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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: Credit No Longer Available
Release Date: May 22, 2008
Date of Last Review/Update: May 22, 2009
Expiration Date: May 22, 2010
This Cases on the Web activity introduces a case about a young woman who is newly diagnosed with HIV and presents 3 clinical decision points, each focusing on a case management objective. At each decision point, learners should select the option that they believe is most sound and then read the presenter’s explanation of that option. Choosing the best option leads to an extended discussion of the medical evidence and practice considerations related to the case-management objective.
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) posttest questions and the course evaluation, both of which must be completed and submitted to receive credit. Please see the posttest form and the evaluation form for further instructions.
On completion of this activity, the learner will be able to: - Summarize current guidelines for initiating antiretroviral therapy for HIV-infected patients, including aspects of efficacy, durability, toxicity, and tolerability.
- Describe the appropriate use of laboratory testing to support the selection of the initial antiretroviral regimen for newly diagnosed, HIV-infected patients.
- Compare the advantages and disadvantages of various drug options for initial antiretroviral therapy for specific patient situations.
- Give examples of potential barriers to a patient’s adherence to initial antiretroviral regimens.
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 managing the initiation of antiretroviral therapy in a treatment-naive patient with relapsing substance use and depression.
This online CME activity is designed for physicians who are actively involved in HIV and AIDS care. Specifically, these activities have been designed for physicians who: - Have a solid, working knowledge of HIV disease management.
- Provide comprehensive or specialty care for at least 10 patients with HIV and AIDS or are involved in HIV and AIDS clinical trials or investigations.
- Have completed at least 10 hours of CME in the area of HIV and AIDS medicine in the past 2 years.
This activity is also relevant to nurse practitioners, physician assistants, nurses, and other health professionals who provide care for people with HIV disease.
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 Credit No Longer Available. Physicians should only claim credit commensurate with the extent of their participation in the activity.
This CME activity is offered from Credit No Longer Available. 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
Sara Vazquez, MD
Dr Vazquez is a staff physician at El Rio Special Immunology Associates, a clinic of The El Rio Community Health Center in Tucson, Arizona.
J. Kevin Carmichael, MD
Dr Carmichael is Chief of Service, El Rio Special Immunology Associates in Tucson, Arizona. Dr. Carmichael is a member of the core faculty of the International AIDS Society-USA. His research interests include the primary care of HIV-infected persons, the treatment of substance abuse in persons with HIV-infection, and issues related to the delivery of HIV/AIDS health care in the US—Mexico borderlands and other rural areas.
Editors
Harry W. Lampiris, MD
Dr Lampiris is Associate Professor of Clinical Medicine at the University of California San Francisco and a staff physician in the Infectious Diseases Section, Department of Medicine, at the San Francisco Veterans Affairs Medical Center. He is also the Associate Program Director of the Adult Infectious Diseases Fellowship Program at the University of California San Francisco.
Marshall J. Glesby, MD, PhD
Dr Glesby is Associate Professor of Medicine and Public Health at Weill Medical College of Cornell University and Codirector of the Cornell Clinical Trials Unit. He is also the Regional Clinical Director of the New York-New Jersey AIDS Education and Training Center.
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 Vazquez has served as a scientific advisor to Gilead Sciences, Inc, Bristol-Myers Squibb, and Abbott Laboratories. She has been a member of the speakers’ bureaus of Bristol-Myers Squibb and Gilead Sciences, Inc.
Dr Carmichael has been a member of the speakers’ bureaus for GlaxoSmithKline, Merck & Co, Inc, and Tibotec Therapeutics.
Dr Lampiris has been a scientific advisor to Abbott Laboratories and has received grants and research support from Gilead Sciences, Pfizer, Inc, and Roche Laboratories. He has been a paid lecturer for Boehringer Ingelheim Pharmaceuticals, Inc, Merck & Co, Inc, and Monogram Biosciences.
Dr Glesby has served as a consultant for and received research support from EMD Serono.
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.
Grant Support: 2009 Update
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
Grant Support: 2008
Substantial Grant Support
Bristol-Myers Squibb
Tibotec Therapeutics
Abbott Laboratories
Gilead Sciences
Merck & Co, Inc
Pfizer Global Pharmaceuticals
Generous Grant Support
GlaxoSmithKline
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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