Selected Endocrine Problems in HIV-infected Patients by Todd T. Brown, MD, PhD

Overview CME Credit Available: 1 AMA PRA Category 1 CreditTM Release Date: December 21, 2007 Date of Last Review/Update: July 7, 2008 Expiration Date: December 21, 2008 This Cases on the Web activity consists of a case about an HIV-seropositive patient whose treatment course has been complicated by two common endocrine problems: diabetes mellitus and adrenal insufficency. Following the initial presentation of the case, learners are presented a series of clinical decision points, each focusing on a crucial case management objective. At each decision point, learners should select the treatment option that they believe is most sound and read the presenter’s discussion of that option. Choosing the best option leads to an extended discussion of the medical findings and scientific evidence that inform the case management objective. In order 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 completion of this activity, the learner will be able to Identify current issues in the diagnosis and management of diabetes mellitus and discuss special considerations in choosing diabetes treatment options for HIV-infected patients with diabetes. Identify situations in which a diagnosis of adrenal insufficiency should be considered for an HIV-infected patient; describe how this diagnosis should be pursued; and outline the most common causes of adrenal insufficiency in HIV-infected 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 the clinical management of patients who are HIV-seropositive with diabetes mellitus or adrenal insufficiency. 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 Credit.TM Physicians should only claim credit commensurate with the extent of their participation in the activity. This CME activity is offered from December 21, 2007 to December 21, 2008. Participants who successfully complete the activity post test 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. Non-physician health care practitioners will receive a certificate of attendance. Faculty Todd T. Brown, MD, PhD Author Todd T. Brown, MD, PhD is Assistant Professor of Medicine in the Division of Endocrinology and Metabolism at The Johns Hopkins University, where he is the primary endocrine consultant to The Johns Hopkins HIV Clinic. His clinical and research interests focus on metabolic and endocrine problems in HIV-infected patients. Marshall J. Glesby, MD, PhD Editor Dr Glesby is Associate Professor of Medicine and Public Health at Weill Medical College of Cornell University and Co-Director of the Cornell Clinical Trials Unit. He is also the Regional Clinical Director of the New York-New Jersey AIDS Education and Training Center. 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 Brown has received grants and research support from Abbott Laboratories, Reliant Pharmaceuticals, Merck & Co., and Theratechnologies, and has served as a consultant to Abbott Laboratories, Reliant Pharmaceuticals, Serono, and Merck & Co. Dr Glesby has served as a consultant for, and received grants and research support from, Serono Laboratories. 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 Pfizer Global Pharmaceuticals Roche 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: info2007"at"iasusa.org