ART Provider Treatment Planning & Patient Care 2 — Questions and Answers
Question 1: A patient with HIV initiating ART has a baseline CD4 count of 180 cells/µL. Which additional prophylaxis should the provider prioritize?
- Fluconazole for cryptococcal meningitis
- Trimethoprim-sulfamethoxazole for Pneumocystis pneumonia (Correct answer)
- Azithromycin for MAC prophylaxis
- Isoniazid for latent TB only
Correct answer: Trimethoprim-sulfamethoxazole for Pneumocystis pneumonia
TMP-SMX prophylaxis is indicated when CD4 count falls below 200 cells/µL to prevent Pneumocystis jirovecii pneumonia.
Question 2: When counseling a patient newly starting ART, which adherence strategy is most evidence-based for long-term viral suppression?
- Skipping doses only on weekends to reduce pill fatigue
- Using a daily pill organizer combined with mobile phone reminders (Correct answer)
- Taking all weekly doses on one day to simplify the schedule
- Stopping ART temporarily during illness to rest the immune system
Correct answer: Using a daily pill organizer combined with mobile phone reminders
Combining organizational tools like pill organizers with electronic reminders has strong evidence for improving ART adherence and sustaining viral suppression.
Question 3: A patient on a tenofovir-based regimen presents with rising creatinine and decreased phosphate. What is the most appropriate next step?
- Increase dietary protein intake
- Add a phosphate supplement and continue ART unchanged
- Evaluate for tenofovir-associated nephrotoxicity and consider regimen switch (Correct answer)
- Order a renal biopsy immediately
Correct answer: Evaluate for tenofovir-associated nephrotoxicity and consider regimen switch
Rising creatinine with hypophosphatemia on tenofovir suggests proximal tubular dysfunction (Fanconi syndrome), warranting evaluation and possible switch to TAF or an alternative agent.
Question 4: Which viral load result indicates confirmed virologic failure requiring regimen reassessment in a patient on ART for 12 months?
- A single value of 65 copies/mL
- Two consecutive values above 200 copies/mL (Correct answer)
- A single value of 300 copies/mL after missed doses
- A blip to 85 copies/mL that spontaneously resolves
Correct answer: Two consecutive values above 200 copies/mL
Confirmed virologic failure is defined as two consecutive viral load measurements above 200 copies/mL, requiring resistance testing and regimen evaluation.
Question 5: A pregnant patient with HIV is in her first trimester. Which ART component is specifically recommended to be avoided due to potential neural tube defect risk at conception?
- Tenofovir alafenamide (TAF)
- Emtricitabine (FTC)
- Dolutegravir (DTG) at the time of conception (Correct answer)
- Lamivudine (3TC)
Correct answer: Dolutegravir (DTG) at the time of conception
Early data raised concern about dolutegravir use at conception and neural tube defects, though risk estimates have since been revised; guidelines still require counseling and informed consent.
Question 6: A provider is developing a treatment plan for a patient co-infected with HIV and hepatitis B. Which ART backbone is preferred to address both infections?
- Zidovudine/abacavir
- Tenofovir + emtricitabine (or lamivudine) (Correct answer)
- Stavudine + didanosine
- Abacavir + lamivudine only if HBsAg negative
Correct answer: Tenofovir + emtricitabine (or lamivudine)
Tenofovir combined with emtricitabine or lamivudine is preferred because all three drugs have dual activity against HIV and hepatitis B virus.
Question 7: A patient discloses they use recreational methamphetamine. How should this affect the ART treatment plan?
- Delay ART initiation until the patient is drug-free
- Select a simpler once-daily regimen and provide substance use counseling as part of integrated care (Correct answer)
- Prescribe ART only in a directly observed therapy setting
- Avoid integrase inhibitors due to drug interaction risk with methamphetamine
Correct answer: Select a simpler once-daily regimen and provide substance use counseling as part of integrated care
ART should not be delayed; a simplified regimen combined with integrated substance use support maximizes adherence and health outcomes.
ART Provider Treatment Planning & Patient Care 2
A patient with HIV initiating ART has a baseline CD4 count of 180 cells/µL.
Which additional prophylaxis should the provider prioritize?