2016: The State of HIV & Hepatitis C in the District

Transcription

1 2016: The State of HIV & Hepatitis C in the District Travis A. Gayles, MD, PhD Chief Medical Officer, HIV/AIDS, Hepatitis, STD, and TB Administration Division Chief, STD and TB Control February 29, 2016 Overview Current Projects Advocacy Plan Research resources Interim HIV Surveillance Report Next Directions, Challenges Case Profiles Financial Disclosures I have no financial relationships or interests related to this activity to disclose Plan 90% of those positive know their status 90% linked and retained in car 90% virally suppressed 50% reduction in new cases Research Resources George Washington University Center for AIDS Research DC Cohort Study NIH Gravity Study DC Department of Health 1

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3 14 Next Directions Post-test #1 HIV Biomedical prevention PrEP npep Treatment as prevention Rapid ARV Programs Molecular epidemiology Advanced genetic sequencing/resistanc e profiles Treatment as prevention is a) treating everyone to prevent the transmission of HIV b) Treating only those individuals with viral loads greater than 50,000 c) test all individuals for HIV d) test all individuals and treat all HIV patients with antiretroviral medications Post-test #2 HIV Post exposure Prophylaxis PEP a) Treatment for individuals that have been exposed to HIV b) Treatment for individuals after testing who are in a relationship with a HIV+ person to prevent acquiring HIV c) Treatment Health care workers exposed to HIV through sharps injury d) a and c Post-test #3 HIV When to test for HIV a) All patients between 15 to 65 years of age b) Health Care Worker exposed to blood by needle stick or splatter c) Pregnant women in the 1st and 3rd trimester d) all the above 3

4 II. Hepatitis C Treatment Goals Enhanced Treatment Modalities remove (or clear) all the hepatitis C virus from your body permanently stop or slow down the damage to your liver reduce the risk of developing cirrhosis reduce the risk of developing hepatocellular carcinoma (HCC) reduce the risk of decompensating if you already have cirrhosis Pegylated interferon, ribavirin Harvoni Viekira pak Technivie Daklinza 23 4

5 Sustained biologic response Rapid Virological Response At 4 weeks into treatment if the virus is undetectable or has dropped 2 logs then this is a Rapid Virological Response. It is very likely that if a patient has an RVR that they will also have an SVR. Early Virological Response At 12 weeks into treatment if the virus is undetectable or has dropped 2 logs then this is an Early Virological Response. It is very likely that if a patient has an RVR that they will also have an SVR End of Treatment Response At the end of treatment (usually 24 or 48 weeks depending on planned course) if the virus is undetectable then this is an End of Treatment Virological Response. After the End of Treatment response, treatment is stopped and virus is measured for the next 6 months for any evidence of relapse Hepatitis C Prevalence? Screening? Resistance patterns 25 Post-test #1 Hepatitis C Post-test #2 Hepatitis C Assuming the patient has had HCV for 20 years, how likely is it that he has cirrhosis? Very likely (>50%) Significant (20-50%) Possible (10-20%) Unlikely (<10%) Unable to predict What should a patient with Chronic Hepatitis C avoid to take better care of their liver Avoid Alcohol Mega doses of vitamins Foods with high fat and sugar All the Above Post-test #3 Hepatitis C Which statement is true? The majority of people with HCV will have serious disease progression leading to death The majority of people with HCV can be cured with current medications 5