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ONLINE LEARNING CENTER

Screening and Management of Latent TB Infection and TB Disease in HIV-Infected Patients (13HC01)

Henry S. Fraimow, MD

 
 
 

Release Date: June 1, 2011
Expiration Date: May 30, 2013
Activity Code: 13HC01

To receive CE credit you should:

  • Review the activity in its entirety
  • Successfully complete the post-test
  • Submit an activity evaluation

Upon successful completion of these requirements, you will have access to a printable credit statement.

If you have any questions about this process, please email the Center for Continuing and Outreach Education at ccoereg@ca.rutgers.edu or call CCOE Enrollment Services at (800) 227-4852.

As seen in the June 2011 edition of


ACTIVITY INFORMATION

Sponsor

Sponsored by the University of Medicine & Dentistry of New Jersey (UMDNJ), Center for Continuing & Outreach Education (CCOE), Division of AIDS Education.

Funding

This activity is supported by an educational grant from the New Jersey Department of Health and Senior Services (NJDHSS) – Division of HIV, STD and TB Services, through an MOA, “Education and Training for Physicians and other Healthcare Professionals in the Diagnosis and Treatment of HIV/AIDS.”

Target Audience

This free knowledge-based activity is designed for physicians, nurses, pharmacists, social workers, and other health care professionals in New Jersey who are involved in the care of persons with HIV/AIDS and/or tuberculosis

Statement of Need

Patients with advanced HIV infection who are also infected with tuberculosis (TB) are 20 to 37 times more likely to progress from latent tuberculosis infection (LTBI) to active TB disease compared to patients with TB alone. Co-infection with HIV and TB increases the risk of progression of both diseases, and can also alter the clinical manifestations of TB disease. As CD4 counts fall, extra-pulmonary and disseminated TB disease are increasingly common, and these atypical presentations may delay diagnosis, contributing to increased morbidity and mortality. The CDC now recommends screening HIV patients with either a Tuberculin Skin Test (TST) or with Interferon Gamma Release Assays (IGRAs), which do not require the second visit needed for TST results.

All individuals with TB should be tested for HIV infection, and all individuals with HIV disease should be screened for LTBI, with clinical evaluation as indicated for active TB disease. HIV patients with TB infection should always be treated with preventive therapy if they have LTBI, and with anti-TB therapy if they have developed active TB illness. The 2011 HIV Treatment Guidelines updated recommendations for regimens and monitoring to reduce drug interactions associated with co-management of TB and HIV, and to avoid or treat development of TB-associated immune-reconstitution inflammatory syndrome (IRIS) after initiation of ART. Early identification and appropriate management of individuals co-infected with HIV and TB provides an opportunity to improve the care and outcome of both disease processes.

Learning Objectives

Upon completion of this activity, participants should be able to:

  1. Identify and screen individuals at highest risk for HIV and TB coinfection based on knowledge of global and local epidemiology of co-infection and appropriate use of screening tools including Tuberculin Skin Test (TST) and Interferon Gamma Release Assays (IGRA).
  2. Appropriately treat HIV-infected individuals with latent TB infection and TB disease; including optimal sequencing of HAART and anti-tuberculous therapy in co-infected patients.
  3. Recognize and manage complications of treatment of HIV and TB co-infection including potentially serious drug interactions and development of immune-reconstitution inflammatory syndrome (IRIS).

Faculty

Activity Director(s)/CME Academic Advisor(s)

Patricia Kloser, MD, MPH, Professor of Medicine, UMDNJ-New Jersey Medical School

Author

Henry S. Fraimow, MD, Associate Professor of Medicine, UMDNJ-Robert Wood Johnson Medical School, Camden, NJ; Senior Medical Consultant, Southern New Jersey Regional Specialty Chest Clinic, Division of Infectious Diseases, Cooper University Hospital, Camden, NJ.

Planning Committee

Sindy Paul, MD, MPH, FACPM, Medical Director, Division of HIV, STD and TB Services, New Jersey Department of Health and Senior Services.

Debbie Y. Mohammed, MS, MPH, APRN-BC, ACRN, Nurse Practitioner, UMDNJ-University Hospital and St.Michael’s Medical Center – Peter Ho Clinic

Humberto Jimenez, PharmD, AAHIVE, Infectious Disease Pharmacist, St.Michael’s Medical Center; Clinical Assistant Professor, Ernest Mario School of Pharmacy, Rutgers University

Kimi Nakata, MSW, MPH, UMDNJ-CCOE-Division of AIDS Education Program Supervisor and Editor, NJ AIDSLine.

Bonnie R. Abedini, MSN, RN, Director, Quality & Compliance, Rutgers University Health Services

Method of Instruction

Participants should read the learning objectives and review the activity in its entirety. After reviewing the material, complete the self-assessment test which consists of a series of multiple-choice questions. Upon achieving a passing score of 70% or more on the self-assessment test, and submitting a course evaluation, participants will have access to an online printable credit statement.Estimated time to complete this activity as designed is 1.25 hours for physicians, 1.09 hours for nurses, and 1.25 hours for pharmacists.

Accreditation

Physicians:
UMDNJ–Center for Continuing and Outreach Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

UMDNJ–Center for Continuing and Outreach Education designates this educational activity for a maximum of 1.25 hours of AMA PRA category credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Nurses:
UMDNJ-Center for Continuing Education andOutreach Education is an approved provider of continuing nursing education by NJSNA, an accredited approver, by the American Nurses Credentialing Center’s Commission on Accreditation. Provider Number P173-11/09-12. Provider Approval is valid through November 30, 2012.

This activity is awarded 1.09 contact hours. (60 minute CH)

Provider approved by the California Board of Registered Nursing, Provider Number CEP 13780.

Nurses should only claim those contact hours actually spent participating in the activity.

Approved provider status refers only to continuing education activities and does not imply ANCC COA or NJSNA endorsement of any commercial products.

Pharmacists:
UMDNJ-Center for Continuing and Outreach Education is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

This course (ACPE #0374-0000-11-002-H01-P) qualifies for 0.75 contact hours (0.075 CEU) of continuing pharmacy education credit.

Pharmacists and nurses should only claim those contact hours actually spent participating in the activity.

CEUs:
UMDNJ-CCOE certifies that this continuing education offering meets the criteria for up to 0.125 Continuing Education Units (CEUs), provided the activity is completed as designed. One CEU equals 10 contact hours of participation in an organized continuing education experience under responsible sponsorship, capable direction and qualified instruction. Participants should only claim those contact hours actually spent participating in the activity.

Review

In order to help ensure content objectivity, independence, and fair balance, and to ensure that the content is aligned with the interest of the public, UMDNJ-CCOE has resolved all potential and real conflicts of interest through content review by non-conflicted, qualified reviewers. This activity was peer-reviewed for relevance, accuracy of content and balance of presentation by Patricia Kloser,MD,MPH; Debbie Mohammed, MS, MPH, APRN-BC, AACRN; Humberto Jimenez, PharmD, AAHIVE; and Brenda Christian, MEd, PA-C. UMDNJ-CCOE Director of AIDS Education.

Field Test:
This activity was pilot-tested for time required for participation by Kinshasa Morton, MD; Shobha Swaminathan, MD; Jojy Cheriyan, MD; Mary C. Krug, MSN, APN; Renee Powell, BS, RN; Kara Winslow, BSN, RN; Polly Jen, PharmD; John Faragon, PharmD, AAHIVE; and George Rusuloj, PharmD.

Disclosure Disclaimer

In accordance with the disclosure policies of UMDNJ and to conform with ACCME and FDA guidelines, individuals in a position to control the content of this educational activity are required to disclose to the activity participants: 1) the existence of any relevant financial relationship with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients, with the exemption of non-profit or government organizations and non-health care related companies, within the past 12 months; and 2) the identification of a commercial product/device that is unlabeled for use or an investigational use of a product/device not yet approved.

Faculty Disclosure Declarations

There were no relevant financial relationships to disclose reported by the activity director, planning committee members, peer reviewers or field testers. Henry Fraimow, MD (faculty) has disclosed the following relevant financial relationships: his spouse has received Grant/Research Support: SK, Valeant, Pfizer, UCB, Eisai, Johnson & Johnson, NIH, and Epilepsy Research Foundation; member of Scientific Advisory Board: UCB, Johnson & Johnson, Eisai, Novartis, Valeant, Icagen, Intranasal, Sepracor, and Marinus; Travel funding: UCB, Kyowa, Eisai, Johnson & Johnson, Valeant, GlaxoSmithKline; Associate Editor: Epilepsy current; Supplements editor: Epileptic Disorders; President: Epilepsy Study Consortium.

Off-Label Usage Disclosure

This activity contains information of commercial products/devices that are unlabeled for use or investigational uses of products not yet approved. This content is limited to off-label use of the Quantiferon- TB Gold test and the Tspot.TB test, per current CDC guidelines. Source: CDC. Updated guidelines for using interferon gamma release assays to detect Mycobacterium tuberculosis infection, United States-2010. MMWR 2010; 59 (No. RR-5).

Content Disclaimer

The views expressed in this activity are those of the faculty. It should not be inferred or assumed that they are expressing the views of NJDHSS – Division of HIV, STD and TB Services, any manufacturer of pharmaceuticals or devices, or UMDNJ. It should be noted that the recommendations made herein with regard to the use of therapeutic agents, varying disease states, and assessments of risk, are based upon a combination of clinical trials, current guidelines, and the clinical practice experience of the participating presenters. The drug selection and dosage information presented in this activity are believed to be accurate. However, participants are urged to consult all available data on products and procedures before using them in clinical practice.

Copyright © 2011 UMDNJ-Center for Continuing and Outreach Education. All rights reserved including translation into other languages.No part of this activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval systems, without permission in writing from UMDNJ-Center for Continuing and Outreach Education. Please direct CME related questions to UMDNJ at 973-972-4267 or email ccoe@ca.rutgers.edu.


 

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