Mitigating Progression of Liver Fibrosis in HIV/HCV Coinfection


Nancy Reau, MD
Professor of Medicine
Richard B. Capps Chair of Hepatology
Chief, Section of Hepatology
Associate Director, Solid Organ Transplantation, Rush University Medical Center, Chicago
Nancy Reau, MD

Nancy Reau, MD, is Professor of Internal Medicine, Richard B. Capps Chair of Hepatology, Associate Director of Solid Organ Transplantation, and Section Chief of Hepatology at Rush University Medical Center in Chicago, IL. She received her medical degree from The Ohio State University College of Medicine in Columbus, where she completed a residency and fellowship in gastroenterology/hepatology followed by a second fellowship in advanced transplant hepatology at Johns Hopkins Hospital in Baltimore, MD. Her primary research interests focus on viral hepatitis – from both drug development and a clinical perspective – liver transplantation, and complications of chronic liver disease.

Prof. Reau has been an invited lecturer at numerous presentations focused on viral hepatitis, fatty liver disease, cirrhosis, and liver transplantation. Prof. Reau is a fellow of the American Gastroenterological Association and American Association for the Study of Liver Diseases (AASLD). Additionally, she is the current editor in chief of CLD (Clinical Liver Disease) and was an author of the AASLD/IDSA hepatitis C guidance document. She was the committee chair of the AASLD public policy committee and a member of the AASLD practice guideline committee for four years.

Prof. Reau has authored or coauthored more than 100 peer-reviewed articles that have been published in journals such as Hepatology, Hepatitis Research and Treatment, and Clinics in Liver Disease. She is Co-chair of the National ALF Medical Advisory Committee and sits on multiple advisory boards. She is currently a member of the steering committee for the hepatitis C special interest group (SIG) for the American Association for the Study of Liver Diseases (AASLD) and a member of the ACG training committee.

Christian B. Ramers, MD, MPH, FIDSA, AAHIVS
Neurology Medical Director
Chief, Population Health, Family Health Centers of San Diego
Associate Clinical Professor, UC San Diego School of Medicine, San Diego, CA
Christian B. Ramers, MD, MPH, FIDSA, AAHIVS

Dr. Ramers is the Chief of Population Health and Director of Graduate Medical Education at the Family Health Centers of San Diego (FHCSD), a large Federally Qualified Health Center (FQHC) system serving nearly 200,000 medically underserved individuals throughout San Diego county. He is board certified in Internal Medicine, Infectious Diseases, and Addiction Medicine, and is particularly interested in HIV, HBV, HCV, and service of medically underserved, immigrant, and refugee populations. He co-chairs the California Chapter of the American Academy of HIV Medicine and has advocated for HIV/HCV care at the state legislative level. Dr. Ramers has served as a consultant for CDC- sponsored HIV/HBV/HCV educational projects in Asia and Africa. Since 2018 he has served as the Senior Clinical Advisor for the Clinton Health Access Initiative’s Global Hepatitis Program, working to eliminate HBV and HCV in seven partner countries in Asia and Africa.

Since the onset of the COVID-19 pandemic, Dr. Ramers has taken on a leadership role in policy, laboratory, public health, research, and clinical response. He is a core member of FHCSD’s COVID-19 Response Efforts team, delivering biweekly updates to > 200 clinicians and staff. At the regional level he serves on the county Clinical Vaccine Advisory Committee and Equity task forces. He is a member of the national IDSA-CDC clinical call escalation volunteer group. He has facilitated several telemedicine forums including one on HIV care at the International AIDS Conference, a 10-week intensive telemedicine series (Telemedicine Hack) supported by HHS, and a COVID-19 outpatient therapeutics series supported by HHS and Project ECHO. Internationally, Dr. Ramers facilitates a twice-weekly Spanish-language COVID-19 virtual community of practice for Latin America and has presented at an international WHO AFRO region webinar on SARS-CoV-2 transmission.

Joseph K. Lim, MD
Professor of Medicine
Director, Clinical Hepatology
Vice-Chief, Section of Digestive Diseases Yale University School of Medicine New Haven, CT
Joseph K. Lim, MD

Dr. Lim is a Professor of Medicine and Vice-Chief of the Section of Digestive Diseases at Yale University, where he serves as Director of Clinical Hepatology and Associate Chief of Yale-New Haven Health System (YNHHS) Digestive Health. He is a graduate of the Feinberg School of Medicine at Northwestern University (Chicago, Illinois, USA), and completed training in Internal Medicine at Yale University (New Haven, Connecticut, USA), and Gastroenterology and Hepatology at Stanford University (Palo Alto, California, USA). In his role at the Yale Liver Center, he conducts patient-oriented research evaluating clinical outcomes in chronic liver disease and runs an active clinical trials program examining novel investigational agents for viral hepatitis and NASH. He has held numerous leadership roles for the AASLD, AGA, and the ACG, and serves as Chair of the EPIC Gastroenterology Specialty Steering Board.

Statement of Need

The management of complex cases such as human immunodeficiency virus (HIV) with hepatitis C virus (HCV) coinfection requires awareness and application of the most current real-world efficacy and safety data as well as guidelines. In HIV/HCV coinfection, it is particularly important to mitigate progression of liver-related morbidity and mortality while maintaining awareness of potential drug-drug interactions that can occur between antiretroviral regimens and direct-acting antivirals (DAAs). The American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA) treatment guidelines encompass all types of HCV case scenarios, including uncomplicated (treatment-naïve disease without cirrhosis) and complex (such as HIV/HCV coinfection) cases. It is vital that clinicians refer to the current guidelines and efficacy and safety data in order to make knowledgeable treatment decisions for all patient groups.

This CMEO BriefCase will introduce a complex case involving treatment and management considerations for a patient with HIV and HCV. Join Drs. Nancy Reau and Christian Ramers as they explore the epidemiology and shared pathobiology of liver fibrosis in HIV/HCV, real-world data for available therapies, contraindicated agent combinations, and when and how to treat.

Learning Objectives

At the end of this CME/CE activity, participants should be able to apply efficacy and safety data to treatment decisions for optimal management of HCV.

Financial Support

Supported by an educational grant from Gilead Sciences, Inc.

Target Audience

U.S. and international physicians, PAs, nurse practitioners, nurses, and pharmacists specializing in primary care

Credit Information

Jointly Accredited Provider

In support of improving patient care, CME Outfitters, LLC, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physicians (ACCME)

CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. CME Outfitters, LLC, designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses (CNE)

Provider approved by the California Board of Registered Nursing, Provider Number CEP 15510, for 1.0 contact hour(s).

Note to Nurse Practitioners

Nurse Practitioners can apply for AMA PRA Category 1 Credit through the American Academy of Nurse Practitioners (AANP). AANP will accept AMA PRA Category 1 Credit  from organizations accredited by the Accreditation Council for Continuing Medical Education. Nurse practitioners can also apply for credit through their state boards.

California Residents

This continuing nursing education activity was approved by the California Board of Registered Nursing. CME Outfitters LLC’s provider number is CEP15510.


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Royal College MOC

Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.

MIPS Improvement Activity

This activity counts towards MIPS Improvement Activity requirements under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Clinicians should submit their improvement activities by attestation via the CMS Quality Payment Program website.

Disclosure Declaration

it is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Dr. Reau reports the following financial relationships: Consultant: AbbVie Inc.; Gilead Sciences, Inc.; Intercept Pharmaceuticals, Inc.; and Merck & Co., Inc. Grants/Research Support: GENFIT; Intercept Pharmaceuticals, Inc.; and Shire.

Dr. Ramers reports the following financial relationships: Advisory Board: AbbVie Inc. and Gilead Sciences, Inc. Consultant: AbbVie Inc.; Gilead Sciences, Inc.; and ViiV Healthcare; Grants (Institutional Support): Gilead Sciences, Inc. Grants (Programmatic Support): AbbVie Inc. and Gilead Sciences, Inc. Speakers Bureau: AbbVie Inc.; Gilead Sciences, Inc.; and ViiV Healthcare

Dr. Lim (Reviewer/Advisor) reports the following financial relationships: Research Support: Allergan; Celgene Corporation; Eiger BioPharmaceuticals, Inc.; GENFIT; Gilead Sciences, Inc.; Pfizer Inc.; and Viking Therapeutics

Disclosures were obtained from the CME Outfitters, LLC staff: No disclosures to report.

  • Michael Franks, APRN, AGACNP-BC, FNP-BC (peer reviewer)
  • Kellie Busby, PharmD (planning committee)
  • Janan Sarwar, PharmD (planning committee)
  • Susan Perry (planning committee)
  • Susan H. Yarbrough, CHCP (planning committee)
  • Sharon Tordoff (planning committee)

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

Obtaining Credits

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NOTE: Pharmacist CE Universal Activity Number, Enduring: JA0007185-0000-22-033-H01-P.

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Mitigating Progression of Liver Fibrosis in HIV/HCV Coinfection
Event Date: 05/10/2022