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HIV Over 50: Managing Complex Care (12HC04)

Zeina R.Ghayad, DO and Todd P.Levin, DO

Content is provided for informational purposes only.

Release Date: December 1, 2010
Expired: December 1, 2012
Activity Code: 12HC04-DE02
As seen in the December 2010 edition of



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


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

Statement of Need

HIV patients age 50 and over are much more likely to have metabolic, cardiovascular, and renal disease, due both to HIV disease and HIV medications. HIV care focuses onmonitoring of HIVmarkers including CD4 and viral load, and prescription of antiretroviral medications. Many HIV patients use HIV care as their primary care. However, HIV specialists and clinics usually provide care under a specialty care model. There may be poor coordination between specialists,or patientsmay expect the HIV clinician to provide care for all comorbidities. For patients over age 50, HIV clinicians should identify and coordinate treatment for comorbidities usually managed in primary care or specialty care, such as cardiovascular and metabolic disorders including diabetes and impaired kidney function. Many patients will need to be referred to specialists for further diagnostic testing and treatment. These diagnoses and their treatment may affect the selection of a HAART regimen.

When HIV patients are seen by multiple specialists in separate practices or institutions, there may be incomplete diagnostic and treatment records available in the HIV practice or other specialty care.

Patients risk toxic interactions and effects when combinations are contra-indicated. The HIV clinical team should review all medications for patients with comorbidities to minimize interactions and consult with expert pharmacists as needed.

Learning Objectives

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

  1. Recognize the need to incorporate primary care approach to HIV care to address comorbidities including metabolic, cardiovascular, and renal disease, which are especially common in HIV-positive individuals over age 50.
  2. Develop appropriate treatment strategies for HIV patients who also have metabolic, cardiac, and/or renal disease.
  3. Explain risks of polypharmacy and other complications of co-managing HIV and these complex chronic illnesses.


Zeina Ghayad, DO, Infectious Disease Fellow, Garden State Infectious Disease Associates

Todd P. Levin, DO, Infectious Disease Clinician, Garden State Infectious Disease Associates; and UMDNJ-School of Osteopathic Medicine preceptor

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

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

Planning Committee

  • Sindy Paul, MD, MPH, FACPM, Medical Director, Division of HIV/AIDS Services, NJ 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
  • Kimi Nakata, MSW, MPH, UMDNJ-CCOE-Division of AIDS Education Program
    Supervisor and NJ AIDSLine Editor
  • Humberto Jimenez, PharmD, AAHIVE, Infectious Disease Pharmacist, St.Michael’s Medical Center; Clinical Assistant Professor, Ernest Mario School of Pharmacy, Rutgers University
  • 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 1.0 hour.


Credit is no longer available for this activity..


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, Clinical Assistant Professor, Ernest Mario School of Pharmacy, Rutgers University; and Brenda Christian, MEd, PA-C; Director of AIDS Education, UMDNJ-CCOE; and pilot tested for time required for participation by Kinshasa Morton, MD; Shobha Swaminathan, MD; Jojy Cheriyan, MD;Mary C. Krug,MSN, APN; Renee Powell,MS, RN; Kara Winslow, BSN, RN; Polly Jen, PharmD; John Faragon, 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, faculty, planning committee members, editor, content reviewers or field testers.

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.

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/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 © 2010 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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