CCO Management Series
Strategies for the Management of Multiclass-Resistant Patients
Assessing Prognosis and Treatment Goals in Multiclass-Resistant Antiretroviral-Experienced Patients
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Module 1 of 4
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Program Director:
John P. Phair, MD
- Kimberly Y. Smith, MD, MPH
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 Topics covered include:
- Introduction
- Higher Mortality in MDR HIV Disease
- Are All Patients With MDR HIV Alike?
- Predicting Response in MDR Patients: What We Learned From the TORO Trials
- Predicting Response in MDR Patients: Tipranavir/Ritonavir and Baseline PI Resistance
Learning Objectives
Upon completion of this activity, participants should be able to:
Discuss treatment options when viral control is not possible and outline current data on stopping vs continuing treatment in MDR patients. Identify factors that are associated with risk of death in multidrug-resistant (MDR) patients. Describe clinical data on the use of newly approved and investigational agents in the treatment of MDR patients and the predictors of virologic response to these agents.
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Use and Interpretation of Resistance Tests in Multiclass-Experienced Patients
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Module 2 of 4
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Program Director:
John P. Phair, MD
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Topics covered include:
- Introduction
- Methods of Antiretroviral Resistance Testing
- Evidence Base for Use of Resistance Tests
- Prospective Studies of Genotypic Testing
- Prospective Studies of Phenotypic Testing
Learning Objectives
Upon completion of this activity, participants should be able to:
Summarize data on the impact of resistance testing on patient outcome in randomized trials Describe the advantages and disadvantages of each type of resistance test, and factors to consider when interpreting their results Discuss the role of resistance testing in multiclass-experienced patients
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New and Investigational Antiretroviral Agents With Activity in Multiclass-Resistant Antiretroviral-Experienced Patients
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Module 3 of 4
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Program Director:
John P. Phair, MD
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Topics covered include:
- Introduction
- New NRTIs for the Multiclass-Experienced Patient
- New NNRTIs for the Multiclass-Experienced Patient
- New PIs for the Multiclass-Experienced Patient
- Efficacy of Tipranavir/Ritonavir
Learning Objectives
Upon completion of this activity, participants should be able to:
Describe the challenges of treating patients with multiclass-resistant HIV Review data from clinical trials of new antiretroviral agents in current classes Outline the mode of action and clinical activity of investigational agents in new classes
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Clinical Strategies for Maximizing the Benefits of Antiretroviral Therapy in Multiclass-Resistant Antiretroviral-Experienced Patients
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Module 4 of 4
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Program Director:
John P. Phair, MD
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Topics covered include:
- Introduction
- Development of Multiclass-Resistant Virus
- Address Poor Adherence Early
- Pharmacokinetic Reasons for Treatment Failure
- Principles in Selecting a New Regimen
Learning Objectives
Upon completion of this activity, participants should be able to:
Describe treatment options when a suppressive regimen cannot be created for a patient with multidrug-resistant HIV List causes of multiclass drug resistance in HIV-infected patients Discuss factors to consider when selecting a new antiretroviral regimen for patients with multidrug-resistant HIV
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Interactive Case Challenges
Management of a Patient With Multidrug-Resistant HIV Acquired by Transmission
CME Program Director:
John P. Phair, MD
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 Joseph J. Eron, Jr., MD, discusses clinical considerations for identifying and managing multiclass-resistant HIV in a treatment-naive patient. Learning Objectives
Upon completion of this activity, participants should be able to:
- Describe temporal trends on the prevalence of drug-resistant HIV-1 in treatment-naive HIV-infected patients
- Discuss considerations for using genotype and/or phenotype tests to identify transmission of drug-resistant HIV-1 and mutational patterns that suggest such transmission
- Review data on antiretroviral treatment options for patients with highly resistant HIV-1
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Management of a Multiclass-Experienced Patient With Low-Level Viremia and Several Cardiovascular Risk Factors
CME Program Director:
John P. Phair, MD
- Kimberly Y. Smith, MD, MPH
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Kimberly Y. Smith, MD, MPH, presents difficult management decisions faced when balancing the risks and benefits of treating a patient with multiclass-resistant HIV and several cardiovascular risk factors. Learning Objectives
Upon completion of this activity, participants should be able to:
- Discuss considerations for balancing the risks and benefits of antiretroviral treatment vs the risks of coronary artery disease
- Review clinical trial data on stopping vs continuing a nonsuppressive antiretroviral regimen
- Describe recent data on antiretroviral treatment options for patients with multiclass-resistant HIV
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Management of a Patient With Multiple Regimen Failures and Difficult Follow-up
CME Program Director:
John P. Phair, MD
 
- William A. O'Brien, MD, MS
- Jeff East, PA
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William A. O’Brien, MD, describes a case patient with multiple treatment failures, opportunistic infections, and continuing adherence and tolerability difficulties. Learning Objectives
Upon completion of this activity, participants should be able to:
- List potential factors contributing to medication noncompliance
- Discuss approaches to treating and preventing opportunistic infections in HIV-infected patients
- Outline antiretroviral treatment options for patients who cannot maintain challenging regimens
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Slides
Strategies for the Management of Multiclass-Resistant Antiretroviral-Experienced Patients
CME Program Director:
John P. Phair, MD
  
- Joseph J. Eron, Jr., MD
- Joel E. Gallant, MD, MPH
- William G. Powderly, MD
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- Kimberly Y. Smith, MD, MPH
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Download a CME-certified PowerPoint slide-set reviewing treatment strategies and key studies regarding the management of multiclass-resistant patients. Learning Objectives
Upon completion of this activity, participants should be able to:
Describe the use and interpretation of resistance testing in highly treatment-experienced patients. Discuss appropriate treatment goals for patients with multiclass-resistant HIV. Recount clinical strategies for optimizing the outcomes of antiretroviral therapy in multiclass-experienced patients. Review investigational antiretrovirals in advanced clinical development that show promise for use in treatment-experienced patients.
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Interactive Tool
Selecting a Boosted PI for the Treatment-Experienced Patient
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The tool is designed to provide easy access to data on the characteristics and suitability of the available boosted PIs as potential components of regimens for treatment-experienced patients, using data from prescribing information, clinical studies, and the expert opinion of the author, Joseph J. Eron, Jr, MD
Format: Adobe Flash | File size: 76 KB
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Disclaimer: The materials published on the Clinical Care Options Web site reflect the views of the reviewers or authors of the CCO material, not those of Clinical Care Options, LLC, the CME provider, or the companies providing educational grants. The materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or using any therapies described in these materials.
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Jointly sponsored by University of Alabama School of Medicine and Clinical Care Options, LLC.
Pharmacist and nursing credit provided through the cosponsorship of Medical Education Collaborative and Clinical Care Options, LLC.
Contact Info
Educational grant provided by:
Educational grants support only the CME-certified components of this program.
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