American Board of Internal Medicine (ABIM) Certification Practice Exam

What should patients who have experienced significant HIV exposure immediately begin?

1. A one-drug regimen

2. A three-drug regimen including raltegravir

3. Observation and symptomatic care

4. An aggressive antiviral treatment

The correct answer is: A three-drug regimen including raltegravir

Patients who have experienced significant HIV exposure should immediately begin a three-drug regimen including raltegravir, which is a standard practice in post-exposure prophylaxis (PEP) for HIV. The rationale behind using a three-drug regimen is that it significantly reduces the risk of HIV infection compared to a one-drug regimen. Combining multiple antiretroviral medications helps to suppress the virus more efficiently and also prevents the potential development of drug resistance. Raltegravir, in particular, is an integrase inhibitor that quickly acts to block HIV from integrating into the host cell's DNA, making it a crucial component of the PEP strategy. Starting treatment promptly, ideally within 72 hours of exposure, is critical for effectiveness in lowering the chances of seroconversion. Other approaches like observation and symptomatic care would not provide any therapeutic benefit against HIV and do not address the immediate need for intervention following a significant exposure. Similarly, while aggressive antiviral treatment could be beneficial in some contexts, the standard and recommended protocol for PEP in the case of potential HIV exposure is specifically a three-drug regimen to ensure a higher success rate in preventing infection. Therefore, the adoption of a three-drug regimen that includes raltegravir is an evidence-based strategy for managing potential