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


Treating HIV in the Real World: Clinical Science to Clinical Practice


GOAL
To provide physicians with current data on HIV-1 disease, with emphasis placed on new and emerging treatment strategies.

TARGET AUDIENCE
This activity is designed for infectious disease specialists, internists, general medicine practitioners and nurses who treat persons with HIV-1 disease.

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

  • Understand the nature and magnitude of the problems particular to management of HIV in underdeveloped countries
  • Explain the value of Highly Active Antiretroviral Therapy (HAART) in improving the prognosis of patients with HIV infection
  • Describe the impact of both adherence and nonadherence to therapy in any treatment strategy
  • Outline the controversies surrounding treatment interruption

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 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 1 hour 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 December 31, 2003.

CONTINUING NURSING EDUCATION ACCREDITATION
This educational activity has been approved for 1 contact hour 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 December 31, 2003.

This continuing education activity was produced under the supervision of John G. Bartlett, MD, Director and Professor, Infectious Diseases, Johns Hopkins University School of Medicine; and Kathleen H. Sabatier, MS, RN, Professor of Nursing, The Institute for Johns Hopkins Nursing.

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 highlights from the 1st International AIDS Society Conference on HIV Pathogenesis and Treatment held in Buenos Aires, Argentina, July 8-11, 2001.

FACULTY ADVISORS

    John G. Bartlett, MD
    Director and Professor of Infectious Diseases
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr Bartlett reports serving on the HIV advisory board for Abbott Labs, GlaxoSmithKline, and
    Merck & Co, Inc.

PARTICIPATING FACULTY

    Richard Haubrich, MD
    Associate Professor of Medicine
    Division of Infectious Diseases
    University of California San Diego
    San Diego, California
    • Dr Haubrich reports receiving research support and honoraria from Agouron, GlaxoSmithKline, and Vertex: research support from ViroLogic; and honoraria from Abbott Labs.

    Jens Lundgren, MD
    Coordinating Centre
    EuroSIDA/Copenhagen HIV Programme (CHIP)
    Department of Infectious Diseases
    Hvidovre Hospital
    University of Copenhagen
    Copenhagen, Denmark
    • Dr Lundgren reports receiving research support from Roche, GlaxoSmithKline, Boehringer Ingelheim, Pfizer/Agouron, Bristol-Myers Squibb/DuPont, and Merck Sharp & Dohme Idea, Inc.

    François Raffi, MD, PhD
    Infectious Diseases Department and HIV Research Unit
    University Hospital
    Nantes, France
    • Dr Raffi reports no financial or advisory relationships with any pharmaceutical companies..

    Felix Salaniponi, MD
    Manager and Director, Community Health Services Unit (CHSU)
    National Tuberculosis Control Program
    Lilongwe, Malawi
    • Dr Salaniponi reports no financial or advisory relationships with any pharmaceutical companies.

    Alicia Tesiorowski, MD
    Research Fellow
    British Columbia Centre for Excellence in HIV/ AIDS
    Canadian HIV Trials Network
    St. Paul's Hospital
    University of British Columbia
    Vancouver, British Columbia
    • Dr Tesiorowski reports no financial or advisory relationships with any pharma-ceutical companies.

Advanced Studies in Medicine provides disclosure information from contributing authors, participating faculty, and presenters only. 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.

Treating HIV in the Real World: Clinical Science to Clinical Practice
John G. Bartlett, MD*

This issue of Advanced Studies in Medicine will focus on advances in human immu-nodeficiency virus (HIV) therapy. The proceedings of this issue are based on presentations from the first International AIDS Society (IAS) Conference on HIV Pathogenesis and Treatment, held in Buenos Aires, Argentina, July 8-11, 2001.

Twenty years ago, when AIDS was first reported, few physicians or scientists were able to forecast the magnitude and impact of what is now known as the acquired immune deficiency syndrome (AIDS) crisis. Since the appearance of HIV and AIDS, nearly 40 million people have contracted the disease, many dying as a result. The situation was met with clinical and social responses that fostered rapid advances in the understanding of the pathogenesis of HIV and in approaches to treatment and prevention. Yet despite advances in HIV therapy in the past 2 decades, such as highly active antiretroviral therapy (HAART), many issues remain unsolved and unclarified. Among these issues is the control of the HIV epidemic in many developing countries, where the disease threatens social, economic, and political systems.

The most vulnerable have remained the least protected. In many of these countries, the health care infrastructure is simply inadequate to cope: poverty as well as lack of appropriate housing, clean water, food, and sanitation are already major health problems. Dr Felix Salaniponi illustrated how chronic diseases such as tuberculosis and malaria, continuing components of the HIV scenario in sub-Saharan Africa, offer important lessons about how to confront the HIV epidemic. Key treatment issues include diagnosis, providing information and counseling to patients, improving access to treatment, and monitoring patient treatment to ensure compliance with complicated pharmacologic regimens.

Dr Jens Lundgren offered insight into treatment successes and failures and further proof of the efficacy of HAART. Where HAART is available, it improves the prognosis of HIV-infected patients, increases CD4 cell counts dramatically, and reduces the risk of death.

Dr Richard Haubrich explored the issues surrounding resistance testing and identification of clinically relevant phenotypic assay breakpoints, an issue particularly important in clinical practice.

While a drug regimen must show promising results in vitro and/or in clinical trials, its effectiveness must be transferable to clinical practice. Dr François Raffi offered further proof that the best drug regimens are those that patients can follow. Adherence is a major issue that must not be excluded from any analysis of efficacy, regardless of the treatment strategy selected.

And finally, Dr. Alicia Tesiorowski reported the results of a study that examined the impact of treatment interruption among a population of patients that had experienced virologic failure and who had developed genotypic resistance to at least 2 classes of antiretroviral drugs.

We hope that by applying the lessons learned in working with patients in areas of greater access to medical care, we will be able to share the benefits of treatment with patients in other parts of the world.

*Director and Professor of Infectious Diseases, 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.