arrow Log In to View Account     |      
HOME
Johns Hopkins Medicine
Hopkins Logo


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


Optimizing Treatment Effectiveness in Patients With HIV


GOAL
The goal of this activity is to provide practicing clinicians with current information regarding the treatment of patients with human immunodeficiency virus (HIV).

TARGET AUDIENCE
This activity is designed for infectious disease specialists, internists, general medicine practitioners, and nurses who treat HIV.

LEARNING OBJECTIVES
After reading this issue, the participant should be able to:

  • Understand the approaches to strengthening adherence to HIV therapy.
  • Describe how resistance testing aids in optimizing HIV treatment regimens.
  • Describe methods for managing the long-term tolerability of antiretroviral therapy in patients with HIV.
  • Explain the benefits of drug sequencing in patients with HIV who are resistant to initial treatment.

ACCREDITATION STATEMENT
This activity has been planned and produced in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education. The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this continuing medical education activity for a maximum of 2 hours in Category 1 credit toward the American Medical Association Physicians' Recognition Award. Each physician should claim only those hours of credit that are actually spent on the educational activity. Credits are available until the expiration date of November 30, 2004.

CONTINUING NURSING EDUCATION ACCREDITATION
This educational activity has been approved for 2 contact hours by the Institute for Johns Hopkins Nursing, which is accredited as a provider of continuing education in nursing by the American Nurses' Credentialing Center's Commission on Accreditation. Credit will be awarded until November 30, 2004.

This continuing medical educational activity was produced under the supervision of John G. Bartlett, MD, Chief, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine; and Kathleen H. Sabatier, MS, RN, Director, The Institute for Johns Hopkins Nursing, Baltimore, Maryland.

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

Publisher's Note and Disclaimer: The opinions expressed in this issue are those of the authors, presenters, and/or panelists and are not attributable to the publisher, editor, advisory board of Advanced Studies in Medicine, or The Johns Hopkins University School of Medicine or its Office of Continuing Medical Education. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this issue are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, LLC, an HMG Company. P.O. Box 340, Somerville, NJ 08876. (908) 253-9001. Web site: www.galenpublishing.com. Copyright ©2001 by Galen Publishing, LLC. 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. Bulk postage paid at Somerville, NJ Post Office and at additional mailing offices. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC. Printed on acid-free paper. BPA Membership applied for December 2000.

The contents of this issue of Advanced Studies in Medicine include articles based on presentations given at the XIVth International AIDS Conference held in Barcelona, Spain, July 7-12, 2002.

FACULTY ADVISOR

    John G. Bartlett, MD
    Chief
    Division of Infectious Diseases
    Department of Medicine
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr Bartlett reports serving on the HIV advisory board for Abbott Laboratories, Agouron Pharmaceuticals, Inc, GlaxoSmithKline, and Merck & Co, Inc.

PARTICIPATING FACULTY

    Mina John, MBBS, FRACP, FRCPA
    Senior Clinical Research Fellow
    Centre for Clinical Immunology and Biomedical Statistics
    Royal Perth Hospital
    Perth, Australia
    • Dr John reports having received honoraria from GlaxoSmithKline for invited speaking at educational meetings.

    François Raffi, MD, PhD
    Professor
    Infectious and Tropical Diseases
    HIV Research Unit
    University Hospital Nantes
    Nantes, France
    • Dr Raffi reports receiving grants and/or research support from Bristol-Myers Squibb Company, Gilead, and GlaxoSmithKline.

    Lidia Ruiz, PhD
    Irsi Caixa Foundation
    Retrovirology Laboratory
    University Hospital Germans i Pujol
    Barcelona, Spain
    • Dr Ruiz reports having no financial or advisory relationships with corporate organizations related to this activity.

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.

Optimizing Treatment Effectiveness in Patients With HIV
John G. Bartlett, MD*

This issue of Advanced Studies in Medicine features the proceedings of a satellite symposium on current treatment of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), as well as highlights of selected poster presentations at the XIVth International AIDS Conference held in Barcelona, Spain, July 7-12, 2002.

Drawing more than 15 000 delegates from around the world, the conference reflected both the progress made thus far in the war against AIDS and the work that remains to be done with regard to research, education, prevention, development of more effective treatment regimens, and implementation of strategies to make treatment available to all who need it. In line with these goals, the contents of this issue focus on several of the challenges addressed at the conference as they apply to the developed world.

Dr Lidia Ruiz explains why it is important to measure HIV-1 drug resistance and how the interpretation of resistance test results contributes to the optimization of treatment regimens. She also reviews the need to identify genotypic algorithms and phenotypic breakpoints for individual drugs that are based on responses to highly active antiretroviral therapy (HAART), as well as the discrepancy between the effect of genotype on phenotype and virologic response, and the variability of biologic cutoffs in drug susceptibility by drug and assay.

Prof François Raffi discusses ways to maximize the effectiveness of HAART, beginning with efforts to improve adherence to therapy, which may be the single most important factor affecting treatment outcomes. These efforts include lowering pill burden, simplifying dosing regimens, and reducing adverse effects. Prof Raffi also explains why there is a role for quadruple therapy—treatment with 4 agents as initial therapy—and reviews the promising results of several quadruple therapy studies with regard to potency, durability, short- and long-term tolerability, and adherence to therapy.

Dr Mina John focuses on the treatment and prevention of the long-term complications of antiretroviral therapy, such as subcutaneous fat wasting, visceral obesity, hyperlactatemia, dyslipidemia, and increased insulin resistance. She discusses the overlapping—but not identical—long-term complications associated with the nucleoside reverse transcriptase inhibitors (NRTIs) and the protease inhibitors (PIs), and explains why switching from a PI to a non-NRTI while maintaining 2 NRTIs as the backbone of the HAART regimen in patients with sustained undetectable viral loads reduces lipid levels, increases insulin sensitivity, and improves adherence to therapy.

Rounding out this issue are synopses of several oral and late-breaking poster presentations on a variety of topics and a continuing education test. I hope that the information presented in this publication will ultimately result in improved treatment of HIV/AIDS and better care for all affected patients.

*Chief, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.





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.