Infectious diseases: HIV and tuberculosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Infectious diseases: HIV and tuberculosis

Sample item

A man newly diagnosed with HIV, with a CD4 count of 30 cells/mm3, has smear-positive pulmonary tuberculosis and no neurological symptoms. He starts antituberculosis treatment. What is the best timing for starting antiretroviral therapy?

AAfter 8 weeks of antituberculosis treatmentBWithin 2 weeks of starting antituberculosis treatmentCAfter completing 6 months of antituberculosis treatmentDOnly when the CD4 count rises above 200

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Within 2 weeks of starting antituberculosis treatment

In HIV-associated tuberculosis, antituberculosis treatment is started first, and ART is begun within 2 weeks when the CD4 count is below 50, because delay raises mortality. In patients with higher CD4 counts ART can wait up to 8 weeks, and in tuberculous meningitis it is deferred to reduce serious adverse events. Dolutegravir dose is increased to twice daily with rifampicin, and IRIS should be anticipated.

Option by option

A. After 8 weeks of antituberculosis treatment
Delay to 8 weeks suits patients with higher CD4 counts, but is harmful at a CD4 of 30.
B. Within 2 weeks of starting antituberculosis treatment (correct)
Early ART within 2 weeks improves survival in severe immunosuppression.
C. After completing 6 months of antituberculosis treatment
Delaying until treatment completion exposes him to prolonged, severe immunodeficiency.
D. Only when the CD4 count rises above 200
Waiting for CD4 recovery is not possible without ART and is not recommended.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Within 2 weeks of starting antituberculosis treatment. In HIV-associated tuberculosis, antituberculosis treatment is started first, and ART is begun within 2 weeks when the CD4 count is below 50, because delay raises mortality.

Why is "After 8 weeks of antituberculosis treatment" not the answer?

Delay to 8 weeks suits patients with higher CD4 counts, but is harmful at a CD4 of 30.

Why is "After completing 6 months of antituberculosis treatment" not the answer?

Delaying until treatment completion exposes him to prolonged, severe immunodeficiency.

Why is "Only when the CD4 count rises above 200" not the answer?

Waiting for CD4 recovery is not possible without ART and is not recommended.

What concept does this question test?

It tests Infectious diseases: HIV and tuberculosis in General Medicine. In patients with higher CD4 counts ART can wait up to 8 weeks, and in tuberculous meningitis it is deferred to reduce serious adverse events. Dolutegravir dose is increased to twice daily with rifampicin, and IRIS should be anticipated.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infectious diseases: HIV and tuberculosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.