Week 3[ Test1] HIV: Infection Control/Exposure Control Issues for Oral Healthcare Personnel

Which of the following statements is incorrect with respect to the CDC’s estimates of HIV infection in the United States?

A. Approximately 32,100 people became infected with HIV in 2021.

B. An estimated 5 million people are living with HIV.

C. About 13 percent of those infected with HIV in 2021 were not aware of their infectious status.

D. An estimated 1.2 million people were living with HIV in 2021.

HIV is acquired in non-occupational settings either across mucous membranes or parenterally by _______________.

A. unprotected anal sex

B. sharing utensils such as a spoon or fork

C. unprotected vaginal sex

D. A and C

Which of the following statements is incorrect with respect to the estimated per exposure risk of HIV transmission? Following _______________.

A. oral sex it is 0.67

B. receptive anal intercourse it is 1 to 30%

C. insertive anal or receptive vaginal intercourse it is 0.1 to 10%

D. insertive vaginal intercourse it is 0.1 to 1%

Which of the following statements with respect to the pattern of disease progression is incorrect?

A. After an incubation period of 1 to 3 weeks, 50 to 80 percent of patients experience an ill-defined Acute Retroviral Syndrome.

B. Non-specific signs and symptoms associated with primary infection include malaise, lethargy, and a sore throat, arthralgia, myalgia, headache, photophobia, maculopapular rash and lymphadenopathy.

C. During the period of clinical latency, which typically lasts 8 to 24 years, the patient is usually free of overt illness.

D. The final phase is characterized by the appearance of opportunistic illnesses.

Which of the following oral conditions have been demonstrated to be positive predictors of HIV-associated disease progression?

A. Oral candidiasis

B. Hairy leukoplakia

C. Salivary gland disease

D. A and B

Which of the following statements with respect to the diagnosis and staging of HIV infections is incorrect?

A. Laboratory criteria for defining a confirmed case now accommodate new multi-test algorithms, including criteria for differentiating between HIV-1 and HIV-2 infection and for recognizing early HIV infection.

B. A confirmed case of HIV infection is now classified in one of five stages (0, 1, 2, 3, or unknown).

C. Early infection, i.e., a positive HIV test within 6 months of HIV diagnosis, is classified as stage 0.

D. If the criteria for stage 0 are not met, the stage is classified as 1, 2, 3, or unknown depending on CD4+ T-lymphocyte test results or whether an opportunistic illness was diagnosed >180 days after the diagnosis of HIV infection.

Which of the following statements related to antiretroviral drug therapy is incorrect?

A. To reduce the risk of disease progression and to prevent the transmission of the virus to others, antiretroviral therapy (ART) is recommended for all patients with HIV infection.

B. The Food and Drug Administration has approved more than 25 antiretroviral drugs in 4 mechanistic classes.

C. Recommended regimens are those with durable virologic efficacy, favorable tolerability and toxicity profiles, and ease of use (including some newer combinations).

D. Multiple combination formulations are available to improve ease of use and compliance.

A fusion inhibitor acts to:

A. blocks CCR5, one of the two major co-receptors used by HIV-1 to attach to host cells

B. prevent cleavage of viral proteins during assembly and maturation

C. binds to the gp120 protein on the outer surface of HIV, preventing HIV from entering CD4 cells

D. blocks membrane fusion

Which of the following scenarios does not appear to increase the risk of infection among HCP following percutaneous exposure to HIV-infected blood?

A. Patient blood was visibly noted on the instrument before exposure.

B. The injury involved a needle that was placed directly into the patient’s vein or artery prior to the exposure.

C. The exposure resulted in profuse bleeding.

D. The exposure was superficial and resulted in no bleeding.

Which of the following statements related to the average risk of HIV transmission following various routes of exposure is incorrect?

A. Prospective studies estimate that the average risk for HIV infection after percutaneous exposure to HIV-infected blood is approximately 0.3% (1 infection associated with 2,885 exposures).

B. Prospective studies estimate that the average risk for HIV infection after mucous membrane (eyes, nose, and mouth) is approximately 0.09%.

C. The transmission of HIV infection after nonintact skin exposure is estimated to be higher than the risk following mucous membrane exposure.

D. The risk of infection associated with intact skin is below detection.

Which of the following statements related to provider-to-patient transmission of HIV is incorrect?

A. Since HIV was isolated, only 4 instances of HIV transmission from infected provider to patient have been documented worldwide and no cases have been reported since 2003.

B. The U.S. cluster involved a dentist, although the precise mechanisms of transmission were never determined.

C. More than 4 dozen look-back studies have been conducted and none of these studies identified evidence of provider-to-patient transmission.

D. The U.S. cluster of a provider to patient transmission was determined to have been the result of intentional malfeasance.

The first step in managing a percutaneous wound to the finger is _______________.

A. to inject the wound with an antiseptic

B. to squeeze the wound to express fluid

C. to flush the wound with water

D. to wash the wound with soap and water

Which of the following statements is incorrect with respect to the process and requirements for determining the risk associated with a percutaneous exposure?

A. Recording and reporting occupational injuries should be in accordance with state and federal requirements.

B. When an occupational exposure occurs, the circumstances of the incident should be recorded on a form appropriate for the oral healthcare setting.

C. When an occupational exposure occurs one should record the type of fluid (blood, OPIM, concentrated virus) and the type of exposure (percutaneous, mucous membrane, nonintact skin, bites).

D. Ensuring the exposed provider is evaluated within 4 days of the exposure.

Which of the following statements is incorrect with respect to the evaluation and management of the exposed person?

A. The exposed person should be evaluated within two hours after exposure.

B. The exposed person should have his/her HBV vaccination and response status determined.

C. To establish the HIV status at the time of exposure (baseline), the exposed person should be tested for HIV.

D. PEP prophylaxis should be initiated and completed regardless the HIV status of the patient.

Which of the following statements concerning post-exposure prophylaxis (PEP) for the healthcare worker potentially exposed to HIV is incorrect?

A. PEP should be initiated as soon as possible, preferably within 72 hours after a possible exposure to HIV.

B. Antiretroviral PEP has been shown to be 100% effective in preventing infection.

C. The U.S. Public Health Service no longer recommends that the severity of exposure be used to determine the number of drugs to be offered in an HIV PEP regimen.

D. The recommended 4-week PEP regimen include two NRTIs plus an INSTI, or a NNRTI, or a PI) with a pharmacokinetic booster such as cobicistat or ritonavir.

Elements of post-exposure counseling should include information _______________.

A. about precautions related to donating blood or tissue, becoming pregnant, breastfeeding, and to practice sexual abstinence or safe sex

B. mandatory registration with the appropriate state health agency

C. about possible drug toxicities, drug-drug interactions, measures to be taken to minimize side effects, and methods for clinical monitoring of toxicity

D. A and C

In managing a possible occupational HIV exposure, follow-up testing to monitor HIV seroconversion is indicated at _______________.

A. 1 month, 6 months, and 1 year

B. 12 weeks, 6 months, and 1 year

C. 6 weeks, 12 weeks, and 6 months

D. 6 weeks, 6 months, and 1 year

Which of the following statements is incorrect with respect of SHEA guidelines to minimize provider-to-patient transmission of HIV in healthcare settings?

A. Infected healthcare providers should be totally prohibited from patient care solely on the basis of an infection with HIV.

B. Clinical privileges should be granted according to the viral load of the infected provider.

C. SHEA guidelines emphasize the importance of Standard and Transmission-based Precautions to minimize HIV transmission.

D. The likelihood of procedure-related provider-to-patient transmission of HIV should be considered when determining the provider’s occupational limitations.

Which of the following statements is incorrect relative to the responsibilities of an HIV infected healthcare provider?

A. Routine, voluntary, confidential testing of providers is encouraged.

B. HIV-infected clinicians are ethically bound to inform local or state public health authorities of their status.

C. In particular, those clinicians who perform Category III procedures should know their immune or infectious status not only with respect to HIV, but HBV and HCV.

D. HIV infected providers should withdraw from all forms of clinical care.

For an HIV infected clinician, which of the following criteria would preclude recommending them to perform Category I, II, and III procedures?

A. There is no evidence of the provider having transmitted infection to patients and obtained advice from an Expert Review Panel about continued practice.

B. The provider demonstrates an HIV viral burden ≥5 x 102 GE/mL.

C. Consulted with an expert about optimal infection control procedures and strictly adheres to the recommended procedures.

D. The provider agrees to twice yearly follow-up to verify viral burden levels