Positive Pulse: Breaking News in HIV Management

Faculty

Needs Statement

There are currently an estimated 1.2 million Americans living with HIV in the United States, with approximately 56,000 new cases annually, according to the latest estimates of the Centers for Disease Control (CDC).  It is important to note that although the overall incidence of HIV infections has been relatively stable over the past few years, some populations have seen the number of HIV cases rise.  US minorities have been disproportionately affected by HIV, particularly black and Hispanic men who have sex with men and black women.  Effective strategies aimed at prevention of HIV transmission, as well as testing and access to care in these patient populations, are still lacking and greatly needed.
In addition to immunosuppression, HIV infection is associated with significant comorbidities that must be carefully managed by the health care provider (HCP) caring for the patient.  HIV patients are at an increased risk of developing renal disease, largely as a result of HIV-associated nephropathy (HIVAN), as well as cardiovascular disease, insulin resistance, and HIV disease of the central nervous system.  The risk of certain non–AIDS-defining cancers such as lung and anal cancers, and non-Hodgkin lymphoma, may also be higher in patients infected with HIV.  As new data emerge on the biology of HIV and its effect on the human host, it is essential for HCPs to be mindful of the impact of HIV infection on the whole health of their patients.   The landscape of HIV management has shifted dramatically with the advent of effective antiretroviral therapy (ART).  The current guidelines recommend combination ART regimens based on dual nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) backbones and supplemented with either a protease inhibitor (PI) or a nonnucleoside reverse transcriptase inhibitor (NNRTI) as initial treatment strategies in ART-naïve patients.  New classes of HIV drugs, including integrase inhibitors and CCR5 inhibitors, have been shown to be effective as second- and third-line treatments in ART-experienced patients who develop resistance to their current therapies.  As more studies are completed, it is likely that these novel HIV agents will be increasingly used as first-line therapy in treatment-naïve patients.  Moreover, new additions to the PI and NNRTI agent classes are further diversifying the arsenal of HIV-targeting drugs at the physician’s disposal.  It is imperative for HCPs to be aware of the latest results from clinical trials so that they can design and implement strategies that effectively integrate the novel HIV agents into existing treatment paradigms.  It is important to note that although ART has largely transformed HIV into a manageable chronic disease, therapy itself is also associated with potentially serious adverse effects and toxicities.  HCPs should be aware of ART-specific benefits and risks, including the risk for cardiovascular and renal disease.  HCPs caring for HIV patients should be aware of the latest data regarding the most effective ART regimens, as well as strategies for monitoring and managing HIV- and ART-related comorbidities. 

Gaps in practical knowledge in HIV management continue to arise owing to changing treatment recommendations, emerging therapy options, and increasing awareness of adverse events in the HIV patient population. Addressing these gaps will help HCPs provide the best possible care for their patients with HIV.  The critical gaps in knowledge that will be addressed over the course of this program include:

•    What are the new changes in the most recent updates to the DHHS HIV treatment guidelines and how will they affect treatment initiation and choice of initial regimens
•    What new treatment options are available for patients with HIV and how can they best be integrated into existing treatment paradigms
•    What is the latest data regarding the comorbidities associated with HIV infection and treatment, including cardiovascular disease, kidney disease, body shape changes, diabetes and dyslipidemias

Scientific conferences such as CROI, IAS, and ICAAC provide participants with the most current updates on developments in HIV management and this data is critical to practitioners in their clinical practices.  The updates, presented by leading experts in the field of HIV research, give insights into the most effective treatment regimens, management of adverse effects and comorbidities, and strategies for overcoming HIV drug resistance—arming HIV HCPs with knowledge they can use to optimize patient outcomes.  However, not all HIV HCPs can attend these critical conferences, thus creating a need for the crucial information presented at these meetings to be effectively communicated to the larger audience of HIV HCPs

Target Audience

This activity is designed for health care practitioners (physicians, physician assistants, nurse practitioners, nurses) involved in the management of HIV patients.

Objectives

1. Identify recent developments in the field of HIV research, including epidemiology, transmission, access to care, and updates to treatment guidelines;
2. Analyze the latest data from clinical trials regarding the use of existing and novel antiretroviral agents for the treatment of naïve and experienced patients with HIV, including strategies to overcome drug resistance;
3. Develop and implement strategies with which to integrate the latest treatment data, as well as new information regarding drug toxicities and comorbidities into the whole health care of patients with HIV.

Accreditation

CME
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 University of Kentucky College of Medicine and HealthmattersCME. The University of Kentucky College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Kentucky College of Medicine designates this educational activity for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The University of Kentucky College of Medicine presents this activity for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of medicine. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field.

CNE
The University of Kentucky, College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation (ANCC).

The Kentucky Board of Nursing (KBN) approves The University of Kentucky College of Nursing (UKCON) as a provider. ANCC and KBN approval of a continuing nursing education provider does not constitute endorsement of program content nor commercial sponsors. This educational activity is offered for a maximum of 1.00 ANCC and 1.2 KBN contact hour(s) for nurses who complete the entire program. Provider #: 3-0008-01-13-147. Certificates may be printed once the program is completed.

University of Kentucky College of Nursing is a provider approved by the California Board of Registered Nursing, Provider 00340864.

Faculty Disclosure

Dr. Hodder has the following to disclose:
Speakers Bureau: Bristol-Myers Squibb
Contract Research Support: Bristol-Myers Squibb, Gilead Sciences, Pfizer Inc, Tibotec
Consultant: Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Tibotec
Spouse’s Financial Interest: Retired Merck employee

Dr. Sax has the following to disclose:
Consultant: Abbott, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Tibotec
Teaching Honoraria: Abbott, Bristol-Myers Squibb, Gilead Sciences, Merck, Tibotec

Activity Sponsorship

This activity is jointly sponsored by the University of Kentucky and HealthmattersCME. Supported by an unrestricted educational grant from Gilead Sciences Medical Affairs, Bristol-Myers Squibb.