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Initiating Antiretroviral Therapy, Beyond the Guidelines (14HC05)

Patricia Kloser, MD, MPH, FACP, Professor Medicine and Public Health, UMDNJ; with Virginia Allread, MPH, Global Program Director and AIDSLine Editor, UMDNJ


Release Date: December 1, 2012
Expired: November 30, 2014
Activity Code: 14HC05

This content is being provided for informational purposes only.

If you have any questions about this process, please email the Center for Continuing and Outreach Education at cccoereg@ca.rutgers.edu or call CCOE Enrollment Services at (800) 227-4852.
As seen in the December 2012 edition of



Sponsored by François-Xavier Bagnoud Center, School of Nursing, University of Medicine and Dentistry of New Jersey and UMDNJ-Center for Continuing and Outreach Education.


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

Statement of Need

HIV Prevention Trials Network (HPTN) 052 demonstrated that earlier use of ARVs by HIV-infected heterosexuals partnered with uninfected individuals (serodiscordant couples) reduced HIV transmission by 96%. The study also demonstrated that participants who delayed ARV therapy until their CD4 cell counts were an average of 230 experienced a shorter time to primary clinical event, including AIDS-defining disease than participants who began ARV therapy sooner (an average CD4 cell count of 440). The current version (dated March 27, 2012) of the United States’ Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents (the Guidelines) supports the findings of HPTN 052 as well as findings from other recent studies in recommending that all HIV-infected individuals initiate ARV therapy, regardless of CD4 cell count.

Evidence from AIDS 2012 and reports from clinicians suggest that there are two knowledge gaps related to the current Guidelines: many physicians who are not HIV specialists are unaware that the Guidelines were updated in March 2012 and are defaulting to guidance in earlier publications. Secondly, prescribers would benefit from guidance on how to tailor the recommendations in the Guidelines to individual client need.

Target Audience

This activity is designed for physicians, nurses, social workers, health educators, and other health care professionals in New Jersey who are involved in the care of people with HIV.

Method of Participation

Participants should read the learning objectives, review the activity in its entirety, and then complete the self-assessment test, which consists of a series of multiple-choice questions. Upon completing this activity as designed, 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 1.17 hours for nurses, and 1.25 hours for physicians.

Learning Objectives

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

  1. Discuss treatment as prevention.
  2. Summarize recommendations from the Guidelines on initiating antiretroviral therapy.
  3. Implement a tailored ARV therapy regimen for patients with HIV, as recommended by the Guidelines.


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

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

Margaret Evans, MSN, RN, Lead Nurse Planner, Nurse Manager for Education and Performance Improvement at Robert Wood Johnson Medical Group.

Planning Committee

Virginia Allread, MPH, AIDSLine Editor and Global Program Director, FXB Center, UMDNJ

Linda Berezny, Supervising Program Development Specialist Prevention and Education, NJDOH, Division of HIV, STD and TB Services

Alicia Gambino, MA, CHES, Director of Public Education, New Jersey Poison Information & Education System

Sindy Paul, MD, MPH, FACPM, Medical Director, NJDOH, Division of HIV, STD and TB Services

Joanne Phillips, RN, MS, Education, Specialist, FXB Center, UMDNJ

Renee Powell, BS, RN, Clinical Coordinator Quality Management, FXB Center, UMDNJ

Sarah Quinless, BA, Program Coordinator, FXB Center, UMDNJ

Michelle Thompson, Program Manager, FXB Center, UMDNJ

Elizabeth Ward, MSJ, Executive Director, CCOE, UMDNJ

Activity Authors

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

Virginia Allread, MPH, AIDSLine Editor and Global Program Director, FXB Center, UMDNJ


Credit is no longer available for this activity.

Peer 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 Joanne Phillips, RN, MS; and Renee Powell, BS, RN.

Field Test:
This activity was pilot-tested for time required for participation by David John Cennimo, MD; Jojy Cheriyan, MD, MPH, MPhil; Anna M. Haywood, RN, MSN; Mary C. Krug, RN, MSN, APN; Debbie Mohammed, MS, MPH, APRN-BC, AACRN; and Kara Winslow, BSN, RN.

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.

Disclosure Declarations

There were no relevant financial relationships to disclose reported by the activity director, authors, planning committee members, peer 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 NJDOH – 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 © 2012 UMDNJ

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.

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