HIV Grand Rounds - Archived Pilot Series

Frequently Asked Questions

Week:

Would you treat Hep. C in an individual who is actively using drugs? (posted at 22:18 in the presentation)
I would not treat someone who is actively using drugs for his/her hepatitis C infection, unless some very specific criteria were met. My main concern is that someone who is actively using drugs would not be sufficiently adherent to the HCV therapy to get the desired response. Therapy for hepatitis C infection is associated the risks for a number of side effects, including depression and low blood cell counts (low white blood cells and anemia, in particular) that often require additional therapy to treat beyond the interferon and ribavirin required to treat the HCV infection. This makes adherence an additional challenge. It is also possible that complications from the ongoing drug, such as infection or liver disease, could occur with greater frequency in someone who is actively using drugs (I am not aware of such data, but there are reasons to think it is possible). If this patient was HIV co-infected and was on antiretroviral therapy, and had an undetectable viral load on therapy, and never missed an appointment despite using drugs, and was a model patient in every way (again, despite using drugs) then I would consider HCV treatment. However, I am not sure I have ever cared for such a patient.
She is a 58 Year old woman - Should we not make sure her basic health issues are taken care of first - Mammo, Colooscopy and Control of her HTN and DM. Maybe she has little interest in turning her life into a medical patient. (Time in presentation 20:04)
Yes, we certainly should not ignore management of her other chronic medical conditions, such as her diabetes and hypertension, and we should ensure that she has had the screening evaluations that are appropriate for her age. Managing her diabetes and hypertension effectively are at least as important for reducing her risk for cardiovascular and renal disease as would be treating her HIV infection at this stage of her HIV disease. In fact, the treatment strategy pursed in this case was increased attention to control of her diabetes, rather than the initiation of antiretroviral therapy. With respect to the impact of her chronic diseases on her outlook on life I think it iss important to give our patients the message that they can live with their disease(s), and their disease(s) do not need to control their lives. I tell my patients that I want 5 minutes of their day - all the time it takes to take their medication, and 23 hours and 55 minutes is their time.
Is there any evidence for HIV and LRD in PLWH in developing countries, especially Asia? (posted at 15:42 in the presentation)
In the developing world one of the most common liver related diseases is hepatitis B virus (HBV) infection, which is especially common in Asia. HIV patients co-infected with HBV are at an increased risk for chronic HBV infection, HBV reactivation and hepatocellular carcinoma. The risk for liver cancer in HIV patients is higher with HBV infection than hepatitis C virus HCV) infection. The nucleoside reverse transcriptase inhibitors lamivudine, emtricitabine, and tenofovir are all effective against HBV. Treatment with lamivudine alone leads to more rapid HBV resistance in co-infected patients - about half of patients have HBV resistance to lamivudine after 6-12 months of monotherapy. Therefore a combination of tenofovir plus lamivudine or emtricitabine is preferred to treat HBV in co-infected patients. HCV coinfection is also common in areas of the developing world where intravenous drug use is a problem. This is the case for regions in Thailand, Southeastern China, and other areas. Approximately 80% - 90% of intravenous drug users have been exposed to HCV. Mycobacterial infection also commonly involves the liver. In developing countries M. tuberculosis and M. avium-intracellulare are the most common species to cause liver disease. Fatty infiltration of the liver, hepatic steatosis, is increasingly a problem in the developing world, as an increasing number of individuals adopt the unhealthy dietary habits seen in the West. Lastly, alcohol remains a major problem in developing world. Alcohol use is associated with more advanced liver disease in patients with HCV co-infection and is associated with a greater risk for non-adherence to antiretroviral therapy.

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Program Overview:

Mirroring the academic grand rounds programs, these CME programs combine traditional academic grand rounds with the innovation and convenience of telemedicine. This weekly webinar program, broadcast from the Perelman School of Medicine at the University of Pennsylvania, and delivered by top experts in the field, covers a wide range of topics involved with the clinical care of patients with HIV/AIDS.

The one-hour presentations will be designed to be immediately relevant to practicing HIV clinicians and many will be case-based. The final 10 minutes of each one-hour program will consist of a live question and answer period with the presenting faculty member available to answer questions asked by participants who attend in person or via the Internet. These weekly grand rounds programs are intended to provide clinicians with convenient and easily accessible knowledge and clinical skills they need to provide the best medical care for their HIV-positive patients.

	John Bartlett, MD Professor of Medicine, Johns Hopkins School of Medicine Baltimore, Maryland		Calvin J. Cohen, MD, MS Research Director, CRI New England Clinical Instructor, Harvard Medical School Boston, Massachusetts
	Ian Frank, MD Professor of Medicine, Director, Antiretroviral Clinical Research University of Pennsylvania Philadelphia, Pennsylvania

Frederick Altice, MD Professor of Medicine, Director of Clinical Research and Community Research Yale University School of Medicine Section of Infectious Diseases, AIDS Program New Haven, Connecticut	Gregory Melikian, PhD Professor, Department of Pediatrics, Division of Infectious Diseases Emory University Atlanta, Georgia
Gregory Bisson, MD Assistant Professor of Medicine, Infectious Diseases Division University of Pennsylvania School of Medicine Assistant Professor of Epidemiology Center for Clinical Epidemiology & Biostatistics Philadelphia, Pennsylvania	David Metzger, Ph.D. Research Professor of Social Policy in Psychiatry Director, HIV Prevention Research Division University of Pennsylvania Department of Psychiatry Philadelphia, Pennsylvania
Jason Brenchley, PhD Investigator, Molecular Microbiology Viral Pathogenesis and Vaccine National Institute for Allergies and Infectious Diseases Bethesda, Maryland	Karam Mounzer, MD Medical Director, The Jonathan LAX Center Philadelphia FIGHT Philadelphia, Pennsylvania
Todd T. Brown, MD Assistant Professor of Medicine Division of Endocrinology and Metabolism Johns Hopkins University Baltimore, Maryland	K. Rajender Reddy, MD Professor of Medicine Professor of Medicine in Surgery Director of Hepatology Medical Director of Liver Transplantation University of Pennsylvania School of Medicine Philadelphia, Pennsylvania
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Richard A. Elion, MD Associate Professor of Clinical Medicine, George Washington University Medical Center Research Director, Director, Whitman-Walker Clinic Washington, DC	Deirdre Sawinski, MD Assistant Professor of Medicine, Renal, Electrolyte and Hypertension Division Hospital of the University of Pennsylvania Philadelphia, Pennsylvania
Joseph Eron, MD Professor, University of North Carolina School of Medicine Chapel Hill, North Carolina	David M. Simpson MD Professor of Neurology Director, Clinical Neurophysiology Laboratories Director, Neuro-AIDS Program Mount Sinai Medical Center New York, New York
Joseph Garland, MD Fellow, Division of Infectious Diseases Department of Medicine University of Pennsylvania Philadelphia, Pennsylvania	Mark Sulkowski, MD Associate Professor of Medicine and Medical Director, Viral Hepatitis Center Johns Hopkins University School of Medicine Baltimore, Maryland
Kelly Gebo MD Associate Professor of Medicine, Epidemiology Johns Hopkins University School of Medicine Baltimore, Maryand	Pablo Tebas, MD Director, AIDS Clinical Trials Unit University of Pennsylvania School of Medicine Philadelphia, Pennsylvania
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Robert Gross, MD Associate Professor of Medicine (Infectious Diseases) Associate Professor of Epidemiology Center for Clinical Epidemiology and Biostatistics University of Pennsylvania School of Medicine Philadelphia, Pennsylvania	Glenn Treisman, MD Professor of Psychiatry, Department of Psychiatry and Behavioral Sciences, Professor of Medicine, Department of Internal Medicine, Johns Hopkins University School of Medicine Director, AIDS Psychiatry Service, Co-director, Pain Treatment Program, Johns Hopkins Medicine Baltimore, Maryland
Trevor Hawkins, MD Associate Professor, University of New Mexico Medical Director, Southwest CARE Center Santa Fe, New Mexico	Christopher Vinnard, MD Fellow, Infectious Diseases University of Pennsylvania, School of Medicine Philadelphia, Pennsylvania
Jay Kostman, MD Clinical Associate Professor of Medicine Division of Infectious Diseases Chief, Infectious Diseases Division, Penn Presbyterian Medical Center University of Pennsylvania Philadelphia, Pennsylvania	Amy Vittor, MD, PhD Fellow, Infectious Diseases University of Pennsylvania, School of Medicine Philadelphia, Pennsylvania
Carrie Kovarik, MD Assistant Professor, Departments of Dermatology and Infectious Diseases University of Pennsylvania School of Medicine Philadelphia, Pennsylvania	Baligh Yehia, MD Fellow, Infectious Diseases University of Pennsylvania, School of Medicine Philadelphia, Pennsylvania
	Andrew Zolopa, MD Associate Professor of Medicine, Division of Infectious Diseases Stanford University School of Medicine Stanford, California

HIV Grand Rounds - Archived Pilot Series

Frequently Asked Questions

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