HIV — SCE Infectious Diseases MCQ

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ModerateHIV MedicineHIVSCE Infectious Diseases

A 55-year-old man with HIV on Abacavir/Lamivudine/Dolutegravir has a QRISK3 score of 18%. His viral load has been <50 copies/mL for 5 years. CD4 is 720 cells/µL. He has no hepatitis B co-infection. Which change to his ART is most appropriate based on current guidelines?

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Correct answer: B — Switch Abacavir to Tenofovir Alafenamide

The BHIVA 2025 interim update removed Abacavir from first-line recommendations and recommends switching away from Abacavir where clinically appropriate. This is particularly relevant for patients with elevated cardiovascular risk, as Abacavir has been associated with increased cardiovascular events in observational data. Switching the NRTI backbone to Tenofovir AF while maintaining Lamivudine and Dolutegravir is the most appropriate step. Adding a statin may also be appropriate but does not address the ART optimisation.

Reference: BHIVA 2025 – Guidelines on antiretroviral treatment for adults living with HIV-1 (2025 interim update)