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A 27-year-old develops fever, pharyngitis, and a diffuse rash three weeks after condomless sex with a new partner. A laboratory fourth-generation HIV antigen/antibody assay is reactive, but the HIV-1/HIV-2 antibody differentiation assay is negative. The patient has not used PrEP or PEP. Which test should resolve this discordant sequence?
Correct answer: C - Obtain an HIV-1 RNA nucleic acid test now.
After three years of HIV RNA results below 20 copies/mL on bictegravir/tenofovir alafenamide/emtricitabine, a patient has results of 84 and 112 copies/mL six weeks apart. Pharmacy records and a detailed interview identify no missed doses, access problems, or interacting medications. The CD4 count remains 580 cells/µL. How should these results affect the treatment plan?
Correct answer: A - Continue ART and recheck HIV RNA within three months.
Intravenous trimethoprim-sulfamethoxazole was started six hours ago for confirmed Pneumocystis pneumonia in an adult with HIV. Before oxygen was administered, the room-air PaO2 was 76 mm Hg and the alveolar-arterial oxygen gradient was 44 mm Hg. The patient can swallow medications and has no contraindication to corticosteroids. Which adjunctive prescription is indicated now?
Correct answer: D - Start prednisone 40 mg twice daily for the first five days.
At a preventive visit, a 62-year-old man with well-controlled HIV asks why a statin is being discussed when his LDL cholesterol is 108 mg/dL and his estimated 10-year cardiovascular risk is only 3%. He has no known atherosclerotic cardiovascular disease and no statin contraindication. Under the 2026 HIV-specific cardiovascular prevention recommendation, what should he be offered?
Correct answer: B - A compatible statin in addition to lifestyle measures.
A 36-year-old woman weighing 62 kg requests PrEP before resuming receptive vaginal sex. Her last sexual exposure was eight weeks ago. Blood HIV antigen/antibody and HIV-1 RNA tests are negative, and she has no symptoms of acute infection. Her estimated creatinine clearance is stable at 44 mL/min. She can attend injection visits. Which option accommodates both her exposure route and renal function?
Correct answer: C - Cabotegravir 600 mg IM now, again in one month, then every two months.
Three months after adding inhaled fluticasone for asthma, a patient taking darunavir/cobicistat plus tenofovir alafenamide/emtricitabine develops facial rounding, easy bruising, and proximal muscle weakness. HIV remains suppressed. There has been no oral or injected corticosteroid use, and morning endogenous cortisol is below the laboratory reference interval. Which explanation reconciles the physical findings with the low cortisol?
Correct answer: B - Exogenous glucocorticoid excess from the cobicistat-fluticasone interaction.
During an HIV follow-up visit, a patient has a PHQ-9 total of 7, including a score of 1 on the item concerning death or self-harm. Asked about that response, the patient says, "Some days I wish I would not wake up, but I am not thinking about killing myself right now." The patient is calm and not intoxicated. A full suicide-risk assessment has not been completed. What takes priority before deciding the disposition?
Correct answer: D - Complete a suicide-safety assessment now, including intent, plan, means, and past attempts.
A newborn is two hours old, was delivered at 39 weeks, weighs 3.3 kg, and can receive oral medication. Maternal HIV-1 RNA was below 20 copies/mL through 32 weeks but measured 620 copies/mL at 37 weeks after an interruption in ART. The infant’s birth HIV nucleic acid test has been collected and is pending. Which initial antiretroviral approach fits this exposure history?
Correct answer: A - Begin presumptive therapy with zidovudine, lamivudine, and neonatal-dose dolutegravir.
A 21-year-old with perinatally acquired HIV returns to care after four months without ART. A plasma genotype obtained at an HIV RNA level of 42,000 copies/mL detects no resistance mutations. Pediatric records document M184V during a previous virologic failure. Dolutegravir/lamivudine is proposed because the new report shows no resistance. Which interpretation should govern review of that proposal?
Correct answer: B - Retain the historical M184V when assessing lamivudine activity.
On the second day of liposomal amphotericin B plus flucytosine for cryptococcal meningitis, a patient with HIV develops worsening headache, vomiting, and blurred vision. Repeat lumbar puncture shows an opening pressure of 36 cm CSF. There is no mass lesion or obstructive hydrocephalus, and platelet count and coagulation studies are normal. Which intervention most directly addresses the immediate threat?
Correct answer: C - Drain CSF therapeutically; repeat lumbar punctures until pressure and symptoms improve.
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