CME/CE Info

HIV and Aging Consensus Project: Recommended Treatment Strategies for Clinicians Managing Older Patients with HIV

CME/CE credit available October 17, 2016 – November 30, 2017
Estimated time to complete all chapters: 12.25 hours
Jointly provided by Postgraduate Institute for Medicine (www.pimed.com) and American Academy of HIV Medicine; in collaboration with ACRIA and American Geriatric Society, Geriatrics Healthcare Professionals.

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These activities are supported, in part, by an independent educational grant from Gilead.

Target Audience

This activity is intended for physicians and pharmacists and other healthcare providers who treat, diagnose and refer older patients with HIV disease.

Faculty – listed under “About/Who We Are”

Physician Continuing Medical Education

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Postgraduate Institute for Medicine and American Academy of HIV Medicine. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The Postgraduate Institute for Medicine designates these enduring materials for a maximum of 12.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Pharmacy Education

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Postgraduate Institute for Medicine is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Postgraduate Institute for Medicine designates these continuing education activities for 12.25 contact hour(s) (1.225 CEUs) of the Accreditation Council for Pharmacy Education.

Chapter 3 – Assessing Frailty and Functional Capacity
Physicians – maximum of 0.75 AMA PRA Category 1 Credits™
Pharmacists – 0.75 contact hours (0.075 CEUs)
ACPE UAN: 0809-9999-16-459-H01-P; knowledge
Learning Objective:

  • Identify different ways of assessing frailty in people living with HIV.

Chapter 5 – Multi Morbidity
Physicians – maximum of 0.5 AMA PRA Category 1 Credits™
Pharmacists – 0.5 contact hours (0.05 CEUs)
ACPE UAN: 0809-9999-16-460-H01-P; knowledge
Learning Objective:

  • Describe multimorbidity and explain how the approach to multimorbidity, including managing polypharmacy should be different than the traditional disease based models of care.

Chapter 7 – Detection and Screening for HIV in Older Adults
Physicians – maximum of 0.5 AMA PRA Category 1 Credits™
Pharmacists – 0.5 contact hours (0.05 CEUs)
ACPE UAN: 0809-9999-16-461-H01-P; knowledge
Learning Objectives:

  • Describe the CDC guidelines for screening for HIV.
  • Compare and contrast barriers to screening.

Chapter 8 – When to Initiate Antiretroviral Therapy in HIV and Aging*
Physicians – maximum of 0.5 AMA PRA Category 1 Credits™
Pharmacists – 0.5 contact hours (0.05 CEUs)
ACPE UAN: 0809-9999-16-462-H01-P; knowledge
Learning Objective:

  • List the indications to offer antiretroviral therapy (ART) in an older adult (> 50 years) living with HIV and describe the challenges seen in older adults on ART.

*The most up-to-date chapter can be found on the Clinical Recommendations page.

Chapter 9 – Immunizations in HIV and Aging*
Physicians – maximum of 0.5 AMA PRA Category 1 Credits™
Pharmacists – 0.5 contact hours (0.05 CEUs)
ACPE UAN: 0809-9999-16-463-H01-P; knowledge
Learning Objective:

  • State what vaccines are contraindicated in HIV-infected patients with advanced immunodeficiency and also where to find the CDC guidelines for vaccination in immunocompromised hosts, which includes HIV.

*The most up-to-date version of this chapter can be found on the Clinical Recommendations page.

Chapter 10 – Smoking Cessation in HIV and Aging*
Physicians – maximum of 0.5 AMA PRA Category 1 Credits™
Pharmacists – 0.5 contact hours (0.05 CEUs)
ACPE UAN: 0809-9999-16-464-H01-P; knowledge
Learning Objectives:

  • Describe the increased cardiovascular risk with smoking in a patient with HIV.
  • Describe strategies to help patients with HIV stop smoking.

*The most up-to-date version of this chapter can be found on the Clinical Recommendations page.

Chapter 11 – Cardiovascular Disease Screening and Prevention in HIV
Physicians – maximum of 0.75 AMA PRA Category 1 Credits™
Pharmacists – 0.75 contact hours (0.075 CEUs)
ACPE UAN: 0809-9999-16-466-H01-P; knowledge
Learning Objectives:

  • Describe factors that contribute to increased risk for CVD in aging individuals with HIV.
  • Discuss strategies for CVD risk assessment.

Chapter 12 – Diabetes Mellitus in HIV and Aging*
Physicians – maximum of 0.5 AMA PRA Category 1 Credits™
Pharmacists – 0.5 contact hours (0.05 CEUs)
ACPE UAN: 0809-9999-16-467-H01-P; knowledge
Learning Objectives:

  • Describe interventions that may prevent the development of diabetes mellitus.
  • State the target glycosylated hemoglobin for older patients with HIV and diabetes.

*The most up-to-date version of this chapter can be found on the Clinical Recommendations page.

Chapter 13 – Drug-drug Interactions and Polypharmacy in HIV and Aging
Physicians – maximum of 0.75 AMA PRA Category 1 Credits™
Pharmacists – 0.75 contact hours (0.075 CEUs)
ACPE UAN: 0809-9999-16-474-H02-P; knowledge
Learning Objective:

  • List two adverse effects of polypharmacy on the health of HIV-infected patients.

Chapter 14 – Cancer in HIV and Aging
Physicians – maximum of 0.75 AMA PRA Category 1 Credits™
Pharmacists – 0.75 contact hours (0.075 CEUs)
ACPE UAN: 0809-9999-16-475-H02-P; knowledge
Learning Objectives:

  • Describe incidence and virulence of Non AIDS cancers in people living with HIV and discuss cancer screening guidelines for older adults with HIV.

Chapter 15 – Viral Hepatitis Screening in HIV and Aging
Physicians – maximum of 0.75 AMA PRA Category 1 Credits™
Pharmacists – 0.75 contact hours (0.075 CEUs)
ACPE UAN: 0809-9999-16-476-H02-P; knowledge
Learning Objective:

  • Explain the importance of viral hepatitis screening for individuals with HIV.

Chapter 16 – Chronic Obstructive Pulmonary Disease in HIV and Aging
Physicians – maximum of 0.5 AMA PRA Category 1 Credits™
Pharmacists – 0.5 contact hours (0.05 CEUs)
ACPE UAN: 0809-9999-16-477-H02-P; knowledge
Learning Objective:

  • Recognize the increased risk of COPD development and progression in HIV-infected patients and the impact this disease has on patient function and survival.

Chapter 17 – Sexual Health in HIV and Aging
Physicians – maximum of 0.75 AMA PRA Category 1 Credits™
Pharmacists – 0.75 contact hours (0.075 CEUs)
ACPE UAN: 0809-9999-16-480-H02-P; knowledge
Learning Objectives:

  • Support the need for the health care team to address high-risk sexual behavior in their patients on a regular basis.
  • Utilize data indicating their comprehension of the fact that sexual activity in older adults occurs at high frequency, that awareness will provide a better basis to respond to requests for erectile dysfunction medications in men and estrogen products for vaginal dryness in women.
  • Explain the need to couple this with a discussion of safe sex practices.
  • Provide the health care team with practical advice on framing questions to start a dialogue with patients on sexual health

Chapter 18 – Osteoporosis in HIV and Aging
Physicians – maximum of 0.25 AMA PRA Category 1 Credits™
Pharmacists – 0.25 contact hours (0.025 CEUs)
ACPE UAN: 0809-9999-16-481-H02-P; knowledge
Learning Objective:

  • Describe two features that distinguish osteoporosis in HIV-infected patients from that in the general population.

Chapter 19 – The Kidney in HIV and Aging
Physicians – maximum of 0.5 AMA PRA Category 1 Credits™
Pharmacists – 0.5 contact hours (0.05 CEUs)
ACPE UAN: 0809-9999-16-482-H02-P; knowledge
Learning Objective:

  • Outline the risk factors for chronic kidney disease (CKD) in HIV-infected patients.

Chapter 20 – Hypertension in HIV and Aging
Physicians – maximum of 0.25 AMA PRA Category 1 Credits™
Pharmacists – 0.25 contact hours (0.025 CEUs)
ACPE UAN: 0809-9999-16-483-H02-P; knowledge
Learning Objectives:

  • Discuss how to optimize BP for older patients with HIV.
  • Modify the BP target for those with hypotension.
  • Follow general treatment guidelines, selecting appropriate anti-hypertensive medications.

Chapter 21 – Older Age and HIV-Associated Neurocognitive Disorder (HAND)
Physicians – maximum of 0.5 AMA PRA Category 1 Credits™
Pharmacists – 0.5 contact hours (0.05 CEUs)
ACPE UAN: 0809-9999-16-484-H02-P; knowledge
Learning Objective:

  • Describe three categories of HIV-associated neurocognitive disorders (HAND).

Chapter 22 – Depression in HIV and Aging
Physicians – maximum of 0.75 AMA PRA Category 1 Credits™
Pharmacists – 0.75 contact hours (0.075 CEUs)
ACPE UAN: 0809-9999-16-485-H02-P; knowledge
Learning Objectives:

  • Explain how depression is a common co-morbidity in older patients infected with HIV.
  • Describe why depression is associated with increased risk taking behavior.
  • Screen for depression using the Geriatric Depression Scale or the Montreal Cognitive Assessment.
  • Explain why SSRI drugs are the mainstay of treating depression but increasingly CBT (Cognitive Behavioral Therapy) is an efficacious intervention in this population.

Chapter 23 – Anxiety Disorders in HIV and Aging
Physicians – maximum of 0.25 AMA PRA Category 1 Credits™
Pharmacists – 0.25 contact hours (0.025 CEUs)
ACPE UAN: 0809-9999-16-486-H02-P; knowledge
Learning Objectives:

  • Discuss the frequency of anxiety disorders in adults with HIV infection.
  • List the preferred behavioral approaches to treatment.
  • Explain the options for psychopharmacotherapy.

Chapter 24 – Substance Abuse Disorders
Physicians – maximum of 0.25 AMA PRA Category 1 Credits™
Pharmacists – 0.25 contact hours (0.025 CEUs)
ACPE UAN: 0809-9999-16-487-H02-P; knowledge
Learning Objective:

  • Recognize the burden of substance use disorder in HIV infected adults above 50 years of age and how the treatment of this disorder is done in a comprehensive care model that integrates behavioral health services with medical treatment.

Chapter 25 – HIV-1 Associated Peripheral Neuropathologies in HIV and Aging
Physicians – maximum of 0.5 AMA PRA Category 1 Credits™
Pharmacists – 0.5 contact hours (0.05 CEUs)
ACPE UAN: 0809-9999-16-488-H02-P; knowledge
Learning Objective:

  • Name the most common type of HIV-1 associated peripheral neuropathy, its symptomatology and evidenced based treatment options.

Chapter 26 – Advance Care Planning in HIV and Aging*
Physicians – maximum of 0.25 AMA PRA Category 1 Credits™
Pharmacists – 0.25 contact hours (0.025 CEUs)
ACPE UAN: 0809-9999-16-489-H02-P; knowledge
Learning Objective:

  • Explain the importance of advanced care planning as standard practice for HIV-infected patients.

*The most up-to-date version of this chapter can be found on the Clinical Recommendations page.

Chapter 28 – PrEP and the Older Adult with HIV
Physicians – maximum of 0.25 AMA PRA Category 1 Credits™
Pharmacists – 0.25 contact hours (0.025 CEUs)
ACPE UAN: 0809-9999-16-490-H02-P; knowledge
Learning Objectives:

  • Provide the rationale for the use of PrEP (Pre-Exposure Prophylaxis) to reduce new HIV infections in older adults.
  • Explain the importance of the older adult with HIV becoming a conduit to provide information and encouragement for PrEP use in sexual partners and other older adults.

Chapter 29 – Nutrition in HIV and Aging
Physicians – maximum of 0.5 AMA PRA Category 1 Credits™
Pharmacists – 0.5 contact hours (0.05 CEUs)
ACPE UAN: 0809-9999-16-491-H02-P; knowledge
Learning Objective:

  • Demonstrate an understanding of the relationship between nutrition and health outcomes in aging individuals with HIV.

Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty
Christine Abrass – nothing to disclose
Jonathan Appelbaum – Consulting Fees: Merck; Gilead; Janssen
Cynthia Boyd – Royalty: Up-to-Date
Kristina Crothers – nothing to disclose
Marshall Forstein – nothing to disclose
Karl Goodkin – Contracted Research: Sunovion
Meredith Greene – nothing to disclose
James Havlik – nothing to disclose
Kevin High – Royalty: McGraw Hill
Stephen Karpiak – nothing to disclose
Ian McNicholl – nothing to disclose
Mark Simone-Skidmore – nothing to disclose
Charlie Smigelski – nothing to disclose
James Sosman – nothing to disclose
David Spach – nothing to disclose
Brian Wood – nothing to disclose

Planners and Managers
The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose. The AAHIVM planners and managers have nothing to disclose.

Method of Participation and Request for Credit
There are no fees for participating and receiving CME credit for this activity. During the period October 17, 2016 through November 30, 2017, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation on www.cmeuniversity.com.  On the navigation menu, click on “Find Post-test/Evaluation by Course” and search by course ID 11671.  Upon registering and successfully completing the post-test with a score of 70% or better and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 70% or better and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service.

Media: Internet

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.