skip to main content

Cervical Dysplasia in HIV — SCE Infectious Diseases MCQ

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

HardHIV MedicineCervical Dysplasia in HIVSCE Infectious Diseases

A patient with advanced HIV has progressive genital and perianal HSV-2 ulceration during directly observed intravenous aciclovir. The isolate is thymidine-kinase deficient and phenotypically resistant to aciclovir and penciclovir. Renal function and electrolytes are normal. Which systemic treatment is best supported by BASHH?

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

Reveal the answer and explanation

Correct answer: E — Foscarnet 40 mg/kg intravenously every 8 hours with renal and electrolyte monitoring

Explanation lettering: D = shown as A · A = shown as D

E is correct. Aciclovir and penciclovir require initial phosphorylation by viral thymidine kinase, so a thymidine-kinase-deficient isolate is cross-resistant to aciclovir, valaciclovir and usually famciclovir. Foscarnet directly inhibits viral DNA polymerase without that activation step; BASHH supports 40 mg/kg intravenously every eight hours for resistant herpes in people living with HIV. A and B remain dependent on the missing activation pathway. C is not the recommended systemic salvage agent for this phenotype. D uses an incorrect intensive cidofovir schedule; supported intravenous cidofovir is weekly initially, with probenecid and hydration. Foscarnet requires close renal, calcium, magnesium and potassium monitoring.

Reference: BASHH 2024: management of anogenital herpes: https://www.bashh.org/_userfiles/pages/files/pateletal2024britishassociationofsexualhealthandhivuknationalguidelineforthemanagementofanogenital.pdf