eHIV Review eHIV Review
HOME        CME INFORMATION        PROGRAM DIRECTORS        NEWSLETTER ARCHIVE        EDIT PROFILE        RECOMMEND TO A COLLEAGUE
  VOLUME 2 – ISSUE 4 Podcast Link Below

Editor's Note: The 20th International AIDS Congress hosted a range of outstanding presentations on HIV science and practices. Studies targeting HIV treatment were a strong theme, highlighting antiretroviral therapy (ART) resistance and virologic failure, while other interesting investigations included patient compliance to a once-daily drug regimen and a treatment designed for hepatits-C/ HIV co-infected patients.

The SECOND LINE study involved a switch to ritonavir-boosted lopinavir (r/LPV) plus 2-3 nucleotide reverse transcriptase inhibitors (NtRTIs) or to r/LPV plus raltegravir, recommended by the World Health Organization for patients with confirmed virologic failure (VF) of first line non-nucleoside reverse transcriptase inhibitor (NNRTI) plus 2NtRTI ART therapy.

The study demonstrated the noninferiority of r/LPV plus raltegravir versus r/LPV plus 2-3 NRTIs after 96 weeks of treatment. It reported a higher risk of virologic failure in SECOND LINE patients with lower levels of baseline NRTI resistance versus high/ moderate levels, higher baseline HIV-1 RNA, incomplete adherence by self-report, low levels of baseline NRTI resistance in multivariate analysis, and according to race.

Acquired drug resistance is an ongoing battle in HIV research. The emergence of drug-resistant HIV variants is a common occurrence given the nature of viral mutation and the lack of an antiretroviral drug combination able to completely shut down viral replication. The SAILING trial showed a significantly lower incidence of treatment-emergent resistance in patients receiving dolutegravir compared to raltegravir (each combined with with 2 NRTIs) at Week 48, in ART-experienced, integrase inhibitor-naïve patients with baseline drug resistance. Dolutegravir remained active in this patient group with no virologic failures observed, including in patients lacking full ART backbone activity. The virologic failure rates were also lower with dolutegravir vs raltegravir in patients receiving protease-inhibitor (PI) -containing regimens without fully active PI.

Compliance and efficacy were addressed in the 48-week results of the phase III MODERN study that compared an investigational 2-drug regimen of once daily maraviroc (MVC) with darunavir/ritonavir (DRV/r) to a 3-drug, twice-daily regimen of emtricitabine/tenefovir (FTC/TDF) with DRV/r in antiretroviral-naïve patients. The results showed inferior efficacy of once daily MVC compared to FTC/TDF and failed to meet the -10% non-inferiority endpoint. More MVC subjects discontinued the study due to a lack of efficacy and there were more protocol defined treatment failures in the MVC study-arm. There were, however, no reports of viral resistance in either arm.

Lastly, the randomized, open-label TURQUOISE-I study revealed a high, sustained virologic response and a low rate of treatment discontinuation with the 3-direct-acting antiviral (3D) regimen of ABT-450 (co-dosed with ritonavir), ombitasvir, and dasabuvir , plus ribavirin (RBV), in treatment-naïve and treatment-experienced GT1 hepatits-C virus (HCV)/ HIV-1 co-infected patients, with or without cirrhosis. The results were consistent with those seen in HCV GTI1-monoinfected populations receiving this regimen.


NEW RECOMMENDATIONS FOR HAART IN HIV
Our guest author is Joel Gallant, MD, MPH, Adjunct Professor of Medicine, in the Division of Infectious Diseases at the Johns Hopkins University School of Medicine. Dr. Gallant is also Associate Medical Director of Specialty Services at Southwest Care in Santa Fe, New Mexico

After participating in this of this activity, the participant will demonstrate the ability to:

List the currently recommended antiretroviral regimens and discuss the data supporting their use.
Discuss the approach to patients with absolute or relative contraindications to nucleoside analogs.
Describe a patient for whom a protease inhibitor-based regimen might be chosen for initial antiretroviral therapy.

This discussion, offered as a downloadable audio file and companion transcript, covers the important topic of HAART in HIV in the format of case-study scenarios for the clinical practice. This program is a follow up to the Volume 2, Issue 3 eHIV Review newsletter—New Recommendations for HAART in HIV.


Unlabeled/Unapproved Uses
Dr. Gallant has indicated that there will be references to the following agents and combinations of agents not approved at the time this podcast was recorded: a once-daily formulation of raltegravir; a dolutegravir/abacavir/lamivudine single tablet co-formulation; tenofovir/alafenamide (TAF) in various co-formulations; and doravirine, also known as MK-1439. Please note the dolutegravir/abacavir/lamivudine single tablet co-formulation is now FDA approved.
  MEET THE AUTHOR

Joel Gallant, MD

Joel Gallant, MD, MPH

Associate Medical Director of Specialty Services
Southwest CARE Center
Santa Fe, New Mexico
Adjunct Professor of Medicine, Division of Infectious Diseases
Johns Hopkins University School of Medicine


Faculty Disclosure
Dr. Gallant has indicated he has received grant and or research funding from AbbVie, Bristol-Myers Squibb, Gilead Sciences, Merck & Co., Sangamo BioSciences, Vertex Pharmaceuticals, and ViiV Healthcare. He has served as a consultant or advisor to Bristol-Myers Squibb, Gilead Sciences, and Janssen Therapeutics, and he has been a paid member of the committee/panel/board at Takara Bio.

Release Date
September 25, 2014
Expiration Date
September 24, 2016
 
Richard Moore, MD, MHS
Professor of Medicine
Director, Moore Clinic for HIV Care
Divisions of Infectious Diseases and
Clinical Pharmacology
Johns Hopkins University School of Medicine
Baltimore, Maryland
Michael Melia, MD
Assistant Professor of Medicine
Associate Fellowship Program Director
Division of Infectious Diseases
Johns Hopkins University School of Medicine
Baltimore, Maryland
Jeanne Keruly, MS, CRNP
Assistant Professor of Medicine
Department of Medicine, Division of Infectious Diseases
Director, Ryan White Ambulatory Services
Johns Hopkins University School of Medicine
Baltimore, Maryland
 Accreditation Statements
Physicians
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing. The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Nurses
The Institute for Johns Hopkins Nursing and the American Nursing Credentialing Center do not endorse the use of any commercial products discussed or displayed in conjunction with this educational activity.

Credit Designation Statement
Physicians
eNewsletter: The Johns Hopkins University School of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Podcast: The Johns Hopkins University School of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses
eNewsletter: This 1 contact hour educational activity is provided by the Institute for Johns Hopkins Nursing. Each newsletter carries a maximum of 1 contact hour or a total of 6 contact hours for the six newsletters in this program.

Podcast: This 0.5 contact hour educational activity is provided by the Institute for Johns Hopkins Nursing. Each podcast carries a maximum of 0.5 contact hours or a total of 3 contact hours for the six podcasts in this program.

There are no fees or prerequisites for this activity.

Successful Completion
To successfully complete this activity, participants must read the content, and then link to the Johns Hopkins University School of Medicine's website or the Institute for Johns Hopkins Nursing's website to complete the post-test and evaluation. A passing grade of 70% or higher on the post-test/evaluation is required to receive CE credit.

Launch Date
September 25, 2014; activities expire 2 years from the date of publication.

Length of Activity: 30 minutes

Intended Audience
The target audience (clinicians) for this initiative includes infectious disease (ID) specialists, primary care physicians (PCPs), nurse practitioners (NPs), physician assistants (Pas), and other health care practitioners whose work/practice includes treating patients with HIV.

Internet CME Policy
The Office of Continuing Medical Education (CME) at the Johns Hopkins University School of Medicine is committed to protecting the privacy of its members and customers. The Johns Hopkins University School of Medicine maintains its Internet site as an information resource and service for physicians, other health professionals, and the public.

Continuing Medical Education at the Johns Hopkins University School of Medicine will keep your personal and credit information confidential when you participate in an Internet-based CME program. Your information will never be given to anyone outside of the Johns Hopkins University School of Medicine program. CME collects only the information necessary to provide you with the services that you request.

Disclaimer Statement
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information for specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients.



Statement of Responsibility
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

PLANNER DISCLOSURE
As a provider approved by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine Office of Continuing Medical Education (OCME) to require signed disclosure of the existence of financial relationships with industry from any individual in a position to control the content of a CME activity sponsored by OCME. Members of the Planning Committee are required to disclose all relationships regardless of their relevance to the content of the activity. Faculty are required to disclose only those relationships that are relevant to their specific presentation. The following relationship has been reported for this activity:
Richard Moore, MD, MHS discloses that he has served as a consultant for Merck.
Michael Melia, MD discloses that he has received grants from Merck, Gilead, Bristol-Myers Squibb, Janssen and AbbVie. No other planners have indicated that they have any financial interest or relationships with a commercial entity whose products or services are relevant to the content of their presentation.


Guest Author Disclosures

STATEMENT OF NEED:
As the demographics of HIV have shifted to include many older adults, clinicians require education regarding the treatment of common comorbidities.
Clinicians may be unclear about issues specific to the diagnosis and treatment of women with HIV.
Many clinicians require education regarding current treatment and new emerging hepatitis C medications in patients coinfected with HIV/HCV who require antiretroviral therapy.
Clinicians may need an update on current recommendations for the treatment of HIV with HAART.

Confidentiality Disclaimer for Conference Attendees
I certify that I am attending a Johns Hopkins University School of Medicine CME activity for accredited training and/or educational purposes.

I understand that while I am attending in this capacity, I may be exposed to "protected health information," as that term is defined and used in Hopkins policies and in the federal HIPAA privacy regulations (the Privacy Regulations). Protected health information is information about a person's health or treatment that identifies the person.

I pledge and agree to use and disclose any of this protected health information only for the training and/or educational purposes of my visit and to keep the information confidential.

I understand that I may direct to the Johns Hopkins Privacy Officer any questions I have about my obligations under this Confidentiality Pledge or under any of the Hopkins policies and procedures and applicable laws and regulations related to confidentiality. The contact information is Johns Hopkins Privacy Officer, telephone: 410-735-6509, e-mail:HIPAA@jhmi.edu.

"The Office of Continuing Medical Education at The Johns Hopkins University School of Medicine, as provider of this activity, has relayed information with the CME attendees/participants and certifies that the visitor is attending for training, education and/or observation purposes only."

For CME Questions, please contact the CME Office at (410) 955-2959 or e-mail cmenet@jhmi.edu.

For CME Certificates, please call (410) 502-9634.

Johns Hopkins University School of Medicine
Office of Continuing Medical Education
Turner 20/720 Rutland Avenue
Baltimore, Maryland 21205-2195

Reviewed and Approved by
General Counsel, Johns Hopkins Medicine (4/1/03)
Updated 4/09

Hardware & Software Requirements
Pentium 800 processor or greater, Windows 98/NT/2000/XP/7 or Mac OS 9/X, Microsoft Internet Explorer 5.5 or later, 56K or better modem, Windows Media Player 9.0 or later, 128 MB of RAM, sound card and speakers, Adobe Acrobat Reader, storage, Internet connectivity, and minimum connection speed. Monitor settings: High color at 800 x 600 pixels.

Listen
If you want to now listen to the eHIV Review podcast, just click on the button above. This will open your Internet browser to play the podcast by streaming the media via the web.

Please note: This podcast file is large so please be patient while the content downloads.
Download
b
Save the podcast to your computer. Once saved you can manage and play the file like any song or music using your music software (iTunes, Windows Media, Real Player, etc.). You can also transfer the podcast file to your iPod, MP3 player and listen while on–the–go.
b
b
Subscribe
Like any RSS subscription,
when you subscribe to
this Review you will automatically receive each new edition, downloaded to your hard drive as soon as it becomes available. You may manage and play the downloaded podcast file like any song or audio file by using your music software (iTunes, Windows Media, Real Player, etc.). You can also transfer the podcast file to your iPod, MP3 player to listen while on–the–go.
Subscribe to eHIV Review
COMPLETE THE
POST-TEST


Step 1. Click on the appropriate link below. This will take you to the post–test.

Step 2. If you have participated in a Johns Hopkins on–line course, login. Otherwise, please register.

Step 3. Complete the post–test and course evaluation.

Step 4. Print out your certificate.
Physicians Post-test
eHypertension Review Newsletter Archive
» Download the podcast transcript
(Podcast recorded 6/9/14; transcript updated 9/23/14)
» Go to the companion newsletter
» iCases Samantha
image

Follow Samantha throughout her life with HIV. In three 15-minute cases you will visit with Samantha when first diagnosed, when she wants to start a family, and as she is aging.

»SCALE HIV™ Mobile for iPhone
image

The AAHIVM's database of HIV specialists now available on your smart phone, searchable by zip code and other criteria. The App also has HIV screening and counseling guidance.

 
Help other specialists and primary care clinicians find solutions to the diagnosis and treatment of HIV. Forward a link to the eHIV Review website to a colleague.
Share with a colleague

© 2014 JHUSOM and eHIV Review

All rights reserved – The Johns Hopkins University School of Medicine

This activity was developed in collaboration with DKBmed.