Que. 1. Which is the causative organism of Acquired Immune Deficiency Syndrome (AIDS)?

Ans. 1. Caused by a retrovirus – Human immune-deficiency virus (HIV).

Que. 2. What are the different types of HIV epidemics?

Ans. 2. The different types of HIV epidemics are as follows –

• Low level HIV epidemics
• Concentrated HIV epidemics
• Generalized HIV epidemics

Que. 3. What do you mean by low level HIV epidemics?

Ans. 3. Although HIV is present for many years, it has never spread to substantial levels in any sub-population. Infection is largely confined to individuals with high risk behaviour.

Que. 4. What do you mean by concentrated HIV epidemics?

Ans. 4. HIV has established itself in sub-population but not has become generalized affecting general population.

Que. 5. What do you mean by generalized HIV epidemics?

Ans. 5. HIV has established itself in general population.

Que. 6. Which is the key indicator that HIV prevention efforts aim to reduce?

Ans. 6. HIV incidence.

Que. 7. What are the reasons of observed decline in HIV incidence?

Ans. 7. The reasons of observed decline in HIV incidence are –

• Natural history of disease
• Result of HIV prevention program
• Change in sexual behaviour
• Targeting high risk groups
• Maximizing preventive benefits of Anti-retroviral (ARV) therapy
• Prevention of mother to child transmission
• Voluntary medical male circumcision in high HIV settings

Que. 8. What is the target of Sustainable Development Goal (SDG) in relation to HIV?

Ans. 8. To end HIV epidemic by 2030.

Que. 9. Global strategy Fast Track: Ending the HIV epidemic by 2030 was developed by which organization?

Ans. 9. UNAIDS.

Que. 10. Which are the main areas of focus in Fast Track Strategy?

Ans. 10. The main areas of focus are –

• Left behind population e.g. migrants, children & adolescents etc.
• Localize areas with greatest HIV transmission & greatest HIV burden & use of data to support the program.
• An integrated HIV response that extends the contribution towards universal health coverage
• Sustainable programs using domestic funds for essential HIV services.

Que. 11. In India, which is the predominant mode of HIV transmission?

Ans. 11. Sexual Contact, responsible for 86% of new infections in 2017.

Que. 12. What is the overall HIV prevalence among ANC clinic attendees in India?

Ans. 12. 0.29% (HSS 2016-17).

Que. 13. What is the type of HIV epidemic prevailed in India?

Ans. 13. Concentrated HIV epidemic.

Que. 14. What is the prevalence in female sex workers (FSWs) in India?

Ans. 14. 1.6% (HSS 2017).

Que. 15. What is the overall HIV prevalence among injecting drug users (IDUs) in India?

Ans. 15. 6.3 % (HSS 2017).

Que. 16. What is the HIV prevalence among transgender people in India?

Ans. 16. 3.1 % (HSS 2017).

Que. 17. What is the HIV prevalence among migrants in India?

Ans. 17. 0.2 % (HSS 2017).

Que. 18. What is the HIV prevalence among truck drivers in India?

Ans. 18. 0.2% (2017-18 data).

Que. 19. Which are the body fluids in which HIV is found in abundance?

Ans. 19. Blood, semen & CSF.

Que. 20. Which is the age group most commonly affected for HIV?

Ans. 20. Sexually active age group (20-49 years).

Que. 21. Which are the groups considered at high risk for HIV/AIDS?

Ans. 21. These groups are –

• Male homosexuals & bisexuals
• Heterosexual partners
• Intravenous drug users
• Recipients of blood & its product transfusion
• Clients of STDs
• Migrant population
• Truck drivers
• Transgender population

Que. 22. What are the factors governing size of risk involved with sexual transmission in HIV/AIDS?

Ans. 22. The factors are as follows –

• Presence of STD
• Age & Sex of uninfected partner
• Type of sexual act
• Stage of illness of infected partner
• Virulence of HIV strain

Que. 23. Why women are more vulnerable to HIV infection?

Ans. 23. The vulnerability for HIV infection in females is high due to –

• Large surface area of vagina exposed
• Higher concentration of HIV in semen

Que. 24. Why anal intercourse do carry a higher risk of transmission than vaginal intercourse?

Ans. 24. Because more tissues of the receptive partner are injured in anal intercourse.

Que. 25. Why exposed adolescent girls and women above 45 years of age are more prone for HIV infection?

Ans. 25. They are more prone because –

• In adolescent girls, cervix is less efficient barrier to HIV.
• Around menopause, thinning of mucosa offer less protective effect
• Production of mucus in both are not prolific or sufficient.

Que. 26. How does an infected mother transmit the HIV infection to her baby?

Ans. 26. Through placenta, during child birth & through breastfeeding.

Que. 27. How will you prevent transmission of HIV from mother to child?

Ans. 27. Transmission of HIV from mother to child can be prevented by –

• ARV prophylaxis
• Elective Caesarean section before onset of labour & rupture of membrane
• Refraining from breastfeeding

Que. 28. What is the incubation period from HIV infection to development of AIDS?

Ans. 28. Few months to 10 years (or even more).

Que. 29. Which are the broad groups of clinical manifestations of HIV infection?

Ans. 29. Broad groups are –

• Initial infection with virus
• Asymptomatic carrier state
• AIDS -related complex (ARC)
• AIDS

Que. 30. What do you mean by window period?

Ans. 30. The period from initial HIV infection to appearance of HIV antibodies in the blood stream is called window period. It is around 2-12 weeks.

Que. 31. What is the significance of window period in HIV/AIDS?

Ans. 31. The significance of window period in HIV/AIDS is as follows –

• Person, though infected will test negative for HIV.
• Person is highly infectious during this period.

Que. 32. Which disease is characterized by development of Kaposi sarcoma?

Ans. 32. AIDS.

Que. 33. What are the important features of expanded case definition for AIDS surveillance?

Ans. 33. The important features are –

• HIV serological testing
• Inclusion of TB, neurological disorders, pneumonia & invasive cervical cancer.

Que. 34. What do you mean by HIV wasting syndrome?

Ans. 34. When all 3 features listed below are present in HIV positive person, it will be termed as HIV wasting syndrome –

• Weight loss > 10% of body weight
• Unexplained diarrhoea for one month OR chronic weakness
• Unexplained fever for more than one month

Que. 35. What is the normal level of CD4 count?

Ans. 35. Usually more than 950 CD4 cells/microliter of blood.

Que. 36. Which is the most important laboratory marker to provide prognostic information and guide therapy decisions?

Ans. 36. CD4 Count.

Que. 37. What is the level of CD4 count in persons with AIDS?

Ans. 37. CD4 count below 200.

Que. 38. What are the different type of HIV tests for antibody detection?

Ans. 38. 1^st test (Screening test) —– ELISA.

2^nd test (confirmatory test) — Western Blot.

Que. 39. What are the 5 principles (5 Cs) of WHO that apply to all models of HIV testing services?

Ans. 39. 5 Cs – Consult

• Confidentiality
• Counselling
• Correct test results
• Connection to care & treatment.

Que. 40. When used correctly & consistently, what is the protection offered by condoms in heterosexual & homosexual persons?

Ans. 40. Heterosexuals – 80% & Homosexuals – 64%.

Que. 41. Which are the drugs used for opioid substitution therapy (OST)?

Ans. 41. Methadone & buprenorphine.

Que. 42. How can you prevent transmission of HIV infection in haemophiliacs?

Ans. 42. By heat treatment of factor VIII & IX.

Que. 43. What is the recommendation of WHO (2016) about provision of ART?

Ans. 43. All people living with HIV should be provided life-long ART, irrespective of their clinical status or CD4 count.

Que. 44. Which is the first line ART regimen for adults & adolescents?

Ans. 44. TDF (tenofovir) + 3 TC (lamivudine) or FTC (Emtricitabine) + DTG (Dolutegravir).

Que. 45. What are the components of post exposure prophylaxis (PEP) in HIV?

Ans. 45. Components of PEP in HIV are –

• First Aid
• Counselling & risk assessment
• HIV testing & counselling
• Short term provision of ARV therapy
• Support & Follow up

Que. 46. When PEP is not required?

Ans. 46. PEP is not required –

• Exposed individual is already HIV positive
• Source of exposure is HIV negative
• Exposure to body fluids that do not pose a significant risk such as tears, non-blood stained saliva, urine and sweat.

Que. 47. Which are the body fluids that pose a risk of HIV infection?

Ans. 47. Blood, blood stained saliva, breast milk, genital secretions and cerebrospinal, amniotic, rectal, peritoneal, synovial, pericardial or pleural fluids.

Que. 48. What is the standard PEP regimen?

Ans. 48. 3 drug PEP regimen is raltagravir (isentress) 400 mg PO BD plus Truvada (Tenofovir DF 300mg/ Emtricitabine 200 mg) PO once daily.

Que. 49. What is the indication of cotrimoxazole prophylaxis for HIV related infections in adults including pregnant women?

Ans. 49. It is recommended for severe and advanced HIV clinical disease (WHO stage 3 or 4) and/or for a CD4 count < or equal to 350 cells/mm cube.

In settings where malaria & severe bacterial infections are highly prevalent, Cotrimoxazole prophylaxis should be initiated regardless of CD4 count or WHO clinical stage.

Que. 50. When will you discontinue Cotrimoxazole prophylaxis in adults?

Ans. 50. When adults with HIV infection are clinically stable, on ARV therapy, with evidence of immune recovery & viral suppression.

Que. 51. How will you monitor the efficacy of ART?

Ans. 51. Following features are monitored to observe the efficacy of ART –

• Gain in body weight
• Decrease in severity & occurrence of HIV related infections and malignancies
• Increase in total lymphocyte count
• Improvement in CD4 count
• Increase in plasma HIV RNA levels.

Que. 52. When was the National AIDS control Program (NACP) launched in India?

Ans. 52. 1987.

Que. 53. What was the aim of NACP at the time of launch?

Ans. 53. The aim of NACP was –

• To prevent further transmission of HIV
• To reduce mortality & morbidity associated with HIV infection
• To minimize the socio-economic impact resulting from HIV infection

Que. 54. When was the anti-retroviral therapy (ART) initiated in India?

Ans. 54. 2004.

Que. 55. When was the national strategic plan for HIV/AIDS & STIs launched?

Ans. 55. 2017.

Que. 56. Which are the high prevalence states in India for HIV/AIDS?

Ans. 56. Maharashtra, Tamilnadu, Andhra Pradesh, Manipur & Nagaland.

Que. 57. What are the criteria for defining high prevalence state?

Ans. 57. Where HIV infection is more than 5% in high risk group and 1% or more in antenatal women.

Que. 58. Which are the moderate prevalence states in India for HIV/AIDS?

Ans. 58. Gujarat, Goa & Puducherry.

Que. 59. What are the criteria for defining moderate and low prevalence states for HIV/AIDS?

Ans. 59. Moderate prevalence states – > 5 % in high risk group & < 1 % in antenatal women

Low prevalence state – < 5 % in high risk group & < 1 % in antenatal women.

Que. 60. What are the types of surveillance in HIV/AIDS?

Ans. 60. The types of surveillance in HIV/AIDS are –

• HIV sentinel surveillance
• HIV sero-surveillance
• AIDS case surveillance
• STD surveillance
• Behavioural surveillance
• Integration with other disease like TB, surveillance.

Que. 61. What is the aim of HIV sentinel Surveillance?

Ans. 61. To monitor the trends of HIV infection.

Que. 62. What are the categories of the district as per HIV surveillance data?

Ans. 62. A, B, C & D.

Que. 63. What are the characteristic features of category A district?

Ans. 63. More than 1% ANC/PTCT prevalence in district at any time in any of the sites in the last 3 years.

Que. 64. What are the characteristic features of category D districts?

Ans. 64. Less than 1% in ANC prevalence in all sites during last 3 years with less than 5% in all STD clinic attendees or any HRG OR poor HIV data with no known hot spots.

Que. 65. Which are the components of HIV testing & counselling services?

Ans. 65. The components of HIV testing & counselling services are –

• Integrated Counselling & Testing Centres (ICTCs)
• Prevention of parent to child transmission of HIV (PPTCT)
• HIV/tuberculosis Collaborative studies

Que. 66. What are the functions of ICTC?

Ans. 66. The functions of ICTC are as follows –

• Early diagnosis of HIV
• Provision of basic information on modes of transmission & prevention of HIV/AIDS
• Linking PLHIV with HIV prevention, care and treatment services

Que. 67. Where are stand-alone ICTCs (SA-ICTCs) located?

Ans. 67. Located in medical colleges, District hospitals, Sub-district hospitals & CHCs.

Que. 68. Where are facility integrated ICTCs (f-ICTCs) located?

Ans. 68. Below block level at 24*7 PHCs.

Que. 69. What are the wide range of services provided by mobile ICTCs?

Ans. 69. The range of services provided by mobile ICTCs are –

• Counselling & testing services for HIV
• Syndromic management of STIs/RTIs
• Regular health check ups

Que. 70. Who generally do the community based HIV screening?

Ans. 70. By ANM at the sub centre level.

Que. 71. When PPTCT program was launched in India?

Ans. 71. 2002.

Que. 72. What is the aim of PPTCT program?

Ans. 72. To detect all HIV positive pregnant women by testing every pregnant women and eliminate transmission of HIV from mother to child.

Que. 73. What are the components of early detection of HIV/TB under HIV/TB coordination activity?

Ans. 73. The components are –

• 100% coverage of PITC in TB patients
• PITC in presumptive TB cases
• Rapid diagnostics for detection of TB or DRTB in PLHIV
• ICF activities in all HIV settings

Que. 74. What are the components of prevention under HIV/TB coordination activities?

Ans. 74. The components of prevention are –

• Isoniazid preventive therapy
• Air born infection control
• Awareness generation

Que. 75. What are the targets of fast track 90-90-90?

Ans. 75. The targets are as follows –

• 90% of PLHIV know their status
• 90% of PLHIV are on ART, of which
• 90% of PLHIV have viral suppression

Que. 76. What is assessed in follow up of patients on ART?

Ans. 76. Following are assessed in follow up of patients on ART –

• Assessing drug adherence
• Regularity of visits
• Periodic examination
• CD4 count

Que. 77. Which is the last stage of HIV infection?

Ans. 77. AIDS (Acquired Immune deficiency syndrome).

Que. 78. Which disease is also known as slim disease?

Ans. 78. AIDS.

Que. 79. What are the leading causes of HIV related morbidity?

Ans. 79. TB, bacterial infections & malaria.

Que. 80. HIV prevalence in which category is considered as proxy for prevalence in general population?

Ans. 80. HIV prevalence among ANC attendees.

Que. 81. Who are vulnerable to HIV infection?

Ans. 81. Impoverished, unemployed, underemployed, mobile & migrant youth & street children.

Que. 82. In which types of lymphocytes, HIV does replicate?

Ans. 82. In actively dividing T4 lymphocytes.

Que. 83. Which practices of sex does increase the risk of HIV infection?

Ans. 83. Multiple sex partners, anal intercourse & male homosexuality.

Que. 84. What does indicate the reduced cellular immunity in AIDS patients?

Ans. 84. Decreased ratio of T helper to T suppressor cells.

Que. 85. Whether risk of HIV transmission is lower when women are menstruating?

Ans. 85. No, risk of HIV transmission is greater when women are menstruating.

Que. 86. When HIV infected persons are more infectious to others?

Ans. 86. In early stages of infection and AIDS stage.

Que. 87. What percentage of risk is involved for contracting HIV infection from the transfusion of a unit of infected blood?

Ans. 87. 95%.

Que. 88. Maternal-foetal transmission is responsible for what percentage of cases in absence of any intervention?

Ans. 88. 20-25% of cases.

Que. 89. When do serious fungal & parasitic infections occur in AIDS patients?

Ans. 89. When CD4 count has dropped to around 100.

Que. 90. Whether HIV can cross blood brain barrier?

Ans. 90. Definitely yes.

Que. 91. What does happen with decrease in CD4 count?

Ans. 91. Risk of opportunistic infection increases.

Que. 92. When will you offer post exposure prophylaxis (PEP) to those exposed to HIV infection?

Ans. 92. Within 72 hours.

Que. 93. What is the eligibility criteria of PEP?

Ans. 93. Parenteral or mucous membrane exposure.

Que. 94. Which prophylaxis should be administered to all HIV infected people with active TB disease regardless of CD4 count?

Ans. 94. Cotrimoxazole prophylactic therapy (CPT).

Que. 95. Where a person is counselled & tested for HIV?

Ans. 95. ICTC.

Que. 96. Which services are provided by ART Centre to a patient on ART?

Ans. 96. Following services are provided –

• Counselling on treatment adherence
• Nutrition
• Positive prevention
• Positive thinking
• Treatment services
• Linkages services

Que. 97. What is the advantages of Isoniazid Preventive Therapy (IPT) & ART given together?

Ans. 97. Can reduce the risk of TB among PLHIV by up to 70%.

Que. 98. Whether first line ART is provided free of cost to all eligible PLHIV through ART Centre?

Ans. 98. Definitely yes.

Que. 99. What is a link worker scheme?

Ans. 99. It is a community lased outreach strategy to address HIV prevention and care needs of HRGs & vulnerable population in rural areas.

Que. 100. What are the mobile ICTCs?

Ans. 100. These are setup as temporary clinics in hard to reach areas with flexible working hours. These are a van with room to conduct general examination, counselling and space for collection and processing of samples by paramedical staff.

Suggested Further Readings –

• Park; Park’s textbook of Preventive & Social Medicine, 26^th edition, 2021
• Bhalwar; textbook of Public health & Community Medicine, AFMC-WHO, 1^st edition, 2009
• Mahajan & Gupta; Textbook of Preventive & Social Medicine; 4^th edition
• AH Suryakantha; Community Medicine with Recent Advances, 3^rd