WBR0008

Author	PageAuthor::Anonymous (Edited by Ayokunle Olubaniyi)
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Infectious Disease, SubCategory::Infectious Disease
Prompt	[[Prompt::A 23-year-old HIV-positive woman recently started on HAART therapy comes to the health center for a checkup. Her CD4 count has been decreasing over the last 5 months, although she remains asymptomatic. Physical examination is essentially normal but her current CD4 count reveals 192 mm3. What prophylactic medication is appropriate at this time?]]
Answer A	AnswerA::Isoniazid and rifampin.
Answer A Explanation	AnswerAExp::These are used in the treatment of tuberculosis.
Answer B	AnswerB::Penicillin G
Answer B Explanation	AnswerBExp::This is usually used to treat HIV infected patients with concomitant infection with syphilis. It is not used as a prophylactic medication against PCP.
Answer C	AnswerC::Valacyclovir.
Answer C Explanation	AnswerCExp::valaciclovir is effective in preventing cytomegalovirus in patients with HIV.
Answer D	AnswerD::Trimethoprim/sulfamethoxazole
Answer D Explanation	[[AnswerDExp::This is the drug of choice for the prevention of PCP among HIV-infected patients with CD4+ count of <200 cells/µL.]]
Answer E	AnswerE::Ketoconazole.
Answer E Explanation	AnswerEExp::This is effective in treating opportunistic fungal infections e.g., candidiasis, among HIV-infected patients.
Right Answer	RightAnswer::D
Explanation	[[Explanation::Pneumocystis pneumonia (PCP) is relatively rare in people with normal immune systems but common among people with weakened immune systems, such as premature or severely malnourished children, the elderly, and especially AIDS patients, in whom it is most commonly observed today. PCP can also develop in patients who are taking immunosuppressant medications (e.g. patients who have undergone solid organ transplantation) and in patients who have undergone bone marrow transplantation. HIV-infected adults and adolescents, including pregnant women and those on antiretroviral therapy, should receive chemoprophylaxis against PCP if they have a CD4+ count of <200 cells/µL (AI). The drug of choice is Trimethoprim/sulfamethoxazole (TMP-SMX). Educational Objective: PCP is an opportunistic infection commom among HIV-infected patients with a CD4+ count of <200 cells/µL. The drug of choice is TMP-SMX. References: "The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1. Multicenter AIDS Cohort Study Group". N. Engl. J. Med. 322 (3): 161–5. doi:10.1056/NEJM199001183220304 "Risk factors for primary Pneumocystis carinii pneumonia in human immunodeficiency virus-infected adolescents and adults in the United States: reassessment of indications for chemoprophylaxis". J. Infect. Dis. 178 (4): 1126–32. http://www.wikidoc.org/index.php/HIV_opportunistic_infection_pneumocystis_pneumonia:_prevention_and_treatment_guidelines#Treatment_of_Disease]]
Approved	Approved::No
Keyword	WBRKeyword::HIV, WBRKeyword::HIV opportunistic infections, WBRKeyword::Pneumocystis carinii prophylaxis
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