Opportunistic infections. Sanjay Pujari, MD, FIDSA Institute of Infectious Diseases, Pune, India
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1 Opportunistic infections Sanjay Pujari, MD, FIDSA Institute of Infectious Diseases, Pune, India
2 Disclosures Advisory board, Speaker fees: Mylan, Hetero, Cipla ltd
3 Outline Why OI s still occur? Mycobacterial Fungal Viral Protozoal
4 Decline in deaths esp d/t AIDS related illnesses UNAIDS Data 2018
5 However, UNAIDS Data 2018
6 Impact of cart on late presenters: LSOCA cohort HIV Medicine 2018, 19,
7 Impact of cart on late presenters: LSOCA cohort HIV Medicine 2018, 19,
8 Median CD4 counts at cart initiation Clinical Infectious Diseases 2018;66(6):
9 Late initiation of cart Clinical Infectious Diseases 2018;66(6):
10 Late presentation (CD4<350) to HIV care: Belgium Sci Rep Jun 5;8(1):8594
11 Advanced disease (CD4<200) at presentation: Belgium Sci Rep Jun 5;8(1):8594
12 The status: Eastern Europe/Central Asia UNAIDS Data 2018
13 The status: Western Europe/Central Europe/North America UNAIDS Data 2018
14 Outline Why OI s still occur? Mycobacterial Fungal Viral Protozoal
15 Prevalence of HIV in Individuals with TB Global TB report
16 TB incidence and deaths: Global TB report
17 Estimated deaths d/t HIV, TB: 2016 Global TB report
18 TB incidence and CD4 counts: PLHIV not on cart Peer J Dec 14;5:e4165
19 Clinical Scoring system for prioritizing investigation for TB: XPHACTOR score PloS One 2017; 12:e
20 Clinical Scoring system for prioritizing investigation for TB: XPHACTOR score PloS One 2017; 12:e
21 Screening with Xpert MTB and mortality: CHEPETSA trial Clin Infect Dis Jul 27 (epub ahead of print)
22 Screening with Xpert MTB and mortality: CHEPETSA trial Clin Infect Dis Jul 27 (epub ahead of print)
23 Urinary LAM + Xpert MTB screening for all inpatients: STAMP trial Lancet 2018; 392:
24 Urinary LAM + Xpert MTB screening for all inpatients: CD4<100 vs >100 Lancet 2018; 392:
25 Urinary LAM + Xpert MTB screening for all inpatients: Hb < 8 vs > 8 Lancet 2018; 392:
26 Ultra-Xpert: S-ve, culture +, PTB Lancet Infect Dis 2018;18:76 84.
27 HR drug concentrations and culture conversion
28 DTG bid with RMP: INSPIRING study PVL< DTG BID EFV CROI 2018 abstr 28LB
29 BIC with RMP Mean BIC PK (% CV) Cohort 1 BIC/FTC/TAF QD (n = 26) Cohort 2 BIC/FTC/TAF BID + RIF QD (n = 26) AUC 0-24, ng*h/ml 115,200 (21) 45,600 (23) C max, ng/ml 8530 (16) 4560 (19) C trough, ng/ml 3070 (28) 608 (30) CROI 2018, abstr 34
30 TAF + RMP vs TDF- IC-TFV-DP: RIFT study TAF + RMP TDF CROI 2018; abstr 28LB
31 EFV 400 with HR: study design CROI 2018 abstr 457
32 EFV concentrations with HR + EFV 400 CROI 2018 abstr 457
33 EFV + HR: Metabolizer status CROI 2018 abstr 457
34 Concurrent MDRTB and HIV treatment: SHOUT-MDRTB study Clin Infect Dis 2018;66:
35 Concurrent MDRTB and HIV treatment: SHOUT-MDRTB study Clin Infect Dis 2018;66:
36 No higher IRIS with RAL intensification: REALITY trial CROI 2018, Abstr 23
37 No higher IRIS with RAL intensification: REALITY trial CROI 2018, Abstr 23
38 Prophylactic steroids for paradoxical TB-IRIS: PRED-IRIS study CROI 2017, abstr 81LB
39 IPT and mortality benefit: TEMPARANO Lancet Glob Health 2017; 5:e1080 e1089.
40 IPT benefit according to QuantiFERON status QunatiFERON-TB Gold +ve QuantiFERON-TB Gold -ve Lancet Glob Health 2017; 5:e1080 e1089.
41 3HP vs 9H for LTBI treatment: PREVENT TB trial AIDS 2016, 30:
42 3HP vs 6H for LTBI treatment: completion rates PREVENT TB trial P< AIDS 2016, 30: HP (DOT) 9H (SAT)
43 1HP vs 9H for preventing TB amongst PLHIV: BRIEF-TB/A5279 CROI 2018; Abstract 37LB
44 Immediate IPT and pregnancy/birth outcomes: TB APPRISE study CROI 2018; Abstract 142LB
45 HIV/TB: Research ideas Evaluation of Next generation urinary LAM assays Diagnostic accuracy and Clinical outcomes of screening with Xpert-Ultra vs Xpert in PTB and EPTB across different settings Efficacy and durability of shorter LTBI regimens (3HP, 1HP, 3R) in PLHIV with advanced disease initiating ART Operational research for TDM of anti-tb drugs in high HIV/TB areas
46 Outline Why OI s still occur? Mycobacterial Fungal Viral Protozoal
47 scrag titers and CSF CrAG positivity Clin Infect Dis Nov 29;65(12):
48 Alternative regimens for CM induction treatment: ACTA trial N Engl J Med Mar 15;378(11):
49 ACTA: Alternative regimens for CM induction treatment N Engl J Med Mar 15;378(11):
50 Alternative regimens for CM induction treatment: ACTA trial N Engl J Med Mar 15;378(11):
51 ART timing in CM: All cause mortality Cochrane Database Syst Rev Jul 24;7:CD009012
52 ART timing in CM: CM relapse Cochrane Database Syst Rev Jul 24;7:CD009012
53 ART timing in CM: Cryptococcal IRIS Cochrane Database Syst Rev Jul 24;7:CD009012
54 Histoplasma in Latin America Lancet Infect Dis 2018; Aug 23
55 Histo vs TB in Latin America Lancet Infect Dis 2018; Aug 23
56 Histo vs TB in Latin America Lancet Infect Dis 2018; Aug 23
57 HIV/fungal: Research ideas Management of PLHIV developing CM soon after initiating ART Evaluation and treatment of CM recurrence Flucoanazole for pre-emptive treatment of scrag+ Role of echinocandins in severe PCP
58 Outline Why do OI s still occur? Mycobacterial Fungal Viral Protozoal
59 HZ incidence in the cart era Front Public Health Mar 12;6:70. doi
60 VZV live vaccine in PLHIV suppressed on ART and CD4>200/mm 3 Clin Infect Dis Mar 26 [Epub ahead of print]
61 CMV viremia in advanced HIV improves with ART without anti-cmv treatment CROI 2018, abstr 801
62 PML incidence in France Clin Infect Dis Jul 2;67(2):
63 Risk of PML after cart initiation Clin Infect Dis Jul 2;67(2):
64 JCV DNA levels and PML Clin Infect Dis Jun 18;67(1):65-72
65 HIV-L: Plasma EBV and survival Clin Infect Dis Jun 29
66 HIV-L: Plasma EBV and survival Clin Infect Dis Jun 29
67 qhpv vaccine efficacy in G/WLHIV Clin Infect Dis Jul 7. [Epub ahead of print]
68 HIV/Viral: Research ideas Role of neurotropic viruses like HCV in PML onset Strategies to diagnose and manage PML IRIS Efficacy of HZ/su or ZV amongst elderly PLHIV Efficacy of nine-valent HPV vaccine in WHIV Use of EBV VL in prognostic scores for HIV- Lymphoma
69 Outline Why do OI s still occur? Mycobacterial Fungal Viral Protozoal
70 T. gondii infection in PLHIV worldwide Lancet HIV Apr;4(4):e177-e188
71 Cerebral toxoplasmosis: Treatment HIV Med Feb;18(2):
72 Summary OI s: Going, Going, not gone Improving screening and diagnosis of TB: key to control TB in PLHIV Evidence for use of RAL/DTG with RMP: Encouraging and evolving Urgent access to flucytosine in LMICs needed Vaccine uptake needs to improve: reduce residual morbidity
73
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