CLAUDINE HENNESSEY & THEUNIS HURTER

Size: px
Start display at page:

Download "CLAUDINE HENNESSEY & THEUNIS HURTER"

Transcription

1 HIV/AIDS/TB CLAUDINE HENNESSEY & THEUNIS HURTER

2 KEY TERMS Do these sound familiar? What strange terms do you hear in the clinics? Any others to add?? HIV AIDS Viral Load & suppression CD4 count Regimen Adherence Monitoring Resistance HAART Enrolment Criteria

3 History of HIV 3 Originated in non-human primates in Sub-Saharan Africa Transferred to humans during the late 19th or early 20th century Chimpanzee Hunter theory: virus transmitted from a chimpanzee to a human when a bush meat hunter was bitten or cut while hunting or butchering an animal

4 First cases : British printer (possible AIDS death) 4 Sailor in the navy oldest documented possible case Symptoms included: shortness of breath, extreme fatigue, rapid weight loss, night sweats and high fever 1959: Congolese man One of earliest documented HIV-1 infections discovered in a preserved blood sample 1960: Congolese woman discovered in a preserved lymph node biopsy 1969: Robert R. Suspected to be a prostitute Died from aggressive Kaposi s sarcoma Later tests on stored blood showed HIV infection 1969: Arvid Noe Sailor, wife and 9 year old daughter died of AIDS

5 Can one person start an pandemic? Gaëtan Dugas, 5 so-called "Patient Zero flight attendant who had over 2,500 sexual partners across North America At least 40 of the 248 people diagnosed with AIDS by April 1982 were thought to have had sex either with him or with someone who had. Dugas refused to stop having unprotected sex after being diagnosed, and informed some of his sex partners that he had the "gay cancer" and perhaps they would get it too. TRUE or FALSE?

6 Difference between HIV & AIDS HIV the patient is infected with the Human Immunodeficiency Virus and can be unaware of being infected for a period of 4-8 or more years. The virus that causes AIDS 6 AIDS Acquired Immune Deficiency Syndrome: according the SA guidelines it is when the CD4 cell count drops below 200 and/or the patient has severe opportunistic diseases

7 What is HIV? 7 2 Types: HIV-1 (worldwide): Most common and pathogenic has 3 sub-groups, each of them with many sub-types, but clinically identical. HIV-2 (Localised in West-Africa): has lower pathogenicity and lower MTCT risk.

8 What Is Viral Load? The HIV viral load is simply a measure of the quantity of virus in a drop (ml) of a patient s blood In general, the higher the viral load, the faster CD4 cells are destroyed Over time, viral load increases as more and more viruses are produced

9 What is CD4? Cell in body that fights off infection - police Virus enters your body - criminal CD4 attacks that virus police arrest the criminal Virus dies criminal goes to jail HIV enters your body- criminal Enters CD4 cells criminal fights the police in the police station 9 Other viruses enter the body (TB, Pneumonia) other criminals end up running wild Police (CD4) are busy fighting the criminals (HIV) TB, PNEUMONIA (OTHER CRIMINALS) OVER TAKE THE BODY... Goal of HIV/ARV care: to increase the number of CD4 cells in the body

10 CD4 cells have specialized receptors on their surface. LOCK Once HIV gets into bloodstream, it is able to locate CD4 cells and attaches to CD4 receptors. KEY What is a CD4??? HIV and the immune System HIV has protein spikes around its periphery that fit perfectly into CD4 receptors. Right key CD4

11 Plasma HIV RNA Natural history of HIV infection 10,000,000 1,000, ,000 10,000 1, Primary Infectio n Seroconversio n ARS Viral Load Intermediate Stage CD4 Cells Danger Zone AIDS 1, Weeks 5-10 Years to AIDS Survival with Natural History of HIV Infection AIDS 1 year 11 CD4 Cell Count

12 The HIV Life Cycle

13 Video..\..\..\..\Cider Documents\CIDER\TIER.net training documents\hiv training videos\hiv Replication 3D Medical Animation - YouTube.flv 13

14 Why are multiple drugs needed? RT inhibitors (NRTI/NNRTI) Tenofovir TDF Zidovudine AZT Lamivudine 3TC Didanosine ddi Stavudine d4t Abacavir ABC Nevirapine NVP Efavirenz EFV Emtricitabine FTC PI s Ritonavir RTV Saquinavir SQV Lopinavir/r LPV/r

15 Goals of HAART 15 Decrease viral load Less virus = lower risk of opportunistic infections Question: What would be considered virological success? Decrease in viral load to lower than detectable limit (LDL) Allow the immune system to (partially) recover Question: What would be considered immunological success? Increase in CD4

16 Goals of HAART 16 increase quality of life Work or school/university possible increase survival and duration of infection-free life Life expectancy identical to a HIV- person

17 Goals of HAART 17 limit transmission theoretically no more virus in body fluids BUT, practically, not always true! Less persons with high viral load = less chance of new infections

18 Efficiency of HAART Before HAART: 85% of patients would be dead 3 years after AIDS diagnosis. Now: 85% of patients are still alive 3 years after AIDS diagnosis (if starting HAART at AIDS diagnosis, even more if they started before AIDS diagnosis)

19 Aim of ART 5. Increase in quality of life 1. Suppressed viral replication (VL) 4. Fewer opportunistic infections. Healthy person living with AIDS 2. Immune system recovery 3. Increase in CD4 count

20 Treating HIV 20 Prevention / treatment of opportunistic infections and cancers Specific antiviral treatment Support (psychological, social, etc ) Not just giving ARV s Adherence counseling Prevention of HIV transmission Immune boosters? Prevention and treatment of nutritional deficiencies (vitamins A, B, Fe, )

21 HAART 21 Highly Active Antiretroviral Treatment Combination (3 or more ARVs) HAART is a lifelong treatment Adherence is most important

22 ART enrolment Criteria South Africa

23 Does ART work? Photographs by: David Walton Copyright 2003 Partners In Health Before HAART After 1 year on HAART

24 What is adherence? 24

25 Adherence 25 Means the ability to 1. Take the right dose of medication 2. At the right time 3. At the right frequency 4. For the duration of treatment 5. Monitoring any adverse events, drug and/or dietary restrictions

26 Is Adherence Important? Prevents resistance to drugs developing 2 nd line therapy more complicated & more expensive Limited options in case of treatment failure After 1 st line, 2 nd line then what? 26

27 Timing is everything. Keeping drug levels in the safety zone International AIDS Society.Top HIV Med. 2003;11:

THE SOUTH AFRICAN ANTIRETROVIRAL TREATMENT GUIDELINES 2010

THE SOUTH AFRICAN ANTIRETROVIRAL TREATMENT GUIDELINES 2010 THE SOUTH AFRICAN ANTIRETROVIRAL TREATMENT GUIDELINES 2010 The South African Antiretroviral Treatment Guidelines 2010 Goals of the programme Achieve best health outcomes in the most cost-efficient manner

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

Clinical skills building - HIV drug resistance

Clinical skills building - HIV drug resistance Clinical skills building - HIV drug resistance Richard Lessells Clinical case 44-year old HIV-positive male HIV diagnosis 2010 Pre-treatment CD4+ count not known Initiated first-line ART (TDF/FTC/EFV)

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

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

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

treatment VIRAL SUPPRESSION SUPPORT ART IS THE ONLY WAY TO CONTROL HIV TIPS FOR TAKING ART ADHERENCE Benefits of ART Start Know Your ARVs today ARVs

treatment VIRAL SUPPRESSION SUPPORT ART IS THE ONLY WAY TO CONTROL HIV TIPS FOR TAKING ART ADHERENCE Benefits of ART Start Know Your ARVs today ARVs treatment Benefits of ART Know Your ARVs Start ARVs today SUPPORT VIRAL SUPPRESSION TIPS FOR TAKING ART ART IS THE ONLY WAY TO CONTROL HIV ADHERENCE HIV: BASIC FACTS HIV stands for the Human Immunodeficiency

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

Management of NRTI Resistance

Management of NRTI Resistance NORTHWEST AIDS EDUCATION AND TRAINING CENTER Management of NRTI Resistance David Spach, MD Principal Investigator, NW AETC Professor of Medicine, Division of Infectious Diseases University of Washington

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

HIV Clinical Nurse Specialist CCDHB Wellington

HIV Clinical Nurse Specialist CCDHB Wellington RN James Rice-Davies HIV Clinical Nurse Specialist CCDHB Wellington 11:00-11:55 WS #88: Undiagnosed HIV in Your Practice 12:05-13:00 WS #99: Undiagnosed HIV in Your Practice (Repeated) HIV- Undiagnosed

More information

2 nd Line Treatment and Resistance. Dr Rohit Talwani & Dr Dave Riedel 12 th June 2012

2 nd Line Treatment and Resistance. Dr Rohit Talwani & Dr Dave Riedel 12 th June 2012 2 nd Line Treatment and Resistance Dr Rohit Talwani & Dr Dave Riedel 12 th June 2012 Overview Basics of Resistance Treatment failure Strategies to manage treatment failure Mutation Definition: A change

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

TB/HIV CO-INFECTION ADULT & CHILDREN (INCLUDING INH PROPHYLAXIS) ART Treatment Guideline Training 31 st January to 4 th February, 2011

TB/HIV CO-INFECTION ADULT & CHILDREN (INCLUDING INH PROPHYLAXIS) ART Treatment Guideline Training 31 st January to 4 th February, 2011 TB/HIV CO-INFECTION ADULT & CHILDREN (INCLUDING INH PROPHYLAXIS) ART Treatment Guideline Training 31 st January to 4 th February, 2011 OUTLINE Background Global Incidence The Problem" The 3 I s Drug Resistant

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

0% 0% 0% Parasite. 2. RNA-virus. RNA-virus

0% 0% 0% Parasite. 2. RNA-virus. RNA-virus HIV/AIDS and Treatment Manado, Indonesia 16 november HIV [e] EDUCATION HIV is a 1. DNA-virus 2. RNA-virus 3. Parasite 0% 0% 0% DNA-virus RNA-virus Parasite HIV HIV is a RNA-virus. HIV is an RNA virus which

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

Introduction to HIV Drug Resistance. Kevin L. Ard, MD, MPH Massachusetts General Hospital Harvard Medical School

Introduction to HIV Drug Resistance. Kevin L. Ard, MD, MPH Massachusetts General Hospital Harvard Medical School Introduction to HIV Drug Resistance Kevin L. Ard, MD, MPH Massachusetts General Hospital Harvard Medical School Objectives 1. Describe the epidemiology of HIV drug resistance in sub-saharan Africa. 2.

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

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

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

WESTERN CAPE ART GUIDELINES PRESENTATION 2013

WESTERN CAPE ART GUIDELINES PRESENTATION 2013 WESTERN CAPE ART GUIDELINES PRESENTATION 2013 The WC guidelines are based on SA National ART guidelines dated 24th March 2013 Acknowledgement goes to members of the Adult and Paediatric HAST policy advisory

More information

Management of patients with antiretroviral treatment failure: guidelines comparison

Management of patients with antiretroviral treatment failure: guidelines comparison The editorial staff Management of patients with antiretroviral treatment failure: guidelines comparison A change of therapy should be considered for patients if they experience sustained rebound in viral

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

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

Updates on Revised Antiretroviral Treatment Guidelines Overview 27 March 2013

Updates on Revised Antiretroviral Treatment Guidelines Overview 27 March 2013 Updates on Revised Antiretroviral Treatment Guidelines 2013 Overview 27 March 2013 Introduction of Fixed Dose combination (FDC) FDCs will be available in facilities on 1 April 2013 The FDC ARV that will

More information

Clinical Management Guidelines 2012

Clinical Management Guidelines 2012 Central American Course Monitoring and Evaluation for HIV/AIDS Policy and Program Management 1 2 3 4 Module 1 Unit 1 Clinical Management Guidelines 2012 National TB, HIV/AIDS & other STIs Programme Ministry

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

Difference of opinion? Michelle Moorhouse 24 Sep 2014

Difference of opinion? Michelle Moorhouse 24 Sep 2014 Difference of opinion? Michelle Moorhouse 24 Sep 2014 Meet NN 52 years, female Nurse in pre-art clinic Referred Feb 2012 by dermatologist History of severe reactions to ART Erythema and bullous eruptions

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

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

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

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

Clinical Management of Resistance. AMJ Wensing, MD, PhD

Clinical Management of Resistance. AMJ Wensing, MD, PhD Clinical Management of Resistance AMJ Wensing, MD, PhD Changing treatment paradigm First Line Second Line? New First Line North America Western Europe: Eastern Europe Africa mix South America mix More

More information

SA HIV Clinicians Society Adult ART guidelines

SA HIV Clinicians Society Adult ART guidelines SA HIV Clinicians Society Adult ART guidelines In draft format Graeme Meintjes (on behalf of the guidelines committee) Selected topics When to start ART First-line Second-line Third-line Patients with

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

/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

treatment during pregnancy and breastfeeding

treatment during pregnancy and breastfeeding treatment during pregnancy and breastfeeding Topics covered Introduction. Preventing parent-to-child transmission. AZT as a single therapy. Treatment begun late in pregnancy. Nevirapine for mothers and

More information

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents Visit the AIDSinfo website to access the most up-to-date guideline. Register for e-mail notification of guideline

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

HIV in in Women Women

HIV in in Women Women HIV in Women Susan L. Koletar, MD The Ohio State University How Many of These Women Have HIV? Answer: I don t really know Google Search: Photos of Groups of Women Pub Med Search: HIV and Women 22,732

More information

Tunisian recommendations on ART : process and results

Tunisian recommendations on ART : process and results Second Arab Congress of Clinical Microbiology and Infectious Diseases May 24-26, 2012. Tunisian recommendations on ART : process and results M. BEN MAMOU UNAIDS Email: BenmamouM@unaids.org M. CHAKROUN

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

TB/HIV Co-Infection. Tuberculosis and HIV

TB/HIV Co-Infection. Tuberculosis and HIV TB Intensive Tyler, Texas June 2-4, 2010 TB/HIV Co-Infection Lisa Y Armitige, MD, PhD June 3, 2010 Tuberculosis and HIV Co-Infection Lisa Y Armitige, MD, PhD Medical Consultant Heartland National TB Center

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

NOTICE TO PHYSICIANS. Division of AIDS (DAIDS), National Institute of Allergy and Infectious Diseases, National Institutes of Health

NOTICE TO PHYSICIANS. Division of AIDS (DAIDS), National Institute of Allergy and Infectious Diseases, National Institutes of Health NOTICE TO PHYSICIANS DATE: March 10, 2003 TO: FROM: SUBJECT: HIV/AIDS Health Care Providers Division of AIDS (DAIDS), National Institute of Allergy and Infectious Diseases, National Institutes of Health

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

Anumber of clinical trials have demonstrated

Anumber of clinical trials have demonstrated IMPROVING THE UTILITY OF PHENOTYPE RESISTANCE ASSAYS: NEW CUT-POINTS AND INTERPRETATION * Richard Haubrich, MD ABSTRACT The interpretation of a phenotype assay is determined by the cut-point, which defines

More information

DIAGNOSING AND MANAGING TREATMENT FAILURE. Dr. Jeremy Nel Department of Infectious Diseases Helen Joseph Hospital

DIAGNOSING AND MANAGING TREATMENT FAILURE. Dr. Jeremy Nel Department of Infectious Diseases Helen Joseph Hospital DIAGNOSING AND MANAGING TREATMENT FAILURE Dr. Jeremy Nel Department of Infectious Diseases Helen Joseph Hospital VIRAL LOAD IS EVERYTHING (KINDA ) WHY DOES HIV DEVELOP (SO MUCH) RESISTANCE? Just how much

More information

Occupational and Non- Occupational HIV Post-exposure Prophylaxis

Occupational and Non- Occupational HIV Post-exposure Prophylaxis Occupational and Non- Occupational HIV Post-exposure Prophylaxis Amy V. Kindrick, MD, MPH National Clinicians Post-Exposure Prophylaxis Hotline (PEPline) University of California, San Francisco San Francisco

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

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

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

HIV associated CNS disease in the era of HAART

HIV associated CNS disease in the era of HAART HIV associated CNS disease in the era of HAART CSF/CNS penetration and efficacy Acknowledgements Peter Portegies Department of Neurology, AMC Mark van der Valk Department of Internal Medicine/Infectious

More information

Structured Treatment Interruption in HIV Positive Patients. Leah Jackson, BScPhm Pharmacy Resident HIV Rotation January 23, 2007

Structured Treatment Interruption in HIV Positive Patients. Leah Jackson, BScPhm Pharmacy Resident HIV Rotation January 23, 2007 Structured Treatment Interruption in HIV Positive Patients Leah Jackson, BScPhm Pharmacy Resident HIV Rotation January 23, 2007 Objectives To become re-acquainted with the basics of HAART for HIV infection

More information

First line ART Rilpirivine A New NNRTI. Chris Jack Physician, Durdoc Centre ethekwini

First line ART Rilpirivine A New NNRTI. Chris Jack Physician, Durdoc Centre ethekwini First line ART Rilpirivine A New NNRTI Chris Jack Physician, Durdoc Centre ethekwini Overview: Rilpirivine an option for ARV Naïve patients History Current guidelines Efficacy and Safety Tolerability /

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

The Struggle with Infectious Disease. Lecture 6

The Struggle with Infectious Disease. Lecture 6 The Struggle with Infectious Disease Lecture 6 HIV/AIDS It is generally believed that: Human Immunodeficiency Virus --------- causes ------------- Acquired Immunodeficiency Syndrome History of HIV HIV

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

Case # 1. Case #1 (cont d)

Case # 1. Case #1 (cont d) Antiretroviral Therapy Management: Expert Panel Discussion George Beatty Susa Coffey Steve O Brien December 3, 2011 Moderated by Annie Luetkemeyer Case # 1 38 y.o. man, CD4 =350, VL=340K, new to your clinic

More information

Malaysian Consensus Guidelines on Antiretroviral Therapy Cheng Joo Thye Hospital Raja Permaisuri Bainun Ipoh

Malaysian Consensus Guidelines on Antiretroviral Therapy Cheng Joo Thye Hospital Raja Permaisuri Bainun Ipoh Malaysian Consensus Guidelines on Antiretroviral Therapy 2017 Cheng Joo Thye Hospital Raja Permaisuri Bainun Ipoh Acknowledgement Table of contents Evolution of when to initiate therapy ART improves survival

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

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

James Nuttall Paediatric Infectious Diseases Unit Red Cross Children s Hospital

James Nuttall Paediatric Infectious Diseases Unit Red Cross Children s Hospital James Nuttall Paediatric Infectious Diseases Unit Red Cross Children s Hospital Paediatric HIV Infection Symposium, August 21, 2010, Red Cross Children s Hospital Overview of talk The 2010 paediatric guidelines

More information

HIV and contraception the latest recommendations

HIV and contraception the latest recommendations 1 8-11 June 2015, Chiang-Mai HIV and contraception the latest recommendations Mary Lyn Gaffield, Sharon Phillips, Rachel Baggaley, Petrus Steyn, and Marleen Temmerman 2 Medical eligibility criteria for

More information

HIV in the Brain MANAGING COMORBIDITIES IN PATIENTS WITH HIV

HIV in the Brain MANAGING COMORBIDITIES IN PATIENTS WITH HIV HIV in the Brain MANAGING COMORBIDITIES IN PATIENTS WITH HIV Shibani S. Mukerji MD, PhD Massachusetts General Hospital, Division of Immunologic, Inflammatory and Infectious Neurological Diseases Dana-Farber

More information

Persistent low level viraemia on third line ART

Persistent low level viraemia on third line ART Persistent low level viraemia on third line ART Dr Richard Lessells XXVII International workshop on HIV drug resistance and treatment strategies October 2018 46-year old HIV-positive female HIV diagnosis

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

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

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

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

Cases from the Clinic(ians): Case-Based Panel Discussion

Cases from the Clinic(ians): Case-Based Panel Discussion Cases from the Clinic(ians): Case-Based Panel Discussion Michael S. Saag, MD Professor of Medicine The University of Alabama at Birmingham EDITED: 03-12-14 Learning Objectives After attending this presentation,

More information

Case Study. Dr Sarah Sasson Immunopathology Registrar. HIV, Immunology and Infectious Diseases Department and SydPath, St Vincent's Hospital.

Case Study. Dr Sarah Sasson Immunopathology Registrar. HIV, Immunology and Infectious Diseases Department and SydPath, St Vincent's Hospital. Case Study Dr Sarah Sasson Immunopathology Registrar HIV, Immunology and Infectious Diseases Department and SydPath, St Vincent's Hospital Case 1: Case 1: 45F in Cameroon Cameroon HIV+ Presents with cutaneous

More information

Treatment experience in South Africa. Dr Ian Sanne Clinical HIV Research Unit University of the Witwatersrand

Treatment experience in South Africa. Dr Ian Sanne Clinical HIV Research Unit University of the Witwatersrand Treatment experience in South Africa Dr Ian Sanne Clinical HIV Research Unit University of the Witwatersrand Overview South African Prevalence Adherence Combination ddi + d4t Nevirapine Hepatotoxicity

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

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

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

PHCP 403 by L. K. Sarki

PHCP 403 by L. K. Sarki PHCP 403 by L. K. Sarki objectives To gain insight into the epidemiology of HIV To gain basic understanding of the etiology of HIV disease To know the clinical manifestations of the disease To gain a basic

More information

Improving accessibility to antiretroviral drugs: A south-south collaboration

Improving accessibility to antiretroviral drugs: A south-south collaboration Improving accessibility to antiretroviral drugs: A south-south collaboration Jaideep A Gogtay MD Cipla Ltd Mumbai jgogtay@cipla.com Adults and children estimated to be living with HIV at the end of 2000

More information

Treatment strategies for the developing world

Treatment strategies for the developing world David A Cooper National Centre in HIV Epidemiology and Clinical Research The University of New South Wales Sydney, Australia First line standard of care First line in the developing world First line failure

More information

British HIV Association Guidelines for the Management of Hepatitis Viruses in Adults Infected with HIV 2013 Appendix 2

British HIV Association Guidelines for the Management of Hepatitis Viruses in Adults Infected with HIV 2013 Appendix 2 British HIV Association Guidelines for the Management of Hepatitis Viruses in Adults Infected with HIV 2013 Appendix 2 Systematic literature search 2.1 Questions and PICO criteria Data bases: Medline,

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

A Genetic Test to Screen for Abacavir Hypersensitivity Reactions

A Genetic Test to Screen for Abacavir Hypersensitivity Reactions The Future of Pharmacogenetics in HIV Clinical Care A Genetic Test to Screen for Abacavir Hypersensitivity Reactions Evan Collins & Misty Bath CANAC/ACIIS 15 th Annual Conference Vancouver, BC April 2007

More information

HIV medications HIV medication and schedule plan

HIV medications HIV medication and schedule plan Living with HIV (human immunodeficiency virus) It may be scary to find out that you re HIV-positive or have AIDS. Coping with this news may be difficult. Although HIV is a serious infection, people with

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

Viral Resistance with Topical RT-Microbicides. Ian McGowan MD PhD FRCP David Geffen School of Medicine Los Angeles

Viral Resistance with Topical RT-Microbicides. Ian McGowan MD PhD FRCP David Geffen School of Medicine Los Angeles Viral Resistance with Topical RT-Microbicides Ian McGowan MD PhD FRCP David Geffen School of Medicine Los Angeles verview What antiretrovirals (ARV) are being considered as candidate microbicides? How

More information

Assessment of the therapeutic success of antiretroviral combinations used in a HIV treatment center, Jos, Nigeria

Assessment of the therapeutic success of antiretroviral combinations used in a HIV treatment center, Jos, Nigeria World Journal of Pharmaceutical Sciences ISSN (Print): 3-330; ISSN (Online): 3-3086 Published by Atom and Cell Publishers All Rights Reserved Available online at: http://www.wjpsonline.org/ Original Article

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

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

Department of General Medicine, Juntendo University School of Medicine, Tokyo; and 2

Department of General Medicine, Juntendo University School of Medicine, Tokyo; and 2 Jpn. J. Infect. Dis., 69, 33 38, 2016 Original Article Raltegravir and Abacavir/Lamivudine in Japanese Treatment-Naäƒve and Treatment-Experienced Patients with HIV Infection: a 48-Week Retrospective Pilot

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

Didactic Series. Archive Genotype Resistance Testing in the Setting of Regimen Switching

Didactic Series. Archive Genotype Resistance Testing in the Setting of Regimen Switching Didactic Series Archive Genotype Resistance Testing in the Setting of Regimen Switching Craig Ballard, Pharm.D., AAHIVP UCSD Medical Center Owen Clinic June 11, 2015 ACCREDITATION STATEMENT: University

More information

GUIDELINES FOR THE USE OF ANTIRETROVIRAL THERAPY IN PAPUA NEW GUINEA

GUIDELINES FOR THE USE OF ANTIRETROVIRAL THERAPY IN PAPUA NEW GUINEA GUIDELINES FOR THE USE OF ANTIRETROVIRAL THERAPY IN PAPUA NEW GUINEA These guidelines were prepared for the Papua New Guinea National AIDS Council and the Papua New Guinea National Department of Health.

More information

CONSOLIDATED GUIDELINES ON THE USE OF ANTIRETROVIRAL DRUGS FOR TREATING AND PREVENTING HIV INFECTION WHAT S NEW

CONSOLIDATED GUIDELINES ON THE USE OF ANTIRETROVIRAL DRUGS FOR TREATING AND PREVENTING HIV INFECTION WHAT S NEW POLICY BRIEF CONSOLIDATED GUIDELINES ON THE USE OF ANTIRETROVIRAL DRUGS FOR TREATING AND PREVENTING HIV INFECTION WHAT S NEW NOVEMBER 2015 WHO Library Cataloguing-in-Publication Data Policy brief: consolidated

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

Darunavir STADA 400, 600 and 800 mg film-coated tablets , Version 1.1 PUBLIC SUMMARY OF THE RISK MANAGEMENT PLAN

Darunavir STADA 400, 600 and 800 mg film-coated tablets , Version 1.1 PUBLIC SUMMARY OF THE RISK MANAGEMENT PLAN Darunavir STADA 400, 600 and 800 mg film-coated tablets 7.9.2016, Version 1.1 PUBLIC SUMMARY OF THE RISK MANAGEMENT PLAN VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology Human

More information

SHOULD A TRIAL EVALUATING THE USE OF LOW DOSE STAVUDINE BE CONDUCTED?

SHOULD A TRIAL EVALUATING THE USE OF LOW DOSE STAVUDINE BE CONDUCTED? SHOULD A TRIAL EVALUATING THE USE OF LOW DOSE STAVUDINE BE CONDUCTED? ETHICAL, CLINICAL AND COMMUNITY CONSIDERATIONS Eric Goemaere, MD, DTMH, PHD Senior HIV/TB program adviser MSF South Africa We loved

More information

Summary of treatment benefits

Summary of treatment benefits VI.2 Elements for a public summary VI.2.1 Overview of disease epidemiology Human immunodeficiency virus (HIV) attacks the cells of the immune system, the body's natural defense against germs and other

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

GPRM - Global Price Reporting Mechanism November Transaction prices for Antiretroviral Medicines and HIV Diagnostics from 2008 to October 2009

GPRM - Global Price Reporting Mechanism November Transaction prices for Antiretroviral Medicines and HIV Diagnostics from 2008 to October 2009 Transaction prices for Antiretroviral Medicines and HIV Diagnostics from 2008 to October 2009 A summary report from the Global Price Reporting Mechanism Contents Abbreviations. 5 Table 1 : of first-line

More information