MCQ Quiz: HIV

The management of Human Immunodeficiency Virus (HIV) has transformed from a terminal diagnosis into a manageable chronic condition, largely due to the success of antiretroviral therapy (ART). For PharmD students, a comprehensive understanding of ART is paramount. This includes mastering the different classes of antiretrovirals, from the NRTI backbone to the preferred integrase inhibitors (INSTIs), and understanding their mechanisms, side effects, and significant drug interactions. Pharmacists are integral to HIV care, playing a critical role in regimen selection, patient education, adherence counseling, and prevention strategies like Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP). This quiz will test your knowledge on the complex pharmacotherapy used to treat and prevent HIV.

1. The primary cellular target of the Human Immunodeficiency Virus (HIV) is the:

• a) B lymphocyte
• b) CD4+ T helper lymphocyte
• c) Neutrophil
• d) Red blood cell

Answer: b) CD4+ T helper lymphocyte

2. What is the mechanism of action of Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)?

• a) They prevent the cleavage of viral polyproteins into functional proteins.
• b) They act as faulty building blocks, causing chain termination during the conversion of viral RNA to DNA.
• c) They block the integration of viral DNA into the host cell’s genome.
• d) They inhibit the virus from binding to the host cell.

Answer: b) They act as faulty building blocks, causing chain termination during the conversion of viral RNA to DNA.

3. Which laboratory test is used to measure the amount of HIV in the blood and is the primary indicator of ART efficacy?

• a) CD4+ T-cell count
• b) HIV p24 antigen test
• c) HIV RNA viral load
• d) Complete Blood Count (CBC)

Answer: c) HIV RNA viral load

4. Before initiating therapy with abacavir, genetic testing for which allele is required to screen for a potentially fatal hypersensitivity reaction?

• a) HLA-B*1502
• b) HLA-B*5701
• c) CYP2C19
• d) VKORC1

Answer: b) HLA-B*5701

5. What is the mechanism of action of Integrase Strand Transfer Inhibitors (INSTIs) like dolutegravir?

• a) They inhibit the protease enzyme.
• b) They block the reverse transcriptase enzyme.
• c) They prevent viral DNA from being inserted into the host cell’s DNA.
• d) They prevent the fusion of the viral envelope with the cell membrane.

Answer: c) They prevent viral DNA from being inserted into the host cell’s DNA.

6. Which two medications form the most common NRTI “backbone” in recommended initial HIV regimens?

• a) Zidovudine and Lamivudine
• b) Abacavir and Didanosine
• c) Tenofovir (TAF or TDF) and Emtricitabine
• d) Stavudine and Zalcitabine

Answer: c) Tenofovir (TAF or TDF) and Emtricitabine

7. A patient taking an INSTI-based regimen should be counseled to separate the administration of their ART from which of the following?

• a) High-fat meals
• b) Acid-reducing agents
• c) Antacids and supplements containing polyvalent cations (e.g., calcium, magnesium, aluminum, iron).
• d) Grapefruit juice

Answer: c) Antacids and supplements containing polyvalent cations (e.g., calcium, magnesium, aluminum, iron).

8. Ritonavir and cobicistat are not potent antiretrovirals on their own but are used in some regimens for what purpose?

• a) To prevent side effects.
• b) To act as pharmacokinetic boosters by inhibiting CYP3A4, thus increasing the levels of other ART drugs.
• c) To improve the taste of the medications.
• d) To treat opportunistic infections.

Answer: b) To act as pharmacokinetic boosters by inhibiting CYP3A4, thus increasing the levels of other ART drugs.

9. Efavirenz, a first-generation NNRTI, is known for causing what type of adverse effects, particularly when initiated?

• a) Severe nephrotoxicity
• b) Hyperlipidemia
• c) CNS side effects, such as vivid dreams, dizziness, and depression.
• d) Pancreatitis

Answer: c) CNS side effects, such as vivid dreams, dizziness, and depression.

10. Biktarvy is a common single-tablet regimen (STR) containing bictegravir, emtricitabine, and which other component?

• a) Tenofovir disoproxil fumarate (TDF)
• b) Abacavir
• c) Zidovudine
• d) Tenofovir alafenamide (TAF)

Answer: d) Tenofovir alafenamide (TAF)

11. What is the primary goal of antiretroviral therapy (ART)?

• a) To cure the patient of HIV infection.
• b) To suppress HIV viral load to undetectable levels.
• c) To increase the CD4 count to over 1000 cells/mm³.
• d) To prevent only the sexual transmission of HIV.

Answer: b) To suppress HIV viral load to undetectable levels.

12. The concept “Undetectable = Untransmittable” (U=U) means that a person with HIV who maintains an undetectable viral load through ART:

• a) Still has a high risk of transmitting HIV to others.
• b) No longer needs to practice safe sex.
• c) Has effectively no risk of sexually transmitting HIV to an HIV-negative partner.
• d) Can stop taking their ART medications.

Answer: c) Has effectively no risk of sexually transmitting HIV to an HIV-negative partner.

13. A patient is prescribed rilpivirine, an NNRTI. What counseling point is critical for its absorption?

• a) It must be taken on an empty stomach.
• b) It must be taken with an acidic beverage.
• c) It must be taken with a meal (at least 500 kcal).
• d) It should be taken at bedtime to avoid CNS side effects.

Answer: c) It must be taken with a meal (at least 500 kcal).

14. Pre-Exposure Prophylaxis (PrEP) is a strategy where HIV-negative individuals at high risk take specific ART medications to:

• a) Treat an active HIV infection.
• b) Lower their risk of acquiring HIV.
• c) Boost their immune system.
• d) Prepare for post-exposure prophylaxis.

Answer: b) Lower their risk of acquiring HIV.

15. Which of the following is an FDA-approved oral regimen for HIV PrEP?

• a) Tenofovir disoproxil fumarate (TDF) / Emtricitabine
• b) Zidovudine / Lamivudine
• c) Dolutegravir
• d) Darunavir / Ritonavir

Answer: a) Tenofovir disoproxil fumarate (TDF) / Emtricitabine

16. Post-Exposure Prophylaxis (PEP) should be initiated as soon as possible after a potential HIV exposure, and ideally within:

• a) 7 days
• b) 3 days (72 hours)
• c) 24 hours
• d) 1 week

Answer: b) 3 days (72 hours)

17. Protease Inhibitors (PIs) like darunavir and atazanavir are associated with which class of adverse effects?

• a) Renal dysfunction and bone demineralization.
• b) CNS effects and rash.
• c) Metabolic complications like hyperlipidemia, insulin resistance, and lipodystrophy.
• d) Lactic acidosis.

Answer: c) Metabolic complications like hyperlipidemia, insulin resistance, and lipodystrophy.

18. What is the mechanism of action of maraviroc?

• a) It inhibits reverse transcriptase.
• b) It is a protease inhibitor.
• c) It is a CCR5 antagonist, blocking HIV from entering CD4 cells.
• d) It is a fusion inhibitor.

Answer: c) It is a CCR5 antagonist, blocking HIV from entering CD4 cells.

19. A patient with HIV has a CD4 count of 250 cells/mm³. According to guidelines, when should ART be initiated?

• a) When the CD4 count drops below 200 cells/mm³.
• b) When the patient develops an opportunistic infection.
• c) ART should be initiated in all persons with HIV, regardless of CD4 count.
• d) When the viral load is above 100,000 copies/mL.

Answer: c) ART should be initiated in all persons with HIV, regardless of CD4 count.

20. Tenofovir alafenamide (TAF) was developed as an alternative to tenofovir disoproxil fumarate (TDF) because TAF is associated with:

• a) Higher rates of CNS side effects.
• b) Less renal and bone toxicity compared to TDF.
• c) A lower pill burden.
• d) Better efficacy against HIV.

Answer: b) Less renal and bone toxicity compared to TDF.

21. Immune Reconstitution Inflammatory Syndrome (IRIS) is a condition that occurs when:

• a) A patient’s immune system is severely suppressed.
• b) A patient develops resistance to their ART regimen.
• c) A patient’s recovering immune system, after starting ART, mounts an exaggerated inflammatory response to a previously acquired opportunistic infection.
• d) A patient has an allergic reaction to their ART.

Answer: c) A patient’s recovering immune system, after starting ART, mounts an exaggerated inflammatory response to a previously acquired opportunistic infection.

22. Which two drug classes are combined in most recommended initial single-tablet regimens for treatment-naive adults?

• a) PI and NRTI
• b) NNRTI and PI
• c) INSTI and NRTI
• d) Entry inhibitor and NRTI

Answer: c) INSTI and NRTI

23. Atazanavir, a protease inhibitor, can cause an unconjugated hyperbilirubinemia (jaundice or yellowing of the eyes). This is due to its inhibition of which enzyme?

• a) CYP3A4
• b) UGT1A1
• c) CYP2D6
• d) Amylase

Answer: b) UGT1A1

24. The primary goal of ART in a pregnant person with HIV is to:

• a) Cure the mother of HIV.
• b) Treat the fetus in utero.
• c) Prevent perinatal (mother-to-child) transmission of HIV.
• d) Delay the need for the mother to start lifelong therapy.

Answer: c) Prevent perinatal (mother-to-child) transmission of HIV.

25. Enfuvirtide is a fusion inhibitor that is unique because of its:

• a) Once-daily oral dosing.
• b) Lack of side effects.
• c) Route of administration, which is subcutaneous injection twice daily.
• d) Potent activity as a monotherapy.

Answer: c) Route of administration, which is subcutaneous injection twice daily.

26. A patient starting ART with rilpivirine must avoid co-administration with which class of medications due to a significant drug interaction that reduces rilpivirine levels?

• a) Statins
• b) Beta-blockers
• c) Proton Pump Inhibitors (PPIs)
• d) Diuretics

Answer: c) Proton Pump Inhibitors (PPIs)

27. What is the recommended duration of a standard three-drug PEP regimen?

• a) 7 days
• b) 14 days
• c) 28 days
• d) 3 months

Answer: c) 28 days

28. “Genotypic resistance testing” in HIV management is used to:

• a) Determine the patient’s HLA type.
• b) Measure the patient’s viral load.
• c) Identify mutations in the HIV genome that confer resistance to specific antiretroviral drugs.
• d) Count the number of CD4 cells.

Answer: c) Identify mutations in the HIV genome that confer resistance to specific antiretroviral drugs.

29. Which of the following is a potential long-term adverse effect of older NRTIs like stavudine and didanosine, making them no longer recommended for use?

• a) Lipoatrophy and peripheral neuropathy.
• b) Severe rash.
• c) Insomnia.
• d) Nephrolithiasis.

Answer: a) Lipoatrophy and peripheral neuropathy.

30. The most critical factor for achieving and maintaining viral suppression in a person with HIV is:

• a) The cost of the medication.
• b) The pill size.
• c) High levels of adherence to the ART regimen.
• d) The patient’s diet.

Answer: c) High levels of adherence to the ART regimen.

31. A patient with HIV and a CD4 count of 80 cells/mm³ is at high risk for which opportunistic infection?

• a) Pneumocystis jirovecii pneumonia (PJP)
• b) Toxoplasma gondii encephalitis
• c) Mycobacterium avium complex (MAC)
• d) All of the above

Answer: d) All of the above

32. The mechanism of action of NNRTIs involves:

• a) Competitive inhibition of the reverse transcriptase enzyme.
• b) Binding directly to and non-competitively inhibiting the reverse transcriptase enzyme at a site different from the active site.
• c) Blocking the protease enzyme.
• d) Preventing viral DNA integration.

Answer: b) Binding directly to and non-competitively inhibiting the reverse transcriptase enzyme at a site different from the active site.

33. What is the role of the pharmacist in HIV PrEP management?

• a) Prescribing the PrEP medication.
• b) Educating patients about PrEP, discussing adherence, and counseling on risk reduction.
• c) Performing the initial HIV test.
• d) All of the above roles can be performed by a pharmacist, depending on state law and collaborative practice agreements.

Answer: d) All of the above roles can be performed by a pharmacist, depending on state law and collaborative practice agreements.

34. Which single-tablet regimen is contraindicated in patients with a creatinine clearance < 30 mL/min?

• a) Dovato (dolutegravir/lamivudine)
• b) Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide)
• c) Triumeq (dolutegravir/abacavir/lamivudine)
• d) Most STRs containing tenofovir (TDF or TAF) and emtricitabine are not recommended for initiation at this level of renal function.

Answer: d) Most STRs containing tenofovir (TDF or TAF) and emtricitabine are not recommended for initiation at this level of renal function.

35. A patient on a darunavir/cobicistat-based regimen should be advised to take it:

• a) With a full meal.
• b) On an empty stomach.
• c) At bedtime.
• d) Without regard to meals.

Answer: a) With a full meal.

36. A key reason for using two NRTIs as the “backbone” of most ART regimens is:

• a) They have synergistic activity and a high barrier to resistance as a pair.
• b) They have the fewest side effects.
• c) They are the least expensive drugs.
• d) They do not require renal dose adjustments.

Answer: a) They have synergistic activity and a high barrier to resistance as a pair.

37. Which of the following is a long-acting injectable ART regimen?

• a) Biktarvy
• b) Triumeq
• c) Cabenuva (cabotegravir/rilpivirine)
• d) Descovy

Answer: c) Cabenuva (cabotegravir/rilpivirine)

38. The primary goal of HIV screening is to:

• a) Identify individuals with opportunistic infections.
• b) Identify individuals with HIV infection early to link them to care and prevent further transmission.
• c) Determine a patient’s risk behaviors.
• d) Fulfill a legal requirement.

Answer: b) Identify individuals with HIV infection early to link them to care and prevent further transmission.

39. A patient taking tenofovir disoproxil fumarate (TDF) should have what monitored periodically?

• a) Liver function tests.
• b) Serum creatinine and urinalysis for proteinuria.
• c) Blood glucose.
• d) Complete blood count.

Answer: b) Serum creatinine and urinalysis for proteinuria.

40. A major barrier to HIV eradication, even with effective ART, is:

• a) The rapid mutation rate of the virus.
• b) The high cost of medication.
• c) The presence of a latent viral reservoir in resting CD4+ T-cells.
• d) Poor patient adherence.

Answer: c) The presence of a latent viral reservoir in resting CD4+ T-cells.

41. The initial evaluation of a person newly diagnosed with HIV should include:

• a) CD4 count and HIV viral load.
• b) Genotypic resistance testing.
• c) Hepatitis B and C screening.
• d) All of the above.

Answer: d) All of the above.

42. Which opportunistic infection prophylaxis can typically be discontinued once a patient’s CD4 count has been >200 cells/mm³ for at least 3 months on ART?

• a) Mycobacterium avium complex (MAC) prophylaxis.
• b) Pneumocystis jirovecii pneumonia (PJP) prophylaxis.
• c) Hepatitis B vaccination.
• d) Syphilis treatment.

Answer: b) Pneumocystis jirovecii pneumonia (PJP) prophylaxis.

43. A pharmacist receives a prescription for Triumeq. What critical piece of information must be confirmed before dispensing?

• a) The patient’s viral load.
• b) The patient’s recent CD4 count.
• c) The patient’s HLA-B*5701 status.
• d) The patient’s weight.

Answer: c) The patient’s HLA-B*5701 status.

44. Which of the following is a common drug interaction with ritonavir or cobicistat-boosted regimens?

• a) Decreased levels of atorvastatin.
• b) Significantly increased levels of inhaled fluticasone, leading to potential Cushing’s syndrome.
• c) Decreased levels of warfarin.
• d) No significant interactions.

Answer: b) Significantly increased levels of inhaled fluticasone, leading to potential Cushing’s syndrome.

45. The term “treatment-experienced” in HIV care refers to a patient who:

• a) Has never taken ART before.
• b) Has taken ART in the past and may have developed drug resistance.
• c) Is participating in a clinical trial.
• d) Has been cured of HIV.

Answer: b) Has taken ART in the past and may have developed drug resistance.

46. A patient with HIV complains of new, painless, purple-brown lesions on their skin. This is characteristic of what AIDS-defining illness?

• a) Pneumocystis pneumonia
• b) Toxoplasmosis
• c) Kaposi’s sarcoma
• d) Cryptococcal meningitis

Answer: c) Kaposi’s sarcoma

47. Why is adherence to ART so critical?

• a) The medications are very expensive.
• b) Suboptimal adherence can quickly lead to the development of drug-resistant HIV.
• c) The medications have a very long half-life.
• d) It is required by law.

Answer: b) Suboptimal adherence can quickly lead to the development of drug-resistant HIV.

48. Cobicistat differs from ritonavir as a pharmacokinetic booster in that cobicistat:

• a) Also has potent activity against HIV.
• b) Does not have any intrinsic antiretroviral activity.
• c) Is a more potent enzyme inducer.
• d) Does not inhibit CYP3A4.

Answer: b) Does not have any intrinsic antiretroviral activity.

49. An important part of counseling a patient starting ART is to:

• a) Tell them they will be cured in six months.
• b) Emphasize that ART is a lifelong commitment.
• c) Advise them to stop the medication if they experience any side effects.
• d) Inform them that drug interactions are not a concern.

Answer: b) Emphasize that ART is a lifelong commitment.

50. The development of single-tablet regimens (STRs) has significantly improved HIV management primarily by:

• a) Reducing the cost of therapy.
• b) Eliminating all side effects.
• c) Improving convenience and adherence by reducing pill burden.
• d) Curing HIV infection.

Answer: c) Improving convenience and adherence by reducing pill burden.