Release Date: September 1, 2006
Expiration Date: March 31, 2008 (EXPIRED)

Target Audience
This activity is designed for physicians and nurses, and for other health care professionals in New Jersey.

Statement of Need
Co-infection with the human immunodeficiency virus (HIV) and the hepatitis B virus (HBV) presents a significant challenge to health care providers, affecting approximately 10% of persons with HIV infection.  It is important to screen all HIV infected individuals for HBV infection. HIV/HBV co-infected individuals are at increased risk of chronic hepatitis, cirrhosis, and hepatocellular carcinoma, and of experiencing HAART toxicity.  Provider knowledge of HBV status will affect routine laboratory monitoring and the selection of appropriate treatment regimens for HIV as well as HBV.  Further research is needed on the most effective approach to co-management, however, there is evidence that antiretroviral treatment for HIV can slow the progression of liver damage due to HBV.  Health care providers should also be aware of the importance of risk reduction including reduction or cessation of alcohol and acetaminophen use.

The most recent HIV treatment recommendations are the May 4, 2006 “Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents.”  This report explains the new recommendations for treating patients who are co-infected with HBV and HIV, including staging HBV and HIV treatment, based on the stage of each disease.  It also outlines the optimal treatment options, whether the patient is treated for HBV first, HIV first, or HIV and HBV together. 

Learning Objectives
Upon the completion of this activity, participants should be able:

• To recognize the role of laboratory testing for the diagnosis and ongoing monitoring of HBV/HIV infected patients.
• To describe preventive measures for close contacts of HIV-HBV co-infected persons.
• To identify HBV treatment candidates and implement evidence-based treatment regimens for the management of HBV in HIV co-infected patients.

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 credit letter and the test answer key four (4) weeks after receipt of the self-assessment test, registration, and evaluation materials. 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 Education to provide continuing medical education for physicians.

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

UMDNJ-Center for Continuing and Outreach Education is an approved provider of continuing education by the New Jersey State Nurses Association, Provider Number P173-10/06-09 . NJSNA is accredited by the ANCC Commission on Accreditation. This activity is approved for 1.2 contact hours. Provider approved by the California Board of Registered Nursing, Provider Number CEP 13780.

This activity was reviewed for relevance, accuracy of content, balance of presentation, and time required for participation by Bonnie Abedini, BSN, MS; Mary C. Krug RN, MSN, APN-C; Debbie Y. Mohammed, MS, APRN-BC, ACRN; and Patricia M. Kloser, MD, MPH.

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 Patricia Kloser, MD, MPH.

Faculty
Mark Gentz, DO, is an Infectious Disease specialist in Richmond Virginia.  He completed his fellowship and residency at Kennedy Memorial Health System, through the School of Osteopathic Medicine in Stratford, 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; Assistant Clinical Professor at the University of Medicine and Dentistry of New Jersey (UMDNJ); and President, New Jersey Board of Medical Examiners.

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).

Case Presentation:
David V. Condoluci, DO, FACOI is Clinical Professor of Medicine at UMDNJ-School of Osteopathic Medicine and Medical Director of Garden State Infectious Disease Associates in Voorhees, NJ.

Quality Assurance Perspective:
Brenda J. Christian, MEd, PA-C is the Quality Specialist for the UMDNJ-CCOE-Division of AIDS Education

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; Consultant: Gilead, Boehringer Ingleheim.

The following have no financial relationships to disclose: faculty: Mark Gentz, DO; Eugene Martin, PhD; Sindy M. Paul, MD, MPH; and field testers: Bonnie Abedini, BSN, MS; Mary C. Krug RN, MSN, APN-C, and Debbie Y. Mohammed, MS, APRN-BC, ACRN.

Off-Label Usage Disclosure
This activity does not contain information of 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 © 2006 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.”