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Please read this page before participating in this activity. At the bottom of the page, select “I have read these instructions and understand them,” and then click “Begin Activity.”
CME Credit Available: 1 AMA PRA Category 1 CreditTM
Release Date: October 13, 2009
Date of Last Review/Update: March 4, 2010
Expiration Date: October 13, 2010
This Cases on the Web activity introduces a case and presents 4 clinical decision points, each related to the care of an HIV-infected patient in whom an initial antiretroviral regimen has failed. At each clinical decision point, learners should choose the option that they believe is most sound and then read the presenters’ explanation of that option. Selecting the correct option links the learner to an extended discussion of related medical findings, research-based evidence, and case management considerations.
To advance from one clinical decision point to the next, learners should click on the NEXT arrow at the base of each page that discusses the best clinical option.
After reviewing the case, learners may link to the continuing medical education (CME) post test questions and the course evaluation, both of which must be completed and submitted to receive credit. Please see the post test form and the evaluation form for further instructions.
On completion of this activity, the learner will be able to:
- Identify the clinical and laboratory characteristics of a first antiretroviral regimen failure.
- Discuss the possible causes of antiretroviral regimen failure.
- Give examples of management strategies for patients who are experiencing failure of their first antiretroviral regimen.
- Identify appropriate antiretroviral regimens for treatment-experienced patients.
The International AIDS Society–USA offers this state-of-the-art activity as part of a nationwide CME effort for HIV physicians on the evolving challenges of HIV disease. This activity examines issues relevant to the care of an HIV-infected patient in whom an initial antiretroviral regimen has failed.
This Cases on the Web presentation is part of a series of basic-level CME activities designed for physicians who are:
- New to the practice of HIV medicine or who intend to start providing care for patients with HIV and AIDS.
- Seeking to refresh their understanding of the standard elements of HIV care.
This activity is also relevant to nurse practitioners, physician assistants, nurses, and other health professionals who are new to HIV care or who wish to refresh their understanding of the standard elements of HIV care.
The International AIDS Society–USA is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.
The International AIDS Society–USA designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
This CME activity is offered from October 13, 2009 to October 13, 2010. Participants who successfully complete the activity posttest and submit the evaluation and registration forms are eligible to receive CME credit. Physicians (MDs, DOs, and international equivalents) may receive CME credit for completing this activity. Nonphysician health care practitioners will receive a certificate of attendance.
Authors
Warangkana Sangchan, MD
Dr Sangchan is currently in private practice as an infectious diseases physician with the Scarsdale Medical Group in Scarsdale, New York.
Lisa M. Chirch, MD
Dr Chirch is an assistant professor of clinical medicine in the Division of Infectious Diseases at Stony Brook University Medical Center. She is clinical director of the Center for Public Health Education, the New York/New Jersey AIDS Education and Training Center’s local performance site at Stony Brook University Medical Center.
Editor
Marshall J. Glesby, MD, PhD
Dr Glesby is an associate professor of medicine and public health at Weill Medical College of Cornell University, New York City, and codirector of the Cornell Clinical Trials Unit, a program of the Division of Infectious Diseases in the Department of Medicine of the Weill Medical College of Cornell University. He is also the regional clinical director of the New York/New Jersey AIDS Education and Training Center.
Collaborators
New York/New Jersey AIDS Education and Training Center
This activity was developed in collaboration with the New York/New Jersey AIDS Education and Training Center (AETC), one of 11 federally funded regional centers nationwide that conducts targeted multidisciplinary HIV/AIDS education and training programs for healthcare providers. Funded by the Health Resources and Services Administration (HRSA), the mission of the New York/New Jersey AETC is to assist health care professionals through education and training, to provide optimum quality services and sensitive care to HIV-infected persons, and to provide access to current information related to HIV/AIDS research and treatment. Visit the organization’s Web site at: http://www.nynjaetc.org.
In the interest of maintaining the independence of its continuing medical education activities, and in accordance with the policies of the Accreditation Council for Continuing Medical Education, the International AIDS Society–USA requires all persons with control of content (eg; authors, reviewers, Editorial Board members, and the staff of the Cases on the Web program) to disclose any financial interests that they (or their spouses or partners) have with commercial companies within the past 12 months.
Faculty
Dr Sangchan, Dr Chirch, and Dr Glesby have no relevant financial relationships to disclose.
Cases on the Web Editorial Board
The members of the Cases on the Web (COW) Editorial Board are volunteers and are not compensated for their role in overseeing the program. Listed below are the COW Editorial Board members and their financial interests with commercial companies within the past 12 months from the date of disclosure.
Michael S. Saag, MD — Editor-in-Chief
Professor of Medicine
The University of Alabama at Birmingham
Dr Saag has received grants and research support from and has been a scientific advisor to Ardea Biosciences, Inc, Avexa Ltd, Boehringer Ingelheim Pharmaceuticals, Inc, Bristol-Myers Squibb, Gilead Sciences, Inc, GlaxoSmithKline, Merck & Co, Inc, Monogram Biosciences, Inc, Pain Therapeutics, Inc, Pfizer Inc, Progenics Pharmaceuticals, Inc, Tibotec Therapeutics, and Tobira Therapeutics. (Updated 08/10/10)
Marshall J. Glesby, MD, PhD — Coeditor
Associate Professor of Medicine and Public Health
Weill Medical College of Cornell University
Dr Glesby has no relevant financial interests to disclose. (Updated 09/01/09)
Judith A. Aberg, MD
Associate Professor of Medicine
New York University School of Medicine
Dr Aberg has been a scientific advisor to Gilead Sciences, Inc, Merck & Co, Inc, Tibotec Therapeutics and ViiV Healthcare. She participates in multicenter clinical trials from Gilead Sciences, Inc, GlaxoSmithKline, Merck & Co, Inc, Pfizer Inc, Schering-Plough Corp, Theratechnologies Inc, and Tibotec Therapeutics. Dr Aberg currently holds nonsalaried contracts for pending multicenter clinical trials with Adamas Pharmaceuticals, Inc, and Wyeth Pharmaceuticals. (Updated 03/25/10)
Roger J. Bedimo, MD, MS
Director, Infectious Disease Fellowship Training
University of Texas Southwestern Medical Center
Dr Bedimo has been a scientific advisor to Abbott Laboratories, Merck & Co, Inc, and Tibotec Therapeutics. He has received grants and research support from Abbott Laboratories, Merck & Co, Inc, and Tibotec Therapeutics. (Updated 10/08/09)
Meg D. Newman, MD
Associate Professor of Medicine
University of California San Francisco
Dr Newman has no relevant financial interests to disclose. (Updated 09/01/09)
Paul E. Sax, MD
Associate Professor of Medicine
Harvard Medical School
Dr Sax received grants and research support from GlaxoSmithKline, Merck & Co, Inc, and Tibotec Therapeutics. He served as a consultant to or contributed to CME program materials for Abbott Laboratories, Bristol-Myers Squibb, Gilead Sciences, Inc, GlaxoSmithKline, Merck & Co, Inc, Pfizer Inc, and Tibotec Therapeutics. (Updated 09/14/09)
Staff of the Cases on the Web
Donna M. Jacobsen — Executive Director/President
Ms Jacobsen has no relevant financial affiliations to disclose. (Updated 08/12/10)
IAS–USA Board of Directors
The nonstaff members of the IAS–USA Board of Directors participate in a volunteer capacity. They are not compensated for their roles in governing/overseeing the IAS–USA. Listed below are the IAS–USA Board of Directors and their financial interests with commercial companies within the last 12 months from the date of disclosure.
Constance A. Benson, MD
Professor of Medicine
University of California San Diego
Dr Benson has received research grants awarded to the University of California San Diego from Gilead Sciences, Inc. She has served on scientific advisory boards for GlaxoSmithKline, ViiV Healthcare, and Merck & Co, Inc, and has chaired a data and safety monitoring board for Achillion Pharmaceuticals, Inc. (Updated 08/09/10)
Judith S. Currier, MD
Professor of Medicine
University of California Los Angeles
Dr Currier has received research grants awarded to the University of California Los Angeles from Merck & Co, Inc, and Schering-Plough Corp. (Updated 08/11/10)
Carlos del Rio, MD
Professor of Medicine
Emory University
Dr del Rio has received research grants awarded to Emory University from Merck & Co, Inc, Schering-Plough Corp, and Sanofi Pasteur. (Updated 08/10/10)
Joel E. Gallant, MD, MPH
Professor of Medicine and Epidemiology
The Johns Hopkins University
Dr Gallant has served as a consultant to Abbott Laboratories. He has been a member of data and safety monitoring boards and endpoint adjudication committees for Gilead Sciences, Inc, and Sangamo Biosciences, Inc. He has been a member of scientific or clinical advisory boards for Bristol-Myers Squibb, Gilead Sciences, Inc, Merck & Co, Inc, Tibotec Therapeutics, and ViiV Healthcare. Johns Hopkins University has been the recipient of research grants or contracts from Gilead Sciences, Inc, for research conducted by Dr Gallant. (Updated 08/10/10)
Roy M. Gulick, MD, MPH
Professor of Medicine
Weill Medical College of Cornell University
Dr Gulick has served as a consultant to Bristol-Myers Squibb, Gilead Sciences, Inc, MedImmune, LLC, ViiV Healthcare, and ViroStatics and as an investigator for research study grants (to Weill Cornell) from Pfizer Inc, Schering-Plough Corp, and Tibotec Therapeutics. (Updated 08/10/10)
Douglas D. Richman, MD
Professor of Pathology and Medicine
University of California San Diego
Dr Richman has been a consultant to Biota, Bristol-Myers Squibb, CHIMERx, Gen-Probe Inc, Gilead Sciences, Inc, Idenix Pharmaceuticals, Inc, Merck & Co, Inc, Monogram Biosciences, Inc, Myriad Genetics, Inc, and Theraclone Sciences. He has been on an endpoint adjudication committee for Schering-Plough Corp and has been the recipient of research grants or contracts from Merck & Co, Inc. Dr Richman has been a stock options holder of CHIMERx and Idenix Pharmaceuticals, Inc, and a stock shareholder of Monogram Biosciences, Inc. (Updated 08/09/10)
Michael S. Saag, MD — Editor-in-Chief
Professor of Medicine
The University of Alabama at Birmingham
Dr Saag has received grants and research support from and has been a scientific advisor to Ardea Biosciences, Inc, Avexa Ltd, Boehringer Ingelheim Pharmaceuticals, Inc, Bristol-Myers Squibb, Gilead Sciences, Inc, GlaxoSmithKline, Merck & Co, Inc, Monogram Biosciences, Inc, Pain Therapeutics, Inc, Pfizer Inc, Progenics Pharmaceuticals, Inc, Tibotec Therapeutics, and Tobira Therapeutics. (Updated 08/10/10)
Robert T. Schooley, MD
Professor of Medicine
University of California San Diego
Dr Schooley has served as a consultant to Achillion Pharmaceuticals, Inc, Gilead Sciences, Inc, Inhibitex, Inc, Johnson & Johnson Services, Inc, Tobira Therapeutics, and Laboratory Corporation of America. He has stock options for Achillion Pharmaceuticals, Inc. (Updated 08/10/10)
Paul A. Volberding, MD
Marvin Sleisenger Professor of Medicine
Vice-Chair, Department of Medicine
University of California San Francisco
Dr Volberding has served on data and safety monitoring boards for Merck & Co, Inc, and TaiMed Biologics, and on an endpoint adjudication committee for Schering-Plough Corp. He has served on scientific or clinical advisory boards for Bristol-Myers Squibb, Gilead Sciences, Inc, Pfizer Inc, and Tobira Therapeutics. (Updated 08/10/10)
This Cases on the Web activity is sponsored by the International AIDS Society–USA and was made possible through educational grants from the following commercial companies.
March 2010 Update
The following funders support Cases on the Web as part of the International AIDS Society–USA 2010 national continuing medical education effort:
Substantial Grant Support
Tibotec Therapeutics
Merck & Co, Inc
Bristol-Myers Squibb
Gilead Sciences
Generous Grant Support
ViiV Healthcare
Additional support for Cases on the Web specifically is provided by:
Boehringer Ingelheim Pharmaceuticals, Inc
Abbott Laboratories
October 2009 Release
Substantial Grant Support
Bristol-Myers Squibb
Gilead Sciences
Merck & Co, Inc
Pfizer Global Pharmaceuticals
Tibotec Therapeutics
Generous Grant Support
GlaxoSmithKline
Additional Grant Support
Roche Laboratories
This activity may contain information about the investigational uses of drugs or products that are not approved by the US Food and Drug Administration. Please consult full prescribing information before using any medication or product mentioned in Cases on the Web.
The views and opinions expressed herein are those of the faculty and do not necessarily represent the opinions or recommendations of the International AIDS Society–USA.
If you have any questions about this Cases on the Web activity, please contact the International AIDS Society–USA:
International AIDS Society–USA
425 California Street
Suite 1450
San Francisco, CA 94104-2120
Telephone: 415-544-9400
Fax: 415-544-9401
E-mail: info2009"at"iasusa.org
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