General Medicine for NEET-PG
HIV and Antiretroviral Therapy for NEET-PG
HIV and antiretroviral therapy cover the natural history of infection, opportunistic infections, and the drug classes used to suppress the virus, and this is a dependable NEET-PG topic. The subject links microbiology, immunology, pharmacology, and public health, so it produces a wide range of questions. Because management is guided by CD4 counts and standardised regimens, the CD4 thresholds for opportunistic infections and the structure of first-line therapy are the key deliverables. Examiners favour the diagnostic testing algorithm, the CD4-linked opportunistic infections and their prophylaxis, the first-line antiretroviral regimen, and prevention of mother-to-child transmission. Immune reconstitution inflammatory syndrome and post-exposure prophylaxis recur frequently. The topic links to tuberculosis, obstetrics, and pharmacology. Common traps include mismatching an opportunistic infection to the wrong CD4 threshold, forgetting that all diagnosed patients now start therapy regardless of CD4 count, confusing the drug class adverse effects, and overlooking interactions between antiretrovirals and rifampicin in coinfected patients.
MedNext Academy | 3 min read
HIV and Antiretroviral Therapy for NEET-PG
HIV and antiretroviral therapy cover the natural history of infection, opportunistic infections, and the drug classes used to suppress the virus, and this is a dependable NEET-PG topic. The subject links microbiology, immunology, pharmacology, and public health, so it produces a wide range of questions. Because management is guided by CD4 counts and standardised regimens, the CD4 thresholds for opportunistic infections and the structure of first-line therapy are the key deliverables. Examiners favour the diagnostic testing algorithm, the CD4-linked opportunistic infections and their prophylaxis, the first-line antiretroviral regimen, and prevention of mother-to-child transmission. Immune reconstitution inflammatory syndrome and post-exposure prophylaxis recur frequently. The topic links to tuberculosis, obstetrics, and pharmacology. Common traps include mismatching an opportunistic infection to the wrong CD4 threshold, forgetting that all diagnosed patients now start therapy regardless of CD4 count, confusing the drug class adverse effects, and overlooking interactions between antiretrovirals and rifampicin in coinfected patients.
HIV and antiretroviral therapy cover the natural history of infection, opportunistic infections, and the drug classes used to suppress the virus, and this is a dependable NEET-PG topic. The subject links microbiology, immunology, pharmacology, and public health, so it produces a wide range of questions. Because management is guided by CD4 counts and standardised regimens, the CD4 thresholds for opportunistic infections and the structure of first-line therapy are the key deliverables. Examiners favour the diagnostic testing algorithm, the CD4-linked opportunistic infections and their prophylaxis, the first-line antiretroviral regimen, and prevention of mother-to-child transmission. Immune reconstitution inflammatory syndrome and post-exposure prophylaxis recur frequently. The topic links to tuberculosis, obstetrics, and pharmacology. Common traps include mismatching an opportunistic infection to the wrong CD4 threshold, forgetting that all diagnosed patients now start therapy regardless of CD4 count, confusing the drug class adverse effects, and overlooking interactions between antiretrovirals and rifampicin in coinfected patients.
Key points
- **Diagnosis:** A staged algorithm using antibody-antigen tests confirms infection; viral load and CD4 count then guide monitoring and staging.
- **Treat all policy:** Antiretroviral therapy is started in all diagnosed patients regardless of CD4 count to reduce transmission and disease progression.
- **First-line regimen:** A common first-line combination uses two nucleoside reverse transcriptase inhibitors with an integrase inhibitor such as dolutegravir.
- **Pneumocystis pneumonia:** Occurs when CD4 falls below 200; prophylaxis and treatment use co-trimoxazole.
- **Toxoplasmosis:** Causes ring-enhancing brain lesions when CD4 falls below 100; co-trimoxazole provides prophylaxis.
- **Cryptococcal and CMV disease:** Cryptococcal meningitis and cytomegalovirus retinitis appear at very low CD4 counts, typically below 50.
- **Drug class effects:** Zidovudine causes anaemia, tenofovir affects the kidneys and bone, efavirenz causes neuropsychiatric effects, and protease inhibitors affect lipids.
- **Prevention of transmission to child:** Maternal antiretroviral therapy, safe delivery practices, and infant prophylaxis markedly reduce vertical transmission.
- **Post-exposure prophylaxis:** A short antiretroviral course started as soon as possible after significant exposure reduces the risk of seroconversion.
- **Immune reconstitution syndrome:** Paradoxical worsening of an existing infection as immunity recovers after starting therapy, often involving tuberculosis.
- **Tuberculosis interaction:** Rifampicin induces metabolism of several antiretrovirals, requiring regimen adjustment in coinfected patients.
Frequently Asked Questions
Which opportunistic infection goes with which CD4 count?
Pneumocystis pneumonia below 200, toxoplasmosis below 100, and cryptococcal meningitis and cytomegalovirus retinitis below 50. These thresholds guide prophylaxis and differential diagnosis.
When is antiretroviral therapy started?
In all diagnosed patients regardless of CD4 count under the current treat all approach, because early treatment improves outcomes and reduces transmission.
What is immune reconstitution inflammatory syndrome?
A paradoxical inflammatory worsening of an existing, sometimes latent, infection as the immune system recovers after starting antiretroviral therapy. Tuberculosis is a common trigger.
How is mother-to-child transmission prevented?
By giving the mother antiretroviral therapy, using safe delivery practices, and providing infant prophylaxis with appropriate feeding advice, which together sharply cut vertical transmission.
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