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Todd T. Brown, MD, PhD

Osteoporosis in HIV: Is HIV Bad to the Bone?

Fractures are likely to be a major source of morbidity in people aging with HIV disease. Although the etiology is multifactorial, initiation of antiretroviral therapy has been associated with clinically significant bone loss. When and how can we best screen our patients for primary and secondary causes of osteoporosis? If found, how can we best treat patients with osteopenia or osteoporosis? In this program, Todd Brown discusses the causes, workup, management, and prevention of complications secondary to osteoporosis in HIV disease.

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Joseph P. McGowan, MD

PEP, PEP… PrEP? An Update on HIV Chemoprophylaxis

Post-exposure prophylaxis (PEP) to prevent HIV infection has been around for a long time though the drugs used have fewer risks and side effects than in the past. But when patients present again and again for PEP, it is a great opportunity to discuss a newer and perhaps more effective way to prevent HIV infection in vulnerable patients with ongoing risk: pre-exposure prophylaxis (PrEP) with a single once-a-day tablet. In this presentation, Joe McGowan discusses the new recommendations for PEP in New York State including baseline lab tests and STD screening for PEP recipients, and how patients seeking serial PEP may benefit from ongoing PrEP with periodic follow-up and re-evaluation.

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Markella V. Zanni, MD

Immune-mediated Mechanisms of Heightened Cardiovascular Disease Risk in HIV: Clinical Research and Clinical Implications

In aging HIV-positive population, the percentage of deaths due to non-AIDS-defining illness, including cardiovascular disease, is on the rise. And the risk of myocardial infarction is 1.5 to 2 times higher in HIV-positive patients on antiretroviral therapy than in uninfected people, but why? In this presentation Markella Zanni discusses a new paradigm for conceptualizing elevated MI risk in HIV-- the paradoxical state of immune suppression and activation in HIV disease resulting in increased atherogenicity, and potential future immune-modulatory therapeutic strategies to mitigate this risk.

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Daniel R. Kuritzkes, MD

HIV Drug Resistance and Low-level Viremia

Persistent low-level viremia, when HIV RNA is detectable but less than 1000 copies/mL on repeated measurements, has been associated with new drug-resistance mutations when compared to prior genotyping. Providers should consider repeating genotypic testing especially if the viral load rises to 500 copies/mL or higher, because early detection and appropriate regimen switches may prevent further accumulation of resistance mutations. In this program, Dan Kuritzkes discusses virologic suppresson, incomplete virologic responses, blips, persistent low-level viremia, virologic rebound, virologic failure, and how to use this information to optimize antiretroviral therapy.

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Tae-Wook Chun, PhD, and Michael C. Sneller, MD

Perspectives on Therapeutic Interventions Aimed at Eradicating HIV

In this program, Tae-Wook Chun reviews the mechanism by which HIV reservoirs persist in infected individuals on antiretroviral therapy and advances in HIV Cure research, followed by Mike Sneller who discusses a new therapeutic HIV vaccine trial, the THERAVAX Study, now enrolling HIV-infected individuals who were diagnosed and started on cART during the acute/early stage of HIV infection. If you have any patients that were diagnosed and initiated treatment during the acute/early stage of HIV disease, please view this program-- the NIAID/NIH needs your help to enroll this important trial.

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Stephen E. Goldstone, MD, FACS

Quadrivalent HPV Vaccine and Targeted Ablation to Prevent Anal Condyloma, Dysplasia and Cancer

The increasing incidence of anal cancer, especially in HIV-infected individuals is a cause of great concern, and efforts to reduce the risk for progression to cancer are underway internationally. But can vaccines designed for the prevention of infection with oncogenic Human papillomavirus (HPV) infection also have a therapeutic effect in reducing the recurrence of high-grade anal neoplasia in HIV-infected men? This interesting new work by Stephen Goldstone suggests that this may be so.

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Bernard M. Branson, MD

New HIV Tests and New Algorithms: The Key to Test and Treat

While HIV screening and testing have become more routine, the old testing algorithm made diagnosis during the most infectious acute stage difficult. The new HIV testing algorithm improves detection during acute HIV infection utilizing 4th generation assays that look for antigen as well antibody, and older confirmatory tests, that do not become positive until after the window of acute infection closes, are no longer recommended. Acute HIV infection plays a major role in sustaining onward HIV transmission, and the newer tests and testing algorithm, that can determine whether HIV infection is recent, will allow earlier treatment interventions that may more successfully slow this epidemic.

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Ponni V. Perumalswami, MD

Improving Screening for Viral Hepatitis in Primary Care

Hepatitis C is the most common chronic blood-borne infection in the United States and HCV-related cirrhosis is projected to peak over the next 10 years. New York State has recently mandated that primary care providers offer one-time HCV antibody testing to all baby boomers—the birth cohort from 1945 to 1965—because this is a treatable and curable disease that too often remains undiagnosed until the end stages. Earlier screening and diagnosis of hepatitis C, followed by linkage to care, could save many lives. In this lecture Dr Perumalswami discusses the details of this public health effort in the broader context of viral hepatitis coinfection in people with HIV disease.

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Jürgen Rockstroh, MD

Acute Hepatitis C in HIV: What Have We Learned, Which Questions Remain?

The epidemic of sexually transmitted hepatitis C in men who have sex with men (MSM) is phylogenetically distinct from clusters of HCV in injection drug users, and clinicians caring for MSM, especially those who are HIV-positive, need to be on the look-out. While acute hepatitis C infection may clear spontaneously, this is far less likely to occur in patients who are HIV-coinfected, and coinfection worsens the prognosis for chronic HCV. Understanding the risks and knowing how to diagnose acute HCV infection is important because early treatment of HCV may improve patient outcomes while interrupting the chain of transmission. And newer direct acting agents (DAAs) for the treatment of HCV may lead to interferon-free treatment options that reduce treatment-related side-effects in this curable disease.

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Deborah Persaud, MD

Pediatric HIV Infection: A Model for Cure

With the recently reported functional cure of a Mississippi child, infected with HIV at birth, diagnosed rapidly and treated early, we have further evidence that early diagnosis of HIV during the acute stage, with immediate initiation of combination antiretroviral therapy, contributed to the functional cure of this child after ARV treatment was interrupted. PRN is pleased to present Deborah Persaud with this groundbreaking report.

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Asier Sáez-Cirión, PhD

Long-term Remission of HIV after Interruption of Very Early ART in Adults

Rarely, some individuals are able to control HIV without medication, while the overwhelming majority of people with HIV infection will progress to AIDS and death without lifelong antiretroviral therapy. But for this majority who are unlikely to control HIV spontaneously, is it possible to induce HIV control and prevent progression of disease without medication? The VISCONTI Study implies that this may be so. This important study in France has shown that very early diagnosis and initiation of combination antiretroviral therapy eventually led to virologic control after treatment interruption in a higher-than-expected proportion of study participants. Join us for Dr. Sáez-Cirión’s discussion of this important study and its contribution to research for a cure.

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Roy M. Gulick, MD, MPH

HIV Pre-Exposure Prophylaxis: Past, Present and Future

The number of people newly infected with HIV in the USA has remained steady, at around 50,000 per year, since the early 1990’s, despite the advances in the treatment of HIV and AIDS, and many efforts to promote safer sex. To further protect individuals at highest risk for acquiring HIV infection, pre-exposure prophylaxis with antiretroviral agents was recently approved by the FDA. Ongoing data analysis supporting PrEP as an intervention, current recommendations from the CDC, as well as new drugs and research studies in chemoprophylaxis are reviewed and discussed in this important presentation.

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Joseph M. McCune, MD, PhD

Adding Immune Therapies to ART: Can We Achieve a Functional Cure?

To date, the HIV epidemic continues to grow, despite the use of antiretroviral therapy alone. And inflammation in HIV-infected individuals drives both disease progression and possibly also viral persistence, even while on antiretroviral therapy. Immune therapies that Inhibit inflammation may represent one route toward a “functional cure” of HIV disease.

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Todd T. Brown, MD, PhD

Managing Diabetes in HIV-infected Patients: Current Concepts

Diabetes is common in HIV-infected populations, and prevalence is increasing. Early diagnosis and management of this complication can help prevent cardiovascular disease, blindness, end-stage renal disease, amputations, and hospitalizations. In this presentation Todd Brown discusses regular screening and diagnosis of diabetes HIV-positives, a step-wise approach to individualizing diabetes treatment, and lifestyle changes that can help prevent complications in this aging population.

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Gero Hütter, MD

The Berlin Patient: Eradication of HIV with CCR5 Deficient Hematopoietic Stem Cells

Almost everybody has heard of the "Berlin Patient" and many may have also seen him on morning talk shows, but how many clinicians have had an opportunity to meet and listen to his doctor from Berlin? In this video you will hear Gero Hütter tell about his rationale for performing a bone marrow transplant with CCR5 deficient hematopoietic stem cells, the long term outcomes for his patient, further research to understand if he has been "cured," and attempts to repeat this unique success. Please also see PRN's video of Pablo Tebas, who spoke on gene therapy and other research based on Gero Hütter's "Berlin patient."

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N. Patrick Hennessey, MD

Primary-care Diagnosis and Treatment of Common Dermatological Problems in HIV Medicine

Skin problems are common in primary care, and in HIV medicine they can be especially challenging. With 30 years of experience caring for people with HIV and AIDS as both an internist and dermatologist, Pat Hennessey shares his library of images and extensive clinical insight regarding everything from Kaposi's sarcoma to itchy red bump disease.

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PRN is pleased to offer this new CME opportunity designed for physicians, nurse practitioners and physician assistants caring for patients with or at risk for HIV disease and its many complications. Based on content from The PRN Notebook, credit for each course will be available for a limited period of time noted on each activity.

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