To receive documentation of your participation for CME credit, please complete the following steps:
1. Read this publication carefully
2. Complete this posttest, selecting the most appropriate choice for each statement
3. Complete the CME Evaluation Survey
4. Mail or fax (1-201-617-7333) your Posttest and Evaluation Survey to: Projects In Knowledge, One Harmon Plaza, Secaucus, NJ 07094 before June 30, 2003.
Projects In Knowledge will mail you an acknowledgement of your participation in this activity. Please note: you must score 70% or better on the Posttest. If you score lower than 70%, you will be given another chance to take the Posttest.
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CME Posttest
1.
The high prevalence of coinfection with HIV and HCV is attributed largely to transmission via:
A. Intravenous drug use
B. Heterosexual Sex
C. Mother-to-infant transmission
D. Homosexual sex among men
2.
HIV-infected patients coinfected with HCV:
A. Account for only about 6% of HIV-infected patients
B. Have the same mortality rate as patients infected with HIV alone, because AIDS is almost always the cause of death
C. Have a more rapid rate of progression to fibrosis/cirrhosis compared with patients infected only with HCV
D. All of the above
3.
With reference to the viral characteristics of HIV and HCV, which of the following is true?
A. HIV and HCV are both single-stranded RNA viruses
B. HIV replicates faster than HCV
C. In the abscence of treatment, HIV and HCV viral loads progressively rise in persons with chronic infections
D. Viral load is a major prognostic indicator for both HIV and HCV infections
E. All of the above
4.
Which of the following is false regarding the effects of treatment in HIV/HCV coinfected patients?
A. Inteferon commonly produces an increase in absolute number of CD4 cells
B. Ribavirin inhibits the intracellular phosporylation of zidovudine in vitro
C. Initiation of HAART may increase the HCV viral load for the first 3 to 4 months
D. Mitochondrial toxicity is most common with stavudine
5.
Which of the following is false regarding HAART-related hepatotoxicity?
A. The majority of HCV/HIV coinfected patients experience it
B. It occurs with increased frequency in patients coinfected with HCV
C. It tends to be more severe in patients coinfected with HCV
D. It is most commonly associated with indinavir
6.
Inteferon/ribavirin produces sustained virologic response (ie, viral eradication) in approximately what percentage of treatment-naive patients with HCV infection (HIV negative)?
A. 10%
B. 25%
C. 40%
D. 60%
7.
Which of the following best describes the effects of anti-HCV treatment on hepatic histology?
A. Successful treatment results, at best, in stabilization of fibrosis
B. Histologic improvement is seen only in patients who achieve a sustained virologic response
C. Interferon/ribavirin, but not interferon monotherapy, is associated with histologic improvement
D. Histologic improvement has been observed in both responders and nonresponders to interferon therapy
8.
The most powerful predictor of response to interferon/ribavirin therapy is:
A. Viral genotype
B. Viral load
C. Duration of infection
D. Stage of fibrosis
9.
In a patient with HCV genotype 2 and low viral load, interferon/ribavirin:
A. Is not recommended
B. Should be given for 24 weeks
C. Should be given for 48 weeks
D. Should be given for 60 weeks
10.
Response to interferon/ribavirin therapy should be assessed at:
A. 1 month
B. 3 months
C. 4 months
D. 6 months
11.
If hemoglobin level decreases from 12 g/dL to 9 g/dL in a patient with average cardiac risk who is receiving interferon/ribavirin for treatment of HCV infection, the most appropriate strategy would be to:
A. Decrease the ribavirin dose to 900 mg/day
B. Decrease the ribavirin dose to 600 mg/day
C. Discontinue ribavirin
D. Discontinue both interferon and ribavirin
12.
Patients with compensated cirrhosis:
A.Should receive regular screening (ie, ultrasound and alpha-fetoprotein measurement) for HCC
B. May achieve benefit in most cases from vitamin A supplements
C. Should be prescribed NSAIDs to decrease inflammatory activity
D. Are not candidates for interferon/ribavirin
E. All of the above
CME Evaluation Survey
I. Please rate the extent to which you achieved the learning objectives:
Recognize the magnitude of the problems of HCV infection and HIV/HCV coinfection
Compare and contrast disease paradigms in HIV and HCV Infection, extrapolating lessons learned in HIV to the care of patients with HCV or HIV/HCV coinfection
Identify appropriate candidates for treatment
Develop strategies for managing HIV in coinfected patients using highly active antiretroviral therapy (HAART)
Describe current standards for HCV treatment and ongoing management
Develop strategies for managing HCV in coinfected patients using interferon/ribavirin
Better manage adverse effects of interferon and ribavirin to allow optimum treatment outcomes
Develop strategies for managing special challenges in HIV/HCV coinfection, including non-responders to interferon/ribavirin, cirrhosis, extrahepatic manifestations, and hepatitis B virus (HBV) coinfection
2. Please rate the overall value of this print-based CME activity
3. Is this activity free of commercial bias?
4. Do you anticipate making any changes to your practice as a result of this activity?
5. Please indicate how long it took you to read the entire monograph and complete Sections I, II, III, IV, V, VI, the Posttest, and the Survey:
6. Please rate the level of the material presented:
7. For each section in Expert Perspectives: Strategies for the Management of HIV/HCV Coinfection, please indicate your level of agreement: (4 = Strongly Agree; 3 = Agree; 2 = Disagree; 1 = Strongly Disagree)
The material was interesting
The material helps me manage
patients with HCV/HIV
I. HIV/HCV Coinfections: Magnitude of the problem
II. HCV Virology: Important Lessons Learned from HIV
III. Management of HIV Infection in HCV-Infected patients
IV. Management of HCV Infection in HIV-Infected Patients
V. Managing Side-Effects of Inteferon and Ribavirin
VI. Special Challenges in Coinfected Patients
8. Which educational formats do you prefer?
Audioconference
Symposia
Multimedia (on-line, CD-ROM)
Printed Enduring Materials
Videoconference
Other
9. Do you currently use the Internet? If "yes", please indicate how you most often use it:
E-Mail
On-line CME
Surfing for professional medical information
