All-India Preliminary Round: 10th November 2013: 10 am

There are 100 Questions to be answered within 60 minutes. Every question has only one best possible answer.
1. First dose of post exposure prophylaxis is to be taken as soon as possible, but certainly within --hours of exposure a. 12 b. 24 c. 72 d. 120 Answer: c 2. The latest WHO Guidelines strongly recommend a) Starting all symptomatic HIV +ve pregnant women and breast feeding women on triple drug ART b) Starting all pregnant women and breast feeding women with HIV with CD4 count < 350 cells/c. mm on triple drug ART c) Starting all pregnant women and breast feeding women with HIV on triple drug ART d) Starting all pregnant women and breast feeding women with HIV with CD4 count < 500 cells/c. mm on triple drug ART Answer: c 3. The latest WHO Guidelines recommend that a) ART should be initiated in all children infected with HIV only if their CD4 is less than 14%. b) ART should be initiated in all children infected with HIV below two years of age, regardless of WHO clinical stage or CD4 cell count c) ART should be initiated in all children infected with HIV below five years of age, regardless of WHO clinical stage or CD4 cell count d) ART should be initiated in all HIV-infected children five years of age and older, regardless of WHO clinical stage or CD4 count Answer: c 4. As per the latest WHO Guidelines, LPV/r-based regimen should be used as first-line ART

a) For all children infected with HIV < three years (36 months) of age, regardless of NNRTI exposure b) For all children infected with HIV > three years (36 months) of age, regardless of NNRTI exposure c) For all children infected with HIV < three years (36 months) of age, only if NNRTI exposure present for PMTCT d) For all children infected with HIV > three years (36 months) of age, only if NNRTI exposure present for PMTCT Answer : a 5. For the WHO surveillance for transmitted drug resistance, all are true except: a. b. c. d. Answer: a 6. Recently the USFDA approved the use of Efavirenz in children a) b) c) d) 3 months to 3 years old weighing more than 3.5 kg 3 months to 3 years old weighing less than 3.5 kg more than 3 years old weighing more than 10 Kg more than 5 years old Cities or areas where ART has been available for less than one year are chosen Males selected must be ART-nave males and less than 25 years Women selected must be ART-nave, less than 25 years, without previous pregnancies Areas are classified as having resistance <5%, 5-15%, >15%

Answer: a 7. Recently the USFDA and European Medicines Agency approved using Tenofovir for children a) b) c) d) older than two years of age younger than two years of age older than six years of age older than sixteen years of age

Answer : a 8. All the following are approved for use in neonates and infants, except

a) b) c) d)

Dolutegravir Raltegravir Saquinavir Tipranavir

Answer: b 9. Of the following; which drug causes hypersensitivity reaction, hence needs HLA-B5701 testing

a. b. c. d. Answer: c

Tenofovir Darunavir Abacavir Raltegravir

10. Which of the following NRTI must be taken before food a. b. c. d. Answer: d 11. Which of the following drug acts on Integrase enzyme a. b. c. d. Answer: c 12. Which group of family HIV belongs to? a. Adenovirus b. Retrovirus c. Togavirus d. Rotavirus Answer: b 13. In co-infection of HIV and HCV, all are true except: a. ART should be considered for most HIV/HCV-coinfected patients, regardless of CD4 count. b. Telaprevir and Boceprevir cannot be used to treat HCV with HIV c. There is three times greater risk of progression to cirrhosis or decompensated liver disease as compared to HCV-monoinfected patients d. For patients with CD4 counts <200 cells/mm3, it may be preferable to initiate ART and delay HCV therapy until CD4 counts Answer: c 14. Which drug would require a dosing adjustment for a documented creatinine clearance of less than 30 mL/minute? a. Efavirenz b. Lamivudine Maraviroc Enfurtide Raltegravir Etravarine Abacavir AZT Lamivudine Didanosine

c. Abacavir d. Nevirapine Answer: b 15. Infusion of which of the following has the least chance of transmitting HIV infection? a. b. c. d. Albumin Platelets Plasma Immunoglobulin Answer : d 16. Which among the following ART drugs have best CNS penetration effectiveness score a. b. c. d. Answer B 17. In immediate treatment arm of the HPTN 052 trial, HIV infected partner in discordant setting received ART when his/her CD4 count was; a. b. c. d. Answer: B 18. What is the most appropriate intervention to prevent MTCT in a HIV- 2 pregnant woman with an undetectable viral load; a. b. c. d. Answer: D 19. What is the most appropriate management in a HIV positive woman on Tenofovir+Lamivudine+ Efavirenz with a suppressed viral load who now informs you that she has missed her periods for last three months and is found to be pregnant a. Change her Efavirenz b. Continue same regimen Avoid breast feeding Avoid breast feeding Avoid breast feeding Avoid breast feeding + LSCS + LSCS+ Zidovudine + LSCS +Zidovudine + Nevirapine + LSCS + Zidovudine + Lamivudine + boosted Lopinavir Less than 350 cells Between 350 to 550 cells < 500 cells At any CD4 count Tenofovir AZT Enfuvirtide EFV

c. Suggest she should undergo MTP d. Change her Tenofovir Answer : B 20. Which single drug combination when used together has the highest risk of causing peripheral neuropathy and lactic acidosis; a. b. c. d. Answer: B 21. The highest overall HIV prevalence rate among different sub-populations in India currently is observed among; a. b. c. d. Answer: B 22. According to the recent report by NACO the adult prevalence of HIV in India is a. b. c. d. Answer: a 23. According to the National Guidelines, ART is to be initiated if the CD4 counts go below ; a. b. c. d. Answer: C 24. Following tests are considered essential before initiating ART except a. b. c. d. Answer: C HIV test CD4 count Plasma Viral Load Haemogram <200 cells <250 cells <350 cells <500 cells 0.31 % 0.51% 1.1% 2.1% Female sex workers Injecting drug users STD clinic attendees Men having sex with men Zidovudine + Stavudine Stavudine + ddI Stavudine+Lamivudine Abacavir+Lamivudine

25. Which of the AIDS-defining illnesses is rarely seen in India; a. b. c. d. Answer: c 26. Kaposis sarcoma is caused by; a. b. c. d. Answer: A 27. Following vaccines are contraindicated in an HIV infected individual with severe immunosuppression; a. b. c. d. Answer: C 28. Sexually Transmitted Proctocolitis can be caused among men having sex with men by following organisms; a. b. c. d. Answer: D 29. The CD4 count is known to reveal; a. b. c. d. Answer: D 30. According to the recent WHO guidelines to initiate ART (2013), ART should be initiated irrespective of CD4 counts among patients with except; Diurnal variation Impacted by other co-infection/s Impacted by smoking All of the above E.Coli Campylobacter Syphilis All of the above Hepatitis B Hepatitis A Varicella All of the above Human Herpes Virus 8 Human Papilloma Virus 18 Parvo Virus West Nile Virus Penicillium marneffei infection Cytomegalovirus disease Kaposis sarcoma Cryptococcosis

a. b. c. d. Answer: A

Any patient having hepatitis B Any patient in HIV discordant couple setting Any patient with HIV- tuberculosis None of the above

31. Use of Rifabutin based anti-TB treatment needs to be given in case the patient is receiving any of the following antiretroviral except; a. b. c. d. Answer: a 32. Fanconis syndrome is most likely to be associated with this antiretroviral drug: a. b. c. d. Answer: c 33. ART regime in a child less than 3 years and on Anti-tuberculosis treatment is a. b. c. d. Answer: d 34. Following antiretrovirals can be given if the Child-Pugh Score is 7 except: a. b. c. d. Unboosted Atazanavir Raltegravir Lamivudine Abacavir Answer: d 35. Co-trimoxazole in a patient with HIV is drug of choice for all except a. b. c. d. Prophylaxis against Toxoplasmosis Prophylaxis against P.jiroveci pneumonia Treatment of Cryptosporidium Treatment of Isospora belli Two NRTIs + NVP Triple NRTI (AZT + 3TC + ABC) Two NRTI + EFV Either a or b Boosted Atazanavir Efavirenz Tenofovir Indinavir Nevirapine Any protease inhibitor Raltegravir Etravirine

Answer: c 36. Following categories of cardiovascular medications can cause drug-drug interactions in a patient receiving ART regimen that includes boosted Atazanavir except; a. b. c. d. Answer: C 37. The following medications used in an HIV patient can cause bone marrow suppression excepta. Trimethoprim/Sulphamethoxazole b. Tenofovir c. Interferon-alpha d. Foscarnet Answer: b 38. In a patient receiving boosted PI based regimen and having dyslipidemia, one can prescribe following anti-lipemic drugs except; a. b. c. d. Answer: C 39. Dose adjustment is required for the following antiretroviral drugs in patient having CKD with impaired creatinine clearance except: a. Tenofovir b. Lamivudine c. Stavudine d. Abacavir Answer: D 40. Inhaled corticosteroids including Fluticasone should be avoided in patients receiving boosted Atazanavir or other PI based regime as it can cause; a. b. c. d. Answer: a 41. Of all the antiretroviral drug classes, those that are not associated with Lipoatrophy are; Cushing Syndrome Diabetes Gastric Ulcers Atrophic rhinitis Rosuvastatin Atorvastatin Simvastatin Ezetimibe Calcium Channel Blockers Beta blockers ACE inhibitors Digoxin

a. b. c. d. Answer: d

NNRTI NRTI PI INSTI

42. Dose of Sildenafil needs to be reduced if the patient is also receiving following class of drugs; a. b. c. d. Answer: C 43. The preferred drug to treat Pneumocystis jiroveci pneumonia (PCP) is; a. b. c. d. Answer: A 44. Proton Pump inihibitors should not be given in patients receiving; a. b. c. d. Answer: b 45. Which of the following drugs is an entry-inhibitor a. b. c. d. Maraviroc Enfuviritide Both None Efavirenz Atazanavir Lopinavir Abacavir Trimethoprim+Sulphamethoxazole Trimethoprim+Sulphamidine Dapsone Primaquine NNRTI NRTI PI INSTI

Answer: C 46. The predominant HIV-1 subtype circulating in India is; a. b. c. d. A B C D

Answer: C 47. The risk of acquisition of HIV by needle stick injury is; a. b. c. d. Answer: C 48. Of the organisms listed, the organism that has the highest risk of transmission due to occupational exposure is: a. b. c. d. Answer: B 49. The window period for detection of HIV antibodies is a. b. c. d. Answer: B 50. Following is true for HIV-2 EXCEPT a. b. c. d. Answer: D 51. Which body fluid contains the highest concentration of HIV? a. b. c. d. Answer: C 52. Which of the following antiretroviral agents is not active against HIV-2? a. Zidovudine Blood Serum C.S.F. Saliva The transmission rate is lower than HIV 1 It has a slower progression as compared to HIV 1 Treatment differs from HIV 1 In India, under Early Infant Diagnosis programme, diagnosis of HIV 2 is done by DNA PCR 10-15 days 6 weeks to 6 months 6 months to 1 year 2-4 weeks Hepatitis C Hepatitis B HIV Both b and c 10-20% 5-10% 0.1-1% 0.5-2%

b. Nelfinavir c. Nevirapine d. ddI Answer : C 53. The state with highest HIV prevalence is a. b. c. d. Maharashtra Uttar Pradesh Andhra Pradesh Manipur

Answer: d 54. All HIV exposed children should be provided; a. b. c. d. Answer: D 55. HIV positive male taking treatment for tuberculosis (CAT1) and has Hb of 7 gms%.. Which ART regime will be advocated in this patient a. b. c. d. Answer:A 56. The National Free ART Program started in; a. b. c. d. Answer: C 57. The Nobel Prize for discovering HIV was given to; a. b. c. d. Dr. Robert Gallo Dr. Anthony Fauci Dr. Barre-Sinnousi & Dr. Luc Montagnier Dr. Jay Levy 1999 2001 2004 2006 TDF + 3TC +EFV AZT + 3TC +NVP AZT + 3TC +LPV/r TDF + 3TC +ATV/r Trimethoprim/Sulphamethoxazole Prophylaxis from 4 weeks age Dried blood spot PCR for Early Infant Diagnosis Age appropriate vaccines All of the above

Answer: C 58. Identify the Protease inhibitor that is associated with decreased level of Ethinyl Estradiol when given as a boosted PI and increased level when given without boosting a. b. c. d. Answer: B 59. Plasma Viral Load estimation is basically an a. b. c. d. Answer: B 60. Identify irrational treatment in an HIV infected person having Hepatitis B infection a. b. c. d. Answer D 61. M184V mutation is associated with: a. b. c. d. Answer: d 62. The theme for World AIDS Day 2013 is a. b. c. d. Answer: C 63. The risk of transmission of HIV is highest among those who had unprotected sex and were; a. Receptive partner in peno-oral sex Stop AIDS. Keep the Promise Lead Empower Deliver Stop AIDS. Keep the Promise Getting to Zero Universal Access and Human Right Development of resistance to Emtricitabine It reduces the ability of virus to replicate rapidly It is one of the commonest mutations among patients failing on 2NRTI+NNRTI regimen All of the above Tenofovir+Lamivudine+Efavirenz Zidovudine+Lamivudine+Efavirenz+Adefovir ARV Nave receiving Adefovir + Lamivudine ARV nave receiving Entecavir DNA PCR RNA PCR Haplotyping Genotyping Lopinavir Atazanavir Darunavir Indinavir

b. Receptive partner in peno-vaginal sex c. Receptive partner in peno-anal sex d. Insertive partner in peno- anal sex Answer: C 64. Chancroid is caused by: a. Treponema palladium b. H. simplex c. H. influenzae d. Hemophilus ducreyi Answer: D 65. Identify an antiretroviral drug that is contraindicated in Post-exposure Prophylaxis; a. b. c. d. Answer: C 66. In presence of K65R mutation, one should use one of these NRTIs; a. b. c. d. Answer: D 67. Which of these conditions is not an AIDS-defining condition; a. b. c. d. Answer: C 68. Which of these drugs among NRTIs can be given in a patient developing Lactic Acidosis a. b. c. d. Answer: D Zidovudine Stavudine ddI Tenofovir Extra-pulmonary Tuberculosis Invasive Cervical Cancer Oral Hairy Leukoplakia Cryptococcal meningitis Abacavir Tenofovir Stavudine Zidovudine Saquinavir Indinavir Nevirapine Efavirenz

69. Which of these tests for detecting HIV infection has least window period? a. b. c. d. Answer: D 70. Of the following approaches to cure, identify one that has not been reported to have worked: a. b. c. d. Answer: C 71. What do the 3 I's stand for in TB-HIV joint collaborative activities? A. Intensified case finding, INH chemoprophylaxis and Integrated healthcare B. Infection control, integrated healthcare and INH chemoprophylaxis C. Intensified case finding, INH chemoprophylaxis and Infection control D. Integrated healthcare, Intensified case finding and Infection control Answer: C 72. Which of the following newer vaccines against TB also has the potential to lead to clinically significant rise in CD4+ T lymphocyte count? A. Recombinant BCG B. MVA-85 (Modified Vaccine - Ankara vector) C. Mycobacterium W D. Subunit fusion protein vaccines Answer: B 73. What is FALSE regarding safe handling of sharps in universal precautions? A. Single hand method need not be used where recapping of needles is necessary B. Forceps instead of fingers should be used for guiding sutures C. All sharps should be disposed in puncture proof containers containing bleach D. Prefer single use disposable injection equipment for all injections in HIV positive patients Answer: A 74. All of the following are characteristics of HIV retinopathy except: a. Commonest manifestation of ocular HIV Treating HIV infection very early (during Primary HIV infection) in adults Bone-marrow transplant of a donor who had homozygous delta 32 CCR5 mutation Intensifying ART when Plasma Viral load has become undetectable Treating HIV infection very early (during Primary HIV infection) in a newborn Anti-HIV ELISA Western blot P24 antigen test HIV RNA PCR

b. Cotton-wool spots are common ophthalmoscopic findings c. CMV retinitis is an important differential diagnosis d. Left untreated it progresses to blindness Answer D 75. All of the following are true in respect to Toxoplasma encephalitis except: a. b. c. d. Answer: C 76. Spinal cord involvement occurs in all of the following except a. b. c. d. Answer: B 77. The diagnosis of HIV in a child less than 18 months is best done by a. b. c. d. Answer: D 78. Lymphcytic Interstitial Pneumonia(LIP) is associated with all of the following except a. b. c. d. Answer: d 79. Which of the following statement(s) about testing strategy for diagnosis of HIV infection is/are true? a) The specimen is tested thrice by a particular rapid test with high sensitivity. b) The specimen is tested by indirect EIA from two different companies that employ identical antigens for coating the EIA plate Lymphoid infiltration of lung Hypoxia and bilateral clubbing Imaging findings mimic those of P. jiroveci pneumonia Corticosteroid may aggravate situation HIV-1 detuned-ELISA P 24 antigen assay HIV-1 Western Blot HIV-1 DNA PCR HIV encephalopathy Toxoplasmosis Tuberculosis Syphilis Common cause of ring enhancing lesion in HIV-infected subjects There is a predilection of involvement of basal ganglia Anti-toxoplasma IgM antibodies are found in ~ 75% of cases Treatment of choice is combination of Sulfadiazine, Pyrimethamine and leucovorin

c) The specimen is tested by three tests (EIA/rapid) based on different principles/ different antigen preparations. d) All of the above Answer: C 80. Cottage cheese and ketchup appearance of retina signifies--A. B. C. D. Answer: C 81. According to WHO guidelines, ART should be initiated in all children infected with HIV five years of age and older a. b. c. d. Answer: a 82. WHO guidelines recommend the following as the first line regime in pregnant and breastfeeding women: a. b. c. d. TDF + 3TC (or FTC) + EFV TDF + 3TC (or FTC) + NVP AZT + 3TC + d4T AZT + 3TC + NVP With CD4 cell count 500 cells/cmm regardless of WHO clinical stage With CD4 cell count 350 cells/cmm regardless of WHO clinical stage With WHO clinical stage 3 or 4 regardless of CD4 count Both a and c are correct Ethambutol toxicity HIV retinopathy CMV Retinitis Toxoplasma retinitis

Answer: a 83. HIV is a a. b. c. d. ssDNA virus dsDNA-RT virus ssRNA-RT virus dsRNA virus

Answer: c 84. The antifungal of choice in a patient on a regime containing Nevirapine is a. Itraconazole b. Fluconazole c. Ketoconazole

d. None of the above Answer: b 85. Treatment of choice for Plasmodium falciparum malaria in a HIV positive patient on Efavirenz based regime is a. b. c. d. Artemether plus Lumefantrine Artesunate and Amodiaquine Chloroquine alone Chloroquine plus Doxycycline

Answer: a 86. Which of the following is not an NRTI a. b. c. d. Lamivudine Delaviridine Stavudine Abacavir

Answer : b 87. All of the following medications used in an HIV patient can cause bone marrow suppression except? a. zidovudine b. tenofovir c. interferon-alpha d. foscarnet Answer: b 88. CD4 is a glycoprotein found on the surface of all except: a. b. c. d. Monocytes Macrophages Dendritic cells NK cells

Answer: d 89. One of the following statements of the Western Blot is false: a. Test is considered positive if antibodies exist to two of the three HIV proteins: p24, gp41, gp 120/160 b. The most common cause of Indeterminate result in low-risk individual is antibody crossreactivity c. It is more sensitive than ELISA d. If ELISA is positive and Western Blot is negative, the diagnosis of HIV-1 is ruled out Answer: c

90. One of the following statements regarding Immune Reconstitution Inflammatory Syndrome is false: a. b. c. d. Answer: b 91. In HIV-positive patients with recent diagnosis of cryptococcal meningitis: a. ART should be initiated immediately b. ART should be initiated after two to four weeks of induction/consolidation treatment with amphotericin plus fluconazole c. Maintenance fluconazole can be stopped after 8 weeks d. Positive cultures or cryptococcal Ag detection in blood has no significance Answer: b 92. One of the following is not a common opportunistic protozoa causing diarrhoea in HIV-infected individual a. b. c. d. Cryptosporidia Balantidium Isospora belli Microsporidia Paradoxical worsening of clinical condition within 2weeks to 2 years of initiation of ART Use of glucocorticoids can prove to be fatal Most common in patients starting therapy with CD4 counts <50 Common in patients with untreated underlying TB and fungal infections

Answer: b 93. Which of the following drugs is being phased from the first-line regime due its metabolic toxicities? a. b. c. d. Zidovudine Stavudine Nevirapine Efavirenz

Answer: b 94. Most common skin manifestation in HIV is a. b. c. d. Herpes Zoster Herpes simplex Seborrheic dermatitis Scabies

Answer: c 95. Application of the one of the following vaginal gels might decrease transmission of HIV: a. Tenofovir b. Spermicide nonoxynol-9

c. Lamivudine d. Both a and b Answer: a 96. Drugs recommended for pre-exposure prophylaxis by HIV negative individuals are a. b. c. d. Tenofovir with Emtricitabine Tenofovir with Lamivudine Zidovudine with Lamivudine Boosted Lopinavir

Answer: a 97. HIV virus interacts with the following co-receptor to infect a cell a. b. c. d. CD4 CCR5 CXCR4 Both b and c

Answer: d 98. People living with HIV/AIDS worldwide (2011) is a. b. c. d. 34 billion 3.4 billion 34 million 3.4 million

Answer: c 99. If a sero-discordant couple wishes to conceive, options to reduce transmission are a. b. c. d. Treatment as Prevention to HIV positive partner Pre-exposure prophylaxis to HIV negative partner Sperm washing and artificial insemination All of the above

Answer: d 100. GeneXpert is a diagnostic test that can identify Mycobacterium Tuberculosis and a. b. c. d. Mutations conferring resistance to Rifampicin Mutations conferring resistance to Isoniazid and Rifampicin Results are available after 24 hours Has a high specificity but low sensitivity when compared to microscopy

Answer: a