Which of the following combinations will not be recommended for first line therapy in a patient with HIV associated dementia? a. Zidovudine plus lamivudine plus efavirenz b. Tenofovir plus emtricitabine plus lopinavir/ritonavir c. Tenofovir plus emtricitabine plus atazanavir/ritonavir d. Lamivudine plus abacavir plus fosamprenavir e. Zidovudine plus lamivudine plus abacavir

To answer this question, we must first know the standard recommendations for first-line therapy in patients with HIV associated dementia. According to the current guidelines, the preferred first-line options include combinations of two nucleoside reverse transcriptase inhibitors (NRTIs) such as lamivudine, emtricitabine, zidovudine, and tenofovir, paired with a non-nucleoside reverse transcriptase inhibitor (NNRTI) like efavirenz or a boosted protease inhibitor (PI) such as lopinavir/ritonavir or atazanavir/ritonavir.

Now let's examine each of the given combinations to find the one that is not recommended for first-line therapy in a patient with HIV associated dementia. a. Zidovudine + lamivudine + efavirenz: This combination fits the recommended pattern of two NRTIs (zidovudine and lamivudine) plus an NNRTI (efavirenz). Efavirenz has been associated with CNS side effects, however, it has been used effectively in patients with HIV associated dementia. b. Tenofovir + emtricitabine + lopinavir/ritonavir: This combination contains two NRTIs (tenofovir and emtricitabine) plus a boosted PI (lopinavir/ritonavir), which aligns with the recommended first-line therapy options. c. Tenofovir + emtricitabine + atazanavir/ritonavir: This combination also contains two NRTIs (tenofovir and emtricitabine) plus a boosted PI (atazanavir/ritonavir), fitting the recommended first-line therapy options. d. Lamivudine + abacavir + fosamprenavir: This combination includes two NRTIs (lamivudine and abacavir) but the third drug, fosamprenavir, is a protease inhibitor that is not typically recommended as first-line therapy, especially in patients with HIV associated dementia. e. Zidovudine + lamivudine + abacavir: This combination consists of three NRTIs (zidovudine, lamivudine, and abacavir). The recommended first-line therapy includes two NRTIs and either an NNRTI or a boosted PI, so this combination does not fit the standard guidelines.

Based on our evaluation, the not recommended combination for first-line therapy in a patient with HIV associated dementia is: e. Zidovudine + lamivudine + abacavir