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  Preventing and Treating PCP and MAC: A Continuing Challenge in HIV/AIDS Care (11HC08)

Cindy Meng Hou, DO, MBA and Sindy Paul, MD, MPH, FACPM


Release Date: December 12, 2009
Expiration Date: EXPIRED November 30, 2011
Activity Code: 11HC08

Content is provided for informational purposes only.

As seen in the December 2009 edition of  



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

Grantor Acknowledgement

This activity is supported by an educational grant from the New Jersey Department of Health and Senior Services (NJDHSS) - Division of HIV/AIDS Services through an 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 nurses, pharmacists, and other health professionals in New Jersey who are involved in the care of persons with HIV/AIDS.

Statement of Need

The CDC, with the Infectious Disease Society of America, released updated Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents on April 10, 2009. These Guidelines emphasize the critical role of ART in preventing and treating OIs, and thus significantly reducing mortality fromHIV/AIDS.

HIV care quality indicators set by the USDHSS/HRSA include 95% adherence to preventive treatment of PCP, or Pneumocystis jirovecii pneumonia, among patients with CD4+ counts <200 cells/μL and 95% adherence to preventive treatment of Mycobacteriumavium complex (MAC) for HIV patients with CD4+ counts <50 cells/μL, reducing missed opportunities to prevent opportunistic infections among immune suppressed HIV patients. This activity is designed to provide a summary of the guidelines, and the currently low prophylactic rates in publicly-funded HIV clinics. Case examples and charts of protocols and treatment interactions illustrate challenges and will assist clinicians in improving decision making in implementing the guidelines. The NJDHSS has prioritized targeted quality improvement plans to identify HIV patients at risk of PCP for prophylactic treatment and close monitoring.

Learning Objectives

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

  • Describe the CDC and Infectious Disease Society of America guidelines for identifying HIV/AIDS patients at highest risk of Pneumocystis jirovecii pneumonia (PCP) and Mycobacteriumavium complex (MAC), and providing effective prophylaxis.
  • Identify gaps between the recommended levels of prophylaxis and actual practice in the United States.
  • Incorporate CDC/IDSA guidelines for when to start, to stop, and to restart chemoprophylaxis for HIV/AIDS patients into their practices
  • Identify and address the adverse effects and drug interactions associated with medications for PCP and MAC prophylaxis and treatment.

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 completing this activity as designed and achieving a passing score of 70% or more on the self-assessment test, participants will have access to a printable online credit statement. Estimated time to complete this activity as designed is 0.75 hour for physicians and 1.0 hour for nurses and other health professionals.


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 Patricia Kloser, MD, MPH; Debbie Mohammed, MS, MPH, APRN-BC, AACRN; John J. Faragon, PharmD, BCPS, AAHIVE; and Brenda Christian, MEd, PA-C; Director of UMDNJ-CCOE-Division of AIDS Education; and pilot tested for relevance and time required for participation by Kinshasa Morton, MD, Clinical Instructor of Family Medicine, UMDNJ-Robert Wood Johnson School of Medicine; Bonnie Abedini, MSN, RN; Director, Quality & Compliance, Rutgers Health Services; Mary C. Krug, MSN, APN; Associate Director Health Services, Hurtado Health Center, Rutgers University; Kara Winslow, BSN, RN; Clinical Care Coordinator, UMDNJ-University Hospital; and George Rusuloj, PharmD, Pharmacist, Bell Pharmacy.


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

  • Patricia Kloser,MD,MPH,UMDNJ-NJ Medical School


  • Cindy Meng Hou, DO, MBA, is an Infectious Disease Fellow with Garden State Infectious Diseases Associates, PA (GSIDA), in Voorhees,NJ, through the UMDNJ-School of Osteopathic Medicine in Stratford,NJ.
  • Sindy M. Paul, MD, MPH, FACPM, is the Medical Director of the NJ Dept. of Health and Senior Services, Division of HIV/AIDS Services; Assistant Clinical Professor at the UMDNJ School of Public Health and past President, New Jersey Board of Medical Examiners.

Planning Committee:

  • Sindy Paul, MD, MPH, FACPM, NJ Dept. of Health and Senior Services
  • Debbie Mohammed, MS, APRN-BC, ACRN, UMDNJ-University Hospital; Nurse Practitioner
  • Kimi Nakata, MSW, MPH, UMDNJ-CCOE-Division of AIDS Education Program Supervisor and NJ AIDSLine Editor
  • John Faragon, PharmD, BCPS, AAHIVE; NY/NJ AETC Clinical Pharmacy Director; pharmacist, Albany Medical Center

Faculty Disclosure Declarations

There were no relevant financial relationships to disclose reported by the activity director, faculty, planning committeemembers, editor, content reviewers or field testers.

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 education 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.

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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