Quiz 5: Management of children with antiretroviral treatment

Please choose the one, most correct answer to each question or statement.

1. At which clinical stage should antiretroviral treatment be started in children older than 5 years?
   • Clinical stage 1
   • Clinical stage 2
   • Clinical stage 3 or 4
   • All children irrespective of clinical stage.
2. Which children should be fast tracked onto antiretroviral treatment?
   • A child with MDR-TB clinical disease
   • A 16 month old child with stage 1 disease
   • A child with a CD4 count of 250 cells/μl
   • A 6 year old child with stage 2 disease
3. Which one of the following is essential before starting antiretroviral treatment?
   • The mother should have at least seven years schooling.
   • There must be at least one responsible adult to help administer medication.
   • The father should be employed.
   • The parents should own their house.
4. Where should antiretroviral treatment be started?
   • Always in hospital
   • At any regional hospital
   • At any primary healthcare clinic
   • Only at a clinic or hospital with staff trained in antiretroviral treatment
5. What is ‘patient readiness’?
   • The child should be well enough to take oral medication.
   • The parents should be able to afford the drugs needed for antiretroviral treatment
   • The child and care givers should be educated and motivated to give antiretroviral treatment.
   • The child must be able to take full responsibility for the antiretroviral treatment.
6. Which of the following is an essential part of preparing a family for antiretroviral treatment?
   • The parents must have a good understanding of HIV.
   • The whole family must know the child’s HIV status.
   • The child’s weight should be increased to the 50th percentile.
   • There should be running water and electricity in the home.
7. How long does it usually take to prepare a family for antiretroviral treatment?
   • Two months
   • A months
   • Three weeks
   • Two counselling sessions
8. After starting antiretroviral treatment, when should you arrange the first follow-up visit?
   • One week
   • Two weeks
   • Three weeks
   • Four weeks
9. What special blood test should be done at the 3 month follow-up visit if the child is receiving AZT?
   • Full blood count and differential count
   • A lipid profile
   • Serum lactate concentration
   • Blood glucose concentration
10. What should the viral load be after six months of antiretroviral treatment?
    • No higher and at least 10% below the baseline level
    • At least 25% below the baseline level
    • At least 50% below the baseline level
    • Undetectable
11. What is excellent adherence on twice a day dosage?
    • Taking 50% of the required doses
    • Taking 80–95% of doses
    • Taking at least 95% of doses
    • Not missing any doses
12. What are the dangers of poor adherence?
    • Severe side effects
    • Drug resistance
    • Treatment failure
    • Both drug resistance and treatment failure
13. How can adherence be improved?
    • Using reminders such as an alarm clock or radio programme
    • Threatening to stop antiretroviral treatment
    • Severely criticising the parents at the follow-up clinic
    • Giving the antiretroviral drugs as an intramuscular depot
14. Excellent adherence must be assessed and stressed at:
    • The first follow-up visit
    • The second follow-up visit
    • The six month follow-up visit
    • Every follow-up visit
15. Drug resistance may occur when:
    • INH prophylaxis for TB interferes with the antiretroviral drugs.
    • 3 drugs are used instead of 4.
    • NVP is used as prophylaxis during delivery.
    • Steroids are given at the same time as antiretroviral treatment.
16. What should be done if the first-line treatment fails in spite of excellent compliance?
    • Increase the dose of the drugs.
    • Add a fourth antiretroviral drug.
    • Change to second-line treatment.
    • Nothing more can be offered as treatment.
17. What TB drug commonly interacts with antiretroviral treatment?
    • Ethionamide
    • Rifampicin
    • Ethambutol
    • Pyrazinamide
18. Which antiretroviral drug may interact with INH to cause peripheral neuropathy?
    • EFV and NVP
    • d4T
    • AZT
    • Lopinavir/ritonavir
19. What is the immune reconstitution inflammatory syndrome (IRIS)?
    • One of the criteria for stage 4 HIV infection
    • A common indication for starting antiretroviral treatment
    • A serious side effect of NVP
    • A possible reason for an unexpected deterioration after starting antiretroviral treatment
20. What immunisation is typically associated with the immune reconstitution inflammatory syndrome (IRIS) in children?
    • Polio
    • Pertussis
    • BCG
    • Measles