This program is sponsored by Medical Education Resources, Inc., a nonprofit education organization, and supported by an unrestricted educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.

For Physicians:

Medical Education Resources designates this educational activity for a maximum of 3.0 AMA PRA Category 1 credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This CME activity was planned and produced in accordance with the Accreditation Council for Continuing Medical Education (ACCME) Essentials.

Medical Education Resources is accredited by the ACCME to sponsor continuing medical education for physicians.

For Nurses:

Medical Education Resources is an approved provider of continuing education by the Colorado Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. This continuing education activity provides 3.6 contact hours. Provider approval expires July 31, 2007. Provider approved by the California Board of Registered Nursing, Provider #MER-0704, for 3.6 contact hours.

For Pharmacists:

Medical Education Resources (MER) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. MER designates this continuing education activity for 3.0 contact hours (0.3 CEUs) of the Accreditation Council for Pharmacy Education.

Universal Program Number: #816-000-06-011-H02

Release Date: July 31, 2006. This activity is valid for credit through July 31, 2007.

Purpose Statement:

There are many reasons why a treatment regimen fails, and such failure may be virologic, immunologic, and/or clinical. Approaches to handling these situations, and the goals of rescue therapy, vary and often depend on patients' treatment histories. Strategies such as prospective resistance testing, pharmacokinetic enhancement with ritonavir, or the use of new antiretroviral agents may help optimize a regimen for patients who experience some form of treatment failure.

Factors that may result in antiretroviral failure include pre-existing resistance mutations, poor adherence, or inadequate potency or drug levels. Although changing the failing regimen may not always be necessary, the type and cause of treatment failure is important when determining whether a change of regimen is necessary and what subsequent regimens may be effective. Prospective resistance testing can identify drugs that will still be effective, and a number of strategies exist for identifying and improving regimens that fail because of suboptimal drug levels.

Pharmacokinetic enhancement has been a useful technique, and new strategies based on this are being investigated. Adding another protease inhibitor to an already boosted regimen may be useful in creating a single-class regimen but may be more effective as a rescue therapy for treatment-experienced patients. However, due to the variable interactions with the cytochrome P450 isoenzymes, double protease inhibitor-boosted regimens that contain two active protease inhibitors and ritonavir have complex pharmacokinetic profiles that can be effective but difficult to predict.

Resistance to the current classes of antiretrovirals has prompted the search for new agents in existing classes with different resistance patterns, along with new agents that targ et different parts of the virus life cycle. Recently approved agents for use in treatment-experienced patients include enfuvirtide, an entry inhibitor, and tipranavir, a nonpeptidic protease inhibitor. A number of new compounds for treatment-experienced patients are currently being tested in different phases of clinical trials. Some new agents, including those in development, have an increased genetic barrier to resistance and appear to be effective against highly resistant strains of HIV.

For many patients, HIV has evolved into a manageable disease that requires long-term treatment. However, patients who have failed a number of different regimens are difficult to treat. Failure of a regimen usually results in the evolution of resistance mutations, and each new regimen usually brings with it a new set of mutations that can further limit potential treatment options. Therefore, it is important for clinicians to be aware of new agents and strategies for identifying and treating patients in order to maintain durable, long-term treatment of HIV.

Target Audience:

Physicians, AIDS researchers, pharmacists, nurse practitioners, and registered nurses treating or wishing to treat persons with HIV infection, including persons with AIDS.

Objectives:

Upon completion of this program, the participant should be able to:

• Define what is meant by virologic, immunologic, and clinical failure and the factors that influence treatment failure.
• Discuss different strategies for optimizing therapy in treatment-experienced patients.
• Explain the basis and benefits of pharmacokinetic enhancement and the complex drug-drug interactions between various protease inhibitors.
• Describe the clinical utility of current and new antiretrovirals in treatment-experienced patients.

Completion of this continuing-education activity should take approximately 3 hours. Please follow the steps below to ensure your successful completion of this activity and receipt of credit:

1. Read through the Learning Objectives and Disclosure Information for this activity.
2. Read the Required Articles.
3. Click on one of the "Take Post-Test" links on this page and enter your login information in the pop-up window that appears.
4. Enter or confirm the personal information that is required for you to receive credit for successfully completing this activity.
5. Complete and submit your answers to the post-test for this activity. To pass the post-test, you must answer at least 70% of the questions correctly.
6. Complete and submit your responses to the course evaluation survey.
7. Sit back and wait! Your continuing-education certificate will be mailed to you within six to eight weeks after your successful completion of the above steps. To review the results of the post-tests you have taken to date, please refer to your personalized chart on the CME/CE Central main page. If you have any questions, please don't hesitate to contact us at CME@thebodypro.com.

Hardware/Software Requirements:

No special hardware or software requirements must be met in order to complete this activity. A standard Web browser, such as Internet Explorer or Firefox, and an Internet connection are all that is necessary for participation in this activity.