CMSA FC Fam Med(SA) Part II Practice Questions - CMSA FC Fam Med(SA) Part II - College Of Family Physicians Of South Africa Exam

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A 45-year-old male with confirmed pulmonary tuberculosis (TB) and newly diagnosed HIV infection (CD4 count 42 cells/µL) is initiating antiretroviral therapy (ART) in a primary care clinic. According to South African National ART guidelines, when should TLD (tenofovir disoproxil fumarate / lamivudine / dolutegravir) be started relative to TB treatment, and how should dolutegravir dosing be adjusted if he receives rifampicin-based TB therapy?

Initiate TLD within 2 weeks of starting TB treatment; increase dolutegravir to 50 mg twice daily (adding an extra 50 mg dose 12 hours after TLD) Start TLD immediately on day 1 of TB treatment without dose modification of dolutegravir Delay TLD until 6 months of TB treatment is fully completed to prevent Immune Reconstitution Inflammatory Syndrome (IRIS) Initiate TLD within 2 weeks of starting TB treatment; replace dolutegravir with efavirenz 600 mg once daily

Correct Answer:

Initiate TLD within 2 weeks of starting TB treatment; increase dolutegravir to 50 mg twice daily (adding an extra 50 mg dose 12 hours after TLD)

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