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New Tools in the Toolbox Where Will 2-Drug Regimens and Long-Acting Agents Fit?

Richard Elion, MD

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

Richard Elion, MD
Clinical Professor of Medicine
George Washington University, School of Medicine
Washington, District of Columbia

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:

  • Discuss efficacy, safety, and potential place in therapy of new and emerging long-acting agents and 2-drug regimens

Statement of Need/Program Overview

As HIV care progresses and new treatment options become available for initiating and switching ART regimens, clinicians must know the data, indications, contraindications, and potential for adverse events and drug-drug interactions when individualizing treatment plans. The advent of 2-drug regimens for both as initial treatment and as a switching strategy have precipitated a shift in clinical practice; clinicians may benefit from an expert review of new data and guidelines.1-4 Similarly, if approved, emerging long-acting injectable therapy will lead to another shift in practice, and clinicians should be prepared to translate clinical trial data into practice.5,6 Dr. Elion will review of clinical and real-world data, guidelines, and patient selection for available and emerging therapies and will provide his expert opinion on clinical application and the future of HIV therapy.

References

  1. 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.
  2. Aboud M, Orkin C, Podzamczer D, et al. Efficacy and safety of dolutegravir-rilpivirine for maintenance of virological suppression in adults with HIV-1: 100-week data from the randomised, open-label, phase 3 SWORD-1 and SWORD-2 studies. Lancet HIV. 2019;6(9):e576-e587.
  3. Cahn P, Madero JS, Arribas JR, et al. Durable efficacy of dolutegravir plus lamivudine in antiretroviral treatment-naive adults with HIV-1 infection: 96-week results from the GEMINI-1 and GEMINI-2 randomized clinical trials. J Acquir Immune Defic Syndr. 2020;83(3):310-318.
  4. van Wyk J, Ajana F, Bisshop F, et al. Efficacy and safety of switching to dolutegravir/lamivudine fixed-dose two-drug regimen versus continuing a tenofovir alafenamide-based three- or four-drug regimen for maintenance of virologic suppression in adults with HIV-1: phase 3, randomized, non-inferiority TANGO study. Clin Infect Dis. 2020. [Epub ahead of print]
  5. Swindells S, Andrade-Villanueva JF, Richmond GJ, et al. Long-acting cabotegravir and rilpivirine for maintenance of HIV-1 suppression. N Engl J Med. 2020;382(12):1112-1123.
  6. Orkin C, Arasteh K, Górgolas Hernández-Mora M, et al. Long-acting cabotegravir and rilpivirine after oral induction for HIV-1 infection. N Engl J Med. 2020;382(12):1124-1135.

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:

Richard Elion, MD: Consultant/Independent Contractor, Speakers Bureau: Gilead Sciences, Inc.; Grant/Research Support, Honoraria: Gilead Sciences, Inc., ViiV Healthcare Limited; Other: Work with Trio Health, who gets grants from Gilead Sciences, Inc. and ViiV Healthcare Limited

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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Context class ActivitiesController
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Context properties
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Context properties
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Context properties
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Context ActivitiesController
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Connection ID: db (CDbConnection)

Driver mysql
Server Version 5.5.59-0ubuntu0.14.04.1
Uptime 14w 1d 5h 54m 17s
Threads 1
Questions 40788166
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)
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1 0.005896 0.005896 0.005896 0.005896
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 0.003071 0.003071 0.003071 0.003071
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3 0.002339 0.000780 0.000250 0.001823
SELECT * FROM `activities` `t` WHERE `t`.`id`=219 LIMIT 1
5 0.001715 0.000343 0.000281 0.000466
SHOW COLUMNS FROM `activities`
1 0.001558 0.001558 0.001558 0.001558
SHOW COLUMNS FROM `events`
1 0.001421 0.001421 0.001421 0.001421
SHOW COLUMNS FROM `users`
1 0.001214 0.001214 0.001214 0.001214
SHOW COLUMNS FROM `resources`
1 0.001151 0.001151 0.001151 0.001151
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
2 0.001136 0.000568 0.000299 0.000837
SHOW COLUMNS FROM `interactions`
1 0.001124 0.001124 0.001124 0.001124
SHOW COLUMNS FROM `user_activitiesstatus`
1 0.001046 0.001046 0.001046 0.001046
SHOW COLUMNS FROM `view_log`
1 0.001034 0.001034 0.001034 0.001034
SHOW COLUMNS FROM `questionnaires`
1 0.000988 0.000988 0.000988 0.000988
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
2 0.000970 0.000485 0.000479 0.000491
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 0.000937 0.000312 0.000224 0.000452
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`=219)
1 0.000638 0.000638 0.000638 0.000638
SELECT `activity_id` AS `c`, COUNT(*) AS `s` FROM `user_activitiesstatus` `t` WHERE (user_id=:user AND isFinished=1) AND (`t`.`activity_id`=219) GROUP BY `activity_id`
1 0.000453 0.000453 0.000453 0.000453
SELECT * FROM `questionnaires` `t` WHERE t.activity_id=:id AND t.type=:type LIMIT 1
1 0.000405 0.000405 0.000405 0.000405
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 0.000386 0.000386 0.000386 0.000386
SHOW CREATE TABLE `events`
1 0.000351 0.000351 0.000351 0.000351
SHOW CREATE TABLE `activities`
1 0.000349 0.000349 0.000349 0.000349
SHOW CREATE TABLE `users`
1 0.000336 0.000336 0.000336 0.000336
SHOW CREATE TABLE `user_activitiesstatus`
1 0.000305 0.000305 0.000305 0.000305
SHOW CREATE TABLE `view_log`
1 0.000283 0.000283 0.000283 0.000283
SHOW CREATE TABLE `resources`
1 0.000283 0.000283 0.000283 0.000283
SHOW CREATE TABLE `questionnaires`
1 0.000273 0.000273 0.000273 0.000273
SHOW CREATE TABLE `interactions`
1 0.000269 0.000269 0.000269 0.000269
# Query Time (s)
0
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000837
1
SHOW COLUMNS FROM `activities`
0.001558
2
SHOW CREATE TABLE `activities`
0.000349
3
SHOW COLUMNS FROM `users`
0.001214
4
SHOW CREATE TABLE `users`
0.000336
5
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000479
6
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
0.003540
7
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000491
8
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2491813
0.003071
9
SELECT * FROM `activities` `t` WHERE `t`.`id`=219 LIMIT 1
0.000466
10
SHOW COLUMNS FROM `events`
0.001421
11
SHOW CREATE TABLE `events`
0.000351
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)
0.001823
13
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000299
14
SELECT * FROM `activities` `t` WHERE `t`.`id`=219 LIMIT 1
0.000281
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)
0.000266
16
SELECT * FROM `activities` `t` WHERE `t`.`id`=219 LIMIT 1
0.000288
17
SHOW COLUMNS FROM `user_activitiesstatus`
0.001046
18
SHOW CREATE TABLE `user_activitiesstatus`
0.000305
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)
0.000452
20
UPDATE activities SET archived=1 WHERE finishDate<now();
0.005896
21
SHOW COLUMNS FROM `view_log`
0.001034
22
SHOW CREATE TABLE `view_log`
0.000283
23
INSERT INTO `view_log` (`source`, `unique_id`, `resource_id`, `type`) VALUES (:yp0, :yp1, :yp2, :yp3)
0.003104
24
SHOW COLUMNS FROM `interactions`
0.001124
25
SHOW CREATE TABLE `interactions`
0.000269
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`=219)
0.000638
27
SELECT `activity_id` AS `c`, COUNT(*) AS `s` FROM `user_activitiesstatus` `t` WHERE (user_id=:user AND isFinished=1) AND (`t`.`activity_id`=219) GROUP BY `activity_id`
0.000453
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)
0.000250
29
SELECT * FROM `activities` `t` WHERE `t`.`id`=219 LIMIT 1
0.000288
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)
0.000224
31
SELECT * FROM `activities` `t` WHERE `t`.`id`=219 LIMIT 1
0.000392
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)
0.000261
33
SHOW COLUMNS FROM `questionnaires`
0.000988
34
SHOW CREATE TABLE `questionnaires`
0.000273
35
SELECT * FROM `questionnaires` `t` WHERE t.activity_id=:id AND t.type=:type LIMIT 1
0.000405
36
SHOW COLUMNS FROM `resources`
0.001151
37
SHOW CREATE TABLE `resources`
0.000283
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)
0.000386
Log Messages
Message (details) Level Category Time