HIV — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

HardHIV MedicineHIVSCE Infectious Diseases

A 45-year-old man with HIV on Tenofovir DF/Emtricitabine/Dolutegravir has been virally suppressed (<50 copies/mL) for 3 years with a stable CD4 of 650 cells/µL. He requests switching to a long-acting injectable regimen. HBsAg is negative. His BMI is 26 kg/m². His HIV subtype is B. Which of the following is the most important contraindication to Cabotegravir/Rilpivirine long-acting injectable?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — HIV subtype A1 with BMI >30 kg/m²

Per BHIVA 2025 interim update, having both BMI >30 and subtype A1 is an exclusion criterion for Cabotegravir/Rilpivirine long-acting injectable due to increased risk of virological failure. This patient has subtype B and BMI 26, so would be eligible. Previous INSTI resistance is also a concern but the question asks about the most important specified contraindication from current guidelines. HLA-B*5701 is relevant to abacavir, not CAB/RPV-LA.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections