84    SAJHIVMED   June 2012, Vol. 13, No. 2  

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TRUE (A) or FALSE (B) – click on the correct answer:

Regarding levels of soluble inflammatory markers in HIV 
infection
1.    The kidneys are the major source of increased levels of 

procalcitonin during acute infection.

2.    Levels of C-reactive protein may be used to distinguish 
bacterial from viral infections.

3.    Neopterin is produced by macrophages and is a marker of 
cell-mediated immunity.

4.    Levels of neopterin may be lower in individuals with 
untreated HIV infection, compared with individuals on 
antiretroviral therapy.

Regarding reliability of CD4 cell count enumeration
5.    CD4 cell counts vary naturally according to the time of day 

(diurnal variation) and by the site of phlebotomy.

6.    The time delay between phlebotomy and laboratory testing 
can influence CD4 cell count results, and the World Health 
Organization recommends conducting tests within 72 
hours of specimen collection.

7.    Data from Swaziland show that there is variability in 
CD4 count results within and between laboratories; this 
variability may lead to incorrect decisions to initiate 
antiretroviral therapy in up to 20% of patients.

Regarding tumour necrosis factor-alpha
8.    High levels of TNF-alpha may help to reduce HIV viral 

replication.

9.    TNF-alpha levels may be increased in individuals with 
particular genetic variations, such as -308 TNF-alpha 
polymorphisms.

10.  There is clear evidence that -308 TNF-alpha polymorphisms 
occur more commonly in HIV-infected individuals than 
uninfected individuals.

Regarding cytomegalovirus (CMV) retinitis
11.  Intravitrial gancyclovir injections are the gold-standard for 

managing CMV retinitis.

12.  With management through gancyclovir injections and 
antiretroviral therapy, the vast majority of patients with 
visual loss due to CMV-retinitis will regain normal visual 
function.

13.  CMV disease in the retina occurs early in the course of HIV 
disease, and the incidence of CMV-retinitis is not affected 
by use of antiretroviral therapy.

Regarding pneumocystis pneumonia
14.  Patients with pneumocystis pneumonia who require 

mechanical ventilation have a high risk of mortality.

15.  Lung fibrosis may help to explain the poor prognosis 
of patients with pneumocystis pneumonia who require 
ventilation.

16.  Pneumocystic jirovecii is universally sensitive to 
trimethoprim-sulfamethoxazole, and antibiotic resistance 
is unknown.

Regarding anaemia in the context of HIV infection
17.  Bone marrow infiltration from AIDS-related conditions 

is common in advanced, untreated HIV; this may be 
evidenced by a pancytopaenia, or an anaemia with minimal 
reticulocyte production.

Regarding pre-exposure prophylaxis to prevent HIV infection
18.  Use of tenofovir or Truvada for PrEP requires monitoring of 

renal function and annual bone mineral density scanning in 
all individuals (e.g. DEXA).

19.  Real-world adherence to PrEP regimens is a critical 
determinant of their effectiveness in preventing HIV 
infection, and ongoing adherence counseling is required.

20.  Careful consideration needs to be given to drug-drug 
interactions in PrEP, as tenofovir may interact with 
cimetidine, metformin and some aminoglycosides.

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