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The Kidney in HIV-1 (16HH01)

Mohamed G. Atta, MD, MPH
Division of Nephrology, The Johns Hopkins University School of Medicine, Baltimore, Maryland


Release Date: December 1, 2013
Expiration: November 30, 2015
Activity Code: 16HH01

This content is being provided for informational purposes only.

.As seen in the December 2013 edition of



Sponsored by François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey and the Center for Continuing and Outreach Education at Rutgers Biomedical and Health Sciences.


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

Individuals with HIV-1 infection are inherently prone to unique factors and exposures increasing their risk for kidney disease. In part because traditional risk factors for chronic kidney disease (CKD) such as diabetes, hypertension, and dyslipidemia are more common HIV-1 infected individuals particularly with ART exposure. When tackling kidney disease in this population, one must consider a broader array of potential diagnoses. Kidney disease in HIV-1 infected patients encompasses an array of disorders that includes acute kidney injury (AKI), glomerular disorders, CKD, and drug induced injuries in its toxic or allergic forms.

There is strong evidence linking AKI, proteinuria, and CKD with adverse outcomes among HIV-1 infected individuals. Conversely, the incidence of all-cause mortality, end stage renal disease, cardiovascular disease, and heart failure increases incrementally with the severity of AKI. To exacerbate the situation, late diagnosis is common: the vast majority of kidney disease is asymptomatic and thus requires markers for both screening and diagnosis.

Among antiretroviral agents currently approved for the treatment of HIV-1, CKD has been most clearly established with nucleoside reverse transcriptase inhibitor: tenofovir particularly when used with ritonavir boosting; and protease inhibitors: indinavir, atazanavir, and to lesser extent lopinavir/ritonavir. Whether on ART or not, clinicians who treat HIV populations should screen for renal function.

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 and achieving a passing score of 70% or more on the self-assessment test and submitting a course evaluation, participants will receive a printable credit statement.

Estimated time to complete this activity as designed is 1.06 hours for nurses, and 0.75 hour for physicians.

Learning Objectives

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

  1. List the indicators of renal injury in HIV infected patients
  2. Recognize the array of kidney disorders in HIV infected patients
  3. Describe the management of kidney disease in HIV infected individuals.


Activity Directors/CME Academic Advisors

Patricia Kloser, MD, MPH, Infectious Disease Specialist

Margaret Evans, MSN, RN, CCOE Primary 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, Rutgers

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

Carolyn Burr, RN, EdD, Deputy Director, FXB Center, Rutgers

Ellen Dufficy, RN, Nurse Consultant, Ryan White Part D, 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, Rutgers

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

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

Michelle Thompson, Program Manager, FXB Center, Rutgers

Elizabeth Ward, MSJ, Executive Director, Rutgers CCOE

Activity Authors

Mohamed G. Atta, MD, MPH, Division of Nephrology, The Johns Hopkins University School of Medicine, Baltimore, Maryland


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, CCOE has resolved all potential and real conflicts of interest through content review by a non-conflicted, qualified reviewer. This activity was peer-reviewed for relevance, accuracy of content and balance of presentation by Joanne Phillips, RN, MS.

Field Test:
This activity was field tested for time required for participation by Bonnie R. Abedini, MSN, RN; David John Cennimo, MD; Jojy Cheriyan, MD, MPH, MPhil; Anna M. Haywood, RN, MSN; Mary C. Krug, RN, MSN, APN; Kinshasa Morton, MD; Shobha Swaminathan, MD; and Kara Winslow, BSN, RN.

Disclosure Disclaimer

In accordance with the disclosure policies of Rutgers University 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

Mohamed G. Atta is supported by the National Institute of Diabetes and Digestive and Kidney Diseases grant P01DK056492; he works as a consultant for Gilead and GSK. In addition he is a Scientific Advisory Board Member for both Merck and BMS.

The activity directors, planning committee members, peer reviewer and field testers have no relevant financial relationships to disclose.

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 Rutgers University. 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 © 2013 Rutgers University

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 Rutgers University

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