Antiretrovirals

A 28-year-old woman with HIV infection (CD4 count 280 cells/μL) on ART for 18 months presents with fever, headache, and neck stiffness. CSF analysis shows elevated protein (120 mg/dL), low glucose (35 mg/dL), and negative bacterial culture. Which investigation is most appropriate to confirm the suspected diagnosis of HIV-associated cryptococcal meningitis?

A 32-year-old man with newly diagnosed HIV-1 infection (CD4 count 450 cells/μL, viral load 85,000 copies/mL) presents to the antiretroviral clinic. He is asymptomatic, has no opportunistic infections, and baseline resistance testing shows no mutations. He asks when to start antiretroviral therapy (ART). What is the next step in management?

Which feature best distinguishes protease inhibitors (PIs) from non-nucleoside reverse transcriptase inhibitors (NNRTIs) in terms of their mechanism of resistance and cross-resistance patterns?

A 32-year-old man with newly diagnosed HIV-1 infection is being counselled on antiretroviral therapy (ART) options. His baseline CD4 count is 350 cells/μL and viral load is 150,000 copies/mL. Regarding the pharmacokinetics and drug interactions of commonly used antiretrovirals, all of the following are true EXCEPT:

A 38-year-old woman with HIV-1 infection on a stable ART regimen (dolutegravir + tenofovir/lamivudine for 18 months) presents with a 2-week history of nausea, vomiting, and right upper quadrant pain. Liver function tests show AST 280 U/L, ALT 320 U/L, ALP 180 U/L, and bilirubin 2.8 mg/dL. Viral load is undetectable (< 50 copies/mL) and CD4 count is 680 cells/μL. Hepatitis B and C serology are negative. Abdominal ultrasound is normal. What is the next step in management?