HIV/AIDS Control Program — MCQs
What is the recommended regimen for post-exposure prophylaxis for HIV?
Why is a regimen of four drugs recommended for a TB patient on the first visit?
In diagnosis of AIDS, criteria include the following except -
Which of the following is NOT included in the National Vector Borne Disease Control Programme (NVBDCP)?
Which of the following is TRUE about screening for Trichomonas vaginalis?
Which of the following mechanisms is characteristic of HIV as a retrovirus after it enters the host cell?
What is the primary objective of the National STI Control Program?
Under NTEP, what is the honorarium given to a DOTS provider after the completion of treatment?
The detection of sore throat cases in children and their treatment with Benzathine Penicillin in Community Control Programme of Rheumatic Fever/Rheumatic Heart Disease (RF/RHD) constitutes
Which of the following screening methods is primarily used under the National Tuberculosis Elimination Program (NTEP)?
HIV/AIDS Control Program Indian Medical PG Practice Questions and MCQs
Question 1: What is the recommended regimen for post-exposure prophylaxis for HIV?
- A. Zidovudine + Lamivudine + Lopinavir/ritonavir for 28 days
- B. Tenofovir disoproxil fumarate + Emtricitabine + Raltegravir for 28 days
- C. Single dose Tenofovir + Emtricitabine + Raltegravir
- D. Tenofovir disoproxil fumarate + Emtricitabine + Dolutegravir for 28 days (Correct Answer)
Explanation: ***Tenofovir disoproxil fumarate + Emtricitabine + Dolutegravir for 28 days*** - This is the **current first-line recommended regimen** for **HIV post-exposure prophylaxis (PEP)** according to WHO (2021), CDC, and Indian NACO guidelines. - It includes two **nucleoside reverse transcriptase inhibitors (NRTIs)** and an **integrase strand transfer inhibitor (INSTI)**. - **Dolutegravir** is preferred over Raltegravir due to **superior efficacy, better tolerability, higher barrier to resistance, once-daily dosing**, and fewer drug interactions. - The duration of **28 days** is crucial for effective PEP to cover the window period for potential HIV integration and replication. *Tenofovir disoproxil fumarate + Emtricitabine + Raltegravir for 28 days* - This was the **previous standard PEP regimen** and is still an acceptable alternative if Dolutegravir is contraindicated or unavailable. - Raltegravir requires **twice-daily dosing** compared to Dolutegravir's once-daily regimen, which may affect adherence. - The 28-day duration is correct, but Raltegravir is no longer the first-line INSTI choice in current guidelines. *Single dose Tenofovir + Emtricitabine + Raltegravir* - A **single dose** of these medications is insufficient for **post-exposure prophylaxis (PEP)** as HIV replication needs to be suppressed over an extended period to prevent seroconversion. - PEP typically requires a **28-day course** to be effective. *Zidovudine + Lamivudine + Lopinavir/ritonavir for 28 days* - While this is an older, effective **antiretroviral regimen**, it is **not the preferred first-line PEP regimen** due to a higher incidence of side effects, particularly with zidovudine (anemia, nausea). - Modern guidelines favor regimens with **Tenofovir/Emtricitabine + Dolutegravir** due to better tolerability and superior efficacy.
Question 2: Why is a regimen of four drugs recommended for a TB patient on the first visit?
- A. To prevent emergence of drug-resistant strains (Correct Answer)
- B. To reduce bacterial load effectively
- C. To minimize treatment duration
- D. None of the options
Explanation: ***To prevent emergence of drug-resistant strains*** - Using a **four-drug regimen** at the initial stage significantly reduces the likelihood of **Mycobacterium tuberculosis** developing resistance to any single drug. - This strategy ensures that even if a small number of bacteria are naturally resistant to one drug, the other drugs will still be effective in killing them, preventing the proliferation of **resistant strains**. *To minimize treatment duration* - While a multi-drug regimen is effective, its primary goal is not to minimize treatment duration but rather to ensure **eradication of the infection** and prevent resistance. - Treatment duration is determined by the need to kill both actively multiplying and dormant bacteria, which typically takes several months even with multiple drugs. *To reduce bacterial load effectively* - Reducing bacterial load is certainly a goal of TB treatment, but the use of four drugs is specifically aimed at achieving this while simultaneously preventing **drug resistance**. - A single effective drug could reduce bacterial load, but it would quickly lead to the emergence of resistant bacteria, making the long-term goal of **cure** impossible. *None of the options* - This option is incorrect because the primary reason for a **four-drug regimen** in TB treatment is indeed to prevent the emergence of **drug-resistant strains**.
Question 3: In diagnosis of AIDS, criteria include the following except -
- A. CD8<500 (Correct Answer)
- B. CD4<200
- C. Presence of any of the opportunistic infections tuberculosis, pneumocystis carinii, cytomegalovirus
- D. CD4 : CD 8 =1
Explanation: ***CD8<500*** - While **CD8+ T cells** are involved in the immune response to HIV, their absolute count is not a primary criterion for diagnosing or staging **AIDS**. - **AIDS** diagnosis is primarily based on **CD4+ T cell counts** and the presence of **AIDS-defining opportunistic infections** [1]. *CD4<200* - A **CD4+ T cell count** below **200 cells/µL** is a key diagnostic criterion for **AIDS**, indicating severe immunosuppression [1]. - This threshold signifies a significantly compromised immune system, making the individual highly susceptible to opportunistic infections. *Presence of any of the opportunistic infections tuberculosis, pneumocystis carinii, cytomegalovirus* - The occurrence of **AIDS-defining opportunistic infections** like **tuberculosis**, **Pneumocystis jirovecii pneumonia**, or **cytomegalovirus retinitis** in an HIV-positive individual confirms an **AIDS diagnosis**, regardless of the CD4 count [1]. - These infections typically manifest when the immune system is severely weakened. *CD4 : CD 8 =1* - A **CD4:CD8 ratio of 1** (or any specific ratio) is not a direct criterion for diagnosing **AIDS**. - In HIV infection, the **CD4:CD8 ratio typically inverts** (becomes less than 1) as CD4 cells decline, but this ratio alone is not a defining characteristic for AIDS.
Question 4: Which of the following is NOT included in the National Vector Borne Disease Control Programme (NVBDCP)?
- A. Malaria
- B. Tuberculosis (Correct Answer)
- C. Filarial
- D. Kala azar
Explanation: ***Tuberculosis*** - **Tuberculosis is a bacterial disease** spread via airborne droplets, primarily affecting the lungs, and is **not a vector-borne disease**. - It is managed under the **Revised National Tuberculosis Control Programme (RNTCP)** in India, distinct from vector-borne disease programs. *Malaria* - Malaria is a **mosquito-borne parasitic disease** caused by Plasmodium parasites, and it is a major focus of the **NVBDCP**. - The program aims to reduce morbidity and mortality due to malaria through various control strategies. *Filarial* - **Filariasis (lymphatic filariasis)** is a mosquito-borne parasitic disease caused by filarial worms, and its elimination is a key objective of the **NVBDCP**. - The program focuses on mass drug administration and vector control to prevent its spread. *Kala Azar* - **Kala Azar (visceral leishmaniasis)** is a vector-borne disease transmitted by the bite of infected **sandflies**, making it a target disease under the **NVBDCP**. - The program implements surveillance, case management, and vector control measures to eliminate Kala Azar.
Question 5: Which of the following is TRUE about screening for Trichomonas vaginalis?
- A. Urine samples are inadequate for testing
- B. Culture is no longer used for diagnosis
- C. NAAT is recommended for screening high-risk women (Correct Answer)
- D. Wet mount microscopy has sensitivity >95%
Explanation: ***NAAT is recommended for screening high-risk women*** - **Nucleic Acid Amplification Tests (NAATs)** are highly sensitive and specific for detecting *Trichomonas vaginalis*, making them the preferred method for screening in high-risk populations due to their superior performance over traditional methods. - Screening high-risk women (e.g., those with multiple sexual partners, other STIs, or in areas with high prevalence) with NAATs helps in early detection and treatment, which is crucial for preventing further transmission and complications. *Urine samples are inadequate for testing* - **Urine samples** can indeed be used for *Trichomonas vaginalis* testing, particularly with NAATs, as they provide an alternative to vaginal swabs and are often preferred for their ease of collection and non-invasiveness. - While less sensitive than vaginal swabs for microscopy or culture, **NAATs performed on urine** have good sensitivity and specificity, making them a common option. *Culture is no longer used for diagnosis* - **Culture (e.g., InPouch TV system)** is still considered a **gold standard** for *Trichomonas vaginalis* diagnosis due to its high sensitivity and ability to detect viable organisms, especially when NAATs are not available or for confirming ambiguous results. - It is particularly useful in cases where organisms are present in low numbers or in settings where resources for advanced molecular testing are limited, though it is **less rapid** than NAATs. *Wet mount microscopy has sensitivity >95%* - **Wet mount microscopy** is an inexpensive and rapid diagnostic method, but its sensitivity for detecting *Trichomonas vaginalis* is **relatively low**, typically ranging from **50-70%**, not >95%. - The sensitivity of wet mounts is highly dependent on the **operator's skill**, the concentration of organisms, and the time elapsed since sample collection, making it prone to false negatives.
Question 6: Which of the following mechanisms is characteristic of HIV as a retrovirus after it enters the host cell?
- A. It integrates into the host genome after entry.
- B. It uses reverse transcriptase after entry to convert RNA to DNA. (Correct Answer)
- C. It binds to CD4 via gp120.
- D. It uses CCR5 co-receptor for entry into host cells.
Explanation: ***It uses reverse transcriptase after entry to convert RNA to DNA.*** - After HIV enters a host cell, its **single-stranded RNA genome** is converted into **double-stranded DNA** by the enzyme **reverse transcriptase**. - This is the **defining characteristic** of retroviruses like HIV, distinguishing them from other viruses. - This reverse transcription step is essential before the viral DNA can integrate into the host genome. *It integrates into the host genome after entry.* - While integration is crucial for HIV's lifecycle, this occurs **after reverse transcription** and is not unique to retroviruses. - Many other viruses (e.g., herpesviruses, adenoviruses) can also integrate into host genomes without being retroviruses. *It binds to CD4 via gp120.* - This describes the **entry mechanism**, which occurs **before** the virus enters the cell, not after entry. - The question specifically asks about mechanisms after cellular entry. *It uses CCR5 co-receptor for entry into host cells.* - Like CD4 binding, CCR5 co-receptor use is part of the **entry process**, not a post-entry mechanism. - Additionally, not all HIV strains use CCR5; some use CXCR4 (X4-tropic strains).
Question 7: What is the primary objective of the National STI Control Program?
- A. Research on new treatments
- B. Contact tracing only
- C. Prevention and control of STI transmission (Correct Answer)
- D. Providing free medications
Explanation: ***Prevention and control of STI transmission*** - The fundamental goal of the National STI Control Program is to **minimize the spread** of sexually transmitted infections. - This involves strategies to **reduce incidence** and **prevalence** through various public health interventions. *Research on new treatments* - While research is important for advancing STI management, it is typically a **secondary or supporting activity**, not the primary objective of a control program. - The main focus of a control program is on **direct public health impact** through existing knowledge and tools. *Contact tracing only* - **Contact tracing** is a critical component of STI control, but it is one strategy among many. - It is not the sole objective; comprehensive programs include **education, testing, and treatment**. *Providing free medications* - **Providing free medications** is a crucial part of accessible treatment, which contributes to control efforts. - However, it's a *means to an end* rather than the overarching primary objective, which is the **prevention and control of transmission**.
Question 8: Under NTEP, what is the honorarium given to a DOTS provider after the completion of treatment?
- A. 150 INR
- B. 500 INR (Correct Answer)
- C. 1000 INR
- D. 250 INR
Explanation: ***500 INR*** - Under the **National Tuberculosis Elimination Programme (NTEP)**, a **DOTS provider** receives an honorarium of **INR 500** upon the successful completion of tuberculosis treatment for a **new TB patient**. - This incentive, revised from the earlier amount of INR 250, aims to recognize the crucial role of DOTS providers in ensuring treatment adherence and successful outcomes. - The increased honorarium reflects the government's commitment to incentivizing community participation in TB elimination. *150 INR* - This amount is **significantly lower than the stipulated honorarium** for a DOTS provider upon treatment completion under current NTEP guidelines. - The correct incentive for successful completion of treatment is INR 500 for new TB cases. *250 INR* - This was the **earlier honorarium amount** under the previous NTEP guidelines, which has since been **revised upward**. - Under the current NTEP incentive structure, the honorarium for treatment completion has been increased to INR 500. *1000 INR* - This amount is **higher than the designated honorarium** for a DOTS provider upon treatment completion under NTEP. - While this figure may apply to other incentive schemes or different milestones, the standard honorarium for new TB case completion is INR 500.
Question 9: The detection of sore throat cases in children and their treatment with Benzathine Penicillin in Community Control Programme of Rheumatic Fever/Rheumatic Heart Disease (RF/RHD) constitutes
- A. Primary prevention of RF/RHD (Correct Answer)
- B. Primordial prevention of RF/RHD
- C. Tertiary prevention of RF/RHD
- D. Secondary prevention of RF/RHD
Explanation: ***Primary prevention of RF/RHD*** - **Early detection and treatment** of streptococcal sore throat prevents the initial episode of **acute rheumatic fever (ARF)**, thus preventing the onset of **rheumatic heart disease (RHD)**. - This intervention targets preventing the disease's **initial occurrence** by eliminating the precipitating cause. *Primordial prevention of RF/RHD* - **Primordial prevention** focuses on preventing the development of **risk factors** in the first place, often through broad social or environmental changes. - This involves strategies like improving **socioeconomic conditions** or **housing sanitation** to reduce the overall burden of streptococcal infections, rather than treating individual cases. *Tertiary prevention of RF/RHD* - **Tertiary prevention** aims to **reduce the impact** of an established disease, minimizing complications and improving quality of life. - For RF/RHD, this would involve managing **existing RHD**, such as through cardiac surgery or long-term medication, to prevent further deterioration or disability. *Secondary prevention of RF/RHD* - **Secondary prevention** involves detecting and treating a disease **early** to prevent its progression or recurrence *after* an initial episode. - In the context of RF/RHD, this would refer to **secondary prophylaxis with penicillin** given to individuals who have already had ARF to prevent subsequent attacks and progression to RHD.
Question 10: Which of the following screening methods is primarily used under the National Tuberculosis Elimination Program (NTEP)?
- A. Active
- B. Passive (Correct Answer)
- C. Mass
- D. None of the options
Explanation: ***Passive*** - Under the NTEP, **passive screening** involves individuals presenting to health facilities with symptoms suggestive of TB. - This method relies on **patient self-reporting** and healthcare provider suspicion, rather than active outreach. - Passive case finding is the **primary screening strategy** used across the general population in the NTEP framework. *Active* - **Active screening** involves community-based interventions to proactively identify individuals with TB, often in high-risk populations. - While active case finding is crucial for specific vulnerable groups (contacts, HIV patients, etc.), it is **not the primary screening method** under the standard NTEP framework for initial detection across the entire population. *Mass* - **Mass screening** involves testing large numbers of people in the general population, regardless of symptoms, to detect disease. - This is generally **cost-prohibitive** and not routinely implemented as a primary screening strategy for TB by the NTEP due to resource limitations and low yield in the general population. *None of the options* - **Passive screening** is indeed a primary method used under the NTEP, making this option incorrect. - The NTEP heavily relies on individuals seeking care when they experience symptoms, which aligns with the definition of passive case finding.
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