International Antiviral Society-USA

Cases on the Web (COW) is a series of case-driven continuing medical education activities sponsored by the International Antiviral Society–USA. The COW program was created to offer physicians convenient online access to top-quality education. Two levels of COW activities are offered.

Advanced activities are for physicians who have a working knowledge of viral disease management and currently provide comprehensive or specialty care. Advanced activities are appropriate for those who have completed at least 10 hours of CME in viral disease management in the past 2 years.

Basic activities are for physicians who are new to the clinical practice of providing care for patients with viral diseases or who intend to start providing care for these patients. Basic COW activities are also appropriate for experienced clinicians who are seeking to refresh their understanding of standard elements of viral disease management.

April 18, 2012: Our latest Cases on the Web activity, Sexually Transmitted Infections in the HIV-Infected Patient, by Linda M. Gorgos, MD, MSc, is now available. This presentation examines issues relevant to the treatment of HIV-infected patients with other sexually transmitted infections.

April 12, 2012: Our latest Cases on the Web activities are now available. Preexposure Prophylaxis for HIV Infection, by Jason R. Faulhaber, MD, examines issues relevant to preexposure prophylaxis (PrEP) of HIV infection, and Drug Interactions With Medications for Treating Hepatitis C Virus Infection, by John J. Faragon, PharmD, BCPS, examines issues relevant to interactions between the drugs in HCV regimens and other coadministered drugs.

January 30, 2012: Our latest Cases on the Web activity, Osteomalacia and Osteoporosis in the HIV-infected Patient, by Michael Yin, MD, MS, and Emily Stein, MD, MS, is now available. This presentation examines issues relevant to the treatment of HIV-infected patients with low bone-mineral density.

Alerts

February 21, 2012: Hepatitis Viruses Eclipse HIV in 1999-2007 United States Death Statistics

A study of records of 22 million deaths in the United States from 1999 to 2007 revealed that 15,000 people died from illness related to hepatitis C virus (HCV) in that time period, compared with 13,000 from HIV-related illness. The study, which was funded by the Centers for Disease Control and Prevention (CDC) and published in Annals of Internal Medicine (2011, 156[4]: 271-278), found that factors associated with hepatitis B virus (HBV)- and HCV-related deaths included chronic liver disease, alcohol-related conditions, and HIV coinfection. Factors specific to HBV infection were HCV coinfection and Asian or Pacific Islander descent, and factors specific to HCV infection were HBV coinfection and minority status. Middle-aged and older persons, particularly those born between 1946 and 1964, constituted 75% of the deaths, according to John Ward, MD, director of the CDC’s hepatitis division and an author of the study.

February 8, 2012: US Food and Drug Administration Warns of Drug-Drug Interactions Between Boceprevir and Ritonavir-Boosted HIV Protease Inhibitors

The US Food and Drug Administration (FDA) issued a safety communication regarding the hepatitis C virus NS3/4A protease inhibitor boceprevir. According to a recent pharmacokinetic study, concomitant use of boceprevir with the antiretroviral drugs atazanavir or darunavir boosted by ritonavir, or with lopinavir/ritonavir, reduces exposures of the antiretroviral drug combinations and of boceprevir. Trough concentrations of these antiretroviral drug combinations were reduced 49%, 43% and 59%, respectively. For atazanavir, lopinavir, and darunavir, the area under the curve (AUC) was reduced 34% to 44% and the maximum plasma concentration (Cmax) was reduced 25% to 36%. Boceprevir exposure was not altered by coadministration with atazanavir/ritonavir, but it was reduced when coadministered with lopinavir/ritonavir or darunavir/ritonavir by 45% and 32%, respectively. For patients coinfected with HIV and hepatitis C virus, the safety and efficacy of boceprevir has not been established, and the above-described drug-drug interactions may be clinically significant. The FDA communication is available at http://www.fda.gov/Drugs/DrugSafety/ucm291119.htm, and the prescribing information for boceprevir is available at www.merck.com/product/usa/pi_circulars/v/victrelis/victrelis_pi.pdf.

February 1, 2012: The Journal AIDS Publishes Proposed New Pathway to Approval of Antiretroviral Drugs

HIV experts, responding to the finding that the traditional study designs have become less effective in the ability to demonstrate safety and efficacy of antiretroviral drugs, have delineated new ideas for conducting phase III HIV clinical trials. The pathway they define in their scientific paper, “Novel Clinical Trial Designs for the Development of New Antiretroviral Agents,” includes a short study comparing the study drug to placebo, a follow-on study with all participants receiving the study drug, and a randomized comparative safety trial. The paper, written by the Forum for Collaborative HIV Research, was published in the February 1, 2012 electronic issue of AIDS (doi: 10.1097/QAD.0b013e3283519371).

December 20, 2011: Antiretroviral Regimens Recommended by the International AIDS Society–USA (IAS–USA) Improve One-Year Plasma HIV RNA Level Outcomes

Wandeler and colleagues conducted a study titled, “A Comparison of Initial Antiretroviral Therapy in the Swiss HIV Cohort Study and the Recommendations of the International AIDS Society-USA,” which evaluated whether adherence to the international recommendations of the IAS-USA for antiretroviral therapy was associated with better treatment outcomes. Between 1998 and 2007, 4189 participants started 241 different antiretroviral regimens; 95% of the participants started regimens that were consistent with IAS-USA recommendations. Of the participants taking an initial antiretroviral regimen that was not recommended by the IAS-USA, the proportion with undetectable plasma HIV RNA (< 400 copies/mL) after 1 year was statistically significantly lower than for participants taking the IAS-USA-recommended regimens (adjusted odds ratio [OR], 0.54; 95% confidence interval [CI], 0.37-0.80). The CD4+ cell count after 1 year was similar in the groups taking the recommended regimen and the regimen that was not recommended. (Wandeler G, Keiser O, Hirschel B, Günthard HF, Bernasconi E, et al. (2011) A Comparison of Initial Antiretroviral Therapy in the Swiss HIV Cohort Study and the Recommendations of the International AIDS Society-USA. PLoS ONE 6(12): e27903. Doi:10.137/journal.pone.0027903.)

August 10, 2011: FDA Approves Fixed-Dose Combination Emtricitabine/Rilpivirine/Tenofovir to Treat HIV-1 Infection

A new 1-pill, once-daily drug to treat HIV-1 infection was approved on August 10, 2011 by the US Food and Drug Administration (FDA). Because it contains a nonnucleoside reverse transcriptase inhibitor (NNRTI) (rilpivirine) and 2 nucleoside reverse transcriptase inhibitors (nRTIs) (emtricitabine and tenofovir), fixed-dose combination emtricitabine/rilpivirine/tenofovir is a complete regimen for treatment of HIV-1 infection in therapy-naive patients.

Please see the FDA Web site for more information about fixed-dose combination emtricitabine/rilpivirine/tenofovir.

July 18, 2011: Antiretroviral Therapy Prevented Sexual Transmission of HIV in Study of Serodiscordant Couples

The New England Journal of Medicine has published “Prevention of HIV-1 Infection with Early Antiretroviral Therapy,” which reports the findings from a large, randomized Phase 3 clinical trial, HIV Prevention Trials Network (HPTN) Study 052. The trial evaluated the efficacy of antiretroviral drugs in preventing sexual transmission of HIV, as well as the optimal time to begin antiretroviral therapy. HPTN 052 began in April 2005 and enrolled a total of 1763 serodiscordant adult couples (97% of whom were heterosexual) at 13 sites in Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States, and Zimbabwe. The HIV-seropositive partners, who had CD4+ cell counts between 350/µL and 550/µL at the time of enrollment, were randomly assigned to start a 3-drug antiretroviral regimen immediately or to defer treatment until their CD4+ cell count fell below 250/µL or until they developed an AIDS-related illness.

After an interim review indicated that initiating antiretroviral therapy immediately upon enrollment in HPTN 052 had resulted in a 96% reduction in HIV transmission, an independent Data and Safety Monitoring Board recommended that the study be halted before its planned 2015 end date and that the results be released.

The findings were previously announced on May 12, 2011 in a news release by the National Institute of Allergy and Infectious Diseases (NIAID).

Grant Support

General information about COW program grant support can be viewed by selecting here. Acknowledgment of the funders of specific COW activities is provided on the Instructions page of each presentation.

About the IAS–USA

The mission of the IAS–USA is to improve the treatment, care, and quality of life for people with HIV, HCV, or other viral infections through high-quality, relevant, balanced, and needs-oriented education and information for practitioners who are actively involved in medical care.

Recent Presentations

The following activities provide CME credit. Please see the Presentation Archive for expired COW activities that are available for study but that no longer provide CME credit.

Presentation 67

Sexually Transmitted Infections in the HIV-Infected Patient

by Linda M. Gorgos, MD, MSc

CME Credit Available: 1.75 AMA PRA Category 1 Credits™
Release Date: April 18, 2012
Date of Last Review/Update: April 18, 2012
Expiration Date: April 18, 2013

Presentation 66

Drug Interactions With Medications for
Treating Hepatitis C Virus Infection

by John J. Faragon, PharmD, BCPS

CME Credit Available: 1.5 AMA PRA Category 1 Credits™
Release Date: April 11, 2012
Date of Last Review/Update: April 11, 2012
Expiration Date: April 11, 2013

Presentation 65

Preexposure Prophylaxis for HIV Infection

by Jason R. Faulhaber, MD

CME Credit Available: 1.5 AMA PRA Category 1 Credits™
Release Date: March 26, 2012
Date of Last Review/Update: March 26, 2012
Expiration Date: March 26, 2013

Presentation 64

Osteomalacia and Osteoporosis in the HIV-infected Patient

by Michael Yin, MD, MS, and Emily Stein, MD, MS

CME Credit Available: 1.5 AMA PRA Category 1 Credits™
Release Date: January 30, 2012
Date of Last Review/Update: January 30, 2012
Expiration Date: January 30, 2013

Presentation 63

HIV and Pain

by Jessica S. Merlin, MD, MBA, and Rodney Tucker, MD, MMM

CME Credit Available: 2.5 AMA PRA Category 1 Credits ^TM
Release Date: October 11, 2011
Date of Last Review/Update: October 11, 2011
Expiration Date: October 11, 2012

Presentation 62

Approaching the HIV-Infected Patient With Addiction

by R. Douglas Bruce, MD, MA, MSc

CME Credit Available: 1.75 AMA PRA Category 1 credits ^TM
Release Date: July 20, 2011
Date of Last Review/Update: July 20, 2011
Expiration Date: July 20, 2012

Presentation 61

Smoking Cessation: Treatment Strategies for the HIV Practitioner

by Steven A. Schroeder, MD, and Margaret Meriwether, PhD

CME Credit Available: 1.0 AMA PRA Category 1 Credits^TM
Release Date: July 19, 2011
Date of Last Review/Update: July 19, 2011
Expiration Date: July 19, 2012

Presentation 60

New Treatments for Hepatitis C Virus Infection

by Melissa K. Osborn, MD

CME Credit Available: 1.5 AMA PRA Category 1 credits ^TM
Release Date: July 19, 2011
Date of Last Review/Update: July 19, 2011
Expiration Date: July 19, 2012

Presentation 59

Initiation of Antiretroviral Therapy in Treatment-Naive HIV-Infected Patients

by Greer A. Burkholder, MD

CME Credit Available: 1.75 AMA PRA Category 1 credits ^TM
Release Date: July 19, 2011
Date of Last Review/Update: July 19, 2011
Expiration Date: July 19, 2012

Presentation 58

Quality Measures in HIV Care

by Kathleen Clanon, MD, and Steven Bromer, MD

CME Credit Available: 1.75 AMA PRA Category 1 credits ^TM
Release Date: July 18, 2011
Date of Last Review/Update: July 18, 2011
Expiration Date: July 18, 2012

Presentation 57

Diagnosis and Treatment Options for Acute HIV Infection

by Elizabeth Reddy, MD, and Charles B. Hicks, MD

CME Credit Available: 1.75 AMA PRA Category 1 Credits^TM
Release Date: April 29, 2011
Date of Last Review/Update: April 29, 2011
Expiration Date: May 29, 2012

Level: Advanced

Presentation 56

Dermatologic Complications of HIV Infection

by Jennifer A. Cafardi, MD, and John M. Cafardi, MD

CME Credit Available: 2.5 AMA PRA Category 1 Credits^TM
Release Date: March 24, 2011
Date of Last Review/Update: March 12, 2012
Expiration Date: March 12, 2013

Level: Advanced

Presentation 55

HIV and Hepatitis B Virus Coinfection

by Elizabeth Reddy, MD, and Susanna Naggie, MD

CME Credit Available: 1.75 AMA PRA Category 1 Credits^TM
Release Date: December 20, 2010
Date of Last Review/Update: January 31, 2012
Expiration Date: January 31, 2013

Level: Advanced

Presentation 54

Treatment of Opioid Dependence in Patients with HIV/AIDS

by Hillary Kunins, MD, MPH, MS, and
Chinazo Cunningham, MD, MS

CME Credit Available: 1.75 AMA PRA Category 1 Credits^TM
Release Date: November 10, 2010
Date of Last Review/Update: December 21, 2011
Expiration Date: December 21, 2012

Level: Advanced

Presentation 53

Management of Depression and Alcohol Dependence in an HIV/HCV Coinfected Patient

by Gareen Hamalian, MD, MPH, and Joseph Z. Lux, MD

CME Credit Available: 1.5 AMA PRA Category 1 Credits^TM
Release Date: August 11, 2010
Date of Last Review/Update: September 29, 2011
Expiration Date: September 29, 2012

Level: Advanced

Presentation 52

Human Papillomavirus Infection in the HIV-Infected Woman

by Erna Milunka Kojic, MD, and Susan Cu-Uvin, MD

CME Credit Available: 1.75 AMA PRA Category 1 Credits^TM
Release Date: August 10, 2010
Date of Last Review/Update: December 23, 2011
Expiration Date: December 23, 2012

Level: Advanced

Presentation 51

Care of HIV-Infected Women During Pregnancy

by Deborah Cohan, MD, MPH

CME Credit Available: 2.0 AMA PRA Category 1 Credits^TM
Release Date: July 1, 2010
Date of Last Review/Update: August 10, 2011
Expiration Date: August 10, 2012

Level: Advanced

Presentation 50

Viral Blips in the HIV-Infected Patient

by Timothy J. Henrich, MD

CME Credit Available: 1.5 AMA PRA Category 1 Credits^TM
Release Date: June 23, 2010
Date of Last Review/Update: August 19, 2011
Expiration Date: August 19, 2012

Level: Advanced

Presentation 49

Common Bacterial Infections in the HIV-Infected Patient

by Ricardo M. La Hoz, MD, and J. Martin Rodriguez, MD

CME Credit Available: 1.75 AMA PRA Category 1 Credits^TM
Release Date: June 22, 2010
Date of Last Review/Update: May 5, 2011
Expiration Date: June 5, 2012

Level: Advanced

Presentation 47

Common Drug Interactions in Patients Receiving Antiretroviral Therapy

by John J. Faragon, PharmD, BCPS,
David Condoluci, DO, and
Cindy M. Hou, DO, MBA

Level: Basic

CME Credit Available: 1.25 AMA PRA Category 1 Credits^TM
Release Date: November 3, 2009
Date of Last Review/Update: December 14, 2011
Expiration Date: December 14, 2012

Presentation 46

Non-AIDS-Defining Cancers in Patients with HIV Infection

by Roger J. Bedimo, MD, MS

Level: Advanced

CME Credit Available: 1.25 AMA PRA Category 1 Credits^TM
Release Date: October 21, 2009
Date of Last Review/Update: June 24, 2011
Expiration Date: June 24, 2012

Note: Slide set available!

Presentation 45

Management of an HIV-Infected Patient After Initial Antiretroviral Regimen Failure

by Lisa M. Chirch, MD

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: October 13, 2009
Date of Last Review/Update: January 13, 2012
Expiration Date: January 13, 2013

Level: Basic

Presentation 43

End-Stage Renal Disease in the HIV-Infected Patient

by Christina M. Wyatt, MD

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: July 1, 2009
Date of Last Review/Update: February 16, 2012
Expiration Date: February 16, 2013

Presentation 42

Pregnancy Planning and Preconception Health Care for HIV-Infected Individuals and Couples

by Erika Aaron, MSN, CRNP, and Shannon M. Criniti, MPH

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: June 25, 2009
Date of Last Review/Update: February 17, 2011
Expiration Date: May 31, 2012

Presentation 41

Initiation and Maintenance of HIV Treatment in Adolescents

by Jaime Martinez, MD

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: June 17, 2009
Date of Last Review/Update: June 24, 2011
Expiration Date: June 24, 2012

Presentation 40

HIV-Infection and International Travel: Pretravel Patient Assessment and Management

by Carlos Franco-Paredes, MD, MPH

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: January 29, 2009
Date of Last Review/Update: March 9, 2012
Expiration Date: March 9, 2013

Presentation 39

Initial Evaluation of a Patient with a New HIV Diagnosis

by Michael Melia, MD, and Howard Libman, MD

Level: Basic

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: December 22, 2008
Date of Last Review/Update: January 31, 2012
Expiration Date: January 31, 2013

Presentation 36

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

by David L. Wyles, MD

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: October 2, 2008
Date of Last Review/Update: May 1, 2012
Expiration Date: May 1, 2013

Level: Advanced

Presentation 35

HIV-Associated Neurocognitive Disorder

by Susan Swindells, MBBS

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: August 26, 2008
Date of Last Review/Update: January 2, 2012
Expiration Date: January 2, 2013

Presentation 32

Sexual Addiction in an HIV-Infected Patient

by Edward R. Hammond, MD, MPH, and Glenn J. Treisman, MD, PhD

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: May 29, 2008
Date of Last Review/Update: April 14, 2011
Expiration Date: May 31, 2012

Presentation 30

Managing Oral Health Problems in People with HIV Infection

by David A. Reznik, DDS

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: May 5, 2008
Date of Last Review/Update: November 16, 2011
Expiration Date: November 16, 2012

Presentation 28

Syphilis in the HIV-Infected Patient

by Jeanne M. Marrazzo, MD, MPH

Level: Advanced

CME Credit Available: 1 AMA PRA Category 1 Credit^TM
Release Date: February 22, 2008
Date of Last Review/Update: April 11, 2011
Expiration Date: May 31, 2012

Presentation 24

HIV-Related Renal Disease

by Christina M. Wyatt, MD, and Lynda Anne Szczech, MD, MSCE, FASN

Level: Advanced

CME Credit Available: 2.5 AMA PRA Category 1 Credits^TM
Release Date: November 16, 2007
Date of Last Review/Update: March 28, 2011
Expiration Date: May 31, 2012

Presentation 23

HIV, HAART, and the Heart: Cardiovascular Risk Associated with HIV Disease and Antiretroviral Therapy: 2012 Edition

by Roger J. Bedimo, MD, MS

Level: Advanced

CME Credit Available: 1.5 AMA PRA Category 1 Credit^TM
Release Date: September 5, 2007
Date of Last Review/Update: April 25, 2012
Expiration Date: April 25, 2013

Note: 0.5 credit for 2009 edition learners.

Please see the Presentation Archive for expired COW activities that are available for study but that no longer provide CME credit.