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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Optimizing Clinical Care in Patients with HIV


GOAL
To provide infectious disease specialists and internal medicine physicians with current information and new developments in the management and treatment of HIV/AIDS.

TARGET AUDIENCE
This activity is designed for infectious disease specialists and internal medicine physicians. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:

  • Review the considerations in making initial drug selection in patients with HIV.
  • Determine when it is appropriate to switch antiretroviral therapy in patients with HIV.
  • Describe methods to reduce the occurrence of resistance to antiretroviral agents in order to preserve future treatment options.
  • Consider short- and long-term toxicity issues in the management of HIV, including the effect of toxicity on patient adherence to therapy.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity: 2 hours.

Release date: October 15, 2003. Expiration date: October 15, 2005.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an unrestricted educational grant from GlaxoSmithKline.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, a division of Advanced Studies in Medicine, an HMG Company. PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2003 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC.

Full Disclosure Policy Affecting CME Activities:
As a sponsor accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

    John G. Bartlett, MD
    Professor, Department of Medicine
    Chief, Division of Infectious Diseases
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr Bartlett reports serving on the HIV advisory board for Abbott Laboratories and Bristol-Myers Squibb Company; and receiving honoraria from Pfizer, Inc.

PARTICIPATING FACULTY

    Françoise Brun-Vezinet, MD, PhD
    Professor of Microbiology
    University of Medicine, Paris
    Head, Department of Virology
    Bichat-Claude Bernard Hospital
    Paris, Franceat Los Angeles School of Medicine
    Los Angeles, California
    • Dr Brun-Vezinet has received grant and/or research support from bioMerieux, Bristol-Myers Squibb Company, GlaxoSmithKline, PE Biosystems, and Visible Genetics, Inc; and has served as a consultant to GlaxoSmithKline and Visible Genetics, Inc.

    Pedro Cahn, MD, PhD
    Director, Fundación Huesped
    Buenos Aires, Argentina
    • Dr Cahn reports serving as a consultant to Abbott Laboratories and GlaxoSmithKline.

    Esteban Martinez, MD, PhD
    Senior Specialist
    Associate Professor of Medicine
    Infectious Diseases Unit
    Hospital Clinic
    University of Barcelona
    Barcelona, Spain
    • Dr Martinez reports receiving grants and/or research support from Boehringer Ingelheim, Bristol-Myers Squibb Company, and GlaxoSmithKline.

    François Raffi, MD, PhD
    Professor, Infectious and Tropical Diseases
    Nantes Medical University
    Head, Infectious and Tropical Diseases Unit
    Hôtel-Dieu
    Nantes, France
    • Dr Raffi reports having no financial or advisory relationships with corporate organizations related to this activity.

    Paul A. Volberding, MD
    Professor and Vice Chair of Medicine
    University of California, San Francisco
    Co-Director, UCSF Gladstone Institute of Virology and Immunology Center for AIDS Research
    Chief, Medical Service
    San Francisco Veterans Affairs Medical Center
    San Francisco, California
    • Dr Volberding reports serving as a consultant to Bristol-Myers Squibb Company, Gilead Sciences, Merck & Co, Inc, Pfizer, Inc, and Shire Pharmaceuticals Group; and receiving honoraria from Boehringer Ingelheim, Bristol-Myers Squibb Company, Gilead Sciences, and GlaxoSmithKline.

Notice:
In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity may contain reference(s) to unlabeled or unapproved uses of drugs or devices. The following faculty member has disclosed that his article has referenced the following unlabeled/unapproved uses of drugs or products:

Faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

A Forum for HIV Care Workers: Answering Questions About Clinical Care*
François Raffi, MD, PhD†

A Forum for HIV Care Workers, one of several satellite symposia held in conjunction with the 2nd International AIDS Society (IAS) Conference on HIV Pathogenesis and Treatment, was specially designed to address key questions about the clinical care of patients with HIV/AIDS. It was also designed to be interactive on 2 levels: first, by incorporating video comments from leading researchers in HIV/AIDS into live presentations by an outstanding faculty, and then by inviting members of the audience to ask their own questions after each of the live presentations and during the concluding portion of the symposium.

Since the launch of zidovudine 16 years ago, 15 other antiretroviral agents have been approved for treatment, and more are on the way. The availability of these agents has led to the use of numerous combination regimens that have, in many cases, successfully suppressed viral replication. Yet, there are virologic failures, side effects such as lipodystrophy, and a host of issues related to adherence to therapy. How, then, should the use of available drugs and regimens be optimized to maintain adequate immune function, minimize toxicity, and maximize adherence over the long term until a cure is found? There are no definitive answers to this question. However, there are possibilities, several of which were explored during the symposium and addressed to varying degrees by other investigators during other sessions at the 4-day IAS conference.

To determine how to optimize therapy, it is first necessary to look at 4 key clinical issues: when to start treatment, when to switch or intensify therapy, whether future treatment options can be preserved, and the overall safety and tolerability of currently available antiviral regimens. In keeping with the subtitle of the symposium, Answering Questions About Clinical Care, each of the clinical issues was posed as a question. Although there are no definitive answers to these questions, the faculty members reviewed data during their live presentations that shed additional light on the issues and suggested feasible approaches and future directions.

Dr Pedro Cahn, from the Juan A. Fernandez Hospital in Buenos Aires, Argentina, addressed the initiation of therapy, focusing on timing, rationale, therapy selection, and dosing. Dr Paul A. Volberding, from the University of California at San Francisco, followed with a discussion of when and why to switch or intensify therapy. Dr Françoise Brun-Vezinet, from the Bichat-Claude Bernard Hospital in Paris, France, reviewed the role of resistance testing in choosing an alternative regimen, the prevention of resistance with boosted protease inhibitors in the first regimen, and the impact of these approaches on preserving future treatment options. Dr Esteban Martinez, of the Clinical Institute for Infections and Immunology and the Hospital Clinic in Barcelona, Spain, closed with a discussion of the safety and tolerability of antiretroviral agents, particularly with regard to long-term effects on fat distribution and cardiovascular risk.

To capture the interactive format of the symposium, each of the 4 presentations featured in this issue of Advanced Studies in Medicine also includes video comments from leading HIV/AIDS researchers, including Dr Joep Lange (Amsterdam, The Netherlands, and president of the IAS), Dr Simon A. Mallal (Perth, Australia), Dr Robert T. Schooley (Denver, Colorado), Dr Constance A. Benson (Denver, Colorado), Dr Julio S. G. Montaner (Vancouver, British Columbia, Canada), Dr Brian Gazzard (London, England), Dr Schlomo Staszewski (Frankfurt, Germany), Dr David Cooper (Sydney, Australia), and Dr Jens Lundgren (Copenhagen, Denmark). Their comments, along with the faculty presentations and questions from the audience, broadened the symposium's perspective and provided a more global exploration of the key clinical issues.

*Based on the introduction given by Prof Raffi at a symposium held in conjunction with the 2nd International AIDS Society Conference on HIV Pathogenesis and Treatment.
†Professor, Infectious and Tropical Diseases, Nantes Medical University, and Head, Infectious and Tropical Diseases Unit, Hôtel-Dieu, Nantes, France.
Address correspondence to: François Raffi, MD, PhD, Infectious and Tropical Diseases, HIV Research Unit, University Hospital Nantes, Hôtel-Dieu, Place Ricardeau, 44035 Nantes, Cedex 1, France.
E-mail: francois.raffi@wanadoo.fr.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.