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Advanced HIV package of care — DTM&H MCQ

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EasyHIV/AIDS in tropical settingsAdvanced HIV package of careDTM&H

A newly diagnosed adult in Lesotho has CD4 count 32 cells/mm³, weight loss and oral candidiasis. The clinic uses WHO advanced HIV disease pathways. What is the most appropriate treatment?

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Correct answer: D — Screen for TB and cryptococcal disease before rapid ART

Screen for TB and cryptococcal disease before rapid ART is the single best answer because advanced HIV disease requires a package including TB screening, cryptococcal screening where appropriate, prophylaxis and timely ART. Start ART without opportunistic infection assessment is plausible in a related presentation, but it is less appropriate because it does not fit the key discriminator in this vignette. The teaching point is that rapid ART is beneficial but should be integrated with evaluation for life-threatening opportunistic infections.

Reference: WHO consolidated HIV guidelines; WHO advanced HIV disease guidance; Manson's Tropical Diseases