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Principles of Initiating or Switching ART to Maximize Convenience and Tolerability Testing your Knowledge

W. David Hardy, MD, AAHIVS

This activity is jointly provided by Global Education Group and Integritas Communications.

 

This activity is supported by an educational grant from Gilead Sciences, Inc.

 

Faculty

W. David Hardy, MD, AAHIVS
Scientific and Medical Consultant
Immediate Past-Chair of the Board of Directors
HIV Medicine Association (HIVMA)
Chair of the Education Committee
American Academy of HIV Medicine (AAHIVM)
Los Angeles, California

Target Audience

The educational design of this activity addresses the needs of physicians, physician assistants, and nurse practitioners involved in the treatment of patients with human immunodeficiency virus (HIV).

Educational Objective

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

  • Utilize switching strategies to individualize treatment and improve clinical outcomes, adherence, and tolerability

Statement of Need/Program Overview

There are many factors that may necessitate switching a patient’s antiretroviral therapy (ART) regimen, such as cost, comorbidities, adverse events, polypharmacy, pregnancy, adherence, or patient preference.1,2 This may be particularly relevant in aging patients as they begin taking more medications to manage comorbidities that typically occur in older patients.1 The proliferation of treatment-switching strategies has made therapeutic selection increasingly complex. Certain ART regimens may exacerbate existing comorbidities, requiring clinicians to carefully weigh switching strategies, whether they are within class, between class, or to a 2-drug regimen.1 This self-assessment will pose clinical scenarios to measure clinician knowledge and practice behavior, which will be followed by an explanation of appropriate ART selection.

References

  1. US Department of Health and Human Services. Recommendations for the use of antiretroviral drugs in pregnant women with HIV infection and interventions to reduce perinatal HIV transmission in the United States. 2020; https://clinicalinfo.hiv.gov/en/guidelines/perinatal/. Accessed September 16, 2020.
  2. US Department of Health and Human Services. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. 2019; https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv/whats-new-guidelines Accessed September 14, 2020.

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 activity for a maximum of 0.25 AMA PRA Category 1 Credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Global Contact Information

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

Instructions to Receive Credit

In order to receive credit for this activity, the participant must score 100% on the posttest and complete the program evaluation.

Fee Information& Refund/Cancellation Policy

There is no fee for this educational activity.

Disclosure of Conflicts of Interest

Global requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices he or his spouse/life partner have with commercial interests related to the content of this CME activity:

W. David Hardy, MD, AAHIVS:  Consultant/Independent Contractor: Enochian BioSciences, Gilead Sciences, Inc., Merck & Co., Inc., ViiV Healthcare/ GlaxoSmithKline plc; Stock Shareholder: Enochian BioSciences

The following planners and managers reported no financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Lindsay Borvansky, Andrea Funk, Liddy Knight, Ashley Cann, Gena Dolson, MS, Stacey JP Ullman, MHS, 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.

Click "Begin Activity" to acknowledge that you have reviewed the preamble information for this activity.

Begin Activity

credit amount 0.25

credit type CME

release 10/01/2020

expiration 10/01/2021


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SQL Queries from 1 connection (39/0.034543s)

Connection ID: db (CDbConnection)

Driver mysql
Server Version 5.5.59-0ubuntu0.14.04.1
Uptime 14w 1d 5h 51m 3s
Threads 1
Questions 40787422
Slow queries 13
Opens 195
Flush tables 1
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Queries per second avg 4.756
Query Count Total (s) Avg. (s) Min. (s) Max. (s)
UPDATE activities SET archived=1 WHERE finishDate<now();
1 0.005890 0.005890 0.005890 0.005890
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
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1 0.002888 0.002888 0.002888 0.002888
SHOW COLUMNS FROM `activities`
1 0.001683 0.001683 0.001683 0.001683
SHOW COLUMNS FROM `events`
1 0.001610 0.001610 0.001610 0.001610
SELECT * FROM `activities` `t` WHERE `t`.`id`=215 LIMIT 1
5 0.001476 0.000295 0.000284 0.000307
SHOW COLUMNS FROM `users`
1 0.001300 0.001300 0.001300 0.001300
SHOW COLUMNS FROM `questionnaires`
1 0.001103 0.001103 0.001103 0.001103
SHOW COLUMNS FROM `resources`
1 0.001091 0.001091 0.001091 0.001091
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
2 0.001066 0.000533 0.000526 0.000540
SHOW COLUMNS FROM `view_log`
1 0.001064 0.001064 0.001064 0.001064
SHOW COLUMNS FROM `user_activitiesstatus`
1 0.001034 0.001034 0.001034 0.001034
SHOW COLUMNS FROM `interactions`
1 0.001021 0.001021 0.001021 0.001021
SELECT `activityStatus`.`id` AS `t1_c0`, `activityStatus`.`user_id` AS `t1_c1`, `activityStatus`.`activity_id` AS `t1_c2`, `activityStatus`.`current` AS `t1_c3`, `activityStatus`.`isFinished` AS `t1_c4`, `activityStatus`.`score` AS `t1_c5`, `activityStatus`.`create_date` AS `t1_c6`, `activityStatus`.`finishDate` AS `t1_c7` FROM `user_activitiesstatus` `activityStatus` WHERE (user_id=:user) AND (`activityStatus`.`activity_id`=:ypl0)
3 0.000982 0.000327 0.000226 0.000519
SELECT `event`.`id` AS `t1_c0`, `event`.`group_id` AS `t1_c1`, `event`.`shortAddress` AS `t1_c2`, `event`.`resource_id` AS `t1_c3`, `event`.`type` AS `t1_c4`, `event`.`addType` AS `t1_c5`, `event`.`title` AS `t1_c6`, `event`.`shortDescription` AS `t1_c7`, `event`.`facultyNames` AS `t1_c8`, `event`.`faculty` AS `t1_c9`, `event`.`calendarDate` AS `t1_c10`, `event`.`creditAmount` AS `t1_c11`, `event`.`creditType` AS `t1_c12`, `event`.`shortWhen` AS `t1_c13`, `event`.`fullWhen` AS `t1_c14`, `event`.`venue` AS `t1_c15`, `event`.`shortWhere` AS `t1_c16`, `event`.`fullWhere` AS `t1_c17`, `event`.`createDate` AS `t1_c18`, `event`.`status` AS `t1_c19`, `event`.`description` AS `t1_c20`, `event`.`image` AS `t1_c21`, `event`.`linkout` AS `t1_c22`, `event`.`registrationEnabled` AS `t1_c23`, `event`.`activity_id` AS `t1_c24`, `event`.`adobe_connect_sco` AS `t1_c25`, `event`.`adobe_connect_datetime` AS `t1_c26`, `event`.`users_limit` AS `t1_c27`, `event`.`adobe_connect_duration` AS `t1_c28`, `event`.`calendar_description` AS `t1_c29` FROM `events` `event` WHERE (`event`.`activity_id`=:ypl0)
3 0.000880 0.000293 0.000257 0.000363
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
2 0.000609 0.000304 0.000289 0.000320
SELECT `activity_id` AS `c`, COUNT(*) AS `s` FROM `user_activitiesstatus` `t` WHERE (user_id=:user AND isFinished=1) AND (`t`.`activity_id`=215) GROUP BY `activity_id`
1 0.000438 0.000438 0.000438 0.000438
SHOW CREATE TABLE `events`
1 0.000367 0.000367 0.000367 0.000367
SHOW CREATE TABLE `activities`
1 0.000366 0.000366 0.000366 0.000366
SHOW CREATE TABLE `resources`
1 0.000360 0.000360 0.000360 0.000360
SELECT `resource`.`id` AS `t1_c0`, `resource`.`shortAddress` AS `t1_c1`, `resource`.`status` AS `t1_c2`, `resource`.`title` AS `t1_c3`, `resource`.`type` AS `t1_c4`, `resource`.`image` AS `t1_c5`, `resource`.`slides` AS `t1_c6`, `resource`.`linkedResources` AS `t1_c7`, `resource`.`reading` AS `t1_c8`, `resource`.`shortDescription` AS `t1_c9`, `resource`.`fullDescription` AS `t1_c10`, `resource`.`link` AS `t1_c11`, `resource`.`createDate` AS `t1_c12`, `resource`.`archived` AS `t1_c13` FROM `resources` `resource` WHERE (`resource`.`id`=:ypl0)
1 0.000328 0.000328 0.000328 0.000328
SELECT `t`.`id` AS `t0_c0`, `t`.`group_id` AS `t0_c1`, `t`.`resource_id` AS `t0_c2`, `t`.`title` AS `t0_c3`, `t`.`type` AS `t0_c4`, `t`.`facultyNames` AS `t0_c5`, `t`.`shortDescription` AS `t0_c6`, `t`.`fullDescription` AS `t0_c7`, `t`.`creditAmount` AS `t0_c8`, `t`.`shortAddress` AS `t0_c9`, `t`.`creditType` AS `t0_c10`, `t`.`startDate` AS `t0_c11`, `t`.`finishDate` AS `t0_c12`, `t`.`sponsors` AS `t0_c13`, `t`.`status` AS `t0_c14`, `t`.`createDate` AS `t0_c15`, `t`.`image` AS `t0_c16`, `t`.`image_featured` AS `t0_c17`, `t`.`archived` AS `t0_c18`, `t`.`managers_list` AS `t0_c19`, `t`.`is_send_pp_email` AS `t0_c20`, `t`.`muvi_sync_date` AS `t0_c21`, `t`.`expert_questions` AS `t0_c22`, `interaction`.`id` AS `t1_c0`, `interaction`.`activity_id` AS `t1_c1`, `interaction`.`title` AS `t1_c2`, `interaction`.`link` AS `t1_c3`, `interaction`.`type` AS `t1_c4`, `interaction`.`status` AS `t1_c5`, `interaction`.`createDate` AS `t1_c6` FROM `activities` `t` LEFT OUTER JOIN `interactions` `interaction` ON (`interaction`.`activity_id`=`t`.`id`) WHERE (`t`.`id`=215)
1 0.000325 0.000325 0.000325 0.000325
SHOW CREATE TABLE `users`
1 0.000323 0.000323 0.000323 0.000323
SHOW CREATE TABLE `view_log`
1 0.000320 0.000320 0.000320 0.000320
SHOW CREATE TABLE `user_activitiesstatus`
1 0.000307 0.000307 0.000307 0.000307
SHOW CREATE TABLE `interactions`
1 0.000283 0.000283 0.000283 0.000283
SHOW CREATE TABLE `questionnaires`
1 0.000275 0.000275 0.000275 0.000275
SELECT * FROM `questionnaires` `t` WHERE t.activity_id=:id AND t.type=:type LIMIT 1
1 0.000272 0.000272 0.000272 0.000272
# Query Time (s)
0
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000320
1
SHOW COLUMNS FROM `activities`
0.001683
2
SHOW CREATE TABLE `activities`
0.000366
3
SHOW COLUMNS FROM `users`
0.001300
4
SHOW CREATE TABLE `users`
0.000323
5
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000540
6
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
0.003773
7
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000526
8
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2491792
0.002888
9
SELECT * FROM `activities` `t` WHERE `t`.`id`=215 LIMIT 1
0.000307
10
SHOW COLUMNS FROM `events`
0.001610
11
SHOW CREATE TABLE `events`
0.000367
12
SELECT `event`.`id` AS `t1_c0`, `event`.`group_id` AS `t1_c1`, `event`.`shortAddress` AS `t1_c2`, `event`.`resource_id` AS `t1_c3`, `event`.`type` AS `t1_c4`, `event`.`addType` AS `t1_c5`, `event`.`title` AS `t1_c6`, `event`.`shortDescription` AS `t1_c7`, `event`.`facultyNames` AS `t1_c8`, `event`.`faculty` AS `t1_c9`, `event`.`calendarDate` AS `t1_c10`, `event`.`creditAmount` AS `t1_c11`, `event`.`creditType` AS `t1_c12`, `event`.`shortWhen` AS `t1_c13`, `event`.`fullWhen` AS `t1_c14`, `event`.`venue` AS `t1_c15`, `event`.`shortWhere` AS `t1_c16`, `event`.`fullWhere` AS `t1_c17`, `event`.`createDate` AS `t1_c18`, `event`.`status` AS `t1_c19`, `event`.`description` AS `t1_c20`, `event`.`image` AS `t1_c21`, `event`.`linkout` AS `t1_c22`, `event`.`registrationEnabled` AS `t1_c23`, `event`.`activity_id` AS `t1_c24`, `event`.`adobe_connect_sco` AS `t1_c25`, `event`.`adobe_connect_datetime` AS `t1_c26`, `event`.`users_limit` AS `t1_c27`, `event`.`adobe_connect_duration` AS `t1_c28`, `event`.`calendar_description` AS `t1_c29` FROM `events` `event` WHERE (`event`.`activity_id`=:ypl0)
0.000363
13
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000289
14
SELECT * FROM `activities` `t` WHERE `t`.`id`=215 LIMIT 1
0.000285
15
SELECT `event`.`id` AS `t1_c0`, `event`.`group_id` AS `t1_c1`, `event`.`shortAddress` AS `t1_c2`, `event`.`resource_id` AS `t1_c3`, `event`.`type` AS `t1_c4`, `event`.`addType` AS `t1_c5`, `event`.`title` AS `t1_c6`, `event`.`shortDescription` AS `t1_c7`, `event`.`facultyNames` AS `t1_c8`, `event`.`faculty` AS `t1_c9`, `event`.`calendarDate` AS `t1_c10`, `event`.`creditAmount` AS `t1_c11`, `event`.`creditType` AS `t1_c12`, `event`.`shortWhen` AS `t1_c13`, `event`.`fullWhen` AS `t1_c14`, `event`.`venue` AS `t1_c15`, `event`.`shortWhere` AS `t1_c16`, `event`.`fullWhere` AS `t1_c17`, `event`.`createDate` AS `t1_c18`, `event`.`status` AS `t1_c19`, `event`.`description` AS `t1_c20`, `event`.`image` AS `t1_c21`, `event`.`linkout` AS `t1_c22`, `event`.`registrationEnabled` AS `t1_c23`, `event`.`activity_id` AS `t1_c24`, `event`.`adobe_connect_sco` AS `t1_c25`, `event`.`adobe_connect_datetime` AS `t1_c26`, `event`.`users_limit` AS `t1_c27`, `event`.`adobe_connect_duration` AS `t1_c28`, `event`.`calendar_description` AS `t1_c29` FROM `events` `event` WHERE (`event`.`activity_id`=:ypl0)
0.000260
16
SELECT * FROM `activities` `t` WHERE `t`.`id`=215 LIMIT 1
0.000306
17
SHOW COLUMNS FROM `user_activitiesstatus`
0.001034
18
SHOW CREATE TABLE `user_activitiesstatus`
0.000307
19
SELECT `activityStatus`.`id` AS `t1_c0`, `activityStatus`.`user_id` AS `t1_c1`, `activityStatus`.`activity_id` AS `t1_c2`, `activityStatus`.`current` AS `t1_c3`, `activityStatus`.`isFinished` AS `t1_c4`, `activityStatus`.`score` AS `t1_c5`, `activityStatus`.`create_date` AS `t1_c6`, `activityStatus`.`finishDate` AS `t1_c7` FROM `user_activitiesstatus` `activityStatus` WHERE (user_id=:user) AND (`activityStatus`.`activity_id`=:ypl0)
0.000519
20
UPDATE activities SET archived=1 WHERE finishDate<now();
0.005890
21
SHOW COLUMNS FROM `view_log`
0.001064
22
SHOW CREATE TABLE `view_log`
0.000320
23
INSERT INTO `view_log` (`source`, `unique_id`, `resource_id`, `type`) VALUES (:yp0, :yp1, :yp2, :yp3)
0.003109
24
SHOW COLUMNS FROM `interactions`
0.001021
25
SHOW CREATE TABLE `interactions`
0.000283
26
SELECT `t`.`id` AS `t0_c0`, `t`.`group_id` AS `t0_c1`, `t`.`resource_id` AS `t0_c2`, `t`.`title` AS `t0_c3`, `t`.`type` AS `t0_c4`, `t`.`facultyNames` AS `t0_c5`, `t`.`shortDescription` AS `t0_c6`, `t`.`fullDescription` AS `t0_c7`, `t`.`creditAmount` AS `t0_c8`, `t`.`shortAddress` AS `t0_c9`, `t`.`creditType` AS `t0_c10`, `t`.`startDate` AS `t0_c11`, `t`.`finishDate` AS `t0_c12`, `t`.`sponsors` AS `t0_c13`, `t`.`status` AS `t0_c14`, `t`.`createDate` AS `t0_c15`, `t`.`image` AS `t0_c16`, `t`.`image_featured` AS `t0_c17`, `t`.`archived` AS `t0_c18`, `t`.`managers_list` AS `t0_c19`, `t`.`is_send_pp_email` AS `t0_c20`, `t`.`muvi_sync_date` AS `t0_c21`, `t`.`expert_questions` AS `t0_c22`, `interaction`.`id` AS `t1_c0`, `interaction`.`activity_id` AS `t1_c1`, `interaction`.`title` AS `t1_c2`, `interaction`.`link` AS `t1_c3`, `interaction`.`type` AS `t1_c4`, `interaction`.`status` AS `t1_c5`, `interaction`.`createDate` AS `t1_c6` FROM `activities` `t` LEFT OUTER JOIN `interactions` `interaction` ON (`interaction`.`activity_id`=`t`.`id`) WHERE (`t`.`id`=215)
0.000325
27
SELECT `activity_id` AS `c`, COUNT(*) AS `s` FROM `user_activitiesstatus` `t` WHERE (user_id=:user AND isFinished=1) AND (`t`.`activity_id`=215) GROUP BY `activity_id`
0.000438
28
SELECT `event`.`id` AS `t1_c0`, `event`.`group_id` AS `t1_c1`, `event`.`shortAddress` AS `t1_c2`, `event`.`resource_id` AS `t1_c3`, `event`.`type` AS `t1_c4`, `event`.`addType` AS `t1_c5`, `event`.`title` AS `t1_c6`, `event`.`shortDescription` AS `t1_c7`, `event`.`facultyNames` AS `t1_c8`, `event`.`faculty` AS `t1_c9`, `event`.`calendarDate` AS `t1_c10`, `event`.`creditAmount` AS `t1_c11`, `event`.`creditType` AS `t1_c12`, `event`.`shortWhen` AS `t1_c13`, `event`.`fullWhen` AS `t1_c14`, `event`.`venue` AS `t1_c15`, `event`.`shortWhere` AS `t1_c16`, `event`.`fullWhere` AS `t1_c17`, `event`.`createDate` AS `t1_c18`, `event`.`status` AS `t1_c19`, `event`.`description` AS `t1_c20`, `event`.`image` AS `t1_c21`, `event`.`linkout` AS `t1_c22`, `event`.`registrationEnabled` AS `t1_c23`, `event`.`activity_id` AS `t1_c24`, `event`.`adobe_connect_sco` AS `t1_c25`, `event`.`adobe_connect_datetime` AS `t1_c26`, `event`.`users_limit` AS `t1_c27`, `event`.`adobe_connect_duration` AS `t1_c28`, `event`.`calendar_description` AS `t1_c29` FROM `events` `event` WHERE (`event`.`activity_id`=:ypl0)
0.000257
29
SELECT * FROM `activities` `t` WHERE `t`.`id`=215 LIMIT 1
0.000294
30
SELECT `activityStatus`.`id` AS `t1_c0`, `activityStatus`.`user_id` AS `t1_c1`, `activityStatus`.`activity_id` AS `t1_c2`, `activityStatus`.`current` AS `t1_c3`, `activityStatus`.`isFinished` AS `t1_c4`, `activityStatus`.`score` AS `t1_c5`, `activityStatus`.`create_date` AS `t1_c6`, `activityStatus`.`finishDate` AS `t1_c7` FROM `user_activitiesstatus` `activityStatus` WHERE (user_id=:user) AND (`activityStatus`.`activity_id`=:ypl0)
0.000237
31
SELECT * FROM `activities` `t` WHERE `t`.`id`=215 LIMIT 1
0.000284
32
SELECT `activityStatus`.`id` AS `t1_c0`, `activityStatus`.`user_id` AS `t1_c1`, `activityStatus`.`activity_id` AS `t1_c2`, `activityStatus`.`current` AS `t1_c3`, `activityStatus`.`isFinished` AS `t1_c4`, `activityStatus`.`score` AS `t1_c5`, `activityStatus`.`create_date` AS `t1_c6`, `activityStatus`.`finishDate` AS `t1_c7` FROM `user_activitiesstatus` `activityStatus` WHERE (user_id=:user) AND (`activityStatus`.`activity_id`=:ypl0)
0.000226
33
SHOW COLUMNS FROM `questionnaires`
0.001103
34
SHOW CREATE TABLE `questionnaires`
0.000275
35
SELECT * FROM `questionnaires` `t` WHERE t.activity_id=:id AND t.type=:type LIMIT 1
0.000272
36
SHOW COLUMNS FROM `resources`
0.001091
37
SHOW CREATE TABLE `resources`
0.000360
38
SELECT `resource`.`id` AS `t1_c0`, `resource`.`shortAddress` AS `t1_c1`, `resource`.`status` AS `t1_c2`, `resource`.`title` AS `t1_c3`, `resource`.`type` AS `t1_c4`, `resource`.`image` AS `t1_c5`, `resource`.`slides` AS `t1_c6`, `resource`.`linkedResources` AS `t1_c7`, `resource`.`reading` AS `t1_c8`, `resource`.`shortDescription` AS `t1_c9`, `resource`.`fullDescription` AS `t1_c10`, `resource`.`link` AS `t1_c11`, `resource`.`createDate` AS `t1_c12`, `resource`.`archived` AS `t1_c13` FROM `resources` `resource` WHERE (`resource`.`id`=:ypl0)
0.000328
Log Messages
Message (details) Level Category Time