1. By 2020, what percentage of PLWH will be 50 years of age or older?
A. 30%
B. 50%
C. 70%
D. 90%
E. Unsure
2. PLWH are at seriously elevated risk for 4 non-HIV conditions. Which of the following accurately lists these conditions?
A. Cancer, gastrointestinal disease, diabetes, hepatitis C
B. Cardiac disease, type 2 diabetes, hepatitis C, norovirus
C. Type 2 diabetes, heart failure, hepatitis C, uveitis
D. Cancer, cardiac disease, type 2 diabetes, hepatitis C
E. Unsure
3. The transdisciplinary team sees a newly diagnosed patient who is 55 years old. He also has active hepatitis B. Which of the following would be the best antiviral to include in his initial regimen?
A. Abacovir
B. Didanosine
C. Tenofovir
D. Zidovudine
E. Unsure
4. Your newly diagnosed patient described in the previous question appears to have been infected recently. His CD4 count is still good (590). The team decides to start him on a preferred regimen based on the guidelines, but he declines, saying he feels fine. Which of the following is the BEST counseling advise to give him?
A. Why don't we agree on a CD4 count at which to start treatment and watch and wait? What CD4 count seems reasonable to you?
B. Your co-infection with HBV puts you at higher risk for liver-related complications, so we need to treat both infections now.
C. Without treatment, older PLWH have a more rapid progression to AIDS and shortened survival than younger people.
D. Since you don't seem ready to start ART and commit to lifelong adherence, we can wait until your CD4 count falls below 500.
E. Unsure
5. This patient returns to the clinic 30 days after staring treatment. He indicates he is not having any problems with adherence, and doesn't seem to have any side effects. You ask the medication reconciliation technician to review his medications, and she reports in answer to her questions about OTC and CAM products, the patient reports he takes panoprazole for heartburn (and has for many years), and recently started milk thistle because he is concerned about his liver. He is currently taking dolutegravir plus tenofovir/emtricitabine. What action do you recommend?
A. Stop both the panoprazole and the milk thistle; use an H2RA for heartburn.
B. Stop the milk thistle, as it has potential to interact with NRTIs/nRTIs and INSTs.
C. Stop the antiviral regimen and check the patient's CD4 count and viral load.
D. Continue ART, OTC and CAM products as they are; there's no problem.
E. Unsure
6. At what point in treatment would you expect a patient to need either a C-C chemokine receptor type 5 (CCR5) inhibitor or an fusion inhibitor in a patient with excellent adherence?
A. In the initial treatment regimen
B. Within the first 3 months of treatment
C. After at least one treatment failure
D. Never in older adults
E. Unsure
7. Which of the following is NOT a compelling reason for pharmacists to join the transdisciplinary team and engage PLWH?
A. Pharmacists are more educated about HIV than other professionals.
B. Current rates of retention in care range from 45% to 70% annually.
C. Pharmacists can use motivational interviewing and educate patients.
D. Pharmacists placement in communities make them accessible.
E. Unsure
8. Which if the following is a concern when counseling the older PLWH?
A. Family fertility planning
B. Visual and auditory decline
C. Sedentary lifestyle
D. Lack of manual dexterity
E. Unsure
9. Select the statement that is TRUE about older PLWH and applying evidence-based management strategies:
A. ART is especially important for older patients because they have a greater risk of serious non-AIDS complications and potentially a blunted immunologic response to ART.
B. Adverse drug events from ART and concomitant drugs may occur less frequently in older patients living with HIV than in younger patients with HIV.
C. The potential for drug-drug interactions should be assessed annually, regardless of when patients start or switch ART and concomitant medications.
D. Counseling to prevent secondary transmission of HIV is less important in the care of the older patient with HIV because they are generally well aware of risks.
E. Unsure
10. Geriatric syndromes in older PLWH are growing concerns. Select the statement that is TRUE:
A. The development of geriatric syndromes often precludes nursing home admission because they complicate care.
B. Risk factors for frailty include medication toxicities, greater immune function dysfunction, and chronic inflammation.
C. HIV infection has not been associated with myopathy, so this symptom is rare in older PLWH.
D. Approximately one tenth of HIV-infected individuals report falls between ages 45 and 65 years.
E. Unsure
Evaluation Questions
11. How confident are you in your treatment recommendation for question #4?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
12. How confident are you in your treatment recommendation for question #5?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
