects With Overweight or Obesity) trial evaluating semaglutide subcutaneous weekly versus A placebo over 68 weeks demonstrated that among persons with obesity, the percentage change in body weight was -15.0% with semaglutide versus -3.6% with placebo. The decrease in body weight resulted from reductions in total fat mass, total lean body mass, and visceral fat mass. Additionally, recent studies evaluating semaglutide subcutaneous weekly versus a placebo over 32 weeks among persons with HIV-associated lipodystrophy with predominant lipohypertrophy similarly showed a decrease in total body weight with semaglutide use. Among those persons with HIV-associated lipohypertrophy treated with semaglutide, there was a decrease in visceral fat, subcutaneous fat, and total lean mass from baseline to 32 weeks. Although glucagon-like peptide-1 receptor agonists (GLP1-RAs) are useful to reduce total body weight, it is crucial to understand how different components of body composition may be affected by GLP-1RAs use. In this regard, preservation of subcutaneous fat or lean body mass is ideal among some clinical phenotypes, such as HIV-associated lipodystrophy with predominant lipoatrophy and sarcopenia, respectively.

References: Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183; McComsey GA, Sattar A, Wu Q, et al. Effects of semaglutide on adipose tissue in HIV-associated lipohypertrophy. Presented at: ID Week; October 13, 2023; Boston, MA.

To learn more about this topic, register for upcoming virtual course, The Annual IAS–USA Washington, DC, Virtual Course: Update on HIV Medicine Emerging Challenges, for Dr Suman Srinivasa’s presentation, “Weighing In” on GLP-1 Receptor Agonists for People With HIV.

Glucagon-like peptide-1 receptor agonist (GLP-1RAs) have shown several potential off-target effects. Which of the following has been demonstrated in randomized control trials?

Correct answer is A. The SELECT (Semaglutide Effects on Heart Disease and Stroke in Patients With Overweight or Obesity) trial evaluated cardiovascular outcomes among those with obesity without diabetes mellitus and demonstrated a 20% risk reduction with semaglutide subcutaneous weekly versus a placebo. The SELECT trial enrolled only those with pre-existing cardiovascular disease (CVD). The benefit to those without known CVD remains unclear at this time. (Reference: Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. Epub November 11, 2023. doi:10.1056/NEJMoa2307563)

In the Step-HFpEF (Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity) trial, treatment with semaglutide among those with heart failure with preserved ejection fraction and obesity resulted in a large reduction in symptoms and improvements in exercise function. The study was not powered to assess heart failure events and further studies are needed. (Reference: Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084. doi:10.1056/NEJMoa2306963)

Preclinical studies have investigated GLP1-RAs to reduce addiction disorders and shown preliminary benefits to decrease substance use and drug-seeking behavior related to alcohol, nicotine, opioids, and simulants. Human studies have not thoroughly investigated GLP-1RA use for addiction disorders to date. (Reference: Jerlhag E. The therapeutic potential of glucagon-like peptide-1 for persons with addictions based on findings from preclinical and clinical studies. Front Pharmacol. 2023;14:1063033. Published 2023 Mar 30. doi:10.3389/fphar.2023.1063033)

To learn more about this topic, register for upcoming virtual course, The Annual IAS–USA Washington, DC, Virtual Course: Update on HIV Medicine Emerging Challenges, for Dr Suman Srinivasa’s presentation, “Weighing In” on GLP-1 Receptor Agonists for People With HIV.

A 35-year-old White man has been on efavirenz (EFV)/emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) for the past 10 years. He has been very reluctant to change a regimen that “saved his life.” However, because of persistent insomnia and depressive disorder, he is willing to consider a change. His CD4+ count is 700 cells/µL and his HIV RNA level is less than 20 copies/mL. Which of the following weight changes might result from a switch to bictegravir (BIC)/FTC/tenofovir alafenamide fumarate (TAF)?

Correct answer is E. Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide fumarate (TAF) has been associated with a risk for increased weight, and so has a switch from efavirenz (EFV) to integrase strand transfer inhibitors. In a pooled analysis of randomized clinical trials, the greatest risk for weight gain was associated with the switch from EFV to rilpivirine (RPV) or elvitegravir (EVG)/cobicistat (COBI) and the switch from TDF to TAF. Switching from abacavir (ABC) to TAF was associated with less weight gain than the switch from TDF to TAF.

To learn more about this topic, see the on-demand webinar, HIV 101: Initial Assessment, Initiation of Antiretroviral Therapy, and Monitoring of People With Newly Diagnosed HIV, presented by Michael S. Saag, MD, Melanie A. Thompson, MD, and Roger J. Bedimo, MD, MS.

A 27-year-old cisgender woman was newly diagnosed with HIV this past week during a visit to a community clinic for a medroxyprogesterone acetate injection. Her HIV RNA level is 134,560 copies/mL, her CD4+ count is 662 cells/µL, and she is hepatitis B immune. Her baseline laboratory values are within normal limits, and genotypic resistance testing is pending. She is interested in starting therapy today and is asking for an injectable HIV treatment similar to her contraception. Based on the results of phase III trials and current HIV treatment guidelines, which of the following is true about initiating injectable antiretroviral therapy?

Correct answer is C. Current US Department of Health and Human Services HIV treatment guidelines (November 2023) indicate long-acting cabotegravir (CAB) and rilpivirine (RPV) can be used to replace an existing oral antiretroviral regimen in people with HIV with sustained viral suppression for 3 to 6 months (AI). Once started, the injections can be administered either monthly or every other month based on a shared decision-making process. The oral CAB/RPV lead-in is optional as of March 2022.

To learn more about this topic, see the on-demand virtual course, Implementation of Long-Acting Drugs for Treatment and Prevention of HIV, for Dr Aadia I. Rana’s presentation, State of the Science: What We Know about Long-Acting Injectable Agents for Treatment of HIV.

At steady state after initial HIV infection, how many virions are produced in a 24-hour period?

Correct answer is D. Studies of viral dynamics in the mid-1990s evaluated the slope of decay of viral load when patients first received highly active antiretroviral therapy. The slope demonstrated a very rapid decline in viral load due to the elimination of CD4+ lymphocytes that were actively producing HIV virus and not being replaced by newly infected cells. These findings demonstrated that the life span of a productively infected cell was approximately 1 day and that the number of viral particles produced in a day was between 1 billion and 10 billion particles per day. Although the number of viral particles produced in a 24-hour period may be a bit less in a patient with a lower viral load, it is still greater than 1 billion virions/day, but toward the lower end of the spectrum.

To learn more about this topic, view the webinar, HIV 101: Initial Assessment, Initiation of Antiretroviral Therapy, and Monitoring of People With Newly Diagnosed HIV, presented by Michael S. Saag, MD, Roger J. Bedimo, MD, MS, and Melanie A. Thompson, MD.

A 35-year-old man was diagnosed with HIV 3 years ago with an HIV RNA level of 57,000 copies/mL and a CD4+ count of 550 cells/µL. He started on bictegravir/emtricitabine/tenofovir alafenamide, suppressed rapidly, and has consistently had HIV RNA levels of less than 20 copies/mL (below the limit of detection) and CD4+ counts of greater than 750 cells/µL. He is hepatitis B virus immune, has a body mass index of 28, and has no comorbidities. He travels extensively for work and is interested in long-acting cabotegravir/rilpivirine administered every 2 months. Based on the results of phase III trials, which of the following is true about his risk of resistance if he follows the injection schedule and has on-time injections?

Correct answer is B. Without any of the defined factors that increase the risk of confirmed virologic failure, his risk of confirmed virologic failure is approximately 0.4% over a 2- to 3-year period. The risk of resistance with confirmed virologic failure is approximately 80% to 90%.

To learn more about this topic, join us in the virtual course, Implementation of Long-Acting Drugs for Treatment and Prevention of HIV, for Dr Joseph J. Eron, Jr’s, presentation, Resistance in Long-Acting Therapy for Prevention and Treatment: Uncommon Outcome or Achilles Heel, which will be presented on November 13, 2023.

What is the main cause of cardiovascular disease (CVD) in people with HIV (PWH)?

Correct answer is D. Traditional and nontraditional inflammatory risks contribute to cardiovascular disease (CVD) in people with HIV (PWH). The effects of antiretroviral therapies on metabolic disorders are thought to contribute only minimally to CVD in PWH. Although the population of PWH is aging, CVD can and often does occur in young PWH, who have premature CVD for their age. Low-density lipoprotein (LDL) is not often elevated, and statins were considered for both LDL and non-LDL effects.

To learn more about this topic, watch the on-demand webinar, Cardiovascular Disease Prevention in Patients With HIV: The REPRIEVE Trial, presented by Steven K. Grinspoon, MD, and moderated by Judith S. Currier, MD, on October 27, 2023.

Do data from REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) suggest the efficacy and overall utility of statins to prevent cardiovascular disease in low to moderate traditional-risk people with HIV who are in the 40- to 75-year age range?

Correct answer is A. Data from the global REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) trial suggest a 35% reduction in major adverse cardiac events, without unanticipated adverse effects, for a statin strategy among people with HIV who are aged 40 to 75 years with low to moderate risk by the pooled American College of Cardiology/American Heart Association equation. The efficacy effect was robust at 35%, including in sensitivity analyses. No significant interactions were seen with antiretroviral therapy. Among the small group with diabetes who suffered from a major adverse cardiac event, the rate was half in those on pitavastatin versus those on placebo. Protection was even conferred upon those with diabetes mellitus.

To learn more about this topic, watch the on-demand webinar, Cardiovascular Disease Prevention in Patients With HIV: The REPRIEVE Trial, presented by Steven K. Grinspoon, MD, and moderated by Judith S. Currier, MD on October 27, 2023.

Doxycycline taken after condomless sex has been shown to reduce incident bacterial sexually transmitted infections (eg, gonorrhea, chlamydia, and syphilis) by which percentage?

Correct answer is C. Doxycycline postexposure prophylaxis (doxy-PEP) reduced the quarterly incidence of bacterial sexually transmitted infections by 65%. The reduction of chlamydia and syphilis incidence specifically was higher (approximately 80%) than the reduction of gonorrhea incidence (approximately 55%). To learn more about the efficacy of doxy-PEP and to earn up to 1.25 AMA PRA Category 1 Credits™, watch the On-Demand webinar, Doxy-Pep: Who, When, and How?, presented by Annie F. Luetkemeyer, MD, and moderated by Connie L. Celum, MD, MPH.

A 35-year-old woman with HIV and opioid use disorder is being admitted to the hospital for infectious complications of injection drug use. She will require intravenous antibiotics and will be in the hospital for 2 weeks. She has previously had a 3-year period of sobriety while on extended-release buprenorphine and would like to restart this treatment, but she has had repeated bouts of precipitated withdrawal when trying to initiate buprenorphine from fentanyl. She waits as long as she feels she can tolerate, but she still feels worse after taking 2 mg to 4 mg of buprenorphine. This has led to repeated fentanyl use. Which of the following is an appropriate strategy for medication for opioid use disorder initiation in this patient?

Correct answer is A. Protocols for low-dose buprenorphine initiation generally include a full-agonist opioid being given at a steady dosage for several days while buprenorphine is slowly increased to therapeutic levels. In the inpatient setting, this is done by replacing the street drug with an ordered full-agonist opioid (eg, slow-release morphine or oxycodone).

To learn more about medication options for opioid use disorder in patients with HIV, be sure to watch the on-demand webinar for (Part 3 of 6) Substance Use Disorder: Initiating Buprenorphine in the Fentanyl Era and Other Treatment Considerations in Patients With Opioid Use Disorder and HIV, presented by Leah J. Leisch, MD, and moderated by Sandra A. Springer, MD.

A 27-year-old woman with a past medical history of HIV presents with a request for help with opioid use disorder. She has been off antiretroviral therapy for the past 3 months but previously had plasma HIV RNA level suppression and no adverse events on lamivudine-zidovudine/efavirenz, and she would like to restart this regimen. She has tried quitting opioids several times, but efforts have been limited because of her inability to tolerate withdrawal symptoms. Her urine drug screen is positive for opiates and negative for fentanyl. Her last drug use was heroin the previous evening. The patient currently has stable housing but relies on friends for transportation. She has moderate withdrawal symptoms and feels very uncomfortable. Which medication for opioid use disorder would be the most appropriate to offer this patient in the clinic today?

Correct answer is B. It is most appropriate to offer this patient buprenorphine.

To learn more about medication options for opioid use disorder in patients with HIV, be sure to register for (Part 3 of 6) Substance Use Disorder: Initiating Buprenorphine in the Fentanyl Era and Other Treatment Considerations in Patients With Opioid Use Disorder and HIV, presented by Leah J. Leisch, MD, and moderated by Sandra A. Springer, MD.

Which of the following should be given as guidance when prescribing doxycycline postexposure prophylaxis (doxy-PEP)?

Correct answer is D. Doxycycline should not be taken at the same time as bivalent-containing antacids, multivitamins, or calcium supplements because of a drug interaction that may lower doxycycline levels. Doxycycline can be taken with HIV antiretroviral therapy, HIV preexposure prophylaxis, and acid-blocking medications. Doxycycline does not protect against viral infections, including mpox.

To learn more, watch the on-demand webinar, Doxy-PEP webinar, Doxy-PEP: Who, When, and How?, presented by Annie F. Luetkemeyer, MD, and moderated by Connie L. Celum, MD, MPH.

A 34-year-old man presents to care after a recent hospital admission for acute alcohol intoxication, complicated by a fall and pneumonia. He is diagnosed with alcohol use disorder. He has an 8-year history of HIV, with an HIV RNA level of 3000 copies/mL and he reports difficulty adhering to his antiretroviral therapy. Which of the following is the most appropriate pharmacotherapy for his alcohol use disorder?

Correct answer is C. Because of difficulties with adherence to antiretroviral therapy (ART) regimens, it may be challenging for this patient to add another daily medication to treat alcohol use disorder (AUD). However, untreated AUD will impair his ability to adhere to ART and achieve viral-load suppression. Hence, treatment of AUD is essential to improving HIV outcomes. Extended-release naltrexone is a long-acting injectable treatment that can be delivered every 4 weeks and effectively improves viral suppression in persons with HIV and AUD. Oral naltrexone given daily at 25-50 mg can also reduce alcohol use and is approved by the US Food and Drug Administration for the treatment of AUD and hazardous drinking but adherence can be an issue, and it has more adverse effects than extended-release naltrexone. Disulfiram would require more monitoring as it can cause fatal ventricular fibrillation if someone continues to drink while on it. Acamprosate is also a potential option but requires oral dosing 3 times daily, which is a challenge for many patients

To learn more, watch the on-demand webinar: Substance Use Disorder (SUD) 101, Part 2: How Should We Care For SUD in Patients With HIV? presented by Ellen F. Eaton, MD, and moderated by Sandra A. Springer, MD.

A 30-year-old woman presents to care with HIV diagnosed 5 years ago. She is asymptomatic with active injection drug use. Her initial laboratory values included an HIV RNA level of 128,000 copies/mL and a CD4+ count of 150 cells/µL. She started on tenofovir disoproxil fumarate (TDF) / emtricitabine (FTC) / rilpivirine (RPV), with intermittent adherence. She now has an HIV RNA level of 12,000 copies/mL and a CD4+ count of 250 cells/µL. Genotypic testing detects M184V and K65R mutations. What regimen is LEAST likely to work?

Correct answer is C. Based on the results of the NADIA (Nucleosides And Darunavir/Dolutegravir In Africa) and D²EFT (Dolutegravir and Darunavir Evaluation in Adults Failing Therapy) studies, ZDV-based regimens were the least successful; TDF + FTC paired with either DRV/r or DTG was statistically superior to the ZDV-based regimen. A combination of DTG + DRV/r was noninferior to DRV/r + 2 nucleoside reverse transcriptase inhibitors. The likely reason for poorer outcomes in ZDV-based regimens is intolerance to ZDV.

To learn more about antiretroviral therapy (ART) resistance, watch the on-demand webinar, What to Do Next: Use of Resistance Testing and Managing ART Failure in People With HIV, presented by Michael S. Saag, MD, Constance A. Benson, MD, Monica Gandhi, MD, MPH, Rajesh T. Gandhi, MD, and David H. Spach, MD.

A patient presents to care newly diagnosed with both HIV infection and opioid use disorder (OUD). He is very concerned about his HIV diagnosis but expresses reluctance regarding OUD treatment, stating that he would prefer to focus on HIV treatment first and consider OUD treatment at a later date. Which of the following is true about the effects of maintaining OUD treatment with concurrent HIV treatment?

Correct answer is C. Improved HIV viral suppression rates are observed regardless of the medication used for opioid use disorder (OUD) treatment. To learn more about the impact of medications used for OUD on HIV outcomes and about integrating medications for OUD into routine HIV care, please register for our upcoming IAS–USA webinar on September 19, 2023, (Part 2 of 6) Substance Use Disorder (SUD) 101: How Should We Care For SUD in Patients With HIV? to be presented by Ellen F. Eaton, MD, and moderated by Sandra A. Springer, MD.

Which of the following best describes the results of a pharmacokinetic study of bictegravir/emtricitabine/tenofovir alafenamide fumarate during pregnancy compared with nonpregnant adults and study participants 12 weeks postpartum?

Correct answer is C. In this pharmacokinetic study, bictegravir levels in the second and third trimesters greatly exceeded the levels required to inhibit wild-type HIV.

Zhang H, Martin H, Lin L, et al. Pharmacokinetics, safety, and efficacy of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in virologically suppressed pregnant women with HIV. Poster presented at: IAS 2023, the 12th International AIDS Society Conference on HIV Science; July 24, 2023; Brisbane, Australia.

To learn more about this topic, watch the on-demand webinar, Overview of Data Presented at the 2023 International AIDS Conference presented by Paul A. Sax, MD, and moderated by Marina Klein, MD, MS, on August 29, 2023.

In the open-label extension phase of HPTN (HIV Prevention Trials Network) 084, which of the following best describes the selection of preexposure prophylaxis by the women who participated?

Correct answer is B. In the open-label extension phase of HPTN (HIV Prevention Trials Network) 084, more women selected injectable cabotegravir (CAB) over oral tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) for preexposure prophylaxis. To learn more about this topic, register for our free upcoming webinar on August 29, 2023, Overview of Data Presented at the 2023 International AIDS Conference presented by Paul A. Sax, MD, and moderated by Marina Klein, MD, MS.

A 46-year-old man was admitted to the hospital for left-sided weakness and slurred speech. He was found to have an acute right corona radiata ischemic stroke. Laboratory values on admission included a CD4+ count of 127 cells/µL and a viral load of 18,000 copies/mL. He was successfully resuscitated with naloxone after an in-hospital overdose on insufflated fentanyl. What is the next best step?

Correct answer is B. In this patient, buprenorphine and naloxone are an appropriate treatment strategy. To learn more about this case, and to earn 1.25 CME credits toward the 8 hours of training mandated by the Drug Enforcement Agency (DEA) Medication Access and Training Expansion (MATE) Act, register for our free upcoming webinar on August 22, 2023, (Part 1 of 6) Substance Use Disorder (SUD) 101: Why Should We Care About SUD in Patients With HIV? presented by Sandra A. Springer, MD, and moderated by Ellen F. Eaton, MD.

Register now for the next activity in our free DEA-compliant webinar series:

(Part 2 of 6) Substance Use Disorder (SUD) 101: How Should We Care For SUD in Patients With HIV?
Presenter: Ellen F. Eaton, MD; Moderator: Sandra A. Springer, MD
September 19, 2023

You are providing care for a patient with newly diagnosed HIV infection and opioid use disorder. The patient expresses strong motivation for starting both antiretroviral therapy (ART) and medication for opioid use disorder. You are considering initiating buprenorphine treatment and ART. If recommending an integrase strand transfer inhibitor (InSTI) to use concurrently with buprenorphine, which strategy to manage potential drug-drug interactions is indicated?

Correct answer is D. No dose adjustments are needed when using integrase strand transfer inhibitors with buprenorphine.

To learn more about substance use disorders, register for the upcoming webinar on August 22, 2023, (Part 1 of 6) Substance Use Disorder (SUD) 101: Why Should We Care About SUD in Patients With HIV?, presented by Sandra A. Springer, MD, and moderated by Ellen F. Eaton, MD.

A 43-year-old female establishes care for HIV infection. She asks about the human papillomavirus (HPV) vaccine. Which of the following is NOT a potential consideration for offering this vaccine?

Correct answer is D. The current HPV vaccine contains 9 serotypes. One randomized, double-blind clinical trial evaluating the efficacy of the quadrivalent HPV vaccine in people with HIV older than 27 years found that the vaccine was safe and immunogenic. However, the trial did not show efficacy for prevention of new anal HPV infections or improvement in anal high-grade squamous intraepithelial lesion outcomes in a population with high levels of prior and current HPV infection.

To learn more about routine and special immunizations for people With HIV, register for the upcoming webinar on August 8, 2023,Routine and Special Immunizations for People With HIV, presented by Steven C. Johnson, MD, and moderated by Melanie A. Thompson, MD.

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

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

To learn more about routine and special immunizations for people With HIV, register for the upcoming webinar on August 8, 2023, Routine and Special Immunizations for People With HIV, presented by Steven C. Johnson, MD, and moderated by Melanie A. Thompson, MD.

Which of the following statements is true during HIV-associated cryptococcal meningitis?

Correct answer is B. Lower cerebrospinal fluid (CSF) interleukin (IL)-10 is associated with lower rates of survival survival, regardless of sex, during HIV-associated cryptococcal meningitis.

To learn more about neuropsychiatric complications in people with HIV, see the article, CROI 2023: Neuropsychiatric Complications in People With HIV, by Albert M. Anderson, MD; Beau M. Ances, MD, PhD; Scott L. Letendre, MD; in volume 31.4 of Topics in Antiviral Medicine™

Which of the following groups experienced approximately 4-kg weight loss over 48 weeks after switching from tenofovir alafenamide/emtricitabine/dolutegravir in the ADVANCE (Dolutegravir Plus Two Different Prodrugs of Tenofovir to Treat HIV) study to tenofovir disoproxil/lamivudine/dolutegravir in the CHARACTERISE (a Cross-sectional, Observational Study to Characterise the Transition to Dolutegravir-Based Regimens in South Africa in Terms of the Emergence of Obesity, Viral Re-suppression, and Integration Into Routine Programme Care) study?

Correct answer is B. Women lost approximately 4 kg over 48 weeks after the switch to tenofovir disoproxil/lamivudine/dolutegravir in the CHARACTERISE (a Cross-sectional, Observational Study to Characterise the Transition to Dolutegravir-Based Regimens in South Africa in Terms of the Emergence of Obesity, Viral Re-suppression, and Integration Into Routine Programme Care) study, but a similar weight effect was not observed in men.

To learn more about metabolic and other complications of HIV Infection, see the article, CROI 2023: Metabolic and Other Complications of HIV Infection, by Sudipa Sarkar, MD; Todd T. Brown, MD, PhD, in volume 31.4 of Topics in Antiviral Medicine™

TRUNCATE-TB (Two-Month Regimens Using Novel Combinations to Augment Treatment Effectiveness for Drug-Sensitive Tuberculosis), a novel strategy study that aimed to reduce tuberculosis treatment duration for some individuals, showed which of the following regimens to be noninferior to the standard 6-month regimen?

Correct answer is B. Bedaquiline, linezolid, isoniazid, pyrazinamide, and ethambutol initially for 8 weeks and extended by at least 1 month if still symptomatic and smear-positive was noninferior to the standard 6-month regimen for tuberculosis treatment.

To learn more about tuberculosis and infectious complications in persons With HIV, see the article, CROI 2023: Tuberculosis and Infectious Complications in Persons With HIV, by Andrew D. Kerkhoff, MD, PhD, MSc, and Diane V. Havlir, MD, in volume 31.4 of Topics in Antiviral Medicine™

A 35-year-old female fully vaccinated runner with hypertension presents 7 months after initial mild COVID-19 infection for dizziness and palpitations. She reports palpitations and dizziness when getting up from a seated or lying position as well as with mild exertion. Symptoms are associated with generalized weakness, post-exertional malaise, forgetfulness, difficulty concentrating, headaches, and blurred vision. The results of a comprehensive physical examination are within normal limits with the exception of tachycardia upon rising from a lying position. Laboratory test values including complete blood cell count, comprehensive metabolic panel, and D-dimer were within normal limits with the exception of C-reactive protein level of 15 mg/dL. Tilt table testing is positive. Which of the following is the next best step in management?

Correct answer is D. Postural orthostatic tachycardia syndrome (POTS) is a well-characterized sequela of COVID-19. Although clinical trials are limited in POTS, observational data support pharmacologic and non-pharmacologic management, including use of lower extremity compression garments, increasing water and salt intake, rehabilitation with recumbent training techniques, and initiation of midodrine, pyridostigmine, fludrocortisone, beta blockers, clonidine, or modafinil. In a patient with hypertension, however, use of lower extremity compression garments is the best option listed.

To learn more about the long COVID diagnosis and management, see the presentation, Evaluation and Management of Long COVID: A Case-Based Panel Discussion, presented by Tiffany Walker, MD, with the panelists: Annie Antar, MD, PhD; Judith S. Currier, MD; Carlos del Rio, MD; Roger Paredes, MD, PhD; Jeffrey N. Siegelman, MD; Kanecia Zimmerman, MD, MPH.

A 41-year-old woman with no past medical history presents 4 months after a mild SARS-CoV-2 infection with primary complaint of shortness of breath. Over the past 3 months she has noticed that her heart races and she feels dizzy while getting up to walk. This occurs often, but not every time she exerts herself. During these spells, she feels short of breath. Otherwise, she has no difficulty breathing. She was previously able to run 10 miles, but now is having difficulty running 1 mile. On examination, her vitals are normal with no orthostatic hypotension. A cardiovascular exam reveals regular rate and rhythm (RRR), no jugular venous pressure (JVP) elevation, and no peripheral edema. Lung exam is clear to auscultation bilaterally (CTAB). Electrocardiogram (EKG) is within normal limits. What is the appropriate next diagnostic test?

Correct answer is C. Postural orthostatic tachycardia syndrome (POTS) is a form of dysautonomia that is characterized by dyspnea, palpitations, and dizziness upon changes in posture. POTS has been reported to occur in up to 30% of long COVID patients, most commonly occurring in younger and female populations. It can be mimic for cardiopulmonary sequelae of COVID-19, as it shares similar symptom profiles. Common POTS symptoms, as well as associated symptoms of headaches, chest pain, brain fog, and sleep disturbances, can lead to substantial disability in the affected population. Appropriate diagnostic management includes a comprehensive cardiopulmonary physical exam, including orthostatic vitals to rule out orthostatic hypotension, followed by tilt table testing. A 30 beats/min or greater increase in heart rate without orthostatic hypotension within the first 10 minutes of a head-up tilt table test is 92% specific for the diagnosis of POTS.

To learn more about the the clinical relationship between long COVID and HIV, watch the presentation, Long COVID: Diagnosis and Management, presented by Tiffany Walker, MD.

In the United States, are people with HIV more likely to experience persistent symptoms and incident diagnoses (eg, long COVID) than people who are HIV negative?

After an annual 2% to 3% decline in new HIV diagnoses in the US in the several years prior to COVID-19, there was a 17% reduction in the number of new HIV diagnoses in 2020 compared with 2019. Which of the following is understood to be the cause of the decline in new HIV diagnoses?

Which of the following pre-exposure prophylaxis (PrEP) regimens are recommended for coverage for missed visits for injectable cabotegravir

A 47-year-old man presents with right ankle swelling and migratory polyarthritis. He is sexually active with men and women. His exam reveals right ankle effusion and distal extremity necrotic skin lesions. Which one of the following is NOT true with regard to disseminated gonococcal infection (DGI)?

Should people with HIV routinely be vaccinated against meningococcus B?

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

A female patient is taking dolutegravir + emtricitabine/tenofovir alafenamide fumarate (DTG + FTC/TAF) and has gained 20 lb over 2 years on therapy. Based upon the CHARACTERISE (a Cross-sectional, Observational Study to Characterise the Transition to Dolutegravir-based Regimens in South Africa in Terms of the Emergence of Obesity, Viral Re-suppression and Integration Into Routine Programme Care) study, which of the following can you tell her may happen to her weight if she switches to dolutegravir + emtricitabine/tenofovir disoproxil fumarate (DTG + FTC/TDF)?

A 22-year-old transgender woman presents to the emergency department for evaluation of a possible bacterial STI. She is using gender-affirming hormone therapy (GAHT). Her psychosocial history is significant for trauma, history of injection drug use, and housing instability. Which of the following statements regarding her possible preexposure prophylaxis (PrEP) options is true?

Which statement is correct about how mRNA technology can uniquely assist in the development of an HIV vaccine?

When is the highest risk period for emergence of drug resistance with long-acting cabotegravir?

A 48-year-old transgender woman presents seeking gender-affirming care. Past medical history includes HIV, diabetes mellitus type II, and hyperlipidemia. Her medications include rosuvastatin 10 mg daily, metformin 500 mg twice a day, and bictegravir/emtricitabine/tenofovir alafenamide. She currently smokes 15 cigarettes per day. What should you consider when starting gender-affirming hormone therapy?

Heart disease in PWH results from increased inflammation and residual immune activation. Which of the following statements is true?

When is the highest risk period for developing drug resistance with long-acting cabotegravir (LA CAB) when used for prevention?

When is the highest risk period for developing drug resistance with long-acting cabotegravir (LA CAB) when used for prevention?

True or False: In the event of an mpox outbreak, vaccination with the third-generation live modified vaccinia Ankara (MVA) should first be administered in a post-exposure ring to exposed individuals, then rolled out to at-risk individuals (multipartnered men who have sex with men [MSM]), regardless of exposure as a preventive strategy.

True or False: Viral and symptom rebound in SARS-CoV-2 infection are associated exclusively with nirmatrelvir (Paxlovid) use

What does the passing of the Mainstreaming Addiction Treatment Act (MAT Act) and the Medication Access and Training Expansion Act (MATE Act) mean for clinicians?

Which class of diabetes medications is preferred for a patient with a history of heart failure?

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

A 50-year-old man with HIV is diagnosed with an anal high-grade squamous epithelial lesion by high-resolution anoscopy (HRA) and biopsy. What treatment would you recommend?

Which of the following statements is true?

You have a patient with HIV who is considering pregnancy and would like more information on breastfeeding. You inform them that the risk of HIV transmission via breast milk from a breastfeeding person on antiretroviral therapy (ART) with a consistently undetectable viral load is which of the following?

Which of the following statements related to HIV and Alzheimer’s disease is correct?

A 65-year-old male presents with low-grade fever, cough, headache, and sore throat for 2 days. Rapid COVID-19 test is positive at home; rapid influenza test is negative. His HIV RNA is less than 20 copies/mL and his CD4+ count is 560 cells/µL. He smokes cigarettes and medications include dolutegravir (DTG)/ lamivudine (fdc), rosuvastatin (for hyperlipidemia). His oxygen saturation is between 94% and 95% on room air. How would you treat his SARS-CoV-2 infection?

A 59-year-old man comes to your office to discuss starting preexposure prophylaxis (PrEP). He has a history of kidney disease, with a creatinine clearance of 40 mL/minute. Which of the following PrEP options should be avoided?

You are providing care for a patient with newly diagnosed HIV infection and opioid use disorder (OUD). The patient expresses strong motivation for starting both antiretroviral therapy (ART) and medication treatment for OUD and notes a preference for a self-administered option that he can take on his own. You are considering initiating buprenorphine treatment and ART. If recommending an integrase strand transfer inhibitor (InSTI) to use concurrently with buprenorphine, which strategy to manage potential drug-drug interactions is indicated?

A 20-year-old woman with vaginal discharge is seen by her ob-gyn. She reports 8 new male sexual partners in the last 6 months. She engages in vaginal and anal sex, and condoms are used sporadically. She has been on oral contraception for a few years but admits to missing several doses each month. Upon further questioning, she reports increased alcohol use and challenges with her parents at home, and at school. She is afraid of sexually transmitted infections (STIs), especially HIV. She was diagnosed with chlamydia using a urine DNA probe but had a negative HIV serology. Unexpectedly, her urine beta-human chorionic gonadotropin (HCG) came back positive. She wants to discuss ways to decrease her HIV risk, particularly now that she is pregnant. TDF/FTC can be safely used during pregnancy; however, it requires daily dosing and may not be ideal for this patient. Which of the following statements regarding the potential use of antibodies in HIV prevention is FALSE?

After failing a regimen of tenofovir disoproxil fumarate (TDF)/lamivudine/efavirenz that resulted in resistance mutations in the nucleos(t)ide components, which of these regimens has been shown to be least effective?

A 48-year-old transgender woman presents seeking gender-affirming care. Past medical history includes HIV, diabetes mellitus type II, and hyperlipidemia. Her medications include rosuvastatin 10 mg daily, metformin 500 mg twice daily, and bictegravir/emtricitabine/tenofovir alafenamide. She currently smokes 15 cigarettes per day. What should you consider when starting gender-affirming hormone therapy?

A patient presents with cryptococcal meningitis, severe headache, and opening pressure greater than 25 cm H20 on day 1 of therapy. Which of the following would you initiate if the central nervous system (CNS) symptoms persist on day 2?

Correct answer is D. If the CNS symptoms persist on day 2, a lumbar puncture should be administered to remove fluid.

To learn more about this topic, click the link below to read watch, Management of AIDS-Related Opportunistic Infections, presented by Henry Masur, MD, at the 2022 Ryan White HIV/AIDS Program CLINICAL CONFERENCE.

Treatment of monkeypox virus infection can include various options for therapy. To recover, most individuals will need which of the following?

A 52-year-old woman without known HIV is diagnosed with Pneumocystis jirovecii pneumonia. Her HIV antibody test is positive, her CD4+ count is 103 cells/µL, and her HIV RNA is 135,000 copies/mL. She is still intubated on day 4 of intravenous trimethoprim-sulfamethoxazole and corticosteroids. When should she start ART?

Which of the following diagnostic tests is most likely to have a high yield in diagnosing cryptosporidiosis?

Which of the following is NOT associated with developing NAFLD/NASH?

A 32-year-old man is started on his first antiretroviral regimen. Within 1 week, his serum creatinine level increased from 1.0 to 1.15 mg/dL. Which of the following drugs is most likely responsible for the 0.15 mg/dL increase in serum creatinine level?

You are asked to consult on a newborn infant born to a parent whose last viral load in pregnancy was 200 copies/mL 3 weeks before delivery. Which of the following regimens is recommended for infant postnatal prophylaxis?

Your patient has been treated 3 times for bacterial STIs over the past 2 years. He is currently on cabotegravir every 2 months for PrEP. Which strategy appears to reduce his subsequent risk of contracting another bacterial STI?

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

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?

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?

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?

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

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.

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?

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

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

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?

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?

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

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

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

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

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

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

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)?

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?

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?

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?

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?

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

Which of the following is NOT true?

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

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

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

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.

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?

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?

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

Which of the following statements is FALSE?

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?

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)?

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

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

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

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?

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?

Which statement regarding interactions with contemporary antiretrovirals is FALSE?

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

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

M.J. is a 30-year-old Hispanic cisgender woman who was diagnosed with HIV when she developed oropharyngeal candidiasis. Her initial CD4+ count was 110 cells/μL. Her treatment, which is antiretroviral therapy (ART) containing efavirenz (EFV) plus abacavir (ABC)/lamivudine (3TC), has poor adherence. Her current viral load is 140,000 copies/mL, and her CD4+ count is 75 cells/μL. HIV genotype shows nucleotide reverse transcriptase inhibitor (nRTI) mutations (M184V, L74V) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) mutation (K103N). According to the results of the NADIA (Nucleosides and Darunavir/Dolutegravir in Africa) study, which of the following is correct?

Your patient has been taking daily preexposure prophylaxis (PrEP) for more than 2 years and reports excellent adherence while on PrEP, but he missed the last quarterly visit. He returns to clinic several weeks later and reports that he stopped PrEP approximately 3 months ago after his insurance lapsed, and he now wants to restart PrEP. His last condomless anal sex was approximately 2 weeks ago with a regular partner who is HIV negative. He reports that he had a bad cold last week with chills, subjective fevers, a sore throat, and a nonproductive cough. All of his roommates have also been sick with similar symptoms. His rapid HIV antibody (Ab)/antigen (Ag) test is negative. What is the most appropriate next step?

Standard tuberculosis (TB) treatment in individuals with HIV can be safely administered with which of the following?

Of the following people with HIV, who is eligible for lung cancer screening according to the United States Preventative Services Task Force (USPSTF)?

The investigational drug islatravir is expected to have a high barrier to resistance as a result of which of the following properties?

Which statement regarding interactions with contemporary antiretrovirals is FALSE?

A 23-year-old man presents to clinic with purulent discharge. He is sexually active with multiple male partners. His sexual practices include receptive and insertive oral and rectal intercourse. He was evaluated in clinic 1 week ago and empirically treated for nongonococcal urethritis with 1 gram of azithromycin. C. trachomatis/N. gonorrhoeae (CT/GC) nucleic acid amplification testing (NAAT) obtained at initial presentation was negative. Physical examination is notable for urethral discharge. First void urine demonstrates >10 white blood cells per high-powered field. Which of the following is TRUE regarding the etiology of persistent or recurrent nongonococcal urethritis?

Which of the following microbiome-associated factors DOES NOT influence HIV transmission?

Which of the following has NOT been associated with poor sleep in people with HIV?

A 26-year-old transgender woman presents complaining of 3 days of severe pain while defecating. She has noted bloody secretions on her bowel movements as well as on her underwear. She has a history of HIV infection with excellent adherence to her antiretroviral medications. She has no prior history of sexually transmitted infections (STIs). She reports active and receptive condomless oral and anal sex with a new cisgender male sex partner. Her examination is unremarkable except for exquisite tenderness on digital rectal examination with evidence of a bloody discharge from the anal canal. A nucleic-acid amplification test (NAAT) performed on a rectal swab is positive for Chlamydia trachomatis and negative for Neisseria gonorrhoeae (pharyngeal and urine NAATs testing is negative). Serologies for syphilis are negative. NAAT for herpes simplex virus (HSV) is negative. Which of the following is the best treatment option for this patient’s Chlamydia trachomatis proctitis assuming no additional testing is available?

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

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

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

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

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?