HIV in in Women Women

Size: px
Start display at page:

Download "HIV in in Women Women"

Transcription

1 HIV in Women Susan L. Koletar, MD The Ohio State University

2 How Many of These Women Have HIV? Answer: I don t really know Google Search: Photos of Groups of Women

3

4 Pub Med Search: HIV and Women 22,732 Results First reports 1983 focused on women as sexual partners Current publications: focus on MTCT; impact of other STDs/HPV drug regimens socioeconomic issues risk reduction strategies

5 Global Summary of the HIV/AIDS Epidemic Estimated Number of people living with HIV in 2009 Total Adults Women Children under 15 years 33.3 million [ million] 30.8 million [ million] 15.9 million [ million] 2.5 million [ million]

6 Global Summary of the HIV/AIDS Epidemic Estimated Number of people living with HIV in 2009 Total Adults Women Children under 15 years 33.3 million [ million] 30.8 million [ million] 15.9 million [ million] 2.5 million [ million]

7 HIV Prevalence in Women in Rural Vulindlela, South Africa Age Group (Years) HIV Prevalence (n=1237) < % % % % % Abdool Karim Q, et al. AIDS Abstract TUSS0202

8

9

10 Young women aged 25 to 44 accounted for the majority of new HIV infections among women in 2010 in the U.S.

11 Risk Factors for HIV Infection in Young Women Anatomic/biologic vulnerability and sexually transmitted disease Lack of awareness Lack of recognition of partner s risk factors Feelings of less power in relationships Substance abuse Sexual abuse Socioeconomic issues Racial/ethnic differences

12 HIV Risks/Behaviors in Individuals >50 years Despite myths and stereotypes, older individuals remain sexually active. The availability of drugs for erectile dysfunction increases sexual activity. Compared to individuals in their 20 s, 50+ year olds are: 1/6 as likely to use condoms 1/5 as likely to have been tested for HIV Postmenopausal women may be at increased risk due to increased likelihood of thinning and dryness of vaginal mucosa.

13

14 Typical Course of Untreated HIV Infection PCP, KS, MAC, CMV & others

15 Characteristics and Specific Issues Relevant to HIV-Infected Infected Women

16 EuroSIDA: No Gender Differences in Outcomes on HAART Prospective cohort study 2547 treatment-naive patients (Male: 2036; Female: 511) Median HAART start date 1997 (range: ) Virologic, immunologic, and clinical response to HAART No significant gender differences were found HIV RNA <500 copies/ml Outcome (% patients) All Men Women Viral rebound CD4 rise cells/mm 3 AIDS Death Moore AL, et al. J Acquir Immune Defic Syndr. 2003;32:

17 Bone Loss Prospective study in HIV+ and HIV- women matched for age, BMI, race ( ) 1 HIV+ women 1 >50% had osteopenia at the hip or spine 2.5 times as likely to have bone loss as HIV- women Bone density correlated with body weight Bone loss did not correlate to use of ART Incidence (%) 1 HIV+ (n=84) HIV- (n=63) Osteopenia Lumbar spine Femoral neck Hip total 27 8 Hip or spine Osteoporosis Lumbar spine 6 5 Femoral neck 0 2 Hip total 1 0 Hip or spine 10 5 Risk factors for osteoporosis/osteopenia included low free testosterone, low weight, and oligomenorrhea Dolan S, et al. AIDS. 2004;18: ; 2. Dolan S, et al. 14th CROI (2007); Poster 777.

18 Stress, Depression, and Anxiety HIV+ Women Compared with HIV+ Men Mean Sc cores for Ps sychologic cal Well-be eing P < P < P <0.01 P <0.05 Stress Depression Anxiety Family/Friends Emotional Support P <0.05 Partner Emotional Support HIV+ Men (n=307) HIV+ Women (n=102) Gordillo V, et al. J Behav Med. Published online June 19, 2009.

19 HIV+ Women Were More Likely to Have Financial Problems obe and Experience e Discrimination ato Compared With HIV+ Men (N=409) Percenta age of pat tients P <0.001 P <0.001 P <0.01 Employed Financial Problems Experienced Discrimination HIV+ Men (n=307) HIV+ Women (n=102) Gordillo V, et al. J Behav Med. Published online June 19, 2009.

20 Trends in Standardized Incident Rates of AIDS-Defining and Non-AIDS Cancers Patel et al. Ann Int Med :728

21 Recommendations for Routine Screening and Care Testing Recommended by CDC 1 : All patients aged years of age should receive an HIV test as part of routine healthcare Individuals considered high risk for HIV infection should be tested annually All pregnant women should be screened for HIV infection All HIV+ women of childbearing potential should be offered preconception counseling and care as a component of routine primary medical care 2 Annual cervical cancer screening is recommended for HIV+ women 3 1 Branson BM, et al. MMWR. 2006;55: Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services December American Cancer Society Guidelines for the Early Detection of Cancer.

22 Treatment

23 Currently Available Antiretroviral Medications NRTI Abacavir (ABC) Didanosine (ddi) Emtricitabine (FTC) Lamivudine (3TC) Stavudine (d4t) Tenofovir (TDF) Zidovudine (AZT) NNRTI Delavirdine ea e( (DLV) Efavirenz (EFV) Etravirine (ETR) Nevirapine (NVP) Rilpivirine (RLP) PI Integrase Inhibitor (II) Atazanavir (ATV) Raltegravir (RAL) Darunavir au a (DRV) [elvitegravir (EVT)] Fosamprenavir (FPV) Fusion Inhibitor Indinavir (IDV) Enfuvirtide (ENF, T-20) Lopinavir (LPV) CCR5 Antagonist Nelfinavir (NFV) Maraviroc (MVC) Ritonavir (RTV) Saquinavir (SQV) Fixed Dose Combinations Tipranavir (TPV) TDF/FTC/EFV (Atripla) TDF/FTC/RLP (Complera) TDF/FTC/EVT/cbc (Stribild)

24 Treatment as Prevention

25 PACTG 076 & USPHS ZDV Recs CDC Recommends Routine HIV screening

26 Partners PrEP Study: Serodiscordant Heterosexual Couples Double-Blind Randomization 1:1 Tenofovir DF qd (n=1584) Phase 3, Double-Blind Study Kenya, Uganda Serodiscordant, heterosexual couples (n=4758) (HIV-positive partner not yet eligible for ART) Primary Endpoints HIV infection in HIV-negative partner Safety l ( 4758) Emtricitabine/Tenofovir DF qd (n=1579) Normal liver, renal, hematologic values/function Follow-Up Up to 36 months (median 23 months; 7830 person-years) Placebo (n=1584) All patients received comprehensive HIV prevention services. 26 Baeten J, et a. N Engl J Med. 2012;367: Murnane P, et al. 20 th CROI. Atlanta, Abstract 1000.

27 Partners PrEP Study: Subsets of High-Risk Women HIV Incidence HIV In ncidence (per 100-p person-yea ars) % 74% Reduction Reduction (P=0.03) (P=0.037) % Reduction (P=0.016) 016) 72% Reduction (P=0.027) 1.7 Placebo Tenofovir DF Emtricitabine/tenofovir DF % Reduction (P=0.043) 78% Reduction (P=0.046) Unprotected Sex Prior 3 Months (n=329/314/319) Partner HIV RNA >50K Copies/mL (n=154/144/146) Male Partner >10 Years Older (n=143/149/136) 27 Murnane P, et al. 20 th CROI. Atlanta, Abstract 1000.

28 Prevention Hopes for the Future Effective microbicide(s) Effective vaccine(s)

29

30 Very Early Triple-Drug ART Elicits Functional Cure in HIV-Infected I Child Infant born to untreated HIV-infected mother at 35 wks gestation via spontaneous vaginal delivery [1] Maternal HIV infection identified during labor via ELISA and Western blot Infant HIV infection confirmed via HIV-1 DNA PCR, HIV-1 RNA analysis of 2 separate samples at 30 and 31 hrs of age [2] ZDV/3TC + NVP (at therapeutic ti dose) initiated iti t at 31 hrs of age, continued for 7 days ZDV/3TC + LPV/RTV continued from 7 days to 18 mos of age HIV-1 RNA undetectable by Day 30 Mother removed patient from care at 18 mos of age 1. Persaud D, et al. CROI Abstract 48LB. 2. DHHS Pediatric Guidelines

31 Functional Cure Child: Standard HIV-1 Assays Undetectable to Age 26 Mos ART regimens: ZDV/3TC + NVP Assessments at Mos 24 and 26 (31 hours 7 days) Western blot negative ZDV/3TC + LPV/RTV (7 days No HIV-specific CD8+ or CD4+ 18 months) T-cell responses Plasma VL on ART displayed typical biphasic decay from baseline VL 19,812 c/ml VL undetectable by < 30d of age VL remained undetectable though > 80d of age Persaud D, et al. CROI Abstract 48LB. Standard HIV-1 RNA and HIV-1 DNA undetectable By ultrasensitive assays Mo 24: HIV-1 RNA 1 c/ml; HIV-1 DNA < 2.7 c/million PBMCs Mo 26: HIV-1 DNA 4 c/million PBMCs Clinical trials of exposed infants treated with ART recommended

Susan L. Koletar, MD

Susan L. Koletar, MD HIV/AIDS Susan L. Koletar, MD Division Director, Infectious Diseases Professor of Internal Medicine Department of Internal Medicine The Ohio State University Wexner Medical Center HIV through the Decades

More information

ART and Prevention: What do we know?

ART and Prevention: What do we know? ART and Prevention: What do we know? Biomedical Issues Trip Gulick, MD, MPH Chief, Division of Infectious Diseases Professor of Medicine Weill Cornell Medical College New York City ART for Prevention:

More information

Pediatric HIV Infection and the Medical Management of Pregnant Women infected with HIV. Ernesto Parra, M.D., M.P.H.

Pediatric HIV Infection and the Medical Management of Pregnant Women infected with HIV. Ernesto Parra, M.D., M.P.H. Pediatric HIV Infection and the Medical Management of Pregnant Women infected with HIV Ernesto Parra, M.D., M.P.H. Adjunct Associate Professor UTHSCSA Department of Pediatrics and Family and Community

More information

The use of antiretroviral agents during pregnancy in Canada and compliance with North-American guidelines

The use of antiretroviral agents during pregnancy in Canada and compliance with North-American guidelines The use of antiretroviral agents during pregnancy in Canada and compliance with North-American guidelines I. Boucoiran, T. Lee, K. Tulloch, L. Sauve, L. Samson, J. Brophy, M. Boucher and D. Money For and

More information

Susan L. Koletar, MD

Susan L. Koletar, MD HIV/AIDS Susan L. Koletar, MD Division Director, Infectious Diseases Professor of Internal Medicine Department of Internal Medicine The Ohio State University Wexner Medical Center HIV through the Decades

More information

Comprehensive Guideline Summary

Comprehensive Guideline Summary Comprehensive Guideline Summary Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents AETC NRC Slide Set Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and

More information

I. HIV Epidemiology. HIV Infection A Primer. Objectives. Disclosures 7/18/2014

I. HIV Epidemiology. HIV Infection A Primer. Objectives. Disclosures 7/18/2014 Objectives HIV Infection A Primer Discuss the worldwide and domestic epidemiology of HIV infection Review HIV Biology Review HIV Transmission and Prevention Review HIV diagnosis Describe the approaches

More information

Pharmacological considerations on the use of ARVs in pregnancy

Pharmacological considerations on the use of ARVs in pregnancy Pharmacological considerations on the use of ARVs in pregnancy 11 th Residential Course on Clinical Pharmacology of Antiretrovirals Torino, 20-22 January 2016 Prof. David Burger, PharmD, PhD david.burger@radboudumc.nl

More information

Criteria for Oral PrEP

Criteria for Oral PrEP Oral PrEP New Drugs Roy M. Gulick, MD, MPH Chief, Division of Infectious Diseases Professor of Medicine Weill Medical College of Cornell University New York City Safe Criteria for Oral PrEP Penetrates

More information

Update on Antiretroviral Treatment for HIV Infection 2008

Update on Antiretroviral Treatment for HIV Infection 2008 Update on Antiretroviral Treatment for HIV Infection 2008 Janet Gilmour MD FRCP(C) Clinical Associate Professor of Medicine University of Calgary November 2008 Disclosure and Acknowledgements Disclosure:

More information

Pediatric HIV Update NORTHWEST AIDS EDUCATION AND TRAINING CENTER

Pediatric HIV Update NORTHWEST AIDS EDUCATION AND TRAINING CENTER NORTHWEST AIDS EDUCATION AND TRAINING CENTER Pediatric HIV Update Christian B. Ramers, MD, MPH Assistant Medical Director, Family Health Centers of San Diego HIV/HCV Distance Education Specialist - NWAETC,

More information

When to Start ART. Reduction in HIV transmission. ? Reduction in HIV-associated inflammation and associated complications» i.e. CV disease, neuro, etc

When to Start ART. Reduction in HIV transmission. ? Reduction in HIV-associated inflammation and associated complications» i.e. CV disease, neuro, etc When to Start ART Exact CD4 count at which to initiate therapy not known, but evidence points to starting at higher counts Current recommendation: ART for all patients with CD4 count of

More information

HIV/AIDS HIV/AIDS: Outline. Morbidity and Mortality Weekly Report (MMWR)

HIV/AIDS HIV/AIDS: Outline. Morbidity and Mortality Weekly Report (MMWR) HIV/AIDS: Outline HIV/AIDS 2013 Roy M. Gulick, MD, MPH Professor of Medicine Chief, Division of Infectious Diseases Weill Medical College of Cornell University New York City January 31, 2013 Epidemiology

More information

Preventing Mother to Child HIV Transmission: Are We There Yet?!'

Preventing Mother to Child HIV Transmission: Are We There Yet?!' Preventing Mother to Child HIV Transmission: Are We There Yet?!' 2017 Michigan Clincal Nursing Conference for HIV and STD Care May 18, 2017 Frankenmuth MI 1 Theodore B. Jones, MD Maternal Fetal Medicine

More information

/AIDS HIV/ HIV Overview. Nelson L. Michael, MD, PhD Division of Retrovirology Walter Reed Army Institute of Research US Military HIV Research Program

/AIDS HIV/ HIV Overview. Nelson L. Michael, MD, PhD Division of Retrovirology Walter Reed Army Institute of Research US Military HIV Research Program /AIDS HIV/ HIV Overview Nelson L. Michael, MD, PhD Division of Retrovirology Walter Reed Army Institute of Research US Military HIV Research Program www.hivresearch.org 1 WRAIR Tropical Medicine Course

More information

HIV Overview. Mary Marovich, MD, DTMH Division of Retrovirology Walter Reed Army Ins?tute of Research US Military HIV Research Program

HIV Overview. Mary Marovich, MD, DTMH Division of Retrovirology Walter Reed Army Ins?tute of Research US Military HIV Research Program HIV Overview Mary Marovich, MD, DTMH Division of Retrovirology Walter Reed Army Ins?tute of Research US Military HIV Research Program www.hivresearch.org 1 Outline HIV Virology, Transmission, and Pathogenesis

More information

HIV Treatment: New and Veteran Drugs Classes

HIV Treatment: New and Veteran Drugs Classes HIV Treatment: New and Veteran Drugs Classes Jonathan M Schapiro, MD National Hemophilia Center Stanford University School of Medicine Rome, March 2013 Overview Many excellent antiretroviral agents are

More information

Continuing Education for Pharmacy Technicians

Continuing Education for Pharmacy Technicians Continuing Education for Pharmacy Technicians HIV/AIDS TREATMENT Michael Denaburg, Pharm.D. Birmingham, AL Objectives: 1. Identify drugs and drug classes currently used in the management of HIV infected

More information

Simplifying HIV Treatment Now and in the Future

Simplifying HIV Treatment Now and in the Future Simplifying HIV Treatment Now and in the Future David M. Hachey, Pharm.D., AAHIVP Professor Idaho State University Department of Family Medicine Nothing Disclosure 1 Objectives List current first line

More information

Overview of HIV WRAIR- GEIS 'Operational Clinical Infectious Disease' Course

Overview of HIV WRAIR- GEIS 'Operational Clinical Infectious Disease' Course Overview of HIV WRAIR- GEIS 'Operational Clinical Infectious Disease' Course UNCLASSIFIED Acknowledgments - Dr. Christina Polyak - Dr. Julie Ake Disclaimer The views expressed in this presentation are

More information

MEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 03/07/18 SECTION: DRUGS LAST REVIEW DATE: 02/19/19 LAST CRITERIA REVISION DATE: ARCHIVE DATE:

MEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 03/07/18 SECTION: DRUGS LAST REVIEW DATE: 02/19/19 LAST CRITERIA REVISION DATE: ARCHIVE DATE: FUZEON (enfuvirtide) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs

More information

The ART of Managing Drug-Drug Interactions in Patients with HIV

The ART of Managing Drug-Drug Interactions in Patients with HIV The ART of Managing Drug-Drug Interactions in Patients with HIV Bradley L. Smith, Pharm.D. smith.bradley1@mayo.edu Pharmacy Grand Rounds December 19, 2017 2017 MFMER slide-1 Presentation Objectives Describe

More information

Overview of HIV. LTC Paige Waterman

Overview of HIV. LTC Paige Waterman Overview of HIV LTC Paige Waterman Outline Background and Epidemiology HIV Virology, Transmission, and Pathogenesis Acute HIV infection HIV Diagnostics Management of Health Care Personnel Exposed to HIV

More information

Selected Issues in HIV Clinical Trials

Selected Issues in HIV Clinical Trials Selected Issues in HIV Clinical Trials Judith S. Currier, M.D., MSc Professor of Medicine Division of Infectious Diseases University of California, Los Angeles Issues Evolving Global and Domestic Epidemic

More information

Northwest AIDS Education and Training Center Educating health care professionals to provide quality HIV care

Northwest AIDS Education and Training Center Educating health care professionals to provide quality HIV care Northwest AIDS Education and Training Center Educating health care professionals to provide quality HIV care www.nwaetc.org The Northwest AIDS Education and Training Center (NW AETC), located at the University

More information

HIV basics. Katya Calvo Medical Director of Antimicrobial Stewardship

HIV basics. Katya Calvo Medical Director of Antimicrobial Stewardship HIV basics Katya Calvo Medical Director of Antimicrobial Stewardship Learning Objectives 1. Review of HIV epidemiology worldwide and locally 2. Review of recommendations on whom to screen 3. Work up of

More information

Overview of HIV. Christina Polyak, MD, MPH. Research Physician. U.S. Military HIV Research Program, Walter Reed Army Institute of Research

Overview of HIV. Christina Polyak, MD, MPH. Research Physician. U.S. Military HIV Research Program, Walter Reed Army Institute of Research Overview of HIV Christina Polyak, MD, MPH Research Physician U.S. Military HIV Research Program, Walter Reed Army Institute of Research The views expressed are those of the authors and should not be construed

More information

HIV Treatment Update. Awewura Kwara, MD, MPH&TM Associate Professor of Medicine and Infectious Diseases Brown University

HIV Treatment Update. Awewura Kwara, MD, MPH&TM Associate Professor of Medicine and Infectious Diseases Brown University HIV Treatment Update Awewura Kwara, MD, MPH&TM Associate Professor of Medicine and Infectious Diseases Brown University Outline Rationale for highly active antiretroviral therapy (HAART) When to start

More information

Selected Issues in HIV Clinical Trials

Selected Issues in HIV Clinical Trials Selected Issues in HIV Clinical Trials Judith S. Currier, M.D., MSc Professor of Medicine Division of Infectious Diseases University of California, Los Angeles Issues Evolving Global and Domestic Epidemic

More information

HIV Update Objectives. Epidemiology. Epidemiology, Transmission and Natural History. Transmission Risk by Exposure. Transmission 9/29/2014

HIV Update Objectives. Epidemiology. Epidemiology, Transmission and Natural History. Transmission Risk by Exposure. Transmission 9/29/2014 Objectives HIV Update 2014 Jay Sizemore, MD, MPH Medical Director Chattanooga CARES Assistant Professor UTCOM Chattanooga 2October 2014 Review HIV epidemiology and screening/testing guidelines Discuss

More information

THE HIV LIFE CYCLE. Understanding How Antiretroviral Medications Work

THE HIV LIFE CYCLE. Understanding How Antiretroviral Medications Work THE HIV LIFE CYCLE Understanding How Antiretroviral Medications Work DEFINITIONS Host: The animal or cell that another organism lives in. In HIV human CD4 T-cells are the host for HIV. Nucleus: The core

More information

Nobel /03/28. HIV virus and infected CD4+ T cells

Nobel /03/28. HIV virus and infected CD4+ T cells Mechanism of HIV drug resistance. Rodrigo Brindeiro / Amilcar Tanuri Laboratório de Virologia Molecular UFRJ 2 -Asso ciate Research Scientist, Internatio nal Center fo r Aids Care and Treatment Programs-ICAP,

More information

Pediatric Antiretroviral Resistance Challenges

Pediatric Antiretroviral Resistance Challenges Pediatric Antiretroviral Resistance Challenges Thanyawee Puthanakit, MD The HIVNAT, Thai Red Cross AIDS research Center The Research Institute for Health Science, Chiang Mai University Outline The burden

More information

A Fatal Imbalance. Tropical diseases: 18 new drugs (incl. 8 for malaria) 1.3% 21 new drugs for neglected diseases. Tuberculosis: 3 new drugs

A Fatal Imbalance. Tropical diseases: 18 new drugs (incl. 8 for malaria) 1.3% 21 new drugs for neglected diseases. Tuberculosis: 3 new drugs ADDRESSING GAPS IN INNOVATION FOR NEGLECTED PATIENTS: DNDI ANDPEDIATRIC HIV/AIDS Rachel Cohen, Regional Executive Director, DNDi North America Proposals for a Global Innovation System that Responds to

More information

0.14 ( 0.053%) UNAIDS 10% (94) ( ) (73-94/6 ) 8,920

0.14 ( 0.053%) UNAIDS 10% (94) ( ) (73-94/6 ) 8,920 0.14 UNAIDS 0.053% 2 250 60 10% 94 73 20 73-94/6 8,920 12 43 Public Health Service Task Force Recommendations 5-10% for Use of Antiretroviral Drugs in 10-20% Pregnant HIV-1-Infected Women for Maternal

More information

HIV for the Non-ID Pharmacist

HIV for the Non-ID Pharmacist Disclosures HIV for the Non-ID Pharmacist I have nothing to disclose at this time Carmen Faulkner-Fennell, PharmD, BCPS (AQ-ID) Clinical Pharmacy Specialist--Infectious Diseases Greenville Hospital System

More information

HIV Drugs and the HIV Lifecycle

HIV Drugs and the HIV Lifecycle HIV Drugs and the HIV Lifecycle Together, we can change the course of the HIV epidemic one woman at a time. #onewomanatatime #thewellproject All HIV drugs work by interrupting different steps in HIV's

More information

HIV Pharmacology 101ish - 202ish: New HIV Clinicians Workshop

HIV Pharmacology 101ish - 202ish: New HIV Clinicians Workshop HIV Pharmacology 101ish - 202ish: New HIV Clinicians Workshop Parya Saberi, PharmD, MAS The Medical Management of HIV/AIDS December 2012 Objectives What are commonly used ARVs and where do they work in

More information

ANTIRETROVIRAL TREATMENTS (Part 1of

ANTIRETROVIRAL TREATMENTS (Part 1of CCR5 CO-RECEPTOR ANTAGONISTS maraviroc (MVC) Selzentry 25mg, 75mg, FUSION INHIBITORS 20mg/mL ANTIRETROVIRAL TREATMENTS (Part 1of 5) oral soln enfuvirtide (ENF, T-20) Fuzeon 90mg/mL pwd for SC inj after

More information

HIV Update. Divya Ahuja, MD Associate Professor of Medicine University of South Carolina School of Medicine

HIV Update. Divya Ahuja, MD Associate Professor of Medicine University of South Carolina School of Medicine HIV Update Divya Ahuja, MD Associate Professor of Medicine University of South Carolina School of Medicine Rates of Diagnoses of HIV Infection among Adults and Adolescents, 2012 United States and 6 Dependent

More information

Nothing to disclose.

Nothing to disclose. Lisa G. Winston, MD University of California, San Francisco San Francisco General Hospital HIV UPDATE FOR THE PRIMARY CARE PROVIDER Nothing to disclose. 1 Outline Epidemiology Screening / testing for HIV

More information

The New Agents: Management of Experienced Patients and Resistance. Joel E. Gallant, MD, MPH Johns Hopkins University School of Medicine

The New Agents: Management of Experienced Patients and Resistance. Joel E. Gallant, MD, MPH Johns Hopkins University School of Medicine The New Agents: Management of Experienced Patients and Resistance Joel E. Gallant, MD, MPH Johns Hopkins University School of Medicine T.D. 45 year old man with HIV infection diagnosed in 2000 On multiple

More information

Sasisopin Kiertiburanakul, MD, MHS

Sasisopin Kiertiburanakul, MD, MHS What s Newin Antiretroviral Therapy? Sasisopin Kiertiburanakul, MD, MHS Division of Infectious Diseases Department of Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University Rotating RCPT,

More information

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) in the Long Term Care Setting Part 2: HIV Medications

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) in the Long Term Care Setting Part 2: HIV Medications Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) in the Long Term Care Setting Part 2: HIV Medications Carrie Allen PharmD, CGP, BCPS, BCPP, CCHP Overview - Part 2: HIV

More information

HIV MEDICATIONS AT A GLANCE. Atripla 600/200/300 mg tablet tablet daily. Complera 200/25/300 mg tablet tablet daily

HIV MEDICATIONS AT A GLANCE. Atripla 600/200/300 mg tablet tablet daily. Complera 200/25/300 mg tablet tablet daily HIV MEDICATIONS AT A GLANCE Generic Name Trade Name Strength DIN Usual Dosage Single Tablet Regimen (STR) Products Efavirenz/ Emtricitabine/ rilpivirine/ elvitegravir/ cobicistat/ alafenamide Emtricitabine/

More information

ARVs on an Empty Stomach: Food Interaction Studies in a resource Limited Setting

ARVs on an Empty Stomach: Food Interaction Studies in a resource Limited Setting ARVs on an Empty Stomach: Food Interaction Studies in a resource Limited Setting Dr. Andrew D Kambugu, FRCP (UK) Infectious Diseases Institute, Makerere University Outline of Discussion Key Definitions

More information

HIV Testing. HIV Symposium Patient Jane. Outline: 4/13/2010. What are your primary concerns for this patient?

HIV Testing. HIV Symposium Patient Jane. Outline: 4/13/2010. What are your primary concerns for this patient? Patient Jane HIV Symposium 2010 Jess Fogler Waldura, MD Mina Matin, MD National HIV AIDS Clinicians Consultation Center San Francisco General Hospital University of California, San Francisco Referral from

More information

HIV Treatment: State of the Art 2013

HIV Treatment: State of the Art 2013 HIV Treatment: State of the Art 2013 Daniel R. Kuritzkes, MD Chief, Division of Infectious Diseases Brigham and Women s Hospital Professor of Medicine Harvard Medical School Success of current ART Substantial

More information

HIV/AIDS Prenatal Care for HIV+ Mothers. 1. Algorithm for Prenatal Screening & Care (Antepartum)

HIV/AIDS Prenatal Care for HIV+ Mothers. 1. Algorithm for Prenatal Screening & Care (Antepartum) 1. Algorithm for Prenatal Screening & Care (Antepartum) 2. Algorithm for Prenatal HIV Screening and Care (Mother refuses screening) 3. Algorithm for Intrapartum Care 4. Prenatal Care for HIV+ Mothers a.

More information

Gaps between Policy and Practice in Managing HIV disease in Asia Pacific

Gaps between Policy and Practice in Managing HIV disease in Asia Pacific Gaps between Policy and Practice in Managing HIV disease in Asia Pacific Dr. N. Kumarasamy Chief Medical Officer YRGCARE Medical Centre Voluntary Health Services Chief-Chennai Antiviral Research and Treatment

More information

SELECTING THE BEST ART FOR EACH PATIENT

SELECTING THE BEST ART FOR EACH PATIENT SELECTING THE BEST ART FOR EACH PATIENT Corklin R Steinhart, MD, PhD Head, Global Medical Directors ViiV Healthcare CNVX/HIVP/0025/16 5th Asian Conference on Hepatitis & AIDS 第五届亚洲肝炎与艾滋病学术会议 28-29 May

More information

HIV Treatment Evolution. Kimberly Y. Smith MD MPH Vice President and Head, Global Research and Medical Strategy Viiv Healthcare

HIV Treatment Evolution. Kimberly Y. Smith MD MPH Vice President and Head, Global Research and Medical Strategy Viiv Healthcare HIV Treatment Evolution Kimberly Y. Smith MD MPH Vice President and Head, Global Research and Medical Strategy Viiv Healthcare Overview of the Evolution of Antiretroviral Therapy Early Treatment 1987

More information

Antiretroviral Therapy

Antiretroviral Therapy Antiretroviral Therapy Scott M. Hammer, M.D. 1986 1990 ZDV monorx 1990 1995 Alternative NRTI monorx Combination NRTI Rx Introduction of NNRTI s Antiretroviral resistance Pathogenetic concepts Evolution

More information

COMPREHENSIVE ANTIRETROVIRAL TABLE: ADULT DOSING, DOSAGE FORM MODIFICATIONS, ADVERSE REACTIONS and INTERACTION POTENTIAL

COMPREHENSIVE ANTIRETROVIRAL TABLE: ADULT DOSING, DOSAGE FORM MODIFICATIONS, ADVERSE REACTIONS and INTERACTION POTENTIAL Generic Name COMPREHENSIVE ANTIRETROVIRAL TABLE: NUCLOESIDE/TIDE REVERSE TRANSCRIPTASE INHIBITORS (N(t)RTIs) Abacavir ABC (Ziagen) Didanosine ddi (Videx EC) Emtricitabine FTC (Emtriva) Lamivudine 3TC (Epivir)

More information

The Global HIV Epidemic. Jerome Larkin, MD

The Global HIV Epidemic. Jerome Larkin, MD The Global HIV Epidemic Jerome Larkin, MD Outline Global Epidemiology Natural History of HIV Antiretroviral Therapy Malaria Tuberculosis Prevention of Mother to Child Transmission Post-Exposure Prophylaxis

More information

Epidemiology Testing Clinical Features Management

Epidemiology Testing Clinical Features Management Jason Cronin, MD Epidemiology Testing Clinical Features Management In 1981, 1 the first cases of AIDS were identified among gay men in the US. However, scientists later found evidence that the disease

More information

Optimizing 2 nd and 3 rd Line Antiretroviral Therapy in Children and Adolescents

Optimizing 2 nd and 3 rd Line Antiretroviral Therapy in Children and Adolescents Optimizing 2 nd and 3 rd Line Antiretroviral Therapy in Children and Adolescents Victor Musiime, MBChB, MMED, PhD Senior Lecturer, Makerere University Investigator, Joint Clinical Research Centre (JCRC)

More information

HIV - Therapy Principles

HIV - Therapy Principles HIV - Therapy Principles Manuel Battegay and Christine Katlama Basel, Switzerland and Paris, France Disclosure MB has received honoraria for advisory board participation from Gilead, MSD, Pfizer, ViiV

More information

Supplementary information

Supplementary information Supplementary information Dose-response Curve Slope Sets Class-Specific Limits on Inhibitory Potential of Anti-HIV Drugs Lin Shen 1,2, Susan Peterson 1, Ahmad R. Sedaghat 1, Moira A. McMahon 1,2, Marc

More information

When to start, when to switch ART and monitoring of ARV side effects

When to start, when to switch ART and monitoring of ARV side effects When to start, when to switch ART and monitoring of ARV side effects Thanomsak Anekthananon, MD Faculty of Medicine Siriraj Hospital September 4, 2009 Recommended Websites Free e-book: HIV Medicine 2007

More information

Distribution and Effectiveness of Antiretrovirals in the Central Nervous System

Distribution and Effectiveness of Antiretrovirals in the Central Nervous System Distribution and Effectiveness of Antiretrovirals in the Central Nervous System Scott Letendre, MD Associate Professor of Medicine HIV Neurobehavioral Research Center and Antiviral Research Center University

More information

ACTHIV 2018: A State-of-the-Science Conference for Frontline Health Professionals

ACTHIV 2018: A State-of-the-Science Conference for Frontline Health Professionals Initial Therapy for Antiretroviral Naïve HIV Infected Patients Michelle Cespedes, MD, MS Associate Professor of Medicine Division of Infectious Disease Icahn School of Medicine at Mount Sinai Disclosures

More information

PAEDIATRIC HIV INFECTION. Dr Ashendri Pillay Paediatric Infectious Diseases Specialist

PAEDIATRIC HIV INFECTION. Dr Ashendri Pillay Paediatric Infectious Diseases Specialist PAEDIATRIC HIV INFECTION Dr Ashendri Pillay Paediatric Infectious Diseases Specialist Paediatric HIV Infection Epidemiology Immuno-pathogenesis Antiretroviral therapy Transmission Diagnostics Clinical

More information

Supplementary Figure 1. Gating strategy and quantification of integrated HIV DNA in sorted CD4 + T-cell subsets.

Supplementary Figure 1. Gating strategy and quantification of integrated HIV DNA in sorted CD4 + T-cell subsets. Supplementary information HIV reservoir size and persistence are driven by T-cell survival and homeostatic proliferation. Chomont, N., M. El Far, P. Ancuta, L. Trautmann, F. A. Procopio, B. Yassine-Diab,

More information

The Future of HIV: Advances in Drugs and Research. Shauna Gunaratne December 17, 2018

The Future of HIV: Advances in Drugs and Research. Shauna Gunaratne December 17, 2018 The Future of HIV: Advances in Drugs and Research Shauna Gunaratne December 17, 2018 Overview Epidemiology Science of HIV How HIV treatment and management have changed over the years New medicines and

More information

HIV and the Central Nervous System Impact of Drug Distribution Scott L. Letendre, MD. Professor of Medicine University of California, San Diego

HIV and the Central Nervous System Impact of Drug Distribution Scott L. Letendre, MD. Professor of Medicine University of California, San Diego HIV and the Central Nervous System Impact of Drug Distribution Scott L. Letendre, MD Professor of Medicine University of California, San Diego Disclosures Grant/research support Abbvie Gilead Sciences

More information

Second-Line Therapy NORTHWEST AIDS EDUCATION AND TRAINING CENTER

Second-Line Therapy NORTHWEST AIDS EDUCATION AND TRAINING CENTER NORTHWEST AIDS EDUCATION AND TRAINING CENTER Second-Line Therapy David Spach, MD Clinical Director, Northwest AETC Professor of Medicine, Division of Infectious Diseases University of Washington Presentation

More information

ART for HIV Prevention:

ART for HIV Prevention: ART for HIV Prevention: KENNETH H. MAYER, M.D. Brown University/The Fenway Institute August 22, 2009 APPROACHES TO PREVENT HIV TRANSMISSION DECREASE SOURCE OF INFECTION Barrier Protection Treat STI Antiretroviral

More information

U=U NHIVNA HIV, Fertility and Contraception in the era of

U=U NHIVNA HIV, Fertility and Contraception in the era of HIV, Fertility and Contraception in the era of U=U NHIVNA 2018 Yvonne Gilleece Consultant in HIV and Sexual Health Brighton &Sussex University Hospitals NHS Trust Honorary Senior Lecturer Brighton & Sussex

More information

Addressing Pediatric Needs of the Most Neglected: next steps

Addressing Pediatric Needs of the Most Neglected: next steps Addressing Pediatric Needs of the Most Neglected: next steps An updated overview of DNDi Pediatric Focus Nathalie Strub Wourgaft (Medical Director) Janice Lee (HIV Pediatric Clinical Manager) A Fatal Imbalance

More information

Didactic Series. Update: 2012 HIV Treatment Guidelines. Daniel Lee, MD August 30, 2012

Didactic Series. Update: 2012 HIV Treatment Guidelines. Daniel Lee, MD August 30, 2012 Didactic Series Update: 2012 HIV Treatment Guidelines Daniel Lee, MD August 30, 2012 ACCREDITATION STATEMENT: University of California, San Diego School of Medicine is accredited by the Accreditation Council

More information

Antiretroviral Therapy During Pregnancy and Delivery: 2015 Update

Antiretroviral Therapy During Pregnancy and Delivery: 2015 Update Frontier AIDS Education and Training Center Antiretroviral Therapy During Pregnancy and Delivery: 2015 Update Brian R. Wood, MD Assistant Professor of Medicine, University of Washington Medical Director,

More information

What's new in the WHO ART guidelines How did markets react?

What's new in the WHO ART guidelines How did markets react? WHO 2013 ARV Guidelines What's new in the WHO ART guidelines How did markets react? Dr. J. Perriëns Coordinator, HIV Technology and Commodities HIV department, WHO, Geneva When to start in adults Starting

More information

Principles of Antiretroviral Therapy

Principles of Antiretroviral Therapy Principles of Antiretroviral Therapy Ten Principles of Antiretroviral Therapy Skills Building Workshop: Clinical Management of HIV Infection and Antiretroviral Therapy, 11 th ICAAP, November 21st, 2011,

More information

COMPREHENSIVE ANTIRETROVIRAL TABLE: ADULT DOSING**, DOSAGE FORM MODIFICATIONS, ADVERSE REACTIONS and INTERACTION POTENTIAL

COMPREHENSIVE ANTIRETROVIRAL TABLE: ADULT DOSING**, DOSAGE FORM MODIFICATIONS, ADVERSE REACTIONS and INTERACTION POTENTIAL COMPREHENSIVE ANTIRETROVIRAL TABLE: NUCLOESIDE/TIDE REVERSE TRANSCRIPTASE INHIBITORS (N(t)RTIs) Abacavir ABC (Ziagen) Didanosine ddi (Videx EC) Emtricitabine FTC (Emtriva) Lamivudine 3TC (Epivir) Stavudine

More information

Vitamin D Deficiency in HIV: A Shadow on Long-Term Management?

Vitamin D Deficiency in HIV: A Shadow on Long-Term Management? AIDS Rev. 2014;16:59-74 (Supplementary Data) Vitamin D Deficiency in HIV: A Shadow on Long-Term Management? Chloe Orkin, et al.: Vitamin D deficiency in HIV (Supplementary Data) Chloe Orkin 1, David A.

More information

I S H P S p r i n g C o n f e r e n c e Megan Koyle, PharmD Elaine Nguyen, PharmD, MPH, BCPS

I S H P S p r i n g C o n f e r e n c e Megan Koyle, PharmD Elaine Nguyen, PharmD, MPH, BCPS I S H P S p r i n g C o n f e r e n c e 2 0 1 5 Megan Koyle, PharmD Elaine Nguyen, PharmD, MPH, BCPS Objectives Increase foundational knowledge of HIV/AIDS through greater awareness of epidemiology, pathophysiology,

More information

HIV Diagnosis and Management 2015 Update. Faria Farhat, MD MedStar Washington Hospital Center

HIV Diagnosis and Management 2015 Update. Faria Farhat, MD MedStar Washington Hospital Center HIV Diagnosis and Management 2015 Update Faria Farhat, MD MedStar Washington Hospital Center Objectives Describe the epidemiology and pathogenesis of HIV infection Highlight HIV diagnosis algorithm and

More information

Actualización y Futuro en VIH

Actualización y Futuro en VIH Actualización y Futuro en VIH Dr. Santiago Moreno Servicio de Enfermedades Infecciosas Hospital U. Ramón y Cajal. Universidad de Alcalá. IRYCIS. Madrid Agenda Control of the HIV-epidemic Coinfections Antiretroviral

More information

Josep Mallolas Hospital Clínic Barcelona

Josep Mallolas Hospital Clínic Barcelona Nuevos paradigmas en la infección VIH Josep Mallolas Hospital Clínic Barcelona 1. Do you believe, I have to start ARV therapy? Incidence and Mortality of AIDS in Spain HIV and NON-AIDS complications HIV

More information

Approach for the Newly Diagnosed HIV Positive Patient

Approach for the Newly Diagnosed HIV Positive Patient Approach for the Newly Diagnosed HIV Positive Patient Jason E. Farley, PhD, MPH, ANP-BC, FAAN, AACRN Associate Professor & NP, Johns Hopkins University School of Nursing & Medicine Director, AETC Adult-Gerontology

More information

Antiretroviral Dosing in Renal Impairment

Antiretroviral Dosing in Renal Impairment Protease Inhibitors (PIs) Atazanavir Reyataz hard capsules 300 mg once daily taken with ritonavir 100 mg once daily No dosage adjustment is needed for atazanavir in renal impairment Atazanavir use in haemodialysis

More information

Didactic Series. Switching Regimens in the Setting of Virologic Suppression

Didactic Series. Switching Regimens in the Setting of Virologic Suppression Didactic Series Switching Regimens in the Setting of Virologic Suppression Craig Ballard, PharmD, AAHIVP UC San Diego Health Owen Clinic June 14 th, 2018 1 Learning Objectives 1) Describe DHHS guidelines

More information

Industry Data Request

Industry Data Request Industry Data Request Purpose: reported data will be used internally to populate patient forecasting models that are used for business planning. Business planning includes stock requirement forecasts,

More information

Disclosures. Update on HIV Drug Therapy: A Case based Discussion. Case # 1: Dr. Grant has received grant support from BMS, Gilead, Janssen, and Viiv

Disclosures. Update on HIV Drug Therapy: A Case based Discussion. Case # 1: Dr. Grant has received grant support from BMS, Gilead, Janssen, and Viiv Disclosures Update on HIV Drug Therapy: A Case based Discussion Dr. Grant has received grant support from BMS, Gilead, Janssen, and Viiv Philip Grant Assistant Professor Division of Infectious Diseases

More information

TB Intensive Tyler, Texas December 2-4, Tuberculosis and HIV Co-Infection. Lisa Y. Armitige, MD, PhD. December 4, 2008.

TB Intensive Tyler, Texas December 2-4, Tuberculosis and HIV Co-Infection. Lisa Y. Armitige, MD, PhD. December 4, 2008. TB Intensive Tyler, Texas December 2-4, 2008 Tuberculosis and HIV Co-Infection Lisa Y. Armitige, MD, Ph.D. December 4, 2008 Tuberculosis and HIV Co Infection Lisa Y. Armitige, MD, PhD Assistant Professor

More information

2016 Perinatal Treatment Guidelines Update

2016 Perinatal Treatment Guidelines Update Mountain West AIDS Education and Training Center 2016 Perinatal Treatment Guidelines Update Shireesha Dhanireddy, MD Associate Professor of Medicine, University of Washington 2 November 2016 This presentation

More information

Somnuek Sungkanuparph, M.D.

Somnuek Sungkanuparph, M.D. HIV Drug Resistance Somnuek Sungkanuparph, M.D. Associate Professor Division of Infectious Diseases Department of Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University Adjunct Professor

More information

Update 2013 HIV Treatment & Prevention

Update 2013 HIV Treatment & Prevention Update 2013 HIV Treatment & Prevention Kiat Ruxrungtham Professor of Medicine, Chulalongkorn University; and HIV-NAT, Thai Red Cross AIDS Research Center Time from HIV seroconversion to death N= 3823 from

More information

Advances in HIV Treatment: When to Start Treatment Which Antivirals to Use

Advances in HIV Treatment: When to Start Treatment Which Antivirals to Use Advances in HIV Treatment: When to Start Treatment Which Antivirals to Use Calvin Cohen MD Harvard Vanguard Medical Associates CRI New England Vice Chair, Science Steering Cmte, INSIGHT Boston MA Learning

More information

Selecting an Initial Antiretroviral Therapy (ART) Regimen

Selecting an Initial Antiretroviral Therapy (ART) Regimen Selecting an Initial Antiretroviral Therapy (ART) Regimen An HIV Diagnosis is a Call to Action In support of the NYSDOH AIDS Institute s January 2018 call to action for patients newly diagnosed with HIV,

More information

HIV infection and Primary Care. HIV Care in /30/2013. It s not the AIDS of 85. Stephen Raffanti MD MPH Vanderbilt University School of Medicine

HIV infection and Primary Care. HIV Care in /30/2013. It s not the AIDS of 85. Stephen Raffanti MD MPH Vanderbilt University School of Medicine HIV infection and Primary Care Stephen Raffanti MD MPH Vanderbilt University School of Medicine HIV Care in 2013 Chronic lifelong treatment with all the associated issues: medication tolerability medication

More information

ART: The New, The Old and The Ugly

ART: The New, The Old and The Ugly ART: The New, The Old and The Ugly Our Current ARVS The Nucleoside/ Nucleotide Reverse Transcriptase Inhibitors (NRTIs/ NtRTIs) Abacavir Emtricitabine Lamivudine Stavudine Tenofovir Zidovudine The Non-Nucleoside

More information

PHARMACOKINETICS OF ANTIRETROVIRAL AND ANTI-HCV AGENTS

PHARMACOKINETICS OF ANTIRETROVIRAL AND ANTI-HCV AGENTS 8. PHARMACOKINETICS OF ANTIRETROVIRAL AND ANTI-HCV AGENTS David Burger José Moltó Table 8.1a: INFLUENCE OF FOOD ON ABSORPTION (AREA UNDER THE CURVE) OF ANTIRETROVIRAL AGENTS NUCLEOSIDE ANALOGUES NtRTI

More information

Central Nervous System Penetration of ARVs: Does it Matter?

Central Nervous System Penetration of ARVs: Does it Matter? NORTHWEST AIDS EDUCATION AND TRAINING CENTER Central Nervous System Penetration of ARVs: Does it Matter? Christina M. Marra, MD Neurology and Medicine (Infectious Diseases) University of Washington 15

More information

POST-EXPOSURE PROPHYLAXIS, PRE-EXPOSURE PROPHYLAXIS, & TREATMENT OF HIV

POST-EXPOSURE PROPHYLAXIS, PRE-EXPOSURE PROPHYLAXIS, & TREATMENT OF HIV POST-EXPOSURE PROPHYLAXIS, PRE-EXPOSURE PROPHYLAXIS, & TREATMENT OF HIV DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none

More information

Overview of HIV WRAIR- GEIS 'Operational Clinical Infectious Disease' Course

Overview of HIV WRAIR- GEIS 'Operational Clinical Infectious Disease' Course Overview of HIV WRAIR- GEIS 'Operational Clinical Infectious Disease' Course The opinions or assertions contained herein are the private views of the author, and are not to be construed as official, or

More information

WOMENS INTERAGENCY HIV STUDY ANTIRETROVIRAL DOSAGE FORM SECTION A. GENERAL INFORMATION

WOMENS INTERAGENCY HIV STUDY ANTIRETROVIRAL DOSAGE FORM SECTION A. GENERAL INFORMATION WOMENS INTERAGENCY HIV STUDY ANTIRETROVIRAL DOSAGE FORM SECTION A. GENERAL INFORMATION A1. PARTICIPANT ID: ENTER NUMBER HERE - - - ONLY IF ID LABEL IS NOT AVAILABLE A2. VISIT #: A3. VERSION DATE: 1 0 /

More information

HIV Infection & AIDS in Low- and Middle-Income Countries

HIV Infection & AIDS in Low- and Middle-Income Countries GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 25: HIV Infection & AIDS in Low- and Middle-Income Countries Author P. Van de Perre, MD, PhD Chapter Editor Michelle Doll, MD, MPH Topic Outline Key Issues

More information

UPDATE ON PEDIATRIC HIV. Roseann Marone MPH, BSN RN Assistant Professor of Pediatrics 9/5/12

UPDATE ON PEDIATRIC HIV. Roseann Marone MPH, BSN RN Assistant Professor of Pediatrics 9/5/12 UPDATE ON PEDIATRIC HIV Roseann Marone MPH, BSN RN Assistant Professor of Pediatrics 9/5/12 DID YOU KNOW? HIV/AIDS was identified in 1981 31 years this June USA has over 1 million individuals living with

More information