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Febrile neutropenia — ABIM Board MCQ

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HardHematology/OncologyFebrile neutropeniaABIM Board

A 36-year-old man with ongoing sexual HIV exposure requests PrEP. HIV antigen-antibody and HIV-1 RNA tests are negative, he has no symptoms of acute infection, and estimated creatinine clearance is 24 mL/min. He has no hepatitis B infection and can attend scheduled injection visits. Which regimen is most appropriate?

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Correct answer: C — Use long-acting injectable cabotegravir after completing baseline evaluation

The best answer is “Use long-acting injectable cabotegravir after completing baseline evaluation”. Both oral tenofovir-based PrEP options fall below their renal thresholds at a creatinine clearance of 24 mL/min. CDC guidance recommends injectable cabotegravir for serious kidney disease when HIV infection has been carefully excluded; kidney monitoring is not required for cabotegravir itself. Event-driven TDF/FTC does not remove nephrotoxicity, and lamivudine alone is not an approved PrEP regimen.

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