BCPS - ID Part 2 Exam Questions With
Accurate Answers
Testing for HIV-RNA - ANSWER Baseline test
Immediately after therapy initiated
Every 2-4 (no longer than 8) weeks after starting or changing therapy
Any time there is clinical decline/change in CD4 count
Every 3-6 months without therapy
Every 3-4 months while on therapy and can extend to 6 months if stable/suppression for
>2 years with immune stability
When to test CD-4 count - ANSWER At baseline
After ART is started to guide OI ppx
Every 12 months for those on therapy + CD4 300-500 for at least 2 years
Optional if CD4 count >500 and stable/immunosuppressed for 2 years
Screening for HIV - ANSWER Patients 13-64 in healthcare settings
Pregnant patients
Patients at risk (IVDU, men who have sex with men, men/women with frequent sexual
partners, patients being treated for STD/STI, men or women who perform sex work,
recipients of blood transfusions 75-85)
Indications for PREP - ANSWER Men who have sex with men
Heterosexual partners
-HIV positive partner
-Recently treated for bacterial STI
-Inconsistent condom use
, -High number of sex partners
-Sex work
PWID: HIV-positive partner or sharing injection equipment
Prevention of maternal-fetal transmission - ANSWER Dual NRTI (abacavir/lamivudine or
tenofovir/emtricitabine or lamivudine) + PI (atazanavir/ritonavir or darunavir/ritonavir) or
integrase strand inhibitor (dolutegravir or raltegravir)
Continue through intrapartum period
If on therapy consider replacing elvitegravir/cobi with raltegravir or a preferred PI
combo and use darunavir BID, not QD
Indications for Zidovudine - ANSWER If RNA copies >100K
Consider if RNA 50-100 K
No need to consider if virally suppressed
Treatment for infants born to mothers who are HIV positive - ANSWER Low risk:
zidovudine 4 mg/kg/dose every 12 hours for 4 weeks, start 6-12 hours after delivery
Higher risk: zidovudine + lamivudine and nevirapine OR zidovudine + lamivudine +
raltegravir for 6 weeks
Indications for PEP - ANSWER Non-occupational: exposure to
vagina/rectum/eye/mouth/mucus membrane/non-intact skin with blood/semen/vaginal
secretions or breast milk of a person with known HIV infx
Start within 72 hours for 4 weeks
Raltegravir BID or dolutegravir+tenofovir/emtricitabine
Indications for PEP (occupational) - ANSWER Start treatment within hours
Continue for 4 weeks
Use raltegravir BID or high dose raltegravir, tenofovir/emtricitabine or lamivudine
Accurate Answers
Testing for HIV-RNA - ANSWER Baseline test
Immediately after therapy initiated
Every 2-4 (no longer than 8) weeks after starting or changing therapy
Any time there is clinical decline/change in CD4 count
Every 3-6 months without therapy
Every 3-4 months while on therapy and can extend to 6 months if stable/suppression for
>2 years with immune stability
When to test CD-4 count - ANSWER At baseline
After ART is started to guide OI ppx
Every 12 months for those on therapy + CD4 300-500 for at least 2 years
Optional if CD4 count >500 and stable/immunosuppressed for 2 years
Screening for HIV - ANSWER Patients 13-64 in healthcare settings
Pregnant patients
Patients at risk (IVDU, men who have sex with men, men/women with frequent sexual
partners, patients being treated for STD/STI, men or women who perform sex work,
recipients of blood transfusions 75-85)
Indications for PREP - ANSWER Men who have sex with men
Heterosexual partners
-HIV positive partner
-Recently treated for bacterial STI
-Inconsistent condom use
, -High number of sex partners
-Sex work
PWID: HIV-positive partner or sharing injection equipment
Prevention of maternal-fetal transmission - ANSWER Dual NRTI (abacavir/lamivudine or
tenofovir/emtricitabine or lamivudine) + PI (atazanavir/ritonavir or darunavir/ritonavir) or
integrase strand inhibitor (dolutegravir or raltegravir)
Continue through intrapartum period
If on therapy consider replacing elvitegravir/cobi with raltegravir or a preferred PI
combo and use darunavir BID, not QD
Indications for Zidovudine - ANSWER If RNA copies >100K
Consider if RNA 50-100 K
No need to consider if virally suppressed
Treatment for infants born to mothers who are HIV positive - ANSWER Low risk:
zidovudine 4 mg/kg/dose every 12 hours for 4 weeks, start 6-12 hours after delivery
Higher risk: zidovudine + lamivudine and nevirapine OR zidovudine + lamivudine +
raltegravir for 6 weeks
Indications for PEP - ANSWER Non-occupational: exposure to
vagina/rectum/eye/mouth/mucus membrane/non-intact skin with blood/semen/vaginal
secretions or breast milk of a person with known HIV infx
Start within 72 hours for 4 weeks
Raltegravir BID or dolutegravir+tenofovir/emtricitabine
Indications for PEP (occupational) - ANSWER Start treatment within hours
Continue for 4 weeks
Use raltegravir BID or high dose raltegravir, tenofovir/emtricitabine or lamivudine
