Self-Assessment Questions (SAQs) for Study Session 21

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the following questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions (SAQs) at the end of this Module.

SAQ 21.1 (tests Learning Outcomes 21.1, 21.2 and 21.4)

Are the following statements that describe the relationship between opportunistic infections in PLHIV and their immune status true or false? In each case, explain your reasoning.

A  The decline in the function of the immune system of a person living with HIV is associated with the onset and increasing severity of opportunistic infections.

B  The onset of severe opportunistic infections usually occurs at CD4 counts between 800 and 1500 cells/mm³.

C  The occurrence of an opportunistic infection in a person who has not been tested for HIV is suggestive of HIV infection.

D  PLHIV can be categorised by the WHO clinical staging system according to their most severe opportunistic infection.


A is true: As the immune system’s ability to defend against infectious diseases declines in PLHIV, various and more severe opportunistic infections appear.

B is false: The appearance of severe opportunistic infections usually occurs when the CD4 count falls to below 450 cells/mm³.

C is true: Patients with opportunistic infections who have not been tested for HIV may be unknowingly HIV-positive. You should counsel and refer the patient for HIV testing. However, you should not classify a patient according to the WHO clinical staging system unless they have tested positive for HIV.

D is true: To classify a patient on the WHO HIV clinical staging system, the patient has to be HIV-positive, and specific diagnoses of opportunistic infections and diseases are required. PLHIV are classified into different stages according to their most severe opportunistic infection.

SAQ 21.2 (tests Learning Outcomes 21.2 and 21.3)

A 27-year-old woman comes to the health post complaining of a painful rash over her back on the right side which started three days earlier. The pain is severe and runs along horizontally. You examine her and identify that the rash is due to vesicles.

  • a.What is the possible diagnosis of this patient?
  • b.What will you do to help this patient?


  • a.The vesicles suggest it may be a herpes zoster rash.
  • b.You need to know first whether the patient is HIV-positive or whether she has ever been tested. If the patient doesn’t know her HIV status, advise her on provider-initiated counselling and testing for HIV. In either case, refer the patient to the health centre for treatment.

SAQ 21.3 (tests Learning Outcomes 21.3 and 21.4)

You are asked to provide a home visit to a 40-year-old man who has been bedridden for four months. He is extremely thin, has diarrhoea and appears feverish. He can hardly speak. His wife died one year ago and he has two children. The elder son says his father was tested positive for HIV four years earlier, but he has not gone back to the health centre since then.

  • a.What is the possible diagnosis of this patient?
  • b.What is his WHO HIV clinical staging?
  • c.What should be done for the patient and his children?


  • a.He may have HIV wasting syndrome.
  • b.This is classified as WHO HIV clinical stage 4.
  • c.The patient has to be referred to the nearest health centre urgently. He needs urgent treatment for his wasting syndrome as well as antiretroviral therapy for HIV. His children also need to be tested for HIV, as it is possible that the mother died of AIDS-related illnesses.

SAQ 21.4 (tests Learning Outcome 21.5)

A 19-year-old HIV-positive woman comes to you and tells you she wants to stop the cotrimoxazole prophylaxis given to her by the nurse in the nearest health centre. She says she is feeling well and doesn’t need to take the drugs any longer. What will you advise her?


You need to tell the patient that cotrimoxazole prophylaxis has to be taken continuously unless she is told to stop by her nurse at the health centre. You need to encourage her to take the drugs, and explain that they are helping her to avoid some of the common infections associated with HIV infections such as those that can cause diarrhoea, lung and brain disease. If she needs more help, refer her to the health centre for further support and care.

Summary of Study Session 21