International AIDS Society-USA

Cases on the Web (COW) is a series of case-driven continuing medical education activities sponsored by the International AIDS Society–USA. The COW program was created to offer physicians convenient online access to top-quality education in the field of HIV medicine. Two levels of COW activities are offered.

Advanced activities are for physicians who have a working knowledge of HIV disease management and currently provide comprehensive or specialty care for at least 10 patients with HIV and AIDS or who are involved in AIDS clinical trials or investigations. Advanced activities are appropriate for those who have completed at least 10 hours of CME in HIV and AIDS medicine in the past 2 years.

Basic activities are for physicians who are new to the practice of HIV medicine or who intend to start providing care for patients with HIV and AIDS. Basic COW activities are also appropriate for experienced HIV clinicians who are seeking to refresh their understanding of the standard elements of HIV care.

August 11, 2010: Our latest Cases on the Web activity, Management of Depression and Alcohol Dependence in an HIV/HCV Coinfected Patient, by Gareen Hamalian, MD, MPH, and Joseph Z. Lux, MD, is now available. This presentation introduces a case concerning factors (adherence, safety profiles, and drug interactions) that influence care of a patient with psychiatric illness, including the choice of psychotropic medication, antiretroviral medication (notably efavirenz), and the decision to use interferon alfa to treat HCV coinfection.

August 10, 2010: Our latest Cases on the Web activity, Human Papillomavirus Infection in the HIV-Infected Woman, by Erna Milunka Kojic, MD, and Susan Cu-Uvin, MD, is now available. This presentation introduces cases addressing the current screening and management guidelines of anogenital HPV diseases in HIV-infected women.

July 1, 2010: Our latest Cases on the Web activity, Care of HIV-Infected Women During Pregnancy, by Deborah Cohan, MD, MPH, is now available. This presentation introduces cases related to the care of an HIV-infected pregnant woman.

Alerts

June 25, 2010: FDA Approves New Hepatitis C Virus Rapid Test

The United States Food and Drug Administration (FDA) has approved a rapid blood test designed to detect antibodies to the hepatitis C virus (HCV) in whole blood specimens from individuals 15 years of age and older. This test (OraSure Technologies Inc., Bethlehem, PA) is designated for individuals who are at risk for infection with HCV or who have symptoms of hepatitis. The results take about 20 minutes, and a positive test result should be followed with a confirmatory test using traditional HCV testing methods. This test can only be administered in a professional medical setting that satisfies the technical requirements for moderate complexity testing.

For more information, please see the FDA press release at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm217318.htm.

June 18, 2010: FDA Approves New, “Fourth Generation” HIV Diagnostic Test

The US Food and Drug Administration (FDA) has approved a diagnostic test (Abbott Laboratories, Abbott Park, Illinois) that simultaneously detects both antigen and antibodies to HIV, allowing for the extended diagnosis in the earlier, acute phase infection with HIV, before the emergence of antibodies produced by the patient. Using this test, the median detection time is 7 days earlier, compared with the third-generation enzyme immunoassay antibody tests.

Although not intended for the routine screening of blood donations, this test has been approved as a screening assay for HIV-1 or HIV-2 infection in urgent situations. This is also the first test that has been approved for children as young as 2 years, and pregnant women.

For more information, please see the FDA press release at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm216375.htm.

March 19, 2010: Drug Label for Etravirine Modified to Include Additional Drug Interactions

The US Food and Drug Administration (FDA) has modified the drug label for etravirine to include information about interactions between this drug and fluconazole or voriconazole and with clopidogrel. Coadministration of etravirine with fluconazole or voriconazole increased etravirine exposures – coadministration should be done with caution. Coadministration of etravirine and clopidogrel decreased activation of clopidogrel to its active metabolite – alternatives to clopidogrel should be considered. Please see the FDA announcement for more information.

March 3, 2010: Saquinavir and Ritonavir Used in Combination May Cause Prolonged QT and PR Intervals

The US Food and Drug Administration (FDA) is reviewing data that suggests that the use of ritonavir-boosted saquinavir may increase the risk of cardiac arrhythmias. When this drug combination was given to healthy patients, there was a dose-dependent prolongation of the QT and PR intervals as seen on electrocardiogram. A prolonged QT interval can increase the risk of a serious rhythm disturbance called torsades de pointes, and a prolonged PR interval can cause heart block. The FDA recommends that ritonavir-boosted saquinavir not be used in patients with a history of QT interval prolongation or who are taking other drugs known to prolong the QT interval. Please see the FDA announcement for more information.

February 15, 2010: FDA Approves Ritonavir Tablet

The US Food and Drug Administration (FDA) has approved a 100 mg tablet formulation of ritonavir. Unlike the soft-gel capsule formulation of ritonavir, the heat-stable tablet formulation does not need refrigeration but must be taken with meals. Ritonavir tablets are not bioequivalent to ritonavir capsules. Under moderate fat conditions, the mean Cmax of a single 100-mg dose increased by 26%. It is not known whether the increase in peak level will affect tolerability. Please see the FDA announcement for additional information.

February 9, 2010: Revised FDA Warnings and Precautions for Use of Didanosine

Based on 42 post-marketing reports of adverse events, the US Food and Drug Administration (FDA) has concluded that an association exists between didanosine use and the development of noncirrhotic portal hypertension. Owing to the potential severity of portal hypertension, including death from hemorrhaging esophageal varices, the FDA has revised the Warning and Precautions section of the didanosine drug label to assure safe use of this drug.

December 11, 2009: Increased Virologic Failure Shown in Some Patients Using Abacavir/Lamivudine versus Tenofovir/Emtricitabine in Initial Therapy

Results reported by the ACTG A5202 study team have shown substantial differences in virologic efficacy of the nucleoside analogue reverse transcriptase backbone in initial antiretroviral regimens in patients with baseline HIV RNA levels at or above 100,000 copies/mL. Four once-daily HIV regimens were compared – abacavir/lamivudine or tenofovir/emtricitabine, each used with either efavirenz or ritonavir-boosted atazanavir. At a scheduled interim review, the time to virologic failure and the time to first adverse event were substantially shorter in abacavir/lamivudine recipients than in tenofovir/emtricitabine recipients (median 60 weeks of follow-up). The part of the study in patients who had high HIV RNA levels at baseline and who were receiving abacavir/lamivudine was stopped, but the study continues to evaluate the other regimens. Please see the abstract of the study in the December 3, 2009 issue of the New England Journal of Medicine for details.

November 20, 2009: Use of Maraviroc Extended to Treatment of Antiretroviral-Naive Adult Patients with HIV

The US Food and Drug Administration (FDA) Antiviral Drugs Advisory Committee has recommended extension of the use of the CCR5 coreceptor antagonist maraviroc to the treatment of antiretroviral-naive adults with exclusively CCR5-tropic HIV-1 virus as part of combination therapy. Maraviroc had been approved for the treatment of antiretroviral-experienced adults with HIV since August 2007. See the complete prescribing information for maraviroc for safety information and warnings.

Grant Support

General information about COW program grant support can be viewed by selecting here. Acknowledgment of the funders of specific COW activities is provided on the Instructions page of each presentation.

About the IAS-USA

The mission of the International AIDS Society–USA is to improve the treatment, care, and quality of life of persons with HIV/AIDS through balanced, relevant, innovative, and state-of-the-art education for physicians who care for people with HIV disease.

Recent Presentations

The following activities provide CME credit. Please see the Presentation Archive for expired COW activities that are available for study but that no longer provide CME credit.

Presentation 53

Management of Depression and Alcohol Dependence in an HIV/HCV Coinfected Patient

by Gareen Hamalian, MD, MPH, and Joseph Z. Lux, MD

CME Credit Available: 1.5 AMA PRA Category 1 Credits^TM
Release Date: August 11, 2010
Date of Last Review/Update: August 11, 2010
Expiration Date: August 11, 2011

Level: Advanced

Presentation 52

Human Papillomavirus Infection in the HIV-Infected Woman

by Erna Milunka Kojic, MD, and Susan Cu-Uvin, MD

CME Credit Available: 1.75 AMA PRA Category 1 Credits^TM
Release Date: August 10, 2010
Date of Last Review/Update: August 10, 2010
Expiration Date: August 10, 2011

Level: Advanced

Presentation 51

Care of HIV-Infected Women During Pregnancy

by Deborah Cohan, MD, MPH

CME Credit Available: 2.0 AMA PRA Category 1 Credits^TM
Release Date: July 1, 2010
Date of Last Review/Update: July 1, 2010
Expiration Date: July 1, 2011

Level: Advanced

Presentation 50

Viral Blips in the HIV-Infected Patient

by Timothy J. Henrich, MD, and Daniel R. Kuritzkes, MD

CME Credit Available: 1.5 AMA PRA Category 1 Credits^TM
Release Date: June 23, 2010
Date of Last Review/Update: June 23, 2010
Expiration Date: June 23, 2011

Level: Advanced

Presentation 49

Common Bacterial Infections in the HIV-Infected Patient

by Ricardo M. La Hoz, MD, and J. Martin Rodriguez, MD

CME Credit Available: 1.75 AMA PRA Category 1 Credits^TM
Release Date: June 22, 2010
Date of Last Review/Update: June 22, 2010
Expiration Date: June 22, 2011

Level: Advanced

Presentation 48

Human Papillomavirus-Related Anal Squamous Cell Dysplasia and Carcinoma in HIV Infection

by John Koeppe, MD, and Steven C. Johnson, MD

Level: All

CME Credit Available: 1.0 AMA PRA Category 1 Credit^TM
Release Date: December 1, 2009
Date of Last Review/Update: December 1, 2009
Expiration Date: December 1, 2010

Presentation 47

Common Drug Interactions in Patients Receiving Antiretroviral Therapy

by John J. Faragon, PharmD, BCPS,
David Condoluci, DO, and
Cindy M. Hou, DO, MBA

Level: Basic

CME Credit Available: 1.25 AMA PRA Category 1 Credits^TM
Release Date: November 3, 2009
Date of Last Review/Update: May 27, 2010
Expiration Date: May 27, 2011

Presentation 46

Non-AIDS-Defining Cancers in Patients with HIV Infection

by Roger J. Bedimo, MD, MS

Level: Advanced

CME Credit Available: 1.25 AMA PRA Category 1 Credits^TM
Release Date: October 21, 2009
Date of Last Review/Update: October 21, 2009
Expiration Date: October 21, 2010

Note: Slide set available!

Presentation 45

Management of an HIV-Infected Patient After Initial Antiretroviral Regimen Failure

by Warangkana Sangchan, MD, and Lisa M. Chirch, MD

Level: Basic

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: October 13, 2009
Date of Last Review/Update: March 4, 2010
Expiration Date: October 13, 2010

Presentation 44

The Use of Chemokine Receptor Antagonists in Antiretroviral Treatment Failure

by David M. Margolis, MD, FACP, and Gretchen Shaughnessy Arnoczy, MD

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: July 28, 2009
Date of Last Review/Update: March 29, 2010
Expiration Date: September 8, 2010

Presentation 43

End-Stage Renal Disease in the HIV-Infected Patient

by Christina M. Wyatt, MD

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: July 1, 2009
Date of Last Review/Update: January 1, 2010
Expiration Date: December 1, 2010

Presentation 42

Pregnancy Planning and Preconception Health Care for HIV-Infected Individuals and Couples

by Erika Aaron, MSN, CRNP, and Shannon M. Criniti, MPH

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: June 25, 2009
Date of Last Review/Update: January 20, 2010
Expiration Date: December 25, 2010

Presentation 41

Initiation and Maintenance of HIV Treatment in Adolescents

by Jaime Martinez, MD

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: June 17, 2009
Date of Last Review/Update: May 28, 2010
Expiration Date: May 28, 2011

Presentation 40

HIV-Infection and International Travel: Pretravel Patient Assessment and Management

by Carlos Franco-Paredes, MD, MPH

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: January 29, 2009
Date of Last Review/Update: January 29, 2010
Expiration Date: January 29, 2011

Presentation 39

Initial Evaluation of a Patient with a New HIV Diagnosis

by Michael Melia, MD, and Howard Libman, MD

Level: Basic

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: December 22, 2008
Date of Last Review/Update: January 26, 2010
Expiration Date: December 22, 2010

Presentation 38

Management of Cryptococcal Meningitis in the Antiretroviral Therapy Era: More than Just Antifungals

by Anuradha Ganesan, MD, and Henry Masur, MD

Level: Advanced

CME Credit Available: 1.75 AMA PRA Category 1 Credits^TM
Release Date: November 26, 2008
Date of Last Review/Update: November 26, 2009
Expiration Date: November 26, 2010

Presentation 37

Immune Reconstitution Inflammatory Syndrome in HIV-Infected Patients

by Jaime C. Robertson, MD, and Carl J. Fichtenbaum, MD

Level: Advanced

CME Credit Available: 2.0 AMA PRA Category 1 Credits^TM
Release Date: October 30, 2008
Date of Last Review/Update: December 23, 2009
Expiration Date: December 23, 2010

Presentation 36

Issues in the Care of HIV and Hepatitis C Virus-Coinfected Patients: Antiretroviral Pharmacokinetics, Drug Interactions, and Liver Transplantation

by David L. Wyles, MD

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: October 2, 2008
Date of Last Review/Update: October 2, 2009
Expiration Date: October 2, 2010

Presentation 35

HIV-Associated Cognitive Impairment

by Susan Swindells, MBBS, and Miguel G. Madariaga, MD

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: August 26, 2008
Date of Last Review/Update: August 26, 2009
Expiration Date: September 27, 2010

Presentation 34

Treatment of Hepatitis C Virus and HIV Coinfection: Selecting Candidates for Hepatitis C Virus Therapy and Managing Side Effects of Treatment

by Melissa K. Osborn, MD

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: July 22, 2008
Date of Last Review/Update: July 22, 2009
Expiration Date: October 1, 2010

Presentation 33

Special Cases in Antiretroviral Therapy Initiation: Focus on Acute HIV and HIV/Hepatitis B Virus Coinfection

by Charles Hicks, MD, and Elizabeth Reddy, MD

Level: Advanced

CME Credit Available: 2 AMA PRA Category 1 Credits^TM
Release Date: July 1, 2008
Date of Last Review/Update: July 1, 2009
Expiration Date: September 30, 2010

Presentation 32

Sexual Addiction in an HIV-Infected Patient

by Edward R. Hammond, MD, MPH, and Glenn J. Treisman, MD, PhD

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: May 29, 2008
Date of Last Review/Update: May 29, 2010
Expiration Date: November 29, 2010

Presentation 30

Managing Oral Health Problems in People with HIV Infection

by David A. Reznik, DDS

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: May 5, 2008
Date of Last Review/Update: May 5, 2010
Expiration Date: November 5, 2010

Presentation 28

Syphilis in the HIV-Infected Patient

by Jeanne M. Marrazzo, MD, MPH

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: February 22, 2008
Date of Last Review/Update: January 20, 2010
Expiration Date: January 20, 2011

Presentation 27

The Use of Preexposure and Postexposure Prophylaxis for HIV Prevention

by Raphael J. Landovitz, MD

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: February 15, 2008
Date of Last Review/Update: February 15, 2010
Expiration Date: February 15, 2011

Presentation 26

Selected Endocrine Problems in HIV-Infected Patients

by Todd T. Brown, MD, PhD

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: December 21, 2007
Date of Last Review/Update: December 21, 2009
Expiration Date: December 21, 2010

Presentation 24

HIV-Related Renal Disease

by Christina M. Wyatt, MD, and Lynda Anne Szczech, MD, MSCE, FASN

Level: Advanced

CME Credit Available: 2.5 AMA PRA Category 1 Credits^TM
Release Date: November 16, 2007
Date of Last Review/Update: November 16, 2009
Expiration Date: November 16, 2010

Presentation 23

HIV-Associated Dyslipidemias

by Roger J. Bedimo, MD, MS

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: September 5, 2007
Date of Last Review/Update: September 9, 2009
Expiration Date: September 9, 2010

Note: 0.5 credit for 2007 edition learners

Please see the Presentation Archive for expired COW activities that are available for study but that no longer provide CME credit.