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Please read this page before participating in this activity. At the bottom of the page, select “I have read these instructions and understand them,” and then click “Begin Activity.”
CME Credit Available: 1.75 AMA PRA Category 1 Credit(s)™
Level: Advanced
Release Date: November 10, 2010
Date of Last Review/Update: December 21, 2011
Expiration Date: December 21, 2012
This Cases on the Web activity introduces a case and presents various clinical decision points, each about an HIV-infected patient who is a candidate for opioid dependence treatment. At each clinical decision point, learners should select the option that they believe is most sound and read the presenters’ explanation of that option. Selecting the correct option links the learner to an extended discussion of related medical findings, research-based evidence, and case management considerations.
To advance from one clinical decision point to the next, learners should click on the NEXT arrow located at the bottom of the page that discusses the best clinical option.
After reviewing the cases, learners may link to the continuing medical education (CME) posttest questions and the course evaluation, both of which must be completed and submitted to receive credit. Please see the posttest form and course evaluation form for further instructions.
On completion of this activity, the learner will be able to:
- Determine which patients are likely candidates for office-based opioid treatment (OBOT) with buprenorphine.
- Identify patient and clinical factors in which buprenorphine is potentially contraindicated.
- Describe potential treatment outcomes and identify the safety benefits of buprenorphine and other opioid agonists.
The IAS–USA offers this state-of-the-art activity as part of a nationwide CME effort for HIV physicians on the evolving challenges of HIV disease. This activity examines issues relevant to the care of an HIV-infected patient who is dependent on heroin.
This Cases on the Web activity is designed for physicians who are actively involved in HIV and AIDS care. Specifically, these activities have been designed for physicians who:
- Have a solid, working knowledge of HIV disease management.
- Provide comprehensive or specialty care for at least 10 patients with HIV and AIDS or are involved in HIV and AIDS clinical trials or investigations.
- Have completed at least 10 hours of CME in the area of HIV and AIDS medicine in the past 2 years.
This activity is also relevant to nurse practitioners, physician assistants, nurses, and other health professionals who provide care for people with HIV disease.
The International Antiviral Society-USA (IAS–USA) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The IAS–USA designates this internet enduring material activity for a maximum of 1.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This CME activity is offered from December 21, 2011 to December 21, 2012. Participants who successfully complete the activity post test and submit the evaluation and registration forms are eligible to receive CME credit. Physicians (MDs, DOs, and international equivalents) may receive CME credit for completing this activity. Nonphysician health care practitioners will receive a certificate of attendance.
Authors
Hillary Kunins, MD, MPH, MS
Hillary Kunins, MD, MPH, MS, is associate professor of clinical medicine and psychiatry and behavioral sciences at Montefiore Medical Center/Albert Einstein College of Medicine. Dr Kunins is a general internist providing HIV care, primary care, and medication-assisted addiction treatment to substance users in primary care and substance abuse treatment settings. She directs an intensive HIV risk reduction and peer education program for substance-using women. Dr Kunins is also director of the residency program in primary care/social internal medicine at Montefiore Medical Center.
Chinazo Cunningham, MD, MS
Chinazo Cunningham, MD, MS, is associate professor of medicine, and family and social medicine at Montefiore Medical Center/Albert Einstein College of Medicine. Dr Cunningham has cared for HIV-infected substance users throughout her career. She has developed unique and innovative programs to deliver health care to this marginalized population, along with research and evaluation focusing on use of and access to health care among vulnerable populations. She has been the principal investigator on several federally funded grants.
Editor
Gerald H. Friedland, MD
Dr Friedland is professor of medicine and epidemiology and public health at Yale School of Medicine. He currently serves on the US Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents and the World Health Organization TB/HIV Working Group, and as the Chairman of the Board of Directors of the Aaron Diamond AIDS Research Center in New York City. Dr Friedland has been directly involved in the care of people living with HIV and AIDS since the beginning of the epidemic in 1981. His research has focused on adherence to HIV therapies, integration of HIV and substance abuse care and treatment, HIV and tuberculosis care and treatment, development and testing of interventions to reduce HIV transmission risk among HIV-infected persons in clinical care settings, and clinical trials of HIV therapies, including studies of the pharmacokinetic interactions between antiretroviral and substance-abuse therapies.
R. Douglas Bruce, MD, MA, MSc
Dr Bruce is assistant professor of medicine at Yale School of Medicine. He is the medical director of South Central Rehabilitation Center (the first Federally Qualified Health Center [FQHC] to become an integrated health clinic), which provides addiction medicine (buprenorphine and methadone), primary care (including HIV and hepatitis C virus [HCV] treatments), and mental health treatment in an integrated-care setting. Dr Bruce has worked clinically treating HIV and HCV in drug-treatment, jail and prison, and mobile-healthcare settings. He has assisted in the development and implementation of buprenorphine in each of these clinical environments and has trained medical practitioners in evidenced-based treatments for addiction and HIV.
In the interest of maintaining the independence of its CME activities, and in accordance with the policies of the Accreditation Council for Continuing Medical Education (ACCME), the IAS–USA requires all persons with control of content (ie, faculty, IAS–USA Board members, and program staff) to disclose any financial relationships that they or their spouses or partners have had with commercial companies within the past 12 months. Any real or apparent conflicts of interest of those parties are resolved prior to the CME activity being delivered. Individuals who refuse to disclose financial interests may not participate in an IAS–USA CME activity.
Faculty
November 2010 Release
Dr Kunins and Dr Cunningham have no relevant financial interests to disclose.
Dr Friedland has received grants and research support from Bristol-Myers Squibb and Merck & Co., Inc.
Dr Bruce has received grants and research support from Merck & Co., Inc. and Reckitt Benckiser Pharmaceuticals, Inc.
Cases on the Web Editorial Board
Members of the Cases on the Web (COW) Editorial Board participate in a volunteer capacity. They are not compensated for their role in overseeing the program. Listed below are the COW Editorial Board members and their financial interests with commercial companies within the past 12 months from the date of disclosure.
Michael S. Saag, MD — Editor-in-Chief
Professor of Medicine
University of Alabama at Birmingham
Dr Saag has received research support from and has been a scientific advisor to Bristol-Myers Squibb, Gilead Sciences, Inc, Janssen Therapeutics, Merck & Co, Inc, and ViiV Healthcare. He has served as a scientific advisor and consultant for Vertex Pharmaceuticals and has received additional research support from Boehringer Ingelheim Pharmaceuticals, Inc, and GlaxoSmithKline. (Updated 04/25/13)
Marshall J. Glesby, MD, PhD — Coeditor
Professor of Medicine and Public Health
Weill Cornell Medical College of Cornell University
Dr Glesby has received grants and research support awarded to Weill Cornell Medical College from Pfizer Inc, and he served as a consultant to Pfizer Inc and Gilead Sciences, Inc. (Updated 05/03/13)
Judith A. Aberg, MD
Professor of Medicine
New York University School of Medicine
Dr Aberg serves as a scientific advisor to Janssen Therapeutics (formerly Tibotec) and Merck & Co, Inc. She has received clinical research support awarded to New York University School of Medicine from Kowa Research Institute during 2012-2013. (Updated 5/17/13)
Roger J. Bedimo, MD, MS, FACP
Associate Professor of Medicine
University of Texas Southwestern Medical Center
Dr Bedimo has received grants and research support awarded to the VA North Texas Healthcare System from Merck & Co, Inc and Tibotec Therapeutics. (Updated 3/25/13)
Paul E. Sax, MD
Professor of Medicine
Harvard Medical School
Dr Sax has received grants and research support awarded to Harvard Medical School from Bristol-Myers Squibb, Gilead Sciences, Inc, GlaxoSmithKline, Merck & Co, Inc, and Janssen Therapeutics. He has served as a consultant to Bristol-Myers Squibb, Gilead Sciences, Inc, GlaxoSmithKline, Merck & Co, Inc, and Janssen Therapeutics. (Updated 3/28/13)
Steven C. Johnson, MD
Professor of Medicine, Division of Infectious Diseases
University of Colorado School of Medicine
Dr Johnson has served as a consultant to Gilead Sciences, Inc, and ViiV Healthcare. (Updated 4/27/13)
Harry W. Lampiris, MD
Professor of Clinical Medicine
University of California San Francisco
Dr Lampiris has no relevant financial affiliations to disclose. (Updated 5/06/13)
David L. Wyles, MD
Associate Professor of Medicine
University of California San Diego
Dr Wyles has received grants awarded to the University of California San Diego from AbbVie, Gilead Sciences, Inc, Merck & Co, Inc, and Vertex Pharmaceuticals. He has served as a consultant to Bristol-Myers Squibb, Janssen Pharmaceuticals, Inc, and Merck & Co, Inc. (Updated 03/26/13)
J. Martin Rodriguez, MD, FACP
Associate Professor of Medicine
University of Alabama at Birmingham
Dr Rodriguez has received research support from Merck & Co, Inc. (Updated 1/29/13)
Kara W. Chew, MD – Fellow Editor
Fellow in Infectious Diseases
University of California Los Angeles
Dr Chew has no relevant financial affiliations to disclose. (Updated 3/22/13)
Staff of the Cases on the Web
Donna M. Jacobsen — Executive Director/President
Ms Jacobsen has no relevant financial affiliations to disclose. (Updated 5/17/13)
Donna L. Scism — Cases on the Web Program Coordinator
Ms Scism has no relevant financial affiliations to disclose. (Updated 5/17/13)
IAS–USA Board of Directors
The nonstaff members of the IAS–USA Board of Directors participate in a volunteer capacity. They are not compensated for their roles in governing/overseeing the IAS–USA. Listed below are the IAS–USA Board of Directors and their financial interests with commercial companies within the last 12 months from the date of disclosure.
Constance A. Benson, MD, FACP
Professor of Medicine
University of California San Diego
Dr Benson has no relevant financial affiliations to disclose. Disclosure information for her spouse, Robert T. Schooley, MD, is indicated below. (Updated 04/15/13)
Judith S. Currier, MD
Professor of Medicine
University of California Los Angeles
Dr Currier has received research grants awarded to the University of California Los Angeles from Merck & Co, Inc. and has served as a consultant to Gilead Sciences. (Updated 04/29/13)
Carlos del Rio, MD
Professor of Medicine
Emory University
Dr del Rio has served as a consultant to Pfizer, Inc. (Updated 4/16/13)
Joel E. Gallant, MD, MPH
Professor of Medicine and Epidemiology
The Johns Hopkins University
Dr Gallant has served as a consultant or advisor to Bristol-Myers Squibb, Gilead Sciences, Inc, GlaxoSmithKline, Merck & Co, Inc, Janssen Therapeutics, and Takara Bio, Inc, and has received research grants or contracts awarded to his institution from Gilead Sciences, Inc. (Updated 05/06/13)
Roy M. Gulick, MD, MPH
Professor of Medicine
Weill Medical College of Cornell University
Dr Gulick has received research grants awarded to Weill Cornell Medical College from Janssen Therapeutics, Pfizer, Inc, and ViiV Healthcare. He has served as an ad-hoc consultant to GlaxoSmithKline and Koronis. (Updated 03/26/13)
Douglas D. Richman, MD
Professor of Pathology and Medicine
University of California San Diego
Dr Richman has been a consultant to Biota, Bristol-Myers Squibb, Chimerix, Gen-Probe, Inc, Gilead Sciences, Inc, Merck & Co, Inc, and Monogram Biosciences, Inc. He has held stock options for Chimerix. (Updated 03/27/13)
Michael S. Saag, MD — Editor-in-Chief
Professor of Medicine
University of Alabama at Birmingham
Dr Saag has received research support from and has been a scientific advisor to Bristol-Myers Squibb, Gilead Sciences, Inc, Janssen Therapeutics, Merck & Co, Inc, and ViiV Healthcare. He has served as a scientific advisor and consultant for Vertex Pharmaceuticals and has received additional research support from Boehringer Ingelheim Pharmaceuticals, Inc, and GlaxoSmithKline. (Updated 04/25/13)
Robert T. Schooley, MD
Professor and Vice Chair of Medicine
University of California San Diego
Dr Schooley has served as a scientific advisory board member for Gilead Sciences, Inc, Monogram Biosciences, Inc, and GlobeImmune Inc, as a member of data monitoring committees for Axio and Gilead Sciences, Inc; and as a consultant or advisor to Merck & Co, Inc, Johnson & Johnson, and Santaris Pharma A/S. He has received grants awarded to his institution from Boehringer Ingelheim Pharmaceuticals, Inc, and has stock in GlobeImmune Inc. (Updated 03/31/13)
Paul A. Volberding, MD
Professor of Medicine
Director, AIDS Research Institute
University of California San Francisco
Dr Volberding has served on scientific advisory boards for Bristol-Myers Squibb and Gilead Sciences, Inc. (Updated 05/02/13)
This Cases on the Web activity is sponsored by the IAS–USA and is made possible through educational grants from the following commercial companies.
Substantial Grant Support
Tibotec Therapeutics
Merck & Co, Inc
Bristol-Myers Squibb
Gilead Sciences
Generous Grant Support
ViiV Healthcare
Additional support for Cases on the Web specifically is provided by:
Boehringer Ingelheim Pharmaceuticals, Inc
Abbott Laboratories
This activity may contain information about the investigational uses of drugs or products that are not approved by the US Food and Drug Administration. Please consult full prescribing information before using any medication or product mentioned in Cases on the Web.
The views and opinions expressed herein are those of the faculty and do not necessarily represent the opinions or recommendations of the IAS–USA.
If you have any questions about this Cases on the Web activity, please contact the IAS–USA:
IAS–USA
425 California Street
Suite 1450
San Francisco, CA 94104-2120
Telephone: 415-544-9400
Fax: 415-544-9401
E-mail: info2011"at"iasusa.org
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