Rosh Internal Medicine Boost Practice Exam

What is the most appropriate therapy for a patient with HIV presenting with respiratory symptoms and confirmed diagnosis by respiratory secretions?

1. Azithromycin

2. Levofloxacin

3. Prednisone

4. Trimethoprim-sulfamethoxazole

The correct answer is: Trimethoprim-sulfamethoxazole

In this scenario, the most appropriate therapy for a patient with HIV who presents with respiratory symptoms and a confirmed diagnosis through respiratory secretions is Trimethoprim-sulfamethoxazole. This medication is particularly effective for treating Pneumocystis jirovecii pneumonia (PCP), which is a common opportunistic infection in individuals with HIV, especially when their CD4 count is below 200 cells/mm³. Trimethoprim-sulfamethoxazole works by inhibiting bacterial folate synthesis and is the first-line treatment for PCP. Given the context of HIV infection, it's critical to consider opportunistic infections, and PCP is one of the most significant concerns. Azithromycin is generally used for atypical pneumonia and certain bacterial infections but is not the first-line treatment for PCP. Levofloxacin, a fluoroquinolone antibiotic, is used for various bacterial respiratory infections but is also not indicated for PCP. Prednisone is a corticosteroid that may help with inflammation but does not address the underlying infection in this context and is typically used in conjunction with treatment for PCP when there is significant hypoxia or respiratory distress, not as initial therapy solely. Thus, Trimethoprim-sulfamethoxazole is the most