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HIV screening — USMLE Step 3 MCQ

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HardPreventive Medicine, Epidemiology, BiostatisticsHIV screeningUSMLE Step 3

A patient with chronic hepatitis B and normal kidney function begins daily F/TDF for HIV PrEP. Six months later, sexual exposure risk has ended and the patient asks to stop PrEP. Which plan is most appropriate?

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Correct answer: B — Coordinate HBV follow-up and monitor liver tests when oral PrEP stops

The best answer is “Coordinate HBV follow-up and monitor liver tests when oral PrEP stops”. Both tenofovir and emtricitabine are active against HBV. Abrupt withdrawal in chronic HBV can lead to rebound replication and hepatic injury, so stopping oral PrEP requires coordinated HBV management and follow-up. Cabotegravir does not treat HBV, and emtricitabine monotherapy is not an appropriate HBV maintenance strategy.

Reference: CDC HIV Nexus: Clinical Guidance for PrEP: https://www.cdc.gov/hivnexus/hcp/prep/index.html