HIV/AIDS and Related Infections — MCQs
WHO AIDS defining illnesses are all EXCEPT:
A person with AIDS related complex is most likely suffering from:
What is the recommended regimen for post-exposure prophylaxis for HIV?
Which of the following is not considered an opportunistic infection in AIDS?
A patient diagnosed to be HIV-positive was started on highly active antiretroviral therapy (HAART). Which of the following can be used to monitor treatment efficacy?
Which of the following statements about p24 is false?
A term infant is born to a known HIV-positive mother. She has been taking antiretroviral medications for the weeks prior to the delivery of her infant. Routine management of the healthy infant should include which of the following?
What is the most common mode of transmission of HIV?
AIDS, secondary infection will be all except
After a renal transplant, what is the most common opportunistic infection?
HIV/AIDS and Related Infections Indian Medical PG Practice Questions and MCQs
Question 1: WHO AIDS defining illnesses are all EXCEPT:
- A. Persistent generalized lymphadenopathy (Correct Answer)
- B. P. carinii pneumonia
- C. CMV retinitis
- D. Oropharyngeal candidiasis
Explanation: ***Persistent generalized lymphadenopathy*** - While associated with HIV infection, **persistent generalized lymphadenopathy** itself is not classified as an **AIDS-defining illness** by the WHO or CDC, but rather a common manifestation of chronic HIV infection (Stage 1 or 2) [1]. - AIDS-defining illnesses are typically severe opportunistic infections or cancers that occur when the immune system is severely compromised (CD4 count below 200 cells/µL). *P. carinii pneumonia* - **P. carinii pneumonia** (now known as **Pneumocystis jirovecii pneumonia** or **PJP**) is a classic and common **AIDS-defining opportunistic infection**. - Its presence indicates severe immunosuppression, often with CD4 counts below 200 cells/µL. *CMV retinitis* - **Cytomegalovirus (CMV) retinitis** is a severe opportunistic infection, particularly of the eye, that is recognized as an **AIDS-defining illness**. - It signifies profound immunodeficiency, typically with CD4 counts below 50 cells/µL. *Oropharyngeal candidiasis* - While common in HIV-infected individuals, **oropharyngeal candidiasis** (thrush) alone is generally not considered an **AIDS-defining illness** [1]. - It is classified as an HIV Stage 2 condition, indicating moderate immune compromise rather than severe, AIDS-defining immunosuppression [1].
Question 2: A person with AIDS related complex is most likely suffering from:
- A. Opportunistic infection (Correct Answer)
- B. Generalized lymphadenopathy
- C. Cancer related to AIDS
- D. Herpes zoster
Explanation: ***Opportunistic infection*** - AIDS-related complex (ARC) describes symptoms experienced by individuals with **HIV infection** before the full onset of AIDS, often including systemic symptoms and increased susceptibility to infections. - The immunocompromised state in ARC makes patients highly vulnerable to **opportunistic infections**, which are common presentations during this phase [1]. *Generalized lymphadenopathy* - While **generalized lymphadenopathy** is a common feature of HIV infection and can be part of ARC, it is a symptom or sign, not the primary "suffering" that defines much of the morbidity [1]. - **Persistent generalized lymphadenopathy (PGL)** is characterized by enlarged lymph nodes in two or more extrainguinal sites for over three months, often seen in early HIV infection, but it *doesn't fully encompass* "suffering" as broadly as opportunistic infections do [1]. *Cancer related to AIDS* - **AIDS-defining cancers** (e.g., Kaposi's sarcoma, non-Hodgkin lymphoma) are more characteristic of full-blown AIDS, when the immune system is severely compromised (CD4 count typically < 200 cells/µL). - While the risk of certain cancers increases with HIV, and some may occur in ARC, **opportunistic infections** are a more ubiquitous and defining feature of the "suffering" associated with the ARC stage [1]. *Herpes zoster* - **Herpes zoster**, or shingles, results from reactivation of the varicella-zoster virus and is more prevalent and often more severe in HIV-positive individuals, including those with ARC [1]. - However, it represents *one specific type* of opportunistic infection or condition, and the question asks what the person is "most likely suffering from" in a general sense within ARC, for which opportunistic infections are the overarching category.
Question 3: 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 4: Which of the following is not considered an opportunistic infection in AIDS?
- A. Candidiasis
- B. Kaposi's sarcoma
- C. Rubella (Correct Answer)
- D. Cytomegalovirus infection
Explanation: ***Rubella*** - Rubella, or **German measles**, is a relatively mild viral infection that typically affects children and is not considered an **opportunistic infection** in immunocompromised individuals like those with AIDS [1]. - While it can cause congenital rubella syndrome in infants whose mothers are infected during pregnancy, it does not disproportionately affect or cause severe disease in AIDS patients due to their compromised immunity [1]. *Candidiasis* - **Oropharyngeal** and **esophageal candidiasis** are common opportunistic infections in AIDS patients, often indicating significant immune suppression [2,3]. - The fungus *Candida albicans* can proliferate unchecked when the **CD4 count** is low [2]. *Kaposi's sarcoma* - This is a **cancer** caused by the **human herpesvirus 8 (HHV-8)**, which is a classic AIDS-defining illness [3]. - Its presence indicates severe immunodeficiency and was a hallmark of the early AIDS epidemic [3]. *Cytomegalovirus infection* - **Cytomegalovirus (CMV)** can cause severe and widespread disease in AIDS patients, including **retinitis**, **colitis**, and **encephalitis** [2]. - It becomes a significant risk when the **CD4 count** drops below 100 cells/mm³ [2].
Question 5: A patient diagnosed to be HIV-positive was started on highly active antiretroviral therapy (HAART). Which of the following can be used to monitor treatment efficacy?
- A. CD4+ T cell count
- B. Viral load (Correct Answer)
- C. p24 antigen
- D. Viral serotype
Explanation: ***Viral load*** - **Viral load** (HIV RNA copies per milliliter of plasma) is the most direct and sensitive measure of HAART efficacy, as it indicates the amount of actively replicating virus [1]. - A successful HAART regimen aims to reduce the **viral load** to undetectable levels, signaling effective suppression of viral replication [1]. *CD4+ T cell count* - While important for monitoring immune status and disease progression, **CD4+ T cell count** changes more slowly than viral load [1]. - An increase in **CD4+ T cell count** is a positive sign of immune reconstitution but is a lagging indicator of immediate treatment efficacy [1]. *p24 antigen* - **p24 antigen** is a core structural protein of HIV, primarily detectable early in acute infection and in advanced stages when viral replication is very high. - It is generally not used for routine monitoring of HAART efficacy in chronic HIV infection because its levels fluctuate and become undetectable as the immune system produces antibodies. *Viral serotype* - **Viral serotype** refers to the specific strain or subtype of HIV (e.g., HIV-1 vs. HIV-2, or different clades within HIV-1). - It is determined at diagnosis to understand the specific virus but does not change significantly during the course of treatment and is not used to monitor HAART efficacy.
Question 6: Which of the following statements about p24 is false?
- A. Cannot be detected after seroconversion (Correct Answer)
- B. Cannot be seen in the first week
- C. All of the above
- D. Can be detected after 3 weeks of infection
Explanation: ***Cannot be detected after seroconversion*** - This statement is **FALSE** and is the correct answer to this question. - **p24 antigen levels do decrease** after seroconversion due to immune complex formation with antibodies, but p24 can still be detected using modern assays. - In **advanced HIV disease** with declining CD4 counts, p24 antigen often becomes detectable again due to high viral loads. - Fourth-generation HIV tests detect both antibodies and p24 antigen throughout the infection course. *Cannot be seen in the first week* - This statement is **TRUE** (not the answer). - p24 antigen typically appears around **10-14 days** (1.5-2 weeks) after infection, which is after the first week (days 1-7). - The eclipse period (first 7-10 days) precedes p24 detection. *Can be detected after 3 weeks of infection* - This statement is **TRUE** (not the answer). - p24 antigen is consistently detectable at 3 weeks post-infection during the acute viremic phase. - Peak p24 levels occur around **2-4 weeks** after infection. *All of the above* - This is a distractor option and is incorrect since only one statement is false.
Question 7: A term infant is born to a known HIV-positive mother. She has been taking antiretroviral medications for the weeks prior to the delivery of her infant. Routine management of the healthy infant should include which of the following?
- A. HIV ELISA on the infant to determine if congenital infection has occurred
- B. Admission to the neonatal intensive care unit for close cardiovascular monitoring
- C. Chest radiographs to evaluate for congenital Pneumocystis carinii
- D. A course of zidovudine for the infant (Correct Answer)
Explanation: ***A course of zidovudine for the infant*** - This is the standard of care for newborns exposed to HIV prenatally, even if the mother received **antiretroviral therapy (ART)**. - **Zidovudine (AZT)** prophylaxis significantly reduces the risk of **perinatal HIV transmission**. *HIV ELISA on the infant to determine if congenital infection has occurred* - **HIV ELISA** tests detect **maternal antibodies** passed to the infant, which can persist for up to 18 months, leading to **false positive results**. - **HIV DNA PCR** or **RNA assays** are used to diagnose HIV infection in infants. *Admission to the neonatal intensive care unit for close cardiovascular monitoring* - Admission to the **NICU** is generally reserved for **premature** or **symptomatic infants**, or those with specific complications. - A **healthy, term infant** born to an HIV-positive mother on ART does not routinely require NICU admission. *Chest radiographs to evaluate for congenital Pneumocystis carinii* - **Pneumocystis jirovecii pneumonia (PJP)** typically presents in HIV-infected infants between **3 to 6 months of age**, not at birth. - Prophylaxis with **trimethoprim-sulfamethoxazole (TMP-SMX)** is initiated at 4-6 weeks of age for HIV-exposed infants.
Question 8: What is the most common mode of transmission of HIV?
- A. Occupational exposure (needle stick injury)
- B. Perinatal transmission (mother to child)
- C. Sexual contact (Correct Answer)
- D. Transmission via blood and blood products
Explanation: ***Sexual contact*** - **Unprotected sexual intercourse**, both heterosexual and homosexual, is overwhelmingly the most common way HIV is transmitted globally. - The virus can be exchanged through **bodily fluids** such as semen, vaginal fluids, and rectal fluids during sexual activity. - Accounts for approximately **80% of new HIV infections** worldwide. *Occupational exposure (needle stick injury)* - While a recognised mode of transmission, **needle stick injuries** account for a very small percentage of total HIV infections, primarily affecting healthcare workers. - The risk of transmission per exposure is relatively low (approximately **0.3%**), especially compared to sexual contact. *Perinatal transmission (mother to child)* - **Mother-to-child transmission** can occur during pregnancy, childbirth, or breastfeeding. - Although significant, especially in resource-limited settings, global efforts and **PMTCT programs** have resulted in a significant reduction in this type of transmission. *Transmission via blood and blood products* - This mode was once a major concern but is now extremely rare in countries with robust **blood screening programs**. - While sharing contaminated needles among **intravenous drug users** remains a risk, transfusion-related HIV is largely controlled.
Question 9: AIDS, secondary infection will be all except
- A. Candida
- B. Kaposi's sarcoma (Correct Answer)
- C. HSV
- D. Rubella
Explanation: ***Kaposi's sarcoma*** - Kaposi's sarcoma is a **cancer** caused by human herpesvirus 8 (HHV-8) [2] that is common in patients with AIDS, but it is a **malignancy**, not a secondary infection [2],[3]. - While it arises due to immune suppression, it represents abnormal cell proliferation rather than direct microbial invasion. *Candida* - **Candidiasis** (e.g., oral thrush, esophageal candidiasis) is a common opportunistic fungal infection in AIDS patients due to their **impaired cellular immunity** [1]. - It often presents as **white plaques** on mucous membranes and is a clear example of a secondary infection. *HSV* - **Herpes Simplex Virus (HSV)** infections, including oral and genital herpes, are common and often severe in AIDS patients. - Due to immunocompromise, these infections can be **more widespread**, chronic, or recur frequently, qualifying as secondary infections. *Rubella* - **Rubella (German measles)** is a viral infection that is generally mild and self-limiting in immunocompetent individuals. - It is **not considered an opportunistic infection** or a common secondary infection specifically associated with AIDS; rather, it is listed as a differential diagnosis for the primary HIV infection rash [1].
Question 10: After a renal transplant, what is the most common opportunistic infection?
- A. Varicella Zoster Virus (VZV)
- B. Coxsackie Virus
- C. Epstein-Barr Virus (EBV)
- D. Cytomegalovirus (CMV) (Correct Answer)
Explanation: ***Cytomegalovirus (CMV)*** - **CMV** is the most common opportunistic infection after renal transplantation, particularly in the first 6 months due to immunosuppression [1]. - It can cause a range of clinical syndromes, including **fever**, **leukopenia**, **gastroenteritis**, **pneumonitis**, and **hepatitis**, and can also have indirect effects that increase the risk of graft rejection. *Varicella Zoster Virus (VZV)* - While VZV can cause opportunistic infections in transplant recipients (e.g., **shingles**), it is less common than CMV [1]. - VZV typically occurs later post-transplant and is characterized by a **vesicular rash** in a dermatomal distribution. *Coxsackie Virus* - **Coxsackie virus** infections are less frequently reported as significant opportunistic infections in renal transplant recipients compared to other viral pathogens. - They are generally associated with hand-foot-and-mouth disease, herpangina, or myocarditis, which are not the most common post-transplant complications. *Epstein-Barr Virus (EBV)* - **EBV** can cause post-transplant lymphoproliferative disorder (PTLD), which is a serious complication, but EBV infection itself is not the most common opportunistic infection overall [1]. - PTLD is more common in the first year after transplant and often presents with **lymphadenopathy**, **fever**, or **graft dysfunction**.
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