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  What is Good Practice? HIV Care Beyond ART (11HC07)

Patricia Kloser, MD, MPH and Kimi Nakata, MSW, MPH


Release Date: June 2009
Expiration Date: EXPIRED May 30, 2011
Activity Code: 11HC07

Content is provided for informational purposes only.

As seen in the June 2009 edition of



Sponsored by the University of Medicine & Dentistry of New Jersey (UMDNJ), Center for Continuing & Outreach Education. This activity is supported by an educational grant from NJDHSS Division of HIV/AIDS Services through a MOA titled “Education and Training for Physicians and other Healthcare Professionals in the Diagnosis and Treatment of HIV/AIDS.”

Grantor Acknowledgement

This activity is supported by an educational grant from NJDHSS Division of HIV/AIDS Services through a MOA titled “Education and Training for Physicians and other Healthcare Professionals in the Diagnosis and Treatment of HIV/AIDS.

Target Audience

This activity is designed for physicians and nurses, and for other health care professionals in New Jersey who are involved in the care of persons with HIV/AIDS.

Statement of Need

Immunosuppression due to HIV infection increases the risk, occurrence, and severity of opportunistic infections (OIs) and other co-infections such as sexually transmitted infections. OIs can also have adverse effects on the natural history of HIV infection. The widespread use of antiretroviral therapy (ART) starting in the mid-1990s has had a profound influence on reducing OI-related mortality in HIV-infected persons, and is the most effective strategy for prevention of OIs.

Since the implementation of ART, OI hospitalizations and deaths have decreased, but OIs remain a leading cause of morbidity and mortality in HIV-infected persons, primarily in those who are either not on ART, or for whom it is not effective due to insufficient adherence or viral resistance to the regimen. Achieving and monitoring undetectable HIV viral loads through treatment adherence efforts can also contribute to lowering HIV transmission and new HIV cases.

The CDC convened a working group, including NIH and the Infectious Disease Society of America, to update guidelines on HIV treatment. They released a new report on April 10, 2009: Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. http://www.cdc.gov/mmwr/pdf/rr/rr5804.pdf

The 2009 Guidelines emphasize the critical role of ART in preventing and treating OIs, especially for infections for which there is no current chemoprophylaxis or treatment. New recommendations include monitoring for development of immune reconstitution inflammatory syndromes (IRIS), and monitoring patients for interactions between rifamycin and antiretroviral therapy.

Learning Objectives

Upon completion of this learning activity, the reader should be able to:

  • Establish short and long-term goals for each HIV patient, based on assessment, triage, and prioritizing with the patient.
  • Provide treatment to prevent opportunistic infections in HIV patients, according to the 2009 CDC guidelines.
  • Provide prophylactic vaccines to HIV patients, based on the most recent CDC guidelines, to reduce preventable disease.
  • Identify and address issues preventing optimal health for HIV patients, including poor nutrition, smoking, mental illness and substance use.

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. Estimated time to complete this activity as designed is 1.25 hours.


EXPIRED- CE is no longer available for this activity. This content is being provided for informational purposes only.


This activity was peer reviewed for relevance, accuracy of content, and balance of presentation by Brenda Christian, MEd, PA-C; and pilot tested for relevance and time required for participation by Kinshasa Morton, MD; Bonnie Abedini, RN, MSN; Mary C. Krug, RN, MSN, APN; and Kara Winslow, BSN, RN.


Activity Director(s)/CME Academic Advisor(s)
Brenda J. Christian, MEd, PA-C; Director, UMDNJ-CCOE-Division of AIDS Education Planning Committee


  • Patricia C. Kloser, MD, MPH, FACP, is Professor of Medicine and Preventive Medicine and Public Health, UMDNJ-New Jersey Medical School and School of Public Health; and Medical Director, Division of AIDS Education, UMDNJ-Center for Continuing & Outreach Education.
  • Kimi Nakata, MSW, MPH, is Supervising Program Coordinator in the Division of AIDS Education, UMDNJ-Center for Continuing & Outreach Education, and the editor of New Jersey AIDSLine.

Planning Committee:
Sindy M. Paul, MD, MPH, FACPM, New Jersey Dept. of Health and Senior Services, Debbie Y. Mohammed, MS, APRN-BC, ACRN, UMDNJ-University Hospital, Kimi Nakata, MSW, MPH, UMDNJ-CCOE

Faculty Disclosure Declarations

Debbie Mohammed has disclosed the following: she is on the speaker’s bureaus of BMS and Gilead. Conflicts of interest were resolved by review by Activity Director Brenda Christian, MEd, PA-C. The following have no relevant financial relationships to disclose: Authors Patricia C. Kloser, MD, MPH, FACP and Kimi Nakata, MSW, MPH; Activity Director Brenda J. Christian, MEd, PA-C; Planning committee members Sindy M. Paul, MD, MPH, FACPM; and field testers: Kinshasa Morton, MD; Bonnie Abedini, MSN, RN; Mary C. Krug, RN,MSN, APN; and Kara Winslow, BSN, RN.

Off-Label Usage Disclosure

This activity does not contain information of commercial products/devices that are unlabeled for use or investigational uses of products not yet approved.


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/AIDS Services, UMDNJ, or any manufacturer of pharmaceuticals. 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 the full prescribing information on any agent(s) presented in this activity for recommended dosage, indications, contraindications, warnings, precautions, and adverse effects before prescribing any medication.

Copyright © 2009 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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