C P D  Q U E S T I O N S
Journal 36

Two CPD points are awarded for the correct completion and submission of the questions below.

CPD questionnaires must be completed online via www.cpdjournals.org.za.
After submission you can check the answers and print your certificate.

Questions may be answered up to 6 months after publication of each issue.
This programme is available free of charge to members of the HIV Clinicians Society and SAMA only.

1. True (A) or false (B) – click on the correct answer:
 The new SA HIV Clinicians Society Guidelines state that 

all infants under 2 years of age should start antiretroviral 
therapy (ART) irrespective of their CD4 count or clinical stage. 

2. True (A) or false (B) – click on the correct answer:
 The Guidelines state that all infants under 1 year of age 

should start ART irrespective of their CD4 count or clinical 
stage. 

3. True (A) or false (B) – click on the correct answer:
 The Guidelines state that tenofovir + FTC or 3TC is the ideal 

NRTI backbone for children. 

4. True (A) or false (B) – click on the correct answer:
 The Guidelines state that abacavir + 3TC is the ideal NRTI 

backbone for children. 

5. True (A) or false (B) – click on the correct answer:
 With regard to lipodystrophy, efavirenz has been implicated in 

lipomastia (fat deposited in the breasts). 

6. True (A) or false (B) – click on the correct answer:
 Breast enlargement typically resolves without changing the 

regimen. 

7. True (A) or false (B) – click on the correct answer:
 Lipo-atrophy of the face typically resolves without changing 

the regimen. 

8. True (A) or false (B) – click on the correct answer:
 It is only necessary to substitute another agent for the 

offending agent when the lipo-atrophy is severe. 

9. True (A) or false (B) – click on the correct answer:
 The commonest agent implicated in lipo-atrophy is stavudine 

(d4T). 

10. True (A) or false (B) – click on the correct answer:
 With regard to changing ART in children, the regimen should 

be changed when the viral load returns to baseline. 

11. True (A) or false (B) – click on the correct answer:
 An isolated viral load of 600 is called a blip and is a sign that 

the regimen must be changed. 

12. True (A) or false (B) – click on the correct answer:
 Do not change therapy until adherence issues have been 

resolved. 

13. True (A) or false (B) – click on the correct answer:
  3TC monotherapy should only be used as a temporary 

measure in a patient with a good CD4 level who has failed 
3TC previously. 

14. True (A) or false (B) – click on the correct answer:
 The M185E mutation is the classic 3TC resistance mutation. 

15. True (A) or false (B) – click on the correct answer:
 With regard to the abacavir hypersensitivity reaction (HSR), 

HLA-B*5701 is common in black Africans. 

16. True (A) or false (B) – click on the correct answer:
 Trimethoprim-sulfamethoxazole, nevirapine and efavirenz 

may cause a very similar HSR. 

17. True (A) or false (B) – click on the correct answer:
 Only 50% of patients experience the HSR within 6 weeks 

after starting abacavir. 

18. True (A) or false (B) – click on the correct answer:
 Fever is the most common manifestation of ABC HSR, 

occurring in 80% of cases. 

19. True (A) or false (B) – click on the correct answer:
 Isolated gastro-intestinal symptoms such as nausea, 

vomiting, diarrhoea and abdominal pain may be a feature of 
ABC HSR, and ABC should be discontinued promptly if they 
occur. 

20. With regard to immune reconstitution inflammatory 
syndrome (IRIS) in children, state which one of the following 
is TRUE:

 a)  The most common cause of IRIS in infants in South Africa 
is tuberculosis.

 b)  One of the differentials for paradoxical TB IRIS is resistant 
TB. 

 c) BCG is never resistant to pyrazinamide (PZA).
 d)  Kaposi’s sarcoma does not present as an IRIS in children 

because it is a malignancy and not an infection. 
 e) Steroids should be used in all cases of IRIS.