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HIV Infection: An Update on
Antiretroviral Therapy – Florida Board-Approved Edition

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Overview

Florida Licensees: This issue, together with the Supplement (pages 18 - 22) meets the requirement of the Florida Board of Pharmacy for a CE course on HIV/AIDS.

Thirty three years after the first case of acquired immunodeficiency syndrome (AIDS) was reported, 35 million people worldwide are living with HIV. About 2.1 million new HIV infections and 1.5 million AIDS deaths were reported in 2013. However, there has been significant progress in battling the disease over the last 13 years. Since 2001, the number of new cases has decreased by 38% in most of the world, and since 2005, AIDS related deaths have declined by 35%. Globally, 4.2 million people aged 50 years or older were living with HIV in 2013, a prevalence that has more than doubled since 1995. It is estimated that 50% of HIV-infected persons in the US will be older than 50 by the year 2015.

About 1.1 million Americans are now living with HIV infection, due to the availability of potent and better tolerated antiretroviral agents (ARVs) that prolong life. Starting ARVs earlier has reduced disease progression and deaths, allowing HIV to be managed as a chronic disease. However, complete viral suppression with ARV treatment does not fully restore health. About 50% of deaths are due to non-AIDS related complications, including cardiovascular, kidney, and liver diseases; cancers; and neurologic disorders often associated with aging. Metabolic complications including dyslipidemia and diabetes also occur. HIV “premature aging” is believed to result from persistent viral inflammation rather than ARV toxicity.

Can HIV be cured? Several cases of possible “cure” have been reported, but only one patient has remained virus free offARVs for more than 7 years. The “Berlin” patient is the only documented “cure” following an allogeneic stem cell transplant for leukemia. Two Boston men who underwent a similar stem cell transplant had the virus re-emerge off ARVs. Another potential cure was the Mississippi baby who received combination ARVs for 18 months before stopping treatment. The HIV viral load remained undetectable for 2 years off ARVs before HIV returned. Other cases are under evaluation, including an Argentinian woman who appeared “cured” after discontinuing ARVs for 7 years, and 2 Australian men who are virus free following stem cell transplants but remain on ARVs. These cases increase the likelihood that HIV can be cured, but most experts believe that a cure is unlikely in the next few decades. Extensive latent HIV reservoirs must be depleted before HIV is eliminated. Under investigation is whether starting ARVs earlier can reduce the reservoirs and increase “cures”. Studies of investigational medications to flush the virus out of latent reservoirs have been disappointing and are not moving forward.

This issue will focus on the most recently approved ARVs and updated information on prophylaxis. ARV therapy and non-AIDs related coexisting conditions such as bone loss and chronic kidney disease are also discussed.

Details

Publication Date: 05/27/2015
Expiration Date: 05/27/2018
CE Credit: 2.5 (0.25 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.

Authors

Betty J. Dong, PharmD, FCCP, FASHP, AAHIVP

Disclosure Statement

Disclosure: Dr. Dong reports no financial or personal relationships with any commercial interest producing, marketing, reselling or distributing a product or service that appears in this issue.

Target Audience

This accredited program is targeted to pharmacists and nurses.

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. List the antiretroviral (ARV) regimens recommended for pre- and post-exposure prophylaxis, and describe their efficacy.
    2. >
    3. Describe the current recommendations for when to start ARVs. Identify the recommended regimens for ARV-naïve persons.persons.
    4. >
    5. Discuss the adverse effects and drug interactions of the most commonly used ARV agents/classes, and of the pharmacokinetic booster cobicistat.
    6. Discuss current recommendations for monitoring therapy. Counsel patients about how to take their ARVs and the importance of adherence.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc.

Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 0428-0000-15-006-H02-P


Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 2.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator


Terry M. Baker, PharmD

Managing Editor


Tracy Farnen, PharmD

Associate Editors


James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor


Gerard Hatheway, PharmD, PhD

Editorial Advisors


Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners


Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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