Virology: HIV virological failure: practice question

A Microbiology 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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Microbiology · Virology: HIV virological failure

Sample item

A 38-year-old man has taken a tenofovir, lamivudine and dolutegravir regimen for 14 months. A routine viral load is 2300 copies/mL. He reports good adherence but admits missing doses during a recent illness. According to current WHO-based programme practice, what is the next step?

AStop all antiretroviral therapy to look for resistanceBEnhanced adherence counselling and repeat viral load after about 3 monthsCSwitch immediately to a second-line regimenDAdd a fourth drug to the current regimen

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

The answer and the reasoning

B. Enhanced adherence counselling and repeat viral load after about 3 months

A viral load above 1000 copies/mL on therapy raises concern for treatment failure, but the commonest cause is poor adherence. The recommended response is enhanced adherence support and a repeat viral load after about 3 months, and switching is done if the viral load remains above 1000 copies/mL. Dolutegravir regimens have a high barrier to resistance.

Option by option

A. Stop all antiretroviral therapy to look for resistance
Stopping therapy risks rebound and selection of resistant virus.
B. Enhanced adherence counselling and repeat viral load after about 3 months (correct)
Repeat testing after adherence support separates adherence problems from true resistance.
C. Switch immediately to a second-line regimen
Immediate switching is premature because the cause is likely missed doses and the regimen has a high resistance barrier.
D. Add a fourth drug to the current regimen
Adding drugs without testing is not recommended and increases toxicity.

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 Microbiology question

What is the answer to this Microbiology question?

The best answer is B, Enhanced adherence counselling and repeat viral load after about 3 months. A viral load above 1000 copies/mL on therapy raises concern for treatment failure, but the commonest cause is poor adherence.

Why is "Stop all antiretroviral therapy to look for resistance" not the answer?

Stopping therapy risks rebound and selection of resistant virus.

Why is "Switch immediately to a second-line regimen" not the answer?

Immediate switching is premature because the cause is likely missed doses and the regimen has a high resistance barrier.

Why is "Add a fourth drug to the current regimen" not the answer?

Adding drugs without testing is not recommended and increases toxicity.

What concept does this question test?

It tests Virology: HIV virological failure in Microbiology. The recommended response is enhanced adherence support and a repeat viral load after about 3 months, and switching is done if the viral load remains above 1000 copies/mL. Dolutegravir regimens have a high barrier to resistance.

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 Virology: HIV virological failure?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology 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.