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Demetre C. Daskalakis, MD, MPH

SPECIAL PUBLIC HEALTH ANNOUNCEMENT: Brief Update on Recent Cases of Invasive Meningococcal Disease Among MSM

Cases of life-threatening Invasive Meningococcal Disease (IMD) were first seen in men who have sex with men (MSM) in New York City in 2012, many with underlying HIV disease, which led to a massive effort to provide protective meningococcal vaccines to HIV-positive MSM and later all at-risk MSM in NYC. After a lull in reported cases, and the hope that “herd immunity” had been achieved, there has been a recent cluster of IMD, even in some men who have already received the recommended vaccines. Demetre Daskalakis, in his newly appointed role at the New York City Department of Health and Mental Hygiene, discusses the details of these disturbing new cases in this special brief public health announcement to the PRN audience.

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Kari Yacisin, MD, MSc

SPECIAL BRIEF REPORT: Fast Facts about Ebola-- What NYC Providers Need to Know

Because of international travel to NYC and the potential for travelers returning from areas of Africa affected by Ebola, this brief presentation on the Ebola epidemic was added to PRN’s August 2014 meeting as a public health service for primary-care providers. It is important for all clinicians in NYC to be familiar with relevant travel history, the signs and symptoms of Ebola, and the triage of suspected cases.

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Daniel Douek, MD, PhD

The Good, the Bad and the Ugly of Inflammation in HIV Infection

Inflammation plays an important role at every stage for HIV infection, from the acute stages of primary infection until death. But even though antiretroviral therapy has radically slowed progression of this disease to near-normal life expectancy, we see immune activation and inflammation in various manifestations, contributing to HIV disease progression, and increasing the risks of morbid non-AIDS events and mortality. Join us for this comprehensive and thought-provoking review of the many changing faces of inflammation in HIV disease.

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Thomas Cherneskie, MD, MPH

Bacterial STIs in NYC: Epidemiological Trends, Diagnostic Considerations and Management Issues in People With or At Risk for HIV Disease

If you have a patient with a sore throat or rectal complaints are you requesting a thorough sexual history and appropriate STD testing? The threat of sexually transmitted bacterial diseases—not just the usual suspects, but also drug-resistant gonorrhea, lymphogranuloma venereum and mycoplasma genitalium -- is increasing even as HIV prevention shows promise of improvement. At this strategic point in time, it is prudent to review the most current recommendations for bacterial STI diagnosis and treatment in the era of oral sex, HIV-serosorting, HIV pre-exposure prophylaxis and condomless sex.

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Martin H. Markowitz, MD

Long-Acting Next-Generation PrEP Agents to Prevent Infection with HIV

Pre-exposure prophylaxis is currently our best possible means of slowing or perhaps stopping the HIV epidemic, but the success of currently available PrEP is strongly dependent on the adherence of each individual to a one-pill-a-day regimen. Longer-acting drugs in the research pipeline, with intermittent dosing up to 3 months apart, may help stabilize preventive levels of prophylactic antiretroviral agents more consistently over time, and may play an important role in the future of PrEP.

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Demetre Daskalakis, MD, MPH

HIV Pre-Exposure Prophylaxis in the Real World

Get ready. If your HIV-negative patients have not already asked you about pre-exposure prophylaxis for the prevention of HIV infection, this presentation will help you answer their questions when they do. And if they already have started asking you for PrEP, this will help you fine-tune your responses, recommendations and management. The rate of new infections with HIV have remained constant over the last decade despite ongoing reminders for consistent condom use, and the use of antiretroviral drugs for PrEP is a new strategy that may greatly enhance ongoing efforts to reduce HIV transmission in vulnerable populations at highest risk for infection.

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Samuel T. Merrick, MD

Virologic and Immunologic Monitoring in HIV-positive Adults: Updated New York State Guidelines

The standard of care for laboratory monitoring of HIV disease has changed, placing the emphasis on measurement of virologic control at variable intervals based on adherence. Routine quarterly measurement of CD4 cells has been replaced with more rational and cost effective strategies. For all the details of the updated guidelines on monitoring virologic and immunologic trends in HIV management, from the AIDS Institute of the New York State Department of Health, please see this video of Sam Merrick’s recent presentation at PRN.

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Roy M. Gulick, MD, MPH

Advances in the Treatment and Prevention of HIV Infection: CROI 2014, Focus on ART

Hot on the heels of CROI 2014, this up-to-date review of HIV treatment and prevention strategies, antiretroviral initiation, options for treatment failure, and new agents in development, is not to be missed. Even if you attended this live meeting, we hope you will find this presentation by Trip Gulick helpful in your day-to-day decision-making.

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Rajesh T. Gandhi, MD

Diagnosis and Treatment of Acute HIV: A Stitch in Time?

Over the years at PRN, we have revisited the pros and cons of early treatment of HIV, even during the acute stage of primary HIV infection. And now, with safer long-term treatment alternatives, the tide is turning toward early treatment as a potential means of preserving immune function, decreasing mutant strains in reservoirs, decreasing risk of further transmission, and improving the chance for a future cure. In this presentation, Raj Gandhi provides an overview of the signs and symptoms of acute HIV, how to diagnose it and initiate treatment, evidence-based research demonstrating the benefits of early treatment, and the potential for functional cure.

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Blayne Cutler, MD, PhD

The HIV Epidemic in NYC and the Nation: What the Numbers Tell Us

Are we ending the HIV/AIDS epidemic in New York? Rapid HIV tests are readily available and easy to use, oral consent for rapid HIV testing is allowed, pre-test counseling is no longer required, and New York State mandates that all primary care providers offer HIV testing to all patients 13-64 years of age and assure linkage to care for positives. So how are we doing? Join us to hear Blayne Cutler discuss the current trends in New York and the nation, advances in testing, management and prevention, and the critical role primary care plays in ending this epidemic.

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Douglas T. Dieterich, MD

The Beginning of a New Era for the Treatment of HCV

Hepatitis C coinfection can be cured in HIV-positive patients, and extends life. HCV-related liver disease including hepatocellular carcinoma have become major causes of death in HIV disease, but the treatment for this life-threatening coinfection has gotten better and will soon be even easier. Or as Doug Dieterich says: “It’s a really good time to have hepatitis C.” In this video he explains what he means as he discusses the history of HCV treatment, recent advances and future improvements supported by current and ongoing research.

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Naomi Jay, RN, NP, PhD

Anal Cancer Screening and Prevention: Diagnosis, Treatment and Helpful Tips for HIV Providers

Anal cancer secondary to human papillomavirus (HPV) is an increasing problem, especially in HIV-positive men and women, despite successful treatment of HIV. But just like cervical cancer, anal cancer can be prevented if providers caring for people living with HIV promote and master anal cancer screening and prevention techniques. Following the inaugural meeting of the newly-formed International Anal Neoplasia Society (IANS), Naomy Jay journeyed from San Francisco to New York to share clinical tips and insights with our PRN audience, and has declared 2014 to be “The Year of the Anus.” We are certain that you will find this video of her lecture both engaging and helpful in the care of your patients.

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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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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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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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Provider Resources

CME

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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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Full PRN membership is now open to clinicians nationwide.

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