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Chapter 87. Human Immunodeficiency Virus Infection

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ML is a 56-year-old man who returns to clinic for a discussion of initiating antiretroviral treatment after being recently diagnosed. HIV RNA = 125,000 copies/mL (125 × 106 copies/L) and CD4+ T-cell count = 390 cells/mm3 (390 × 106/L) were obtained 2 weeks ago. The baseline HIV genotype shows NNRTI resistance. He is 6’ tall (183 cm) and weighs 176 lbs (80 kg). Today, his laboratory test results reveal a serum creatinine of 1.43 mg/dL (126 μmol/L). He is HLA-B*5701 negative. His current medications include simvastatin 40 mg daily, hydrochlorothiazide 25 mg daily, omeprazole 20 mg, and sildenafil 50 mg daily 1 hour prior to sexual activity. He states that he prefers a regimen that requires the “least number of pills per day.” Which regimen would be the best for this antiretroviral-naïve patient?

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A. Tenofovir + emtricitabine + efavirenz

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B. Tenofovir + emtricitabine + rilpivirine

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C. Tenofovir + emtricitabine + elvitegravir + cobicistat

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D. Abacavir + lamivudine + dolutegravir

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E. Tenofovir + emtricitabine + atazanavir

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Which of the following is/are true regarding cobicistat?

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A. Cobicistat is a pharmacokinetic enhancer that is administered with raltegravir.

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B. Cobicistat is an integrase inhibitor with potent antiviral activity.

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C. Cobicistat has a very low potential for drug interactions.

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D. Cobicistat is a pharmacokinetic enhancer that is administered with elvitegravir.

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E. A and C

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Which of the following recommended regimens for antiretroviral naïve patients should be avoided if the baseline HIV RNA is greater than or equal to 100,000 copies/mL (100 × 106 copies/L)?

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A. Tenofovir + emtricitabine + efavirenz

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B. Tenofovir + emtricitabine + elvitegravir + cobicistat

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C. Tenofovir + emtricitabine + atazanavir + ritonavir

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D. Tenofovir + emtricitabine + rilpivirine

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E. Tenofovir + emtricitabine + dolutegravir

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Which of the following is/are commonly associated with the use of atazanavir?

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A. Neuropsychiatric events

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B. Hyperbilirubinemia

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C. Hyperphosphatemia

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D. A and B only

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E. A, B, and C

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