Virologic Failure in HIV: An Updated Clinician’s Guide to Assessment and Management

Target Audience
The educational design of this activity addresses the needs of infectious disease and HIV-specialist physicians and other clinicians involved in the care of patients with HIV infection.

Statement of Need/Program Overview
Though the prevalence of virologic failure (VF) in patients with HIV has decreased as newer antiretroviral (ART) regimens with higher genetic barriers to resistance and reduced toxicity have been approved, VF can still occur. VF may be due to patient, viral, or ART factors, and it is critical that clinicians determine the underlying cause before switching ART regimens so they can work with the patient to select the most appropriate regimen. Resistance will affect selection of subsequent regimens for patients experiencing VF, particularly among those with multidrug resistance (MDR). All patients experiencing VF should undergo resistance testing, and clinicians should engage in shared decision-making when selecting ART regimens, to ensure the patient can be adherent.

Heavily treatment-experienced (HTE) patients with MDR have had few options specifically designed to supplement an optimized background regimen, but these options have expanded over the last several years, and there is hope that this small subset of patients will have even more options in the future. In this eHealth activity, Drs David Wohl and Jürgen Rockstroh discuss evaluation of VF, selection of subsequent regimens for patients experiencing VF, and recently approved and emerging options for HTE patients, including how to create and simplify salvage regimens for these patients.

Educational Objectives
After completing this activity, the participant should be better able to:

Evaluate patient and genotypic causes of virologic failure
Tailor subsequent antiretroviral (ART) regimens according to resistance mutations, adherence, and other patient characteristics
Review mechanisms of action and clinical trial data for newer and emerging options for heavily treatment-experienced (HTE)
patients
Incorporate newer therapies into ART regimens for HTE patients

Physician Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation
Global designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioner Continuing Education
This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of Global and Integritas Communications. Global is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 110121. This activity is approved for 1.0 contact hour(s) (which includes 0.3 hour(s) of pharmacology).

Instructions to Receive Credit
To receive credit for this activity, participants must complete the preactivity questionnaire, complete and receive a score of 75% on the posttest, and complete the program evaluation.

Global Contact Information
For information about the accreditation of this program, please contact Global at 303-395-1782 or cme@globaleducationgroup.com.

Integritas Contact Information
For all other questions regarding this monograph, please contact Integritas via email at info@exchangecme.com.

Fee Information & Refund/Cancellation Policy
There is no fee for this educational activity.

Disclosures of Conflicts of Interest
Global adheres to the policies and guidelines, including the Standards for Integrity and Independence in Accredited CE, set forth to providers by the Accreditation Council for Continuing Medical Education (ACCME) and all other professional organizations, as applicable, stating those activities where continuing education credits are awarded must be balanced, independent, objective, and scientifically rigorous. All persons in a position to control the content of an accredited continuing education program provided by Global are required to disclose all financial relationships with any ineligible company within the past 24 months to Global. All financial relationships reported are identified as relevant and mitigated by Global in accordance with the Standards for Integrity and Independence in Accredited CE in advance of delivery of the activity to learners. The content of this activity was vetted by Global to assure objectivity and that the activity is free of commercial bias. All relevant financial relationships have been mitigated.

The faculty have the following relevant financial relationships with ineligible companies:

Jürgen Rockstroh, MD: Consulting Fee: Abivax, Boehringer Ingelheim, Galapagos, Gilead Sciences, Inc., Janssen, Merck, Theratechnologies, ViiV; Contracted Research: Gilead Sciences, Inc., Merck, ViiV; Honoraria: Gilead Sciences, Inc., Merck, Theratechnologies, ViiV

David A. Wohl, MD: Consulting Fee: Gilead Sciences, Inc., Janssen, Merck, ViiV; Contracted Research: Gilead Sciences, Inc., Merck, ViiV; Honoraria: Gilead Sciences, Inc., Janssen, Merck, ViiV

The following planners and managers have no relevant financial relationships with ineligible companies:

Kristin Delisi, NP, Lindsay Borvansky, Andrea Funk, Liddy Knight, Ashley Cann, Gena Dolson, MS, Jim Kappler, PhD

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global and Integritas Communications do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.