🟥 AIDS / PROPHYLAXIS
A 42-year-old male with HIV has a CD4 count of 180/µL. He has no symptoms and is starting ART today.
What prophylaxis is indicated?
What is trimethoprim-sulfamethoxazole (TMP-SMX)
*PJP prophylaxis is indicated when CD4 <200, regardless of ART initiation.
A patient with HIV and PJP is started on treatment. When should ART be initiated?
What is within 2 weeks?
Early ART improves survival in most opportunistic infections.
A patient with suspected PCP has hypoxemia with PaO₂ <70 mmHg. What additional therapy is indicated?
What are corticosteroids?
Steroids reduce mortality in moderate-to-severe PCP.
A 29-year-old man with HIV is on stable ART with CD4 450. Which vaccine is contraindicated if his CD4 were <200?
What is live vaccines (e.g., MMR, varicella)?
Live vaccines are contraindicated when CD4 <200 due to risk of disseminated infection.
A 38-year-old man is newly diagnosed with HIV. His CD4 count is 35/µL. He is asymptomatic and will start ART immediately. What is the most appropriate strategy for MAC prevention?
What is no MAC prophylaxis and immediate ART initiation?
MAC prophylaxis is not recommended if ART is started promptly. Immune recovery reduces MAC risk.
A patient with cryptococcal meningitis is improving on antifungal therapy. When should ART be started?
What is delayed (4–6 weeks)?
Early ART increases risk of severe/fatal IRIS in cryptococcal meningitis.
A patient with HIV presents with multiple ring-enhancing brain lesions and positive toxoplasma IgG. What is the next step?
What is empiric toxoplasmosis treatment?
Treat first; biopsy only if no response in 10–14 days.
A patient is newly diagnosed with HIV. When should ART be started?
What is as soon as possible (rapid initiation)?
“Rapid start ART” improves outcomes and reduces transmission.
A patient with HIV asks about preventing transmission to a partner. What is the most effective strategy?
What is maintaining an undetectable viral load (U=U)?
Sustained viral suppression results in no sexual transmission of HIV.
A patient has been on ART for 6 months. CD4 count increased from 120 to 240 and remains stable for 4 months. What is the next step?
What is discontinue PCP prophylaxis?
Stop PCP prophylaxis once CD4 >200 for ≥3 months.
A patient with TB and CD4 count of 30 is started on TB therapy. When should ART be initiated?
What is within 2 weeks?
Early ART reduces mortality in patients with CD4 <50.
A patient with CD4 <50 presents with fever and anemia. Blood cultures pending. What is the next step?
What is start empiric MAC therapy?
Disseminated MAC causes systemic illness—do not delay treatment.
A patient has virologic failure on ART. What is the first step?
What is assess adherence?
Nonadherence is the most common cause of failure.
A patient with HIV has never been screened for hepatitis B. What is the most appropriate next step?
What is hepatitis B screening (HBsAg, anti-HBs, anti-HBc)?
All patients with HIV require HBV screening due to shared transmission and treatment implications.
A patient with CD4 count of 90 and positive Toxoplasma IgG is not yet on ART. What is the most appropriate prophylaxis?
What is TMP-SMX?
TMP-SMX prevents both PCP and toxoplasmosis when CD4 <100 and IgG positive.
A patient with TB and CD4 count of 150 is started on TB therapy. When should ART be initiated?
What is within 8 weeks?
Timing depends on CD4 count:
patient with cryptococcal meningitis has opening pressure of 32 cm H₂O. What is the most important intervention?
What is serial lumbar punctures?
Elevated ICP is a major cause of death.
A patient on tenofovir develops renal dysfunction. What is the next step?
What is switch to tenofovir alafenamide or alternative?
TAF has less renal and bone toxicity.
A patient with HIV has CD4 count of 350 and no prior vaccinations. Which vaccine should be given?
What is pneumococcal vaccination (PCV20)?
HIV patients require sequential pneumococcal vaccination regardless of CD4 count.
A patient with HIV develops worsening lymphadenopathy after starting ART for TB. He is stable. What is the best next step?
What is continue ART and treat underlying infection?
Most IRIS cases are self-limited—do NOT stop ART unless severe.
A patient with a single brain lesion and negative toxoplasma IgG presents with neurologic deficits. What is the next step?
What is brain biopsy?
Suggests primary CNS lymphoma, not toxoplasmosis.
A patient with suppressed viral load asks if they can transmit HIV to their partner. What is the correct counseling?
What is U=U (undetectable = untransmittable)?
Patients with sustained viral suppression do not transmit HIV sexually.
A patient with HIV is on ART and asks about cancer screening. Which malignancy requires routine screening regardless of CD4 count?
What is cervical cancer (Pap smear)?
HIV increases risk of HPV-related cancers. Routine screening is essential even with good immune status.