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Wednesday, November 5, 2008

Issues in the Care of HIV and Hepatitis C Virus-coinfected Patients: Antiretroviral Pharmacokinetics, Drug Interactions, and Liver Transplantation by

CME Credit Available: 1 AMA PRA Category 1 CreditTM
Release Date: October 2, 2008
Date of Last Review/Update: October 2, 2008
Expiration Date: October 2, 2009

This Cases on the Web activity consists of 2 cases and 4 clinical decision points, each focusing on providing care for HIV-infected patients with ongoing liver disease. At each clinical decision point, learners should select the option that they believe is most sound and read the presenter’s explanation of that option. Choosing the best option links the learner to an extended discussion of related medical findings, research-based evidence, and case management considerations.

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.

Activity Objectives

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

  • Explain the impact of hepatic dysfunction on antiretroviral pharmacokinetics.

  • Discuss the impact of antiretroviral therapy on the natural history of hepatitis C virus infection.

  • Give examples of important interactions between antiretroviral drugs and ribavirin.

  • Identify unique issues in liver transplantation for end-stage liver disease resulting from hepatitis C virus infection in coinfected patients.

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 managing patients with concurrent liver disease.

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

This CME activity is offered from October 2, 2008 to October 2, 2009. 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

Author

David L. Wyles, MD
Dr Wyles is an Assistant Professor of Medicine in the Division of Infectious Diseases at the University of California, San Diego. His research interests include the in vitro assessment of new hepatitis C virus inhibitors, resistance development, and viral fitness. Clinically he is involved in the care and treatment of patients coinfected with hepatitis C virus and HIV and in conducting early-phase clinical trials of hepatitis C virus–specific antiviral drugs.

Editor

Steven C. Johnson, MD
Dr Johnson is a Professor of Medicine in the Division of Infectious Diseases, Department of Medicine, at the University of Colorado Health Sciences Center in Denver, and Director of the Infectious Disease Group Practice and HIV/AIDS Clinical Program at the University of Colorado Hospital in Denver. His research and writing has focused on clinical outcomes in HIV care, the indications and limitations of antiretroviral therapy, and management of opportunistic infections.

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 (ie; authors, reviewers, Editorial Board members, and the staff of the Cases on the Web [COW] program) to disclose any financial interests that they (or their spouses or partners) have with commercial companies within the past 12 months.

Faculty

Dr Wyles has received grants and research support from Pfizer, Inc.

Dr Johnson has been a consultant for Abbott Laboratories, Gilead Sciences, Inc, GlaxoSmithKline, Merck & Co, Inc, Pfizer, Inc, and Tibotec Therapeutics. He has been a paid lecturer for Abbott Laboratories, GlaxoSmithKline, and Merck & Co, Inc, and a member of the speakers’ bureaus for GlaxoSmithKline and Merck & Co, Inc.

Cases on the Web Editorial Board

The members of the COW Editorial Board are volunteers and are not compensated for their role in overseeing the online COW program. The dates of the most recent update of relationships with commercial entities are indicated in parentheses.

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, Boehringer Ingelheim Pharmaceuticals, Inc, Gilead Sciences, GlaxoSmithKline, Merck & Co, Inc, Monogram Biosciences, Panacos Pharmaceuticals, Inc, Pfizer, Inc, Progenics Pharmaceuticals, Inc, Roche Laboratories, Tibotec Therapeutics, and Virco Lab, Inc. (February, 2008)

Meg D. Newman, MD — Coeditor
Associate Professor of Medicine
University of California San Francisco

Dr Newman has no relevant financial affiliations to disclose. (December, 2007)

Judith A. Aberg, MD
Associate Professor of Medicine
New York University School of Medicine

Dr Aberg has served as a consultant for Abbott Laboratories, Boehringer Ingelheim Pharmaceuticals, Inc, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, and Tibotec Therapeutics. She has received grants and research support from Abbott Laboratories, Bristol-Myers Squibb, Merck & Co, Inc, and Pfizer, Inc and was a paid lecturer for Abbott Laboratories and Bristol-Myers Squibb. Dr Aberg has received fees for written enduring materials, internet activities, or audio activities from Abbott Laboratories and Bristol-Myers Squibb. (December, 2007)

Roger J. Bedimo, MD, MS
Director, Infectious Disease Fellowship Training
University of Texas Southwestern Medical Center

Dr Bedimo has received grants and research support from Abbott Laboratories, Bristol-Myers Squibb, Merck & Co, Inc, and Tibotec Therapeutics and has served as a scientific advisor to Abbott Laboratories and Gilead Sciences. (September, 2007)

Marshall J. Glesby, MD, PhD
Associate Professor of Medicine and Public Health
Weill Medical College of Cornell University

Dr Glesby has served as a consultant for Merck Serono and received grants and research support from EMD Serono. (December, 2007)

Steven C. Johnson, MD
Professor of Medicine
University of Colorado

Dr Johnson has been a consultant for Abbott Laboratories, Gilead Sciences, GlaxoSmithKline, Merck & Co, Inc, and Tibotec Therapeutics. He has been a paid lecturer for Abbott Laboratories and Merck & Co, Inc. (December, 2007)

Harry W. Lampiris, MD
Associate Professor of Clinical Medicine
University of California San Francisco

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. (December, 2007)

Paul E. Sax, MD
Associate Professor of Medicine
Harvard Medical School

Dr Sax has been a consultant for Abbott Laboratories, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, and Tibotec Therapeutics and has received grants and research support from Bristol-Myers Squibb, Merck & Co, Inc, and Pfizer, Inc. He has been a paid lecturer for Abbott Laboratories, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Merck & Co, Inc, and Tibotec Therapeutics. (February, 2008)

Staff

Donna M. Jacobsen — Executive Director/President

Ms. Jacobsen has no relevant financial affiliations to disclose.

Mark F. Wales — Web Content Coordinator

Mr. Wales has no relevant financial affiliations to disclose.

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.

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: info2008"at"iasusa.org

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