Update on HIV and Hepatitis C Virus Co-Infection

CME CREDIT IS NO LONGER AVAILABLE FOR THIS ACTIVITY

Target Audience

This activity is designed for physicians and nurses, and for other health care professionals who are involved in the care of individuals with HIV infection.

Statement of Need

Hepatitis C (HCV) is a common and serious co-infection found in HIV-infected patients, with estimates ranging from 25% in national studies to between 50% and 90% among people with a history of intravenous drug use, the most common HIV transmission mode in New Jersey.

People who are co-infected with HIV and HCV have an accelerated course of HCV infection and liver disease, with 15-25% progressing to cirrhosis compared to 3-6% of HCV mono-infected patients.

HCV treatment is challenging for both clinicians and patients, as there are limited treatment options, and many patients experience serious side effects making treatment contraindicated or intolerable. Among patients who complete a 48-week course of treatment with the recommended regimen of pegylated interferon and ribavirin, estimates of treatment success, measured by sustained viral response (SVR), or success in clearing HCV, range from 27% to 44%.

Clinicians need to make complex assessments of patients’ readiness and appropriateness for HCV treatment based on their liver functions and symptoms, stability of HIV disease management, HIV treatment adherence, and pre-existing mental health conditions. Assessment of patients with HCV includes clinical examination, antibody testing, qualitative and quantitative RNA assays, HCV genotyping, liver biopsy, and additional evaluation of liver enzymes and blood counts.

Although all patients with HIV and chronic HCV infection should be considered for HCV antiviral therapy, many will not be good candidates at the time of assessment.

Treatment for HIV and HCV must be carefully coordinated or co-managed to reduce interactions and toxicities, and assure effectiveness of treatment for both diseases.

Method of Instruction

Participants should read the learning objectives and review the activity in its entirety. After reviewing the material, complete the self-assessment test consisting of a series of multiple-choice and True/False questions.

Upon completing this activity as designed and achieving a passing score of 70% or more on the self-assessment test, participants will receive a CME credit letter awarding AMA/PRA category 1 credit.

Estimated time to complete this activity as designed is 1 hour.

Accreditation

UMDNJ-Center for Continuing and Outreach Education is accredited by the Accreditation Council for Continuing Medical Educationto provide continuing medical education for physicians.

UMDNJ-Center for Continuing and Outreach Education designates this educational activity for a maximum of 1 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The activity was prepared in accordance with the ACCME Essentials.

This activity was reviewed for relevance, accuracy of content, balance of presentation, and time required for participation by Dion Richetti, DC and Patricia Kloser, MD, MPH.

Faculty

Mona Bhatt Shah, MD, MPH is Resident (PGY1) at Abington Memorial Hospital in Abington, PA.

Eliahu Bishburg, MD is Director of Infectious Diseases at the Newark Beth Israel Medical Center and Director of the Family Treatment Center in Newark, NJ.

Sindy M. Paul, MD, MPH, is Medical Director for the New Jersey Department of Health and Senior Services (NJDHSS), Division of HIV/AIDS Services; Director of the Preventive Medicine: Public Health Residency Program at the NJDHSS; and Assistant Clinical Professor at the University of Medicine and Dentistry of New Jersey (UMDNJ).

Eugene Martin, PhD, is Associate Professor of Pathology and Laboratory Medicine at UMDNJ at Robert Wood Johnson Medical School and Administrative Director, University Diagnostic Laboratories (UDL).

Disclosure

In accordance with the disclosure policies of UMDNJ and to conform with ACCME and FDA guidelines, all program faculty are required to disclose to the activity participants: 1) the existence of any financial interest or other relationships with the manufacturers of any commercial products/devices, or providers of commercial services, that relate to the content of their presentation/material, or the commercial contributors of this activity, that could be perceived as a real or apparent conflict of interest; and 2) the identification of a commercial product/device that is unlabeled for use or an investigational use of a product/ device not yet approved.

Faculty Disclosure Declarations

Patricia Kloser, MD, MPH (Field Tester and Activity Director) has the following financial relationships to disclose: Speaker’s Bureau: GlaxoSmithKline, Roche, Glaxo; Consultant: Gilead, Boehringer Ingleheim.

The faculty listed below declare that they have no financial relationships with any corporate organization whose product(s) will be discussed in this presentation:

Mona Bhatt Shah, MD, MPH, Sindy M. Paul, MD, MPH, Eliahu Bishburg, MD, Eugene G. Martin, PhD, and Shobha Swaminathan, MD

Off-Label Usage Disclosure

This activity does not contain information about commercial products/devices that are unlabeled for use or investigational uses of products not yet approved.

Disclaimer

The views expressed in this activity are those of the faculty. It should not be inferred or assumed that they are expressing the views of NJDHSS-Division of HIV/AIDS Services, UMDNJ, or any manufacturer of pharmaceuticals.

The drug selection and dosage information presented in this activity are believed to be accurate. However, participants are urged to consult the full prescribing information on any agent(s) presented in this activity for recommended dosage, indications, contraindications, warnings, precautions, and adverse effects before prescribing any medication. This is particularly important when a drug is new or infrequently prescribed.

Copyright © 2005 UMDNJ-Center for Continuing and Outreach Education. All rights reserved including translation into other languages.

No part of this activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval systems, without permission in writing from UMDNJ-Center for Continuing and Outreach Education.

Grantor Acknowledgement

This activity is supported by an educational grant from NJDHSS Division of HIV/AIDS Services through a MOA titled, “Education and Training for Physicians and other Healthcare Professionals in the Diagnosis and Treatment of HIV/AIDS.”