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Nausea and vomiting of pregnancy — USMLE Step 3 MCQ

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HardOB/GYNNausea and vomiting of pregnancyUSMLE Step 3

A resident presents 68 hours after a deep hollow-bore needlestick from a patient with HIV and a detectable viral load. The resident has a negative baseline HIV antigen-antibody test and normal renal function. The source has prior antiretroviral exposure, and a resistance genotype is pending. What is the best next step?

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Correct answer: C — Start a preferred three-drug HIV postexposure-prophylaxis regimen now for 28 days and modify it later if resistance results require

The best answer is “Start a preferred three-drug HIV postexposure-prophylaxis regimen now for 28 days and modify it later if resistance results require”. The presentation remains within the 72-hour initiation window, and source resistance testing must not delay the first dose. Start a preferred three-drug regimen immediately, prescribe the full 28-day course, and adjust the drugs later if resistance information warrants. After a substantial occupational HIV exposure, a three-drug PEP regimen should begin immediately without waiting for additional source testing and continue for 28 days.

Reference: 2025 US Public Health Service Occupational HIV PEP Guideline: https://stacks.cdc.gov/view/cdc/183609/cdc_183609_DS1.pdf