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 Presentation
Special Cases in Antiretroviral Therapy Initiation: Focus on Acute HIV and HIV/Hepatitis B Virus Coinfection
Charles Hicks, MD, and Elizabeth Reddy, MD

Level: Advanced
33  

Instructions
 
| Overview | Activity Objectives | Assessment of Needs | Intended Audience | CME Accreditation |
| Faculty | Disclosure of Financial Interests | Grant Support | Drug and Product Disclaimer | Contact |
 

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.”

Overview

CME Credit Available: 2 AMA PRA Category 1 CreditsTM
Release Date: July 1, 2008
Date of Last Review/Update: July 1, 2009
Expiration Date: July 29, 2010

This Cases on the Web activity introduces 2 cases and presents 8 clinical decision points, each focusing on an aspect of patient care related to acute HIV infection or HIV and hepatitis B virus coinfection. 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) 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.

Activity Objectives

On completing this activity, the learner will be able to:

  • Describe the latest US Department of Health and Human Services (DHHS) guidelines for initiating antiretroviral therapy.

  • Compare the benefits and risks of initiating antiretroviral therapy for acute HIV infection.

  • Explain the use of resistance testing in acute HIV infection.

  • Describe appropriate laboratory tests and test results indicating antiviral treatment for HIV and hepatitis B virus coinfection.

  • Choose appropriate therapy in patients with acute HIV or HIV and hepatitis B virus coinfection.

  • Explain the risks of discontinuing antiretroviral therapy, particularly in patients with HIV and hepatitis B virus coinfection.

Assessment of Needs

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 performing a comprehensive initial evaluation of a patient with a new HIV diagnosis.

Intended Audience

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.

CME Accreditation

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 2 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This CME activity is offered from July 1, 2009 to July 29, 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.

Faculty

Authors

Charles Hicks, MD
Dr Hicks is an Associate Professor of Medicine in the Division of Infectious Diseases at Duke University Medical Center in Durham, North Carolina. He also serves as associate director of the Duke University AIDS Research and Treatment Center. Dr Hicks has been involved in clinical research and patient care for HIV-infected patients since the early 1980s. He is the recipient of the A. B. Hoff Memorial Research Prize Medal, the Bailey K. Ashford Clinical Research Award and the Eugene A. Stead Jr. Award for Excellence in Teaching.

Elizabeth Reddy, MD
Dr Reddy is an internal medicine and pediatrics trained Fellow in the Division of Infectious Diseases at Duke University Medical Center in Durham, North Carolina. Dr Reddy specializes in international health and currently provides care to HIV-infected adults and children in the Child Centered Family Care Clinic at Kilimanjaro Christian Medical Center in Moshi, Tanzania. Her research is focused on optimal HIV testing strategies and promoting linkage to health services for HIV-seropositive persons.

Editor

Harry W. Lampiris, MD
Dr Lampiris is an 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.

Disclosure of Financial Interests

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 Hicks has served as a scientific advisor for Abbott Laboratories, Boehringer Ingelheim Pharmaceuticals, Inc, Bristol-Myers Squibb, GlaxoSmithKline, Gilead Sciences, Merck & Co, Inc, Monogram Biosciences, and Tibotec Therapeutics. He has received grants or research support from Bristol-Myers Squibb, GlaxoSmithKline, Gilead Sciences, Koronis Pharmaceuticals, Merck & Co, Inc, Schering-Plough Corporation, and Tibotec Therapeutics. Dr Hicks has also been a paid lecturer for Abbott Laboratories, Bristol-Myers Squibb, GlaxoSmithKline, Gilead Sciences, Merck & Co, Inc, Monogram Biosciences, and Tibotec Therapeutics.

Dr Reddy has received research funds from 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.

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)

Grant Support

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

Drug and Product Disclaimer

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.

Contact Information

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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