Gastroenterology

HIV/HBV Coinfection
in Prison Systems

This CME activity has reached its termination date and no longer offers continuing education credit. Please note that expired CME activities may not contain the most up-to-date information available.

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HIV/HBV Coinfection in Prison Systems

Dear Colleague,

In the United States, approximately 1.25 million people have chronic hepatitis B virus (HBV) infection and 850,000 to 950,000 people have human immunodeficiency virus (HIV) infection. Coinfection with HBV and HIV is common due to shared risk factors, such as multiple sex partners, illegal drug use, and exposure to contaminated blood. Studies indicate that up to 90% of HIV infected patients have a history of HBV infection and as many as 10% have active HBV infection. Coinfection has a significant effect on morbidity and mortality. Not only is the rate of progression from acute to chronic HBV infection higher in HIV/HBV coinfected patients compared with HBV monoinfected patients, a number of reports suggest that coinfected patients also have higher HBV viral loads, more cirrhosis, decreased survival time, and twice the risk of liver failure compared with monoinfected patients.

The challenge of HIV/HBV coinfection is intensified in the prison setting. Many prisoners have existing HIV and/or HBV infections due to high-risk behavior prior to entering prison. Furthermore, many prisoners continue their high-risk behavior while in prison, and infections are acquired from and transmitted to other prisoners. As a result, prisoners are at increased risk of HIV/HBV coinfection—as are prison staff, who may have occupational exposure to blood and body fluids from infected prisoners.

In HIV/HBV Coinfection in Prison Systems, we will provide clinicians working within the prison setting with information about new and more efficacious drugs for the treatment of HIV/HBV coinfection. These drugs offer the potential for improved response and tolerability in coinfected patients, including those who are "difficult-to-treat" due to HBeAg-negative pre-core mutant disease, occult HBV infection, or drug resistance. Importantly, we will also demonstrate how to consider both HIV and HBV infections when making treatment decisions.

We hope you will participate in HIV/HBV Coinfection in Prison Systems. The impact of coinfected inmates and staff extends beyond the prison walls and into the communities to which they return and in which they live. Please join us to learn how more-effective treatment can improve outcomes for inmates and staff.

Sincerely,

CHAIR
Mark S. Sulkowski, MD Associate Professor of Medicine Johns Hopkins University School of Medicine Baltimore, Maryland
FACULTY
Anne C. Spaulding, MD, MPH Research Assistant Professor Department of Epidemiology Rollins School of Public Health at Emory University Atlanta, Georgia

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TARGET AUDIENCE

This CME/CE activity is designed for infectious disease specialists, gastroenterologists, and hepatologists, as well as medical directors, clinicians and physicians at correctional facilities, who care for patients either with HIV/HBV coinfection or at increased risk for acquiring coinfection.

ACTIVITY GOAL

The goal of this CME/CE activity is to provide state-of-the-art information on the pathophysiology and diagnosis of HIV/HBV coinfection, as well as current and emerging therapies for its treatment and management.

LEARNING OBJECTIVES

Outline the epidemiology and natural history of HIV/HBV coinfection and its impact on morbidity and mortality as is relevant to the prison setting, using data from the Centers for Disease Control and Prevention and clinical trials.
Improve patient outcomes by applying knowledge of factors that have been demonstrated to contribute to the transmission and progression of HIV/HBV.
Evaluate and assess current, new, and emerging therapies for the treatment of HIV/HBV coinfection in terms of efficacy and safety for your patients.
Incorporate current and new therapies, and formulate treatment strategies to improve response rates across a broad spectrum of HIV/HBV coinfected patients, including those who are "difficult-to-treat" (eg, HBeAg negative with pre-core mutant, occult HBV infection, drug resistance).

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CME INFORMATION

Statement of Accreditation

Projects In Knowledge is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

Projects In Knowledge designates this educational activity for a maximum of 4.0 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This activity is planned and implemented as an independent CME activity in accordance with the ACCME Essential Areas and Policies.

CME Information: Physician Assistants

This program has been reviewed and is approved for a maximum of 4.0 hours of AAPA Category 1 (Preapproved) CME credit by the Physician Assistant Review Panel. Approval is valid for 1 year from the issue date of February 3, 2006. Participants may submit the self-assessment at any time during that period.

This program was planned in accordance with AAPA's CME Standards for Enduring Material Programs and for Commercial Support of Enduring Material Programs.

Successful completion of the self-assessment is required to earn Category 1 (Preapproved) CME credit. Successful completion is defined as a cumulative score of at least 70% correct.

CE Information: Nurses

This activity has been approved by the American Association of Critical-Care Nurses (AACN) for 4.5 contact hours. Provider #00012705.

Contract for Mutual Responsibility in CME/CE
Projects In Knowledge has developed the contract to demonstrate our commitment to providing the highest quality professional education to clinicians, and to help clinicians set educational goals to challenge and enhance their learning experience.
For more information on the contract, click here.

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DISCLOSURE INFORMATION

The Disclosure Policy of Projects In Knowledge requires that presenters comply with the Standards for Commercial Support. All faculty are required to disclose any personal interest or relationship they or their spouse/partner have with the supporters of this activity or any commercial interest that is discussed in their presentation. Any discussions of unlabeled/unapproved uses of drugs or devices will also be disclosed in the course materials.

For complete prescribing information on the products discussed during this CME/CE activity, please see your current Physicians' Desk Reference (PDR).

Anne C. Spaulding, MD, MPH, is on the speakers bureau of Bristol-Myers Squibb Company. Dr. Spaulding has disclosed that she will reference unlabeled/unapproved uses of tenofovir plus emtricitabine for hepatitis B.

Mark S. Sulkowski, MD, has received grant/research support from Akros Pharma Inc, Bristol-Myers Squibb Company, Human Genome Sciences, Idenix Pharmaceuticals Inc, Roche Laboratories, Schering-Plough Corporation, and Vertex Pharmaceuticals Incorporated; is on the speakers bureau of Roche Laboratories and Schering-Plough Corporation; and is on the advisory board for Bristol-Myers Squibb Company, Roche Laboratories, and Schering-Plough Corporation. Dr. Sulkowski has disclosed that he will reference unlabeled/unapproved use of tenofovir.

Peer Reviewer has disclosed no significant relationships.

Projects In Knowledge's staff members have no significant relationships to disclose.

Conflicts of interest are thoroughly vetted by the Executive Committee of Projects In Knowledge. All conflicts are resolved prior to the beginning of the activity by the Trust In Knowledge peer review process.

The opinions expressed in this activity are those of the faculty and do not necessarily reflect those of Projects In Knowledge.

This CME/CE activity is provided by Projects In Knowledge solely as an educational service. Specific patient care decisions are the responsibility of the clinician caring for the patient.

This independent CME/CE activity is supported by an educational grant from
Bristol-Myers Squibb Company.

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