ACRN STUDY SET QUESTIONS AND ANSWERS 2021

Lipoatrophy, the subcutaneous fat wasting of the face and buttocks, is believed to be caused by which of the following antiretroviral medication? - Tenofovir alafenamide (TAF) - Tenofovir (TDF) - Abacavir (ABC) - Zidovudine (ZDV) Correct Answers: Zidovudine (ZDV) Proximal renal tubulopathy and elevated creatinine are an adverse event related to the use of what antiretroviral medication? - Tenofovir (TDF) - Tenofovir alafenamide (TAF) - Triumeq (ABC+3TC+DTG) - Dolutegravir (DTG) Correct Answers: Tenofovir (TDF) If a person with HIV infection has painless flesh-colored papules over the face and neck, which of the following dermatological conditions should be suspected? - Molluscum contagiosum - Psoriasis - Kaposi's sarcoma - Seborrhea Correct Answers: Molluscum contagiosum What adverse event is related to the use of Abacavir? - Myocardial infarction, ischemic stroke - Central nervous system/neuropsychiatric symptoms - Dyslipidemia - Cardiac QTc interval Prolongation Correct Answers: Myocardial infarction, ischemic stroke You have a patient who newly diagnosed with HIV and HCV. She tells you that she is interested in pursuing treatment for HCV immediately as she has a friend who experienced complications from the disease. Which circumstance would most strongly warrant the deferment of HCV treatment for this patient? - Your patient's CD4 is 200 cells/mm3 - Your patient is an active intravenous drug user - Your patient is on opiod substitution therapy (OST) (methadone/buprenorphine) and you are concerned about potential drug-drug interactions - Your patient has advanced liver fibrosis Correct Answers: Your patient's CD4 is 200 cells/mm3 Rationale: Improved immune status should be the priority for patients with a CD4 count below 200 cells/mm3. Research shows us that patients with active substance abuse do not have worse rates of SVR as compared to patients without active substance abuse. However, these patients will likely need increased support and adherence follow up. There are not significant drug-drug interactions between DAAs and OST. References: U.S. Department of Health and Human Services. 2017. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV: Considerations for Antiretroviral Use in Patients with Coinfections. Your patient, who is co-infected with HIV/HBV, wants to know if she can start taking what she heard is the "newer, safer" version of tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), instead. You explain: - TAF is not currently FDA approved for the treatment of HBV - TAF is currently FDA approved for the treatment of HIV/HBV coinfection - TAF is not currently FDA approved for the treatment of HIV/HBV coinfection - TAF is currently FDA approved only for PrEP Correct Answers: TAF is currently FDA approved for the treatment of HIV/HBV coinfection Rationale: While switching from TDF to TAF is acceptable and preferable in many cases, per DHHS guidelines (2017), discontinuation of ART with anti-HBV activity may cause serious hepatocellular damage resulting from reactiva