PrEP and Behavioral Strategies for HIV Prevention. Douglas Krakower, MD January 30, 2014

Size: px
Start display at page:

Download "PrEP and Behavioral Strategies for HIV Prevention. Douglas Krakower, MD January 30, 2014"

Transcription

1 PrEP and Behavioral Strategies for HIV Prevention Douglas Krakower, MD January 30, 2014

2 Potential Competing Interests Dr. Krakower: investigator-initiated research regarding HIV prevention National Institutes of Health NIMH K23 MH Gilead Sciences Bristol-Myers Squibb AMA Foundation No other competing interests 2

3 The number of new HIV infections in the US has remained high at 50,000 per year for the past 10 years despite intensive prevention efforts Effective prevention strategies are needed CDC data, 2011

4 Outline HIV epidemiology Identifying at-risk persons Combination HIV prevention Testing Behavioral Strategies Treatment as Prevention Pre-Exposure Prophylaxis (PrEP) Post-Exposure Prophylaxis (PEP) 4

5 Men who have sex with men are at greatly increased risk for HIV acquisition Other <1% MSM/IDU 3% Injection Drug Use (IDU) 8% Heterosexual Heterosexual Contact 28% Contact 27% Male-to-Male Sexual Contact (MSM) 62% N= 50,007. CDC data, 2011

6 Black and Latino persons are at increased risk US Census and CDC Data, 2010

7 HIV and Transgender Women More than 25% of transgender women in the US are HIV seropositive More than 50% of Black/African- American trans women are HIV seropositive Herbst 2008; Schulden 2008

8 Outline HIV epidemiology Identifying at-risk persons Combination HIV prevention Testing Behavioral Strategies Treatment as Prevention Pre-Exposure Prophylaxis (PrEP) Post-Exposure Prophylaxis (PEP) 8

9 Case: The Starting Point 49M in long-term partnership with HIV-infected woman Asthma and depression How would you approach a conversation about HIV prevention options? 9

10 Discomfort as a Barrier Ironically, it may require greater intimacy to discuss sex than to engage in it. The Hidden Epidemic Institute of Medicine,

11 Assessing Sexuality in Health Care How many of you have ever been asked to discuss your sexual history during a primary care visit? Has a clinician ever asked you about sexual orientation? Has a clinician ever asked about gender identity? 11

12 Assessing for High-Risk Behaviors Have you ever had a sexually transmitted infection? Do you know the HIV status of your partners? Have you had anal sex? Was it receptive (another person s penis in your anus), insertive (your penis in another person s anus), or both? Have you exchanged sex for money, goods, or services? Have you had sex with strangers? 12

13 Case: What we learned from the conversation His partner is pregnant and not on HIV treatment She will take HIV treatment during pregnancy but wants to stop after delivery Vaginal and oral sex 4x/year; never anal sex; rare condom use 13

14 In addition to HIV testing and exploring barriers to condom use, what would you recommend in this scenario? 1. Abstain from sex 2. Behavioral intervention 3. Advise he ask partner to continue ART 4. Post-exposure prophylaxis after unprotected sex 5. Pre-exposure prophylaxis daily 6. None of these 24% 0% Abstain from sex Behavioral intervention 38% 21% 12% 6% Advise he ask partner to... Post-exposure prophylaxi... Pre-exposure prophylaxis... None of these 14

15 Case: We also learned He also has sex with men, ~ 2x/year Some anonymous (e.g., internet) Oral, insertive and receptive anal sex; uses lubrication but not condoms. Does not know the HIV status of partners. Treated for an STD once. His HIV antibody test is negative. 15

16 In addition to HIV testing and exploring barriers to condom use, what would you recommend in this scenario? 1. Abstain from sex 2. Behavioral intervention 3. Advise he ask partner to continue ART 4. Post-exposure prophylaxis after unprotected sex 5. Pre-exposure prophylaxis daily 6. None of these 2% Abstain from sex Behavioral intervention Advise he ask partner to... 65% 16% 14% 2% 0% Post-exposure prophylaxi... Pre-exposure prophylaxis... None of these 16

17 Outline HIV epidemiology Identifying at-risk persons Combination HIV prevention Testing Behavioral Strategies Treatment as Prevention Pre-Exposure Prophylaxis (PrEP) Post-Exposure Prophylaxis (PEP) 17

18 Testing is a prevention intervention Those who test positive tend to decrease risk behavior Testing is a prerequisite for: Treatment as prevention Pre-exposure prophylaxis (PrEP) Post-exposure prophylaxis (PEP) USPSTF Grade A Weinhardt 1999, USPSTF 2013

19 Behavioral interventions are effective at decreasing risk behaviors (MSM) Herbst Am J Prev 2007

20 CDC s evidence-based behavioral interventions

21 HIV+ Transmission HIV- 21

22 Treatment as Prevention HIV+ Transmission HIV- Early antiretroviral therapy to decrease viral load, irrespective of CD4 count 22

23 Does early antiretroviral therapy decrease HIV transmission? 1763 stable, healthy, serodiscordant couples, sexually active CD4 count: 350 to 550 cells/mm 3 Randomization Early antiretroviral therapy CD Delayed antiretroviral therapy CD4 250 Cohen NEJM 2011

24 Early antiretroviral therapy greatly decreases HIV transmission 1763 stable, healthy, serodiscordant couples, sexually active CD4 count: 350 to 550 cells/mm 3 Randomization Early antiretroviral therapy CD infections Delayed antiretroviral therapy CD infections 1 linked, 3 unlinked 27 linked, 8 unlinked 96% relative risk reduction in linked transmissions 24

25 25

26 Treatment as Prevention is limited by gaps in the HIV Treatment Cascade 1,148, % 941,524 82% 757,812 66% 424,834 37% 378,906 33% 287,050 25% HIV Infected Diagnosed Linked to HIV Care Retained in HIV Care On ART Suppressed Viral Load Adapted from CDC, HIV in the US-The Stages of Care July 2012

27 PrEP" HIV+ Transmission HIV- Pre-exposure prophylaxis with antiretroviral medications 27

28 PrEP: Can a pill prevent HIV? Is it effective? Will it lead to increases in risky behaviors? Is it safe? 28

29 Oral PrEP is safe and efficacious; efficacy is dependent upon adherence Study Risk group N Safety Adherence Efficacy Partners PrEP TDF2 Serodiscordant couples Heterosexual men and women 4747 Nausea Diarrhea 1219 Dizziness, nausea Small Bone Mineral Density High 73% High 62% Bangkok IVDU 2413 Nausea Moderate 49% iprex Men who have sex with men 2499 Nausea Rare Cr Small Bone Mineral Density Moderate 44% FEM-PrEP Women 1951 No concerns Low X VOICE Women 5000 No concerns Low X Grant NEJM 2010, Mulligan CROI 2011, Van Damme NEJM 2012, Karim Science 2010, Baeten NEJM 2012, 29 Thigpen NEJM 2012, Marrazzo CROI 2013, Choopanya Lancet 2013

30 Partial adherence may still offer some protection against infection Anderson Sci Trans Med 2012

31 iprex participants did not increase sexual risk behaviors Marcus PLoS One 2013

32 CDC Guidance on Prescribing PrEP Determine Eligibility (negative HIV test, at highrisk for HIV acquisition, screen/treat for STDs, screen/vaccinate for Hep B; pregnancy test) Prescribe tenofovir-emtricitabine 1 tablet by mouth daily Provide condoms and risk-reduction counseling Monitor closely (at 1 month, then q 2-3 months: HIV testing, follow BUN/Cr, repeated risk assessment and counseling) Also see NYS DOH guidelines (hivguidelines.org) 32

33 Informational Guides for Clinicians and Patients 33

34 PEP" HIV+ Transmission HIV- Post-exposure prophylaxis with antiretroviral medications 34

35 Human data support the efficacy of PEP Retrospective case-control study of Healthcare workers 33 cases of HIV transmission after exposure vs. 665 controls with no transmission AZT use 81% decreased odds of transmission Observational studies (e.g., MSM in Brazil) Cardo DM. N Engl J Med 1997

36 Case 1: What we decided with the patient Discussed options Shared decision: PrEP Baseline assessment per CDC guidance Assessed for possibility of acute HIV Prescribed PrEP (30-day supply) Counseling & monitoring Reassess risk behaviors, risks/benefits of PrEP, HIV antibody q 3 months 36

37 In summary, clinicians have an opportunity to be leaders in a new era of HIV prevention HIV incidence is high Clinicians are likely to care for high-risk persons Routine risk assessment can help identify high-risk persons Treatment as Prevention, PrEP (and PEP) work...patients may ask! Combination of available strategies is likely to have the greatest impact on the epidemic 37

38 An HIV Prevention Pathway Universal HIV screening HIV-infected HIV-uninfected HIV care / antiretroviral therapy Safer sex Address STIs PEP or PrEP Reduced HIV incidence 38

39 Thank you! NEAETC Ken Mayer, Harvey Makadon, Kevin Ard, Adrianna Sicari and the LGBT Health Education Center Steve Safren (Fenway) Viraj Patel (Montefiore) Jennifer Mitty (BIDMC) Kathy Hsu and the Sylvie Ratelle STD/HIV Prevention Training Center HPTN Funding: NIMH K23 MH

40 Thank you! Douglas Krakower, MD Division of Infectious Diseases Beth Israel Deaconess Medical Center Instructor in Medicine Harvard Medical School 40

TAKING A HISTORY OF SEXUAL HEALTH: OPENING THE DOOR TO EFFECTIVE HIV AND STI PREVENTION

TAKING A HISTORY OF SEXUAL HEALTH: OPENING THE DOOR TO EFFECTIVE HIV AND STI PREVENTION TAKING A HISTORY OF SEXUAL HEALTH: OPENING THE DOOR TO EFFECTIVE HIV AND STI PREVENTION APRIL 17, 2014 Harvey J Makadon, MD The National LGBT Health Education Center, The Fenway Institute Harvard Medical

More information

Recent Breakthroughs in HIV Prevention for Men who Have Sex with Men and Transgender Populations

Recent Breakthroughs in HIV Prevention for Men who Have Sex with Men and Transgender Populations Recent Breakthroughs in HIV Prevention for Men who Have Sex with Men and Transgender Populations Kevin Ard, MD, MPH Brigham and Women s Hospital The Fenway Institute Boston, MA Funding: The New England

More information

PrEP: Getting to the Tipping Point

PrEP: Getting to the Tipping Point PrEP: Getting to the Tipping Point Harvey J Makadon, MD The National LGBT Health Education Center, The Fenway Institute Professor of Medicine, Harvard Medical School April 15, 2016 Continuing Medical Education

More information

New England healthcare providers perceptions, knowledge and practices regarding the use of antiretrovirals for prevention

New England healthcare providers perceptions, knowledge and practices regarding the use of antiretrovirals for prevention New England healthcare providers perceptions, knowledge and practices regarding the use of antiretrovirals for prevention Douglas Krakower, Catherine Oldenburg, Jennifer Mitty, Ira Wilson, Ann Kurth, Kevin

More information

OR: Steps you can take in the clinic to prevent HIV infections

OR: Steps you can take in the clinic to prevent HIV infections Implementing Changes to Reduce HIV Incidence: Synergies between Public Health and Primary Care Kevin Ard, MD, MPH Brigham and Women s Hospital, Massachusetts General Hospital, and the Fenway Institute

More information

Case Studies in PrEP Management. Kevin L. Ard, MD, MPH Massachusetts General Hospital, National LGBT Health Education Center April 15, 2016

Case Studies in PrEP Management. Kevin L. Ard, MD, MPH Massachusetts General Hospital, National LGBT Health Education Center April 15, 2016 Case Studies in PrEP Management Kevin L. Ard, MD, MPH Massachusetts General Hospital, National LGBT Health Education Center April 15, 2016 Continuing Medical Education Disclosure Program Faculty: Kevin

More information

HIV Prevention among Women

HIV Prevention among Women HIV Prevention among Women Assistant Professor of Medicine Division of Infectious Diseases Baylor College of Medicine Disclosures: Gilead Sciences - Scientific Advisory Board; Investigatorinitiated research

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

Moving beyond condoms to prevent HIV transmission. Are you Prepared for HIV PrEP?

Moving beyond condoms to prevent HIV transmission. Are you Prepared for HIV PrEP? Moving beyond condoms to prevent HIV transmission Are you Prepared for HIV PrEP? The Issues New HIV infections in the US continue Vast majority of infections are sexually acquired Condoms work but are

More information

PrEP in the Real World: Clinical Case Studies

PrEP in the Real World: Clinical Case Studies PrEP in the Real World: Clinical Case Studies Kevin L. Ard, MD, MPH April 30, 2015 Massachusetts General Hospital, National LGBT Health Education Center Continuing Medical Education Disclosure Program

More information

Roy M. Gulick, MD, MPH Chief, Division of Infectious Diseases Professor of Medicine Weill Medical College of Cornell University New York City

Roy M. Gulick, MD, MPH Chief, Division of Infectious Diseases Professor of Medicine Weill Medical College of Cornell University New York City PrEP 2013 Roy M. Gulick, MD, MPH Chief, Division of Infectious Diseases Professor of Medicine Weill Medical College of Cornell University New York City Slide #2 U.S.: New HIV Infections Per Year ~50,000

More information

Pre-Exposure Prophylaxis (PrEP) and the Governor s Plan to End AIDS: What Every Clinician Needs to Know

Pre-Exposure Prophylaxis (PrEP) and the Governor s Plan to End AIDS: What Every Clinician Needs to Know Pre-Exposure Prophylaxis (PrEP) and the Governor s Plan to End AIDS: What Every Clinician Needs to Know ANTONIO E. URBINA, MD Medical Director Associate Professor of Medicine Mt. Sinai Hospital Disclosure

More information

Disclosure. Learning Objectives. Epidemiology. Transmission. Risk of Transmission PRE-EXPOSURE PROPHYLAXIS (PREP) FOR HIV PREVENTION 50,000.

Disclosure. Learning Objectives. Epidemiology. Transmission. Risk of Transmission PRE-EXPOSURE PROPHYLAXIS (PREP) FOR HIV PREVENTION 50,000. Disclosure PRE-EXPOSURE PROPHYLAXIS (PREP) FOR HIV PREVENTION I have no financial interest in and/or affiliation with any external organizations in relation to this CE program. DaleMarie Vaughan, PharmD

More information

Getting Prepped for PrEP. Ken Ho, MD, MPH World AIDS Day

Getting Prepped for PrEP. Ken Ho, MD, MPH World AIDS Day Getting Prepped for PrEP Ken Ho, MD, MPH World AIDS Day Objectives HIV epidemiology What is PrEP? Does it Work? Who gets PrEP? How do I prescribe PrEP What to do at the first visit? What to do at follow

More information

The HIV Prevention Pill: The State of PrEP Science and Implementation. James Wilton Coordinator, Biomedical Science of HIV Prevention CATIE

The HIV Prevention Pill: The State of PrEP Science and Implementation. James Wilton Coordinator, Biomedical Science of HIV Prevention CATIE The HIV Prevention Pill: The State of PrEP Science and Implementation James Wilton Coordinator, Biomedical Science of HIV Prevention CATIE Overview 1. The Basics 2. A review of the science 3. An update

More information

Antiretroviral Drugs for HIV Seronegative People: It works in trials, what about the real world?

Antiretroviral Drugs for HIV Seronegative People: It works in trials, what about the real world? Antiretroviral Drugs for HIV Seronegative People: It works in trials, what about the real world? Lut Van Damme 11 Oct 2012 1 Disclaimer Gilead donated the study product for the FEM-PrEP trial I participated

More information

Implementing HIV Prevention in Patient Centered Medical Homes and Primary Care

Implementing HIV Prevention in Patient Centered Medical Homes and Primary Care A New Era of Highly-Effective HIV Prevention in Primary Care Part I Implementing HIV Prevention in Patient Centered Medical Homes and Primary Care Kevin Ard, MD, MPH and Harvey J Makadon, MD The Fenway

More information

Ready, set, PrEP! Renee-Claude Mercier PharmD, PhC, BCPS-AQ ID, FCCP Professor of Pharmacy and Medicine University of New Mexico

Ready, set, PrEP! Renee-Claude Mercier PharmD, PhC, BCPS-AQ ID, FCCP Professor of Pharmacy and Medicine University of New Mexico Ready, set, PrEP! Renee-Claude Mercier PharmD, PhC, BCPS-AQ ID, FCCP Professor of Pharmacy and Medicine University of New Mexico Objectives At the end of the talk the audience should be able to: Understand

More information

PrEP: Pre Exposure Prophylaxis

PrEP: Pre Exposure Prophylaxis PrEP: Pre Exposure Prophylaxis Lyn Stevens, NP, MS, ACRN Deputy Director Office of the Medical Director NYS Department of Health, AIDS Institute Faculty Disclosure Lyn Stevens No relationships to disclose

More information

HIV PREP THE NEWEST TOOL IN THE BOX

HIV PREP THE NEWEST TOOL IN THE BOX HIV PREP THE NEWEST TOOL IN THE BOX Infectious Disease Update November 7, 2014 Andrew Petroll, MD, MS Department of Medicine, Division of Infectious Diseases Department of Psychiatry and Behavioral Medicine,

More information

HIV: Pregnancy in Serodiscordant Couple. Dr Chow TS ID Clinic HPP

HIV: Pregnancy in Serodiscordant Couple. Dr Chow TS ID Clinic HPP HIV: Pregnancy in Serodiscordant Couple Dr Chow TS ID Clinic HPP Sexual Reproductive Health and Rights The recognition of the sexual and reproductive health and rights (SRHR) of all individuals and couples

More information

Using anti-hiv drugs for prevention

Using anti-hiv drugs for prevention Using anti-hiv drugs for prevention Highlights from AIDS 2012 (and 2 nd International Workshops on Treatment as Prevention) Tim Rogers, trogers@catie.ca Using anti-hiv Drugs for Prevention Outline Treatment

More information

Getting to Zero: Reducing HIV Incidence through Screening, Treatment, and Prevention. Learning Module

Getting to Zero: Reducing HIV Incidence through Screening, Treatment, and Prevention. Learning Module Getting to Zero: Reducing HIV Incidence through Screening, Treatment, and Prevention Learning Module Learning Objectives At the end of this module, learners will be able to: 1. Describe HIV incidence,

More information

REVIEW OF PREP GUIDELINES: A PRIMER FOR THE PRIMARY CARE PRACTITIONER ANTONIO E. URBINA, MD. PrEP Webinar Series

REVIEW OF PREP GUIDELINES: A PRIMER FOR THE PRIMARY CARE PRACTITIONER ANTONIO E. URBINA, MD. PrEP Webinar Series REVIEW OF PREP GUIDELINES: A PRIMER FOR THE PRIMARY CARE PRACTITIONER ANTONIO E. URBINA, MD PrEP Webinar Series Disclosure Speaker s Bureau: Gilead, VIIV, BMS, Merck, Serono LEARNING OBJECTIVES: 1. Review

More information

Pre-exposure Prophylaxis and Primary Care

Pre-exposure Prophylaxis and Primary Care Pre-exposure Prophylaxis and Primary Care National Latino HIV and Hepatitis C Conference June 7 th, 2016 Allison Finkenbinder, MSN, WHNP-BC Denver Prevention Training Center Who s in the audience? Disclosures

More information

Pre exposure Prophylaxis (PrEP): Stepping Up HIV Prevention

Pre exposure Prophylaxis (PrEP): Stepping Up HIV Prevention Pre exposure Prophylaxis (PrEP): Stepping Up HIV Prevention Dawn K. Smith, MD, MS, MPH Centers for Disease Control and Prevention The findings and conclusions in this presentation have not been formally

More information

Pre-exposure Prophylaxis (PrEP)

Pre-exposure Prophylaxis (PrEP) Pre-exposure Prophylaxis (PrEP) Kenneth Mayer, MD Fenway Health Beth Israel Deaconess Medical Center Harvard Medical School and School of Public Health Treatment As Prevention in Africa Workshop May 2

More information

HIV. The Role of Pre-Exposure Prophylaxis (PrEP) for the Prevention of HIV. Brief History of HIV AIDS. Global HIV Infection.

HIV. The Role of Pre-Exposure Prophylaxis (PrEP) for the Prevention of HIV. Brief History of HIV AIDS. Global HIV Infection. The Role of Pre-Exposure Prophylaxis (PrEP) for the Prevention of HIV HIV Sarah Kemink, PharmD, AAHIVP WMSHP Spring Seminar 5/05/2015 AIDS CD4 less than 200 +/- AIDS-defining illness Most common: Candidiasis

More information

Using PrEP as Harm Reduction. Iman Little, MPH Team Lead, Preventative Services Chicago Center for HIV Elimination

Using PrEP as Harm Reduction. Iman Little, MPH Team Lead, Preventative Services Chicago Center for HIV Elimination Be PrEPared! Using PrEP as Harm Reduction Iman Little, MPH Team Lead, Preventative Services Chicago Center for HIV Elimination Ricky Hill, MA, PhD candidate Team Lead, Community Partnerships and Engagement

More information

PEP and PrEP: AWAAC 2014

PEP and PrEP: AWAAC 2014 Acknowledgements: HIVCS PEP guidelines group, Helen Rees, Slim Abdool Karim, Quarraisha Abdool Karim, Clinical Care Options, Edwina Wright, Jared Baeton, AETC PEP and PrEP: AWAAC 2014 Francois Venter Wits

More information

Ending the Epidemic: What Clinicians Need to Know

Ending the Epidemic: What Clinicians Need to Know Ending the Epidemic: What Clinicians Need to Know Mary Goodspeed, RN, BS Coordinator, HIV Clinical Education Erie County Medical Center 716-898-4713 LEARNING OBJECTIVES: 1. List the three points of the

More information

The HIV Prevention Pill: The State of PrEP Science and Implementation

The HIV Prevention Pill: The State of PrEP Science and Implementation The HIV Prevention Pill: The State of PrEP Science and Implementation James Wilton Coordinator, Biomedical Science of HIV Prevention CATIE December 11 th, 2014 Overview 1. The Basics 2. A review of the

More information

Pre-Exposure Prophylaxis: The New Frontier of Prophylaxis Against HIV Infection

Pre-Exposure Prophylaxis: The New Frontier of Prophylaxis Against HIV Infection Pre-Exposure Prophylaxis: The New Frontier of Prophylaxis Against HIV Infection William F. Ryan Community Health Network PrEP Network Coordinator: Trevor Hedberg, MPH, CPH Supervising Health Educator:

More information

PrEP Guidelines for the Ob/Gyn. Outline. 1. How many patient have you discussed PrEP with this year?

PrEP Guidelines for the Ob/Gyn. Outline. 1. How many patient have you discussed PrEP with this year? PrEP Guidelines for the Ob/Gyn Megan J. Huchko, MD, MPH Obstetrics and Gynecology Update October 14, 2015 I have no financial or other conflicts of interest to declare Outline The Need for PrEP: HIV Treatment

More information

Dominic Chow, MD, PhD, MPH, Hawaii Center for AIDS Kunane Dreier, Prevention, Life Foundation Kekoa Kealoha, Hawaii Island HIV/AIDS Foundation Alexis

Dominic Chow, MD, PhD, MPH, Hawaii Center for AIDS Kunane Dreier, Prevention, Life Foundation Kekoa Kealoha, Hawaii Island HIV/AIDS Foundation Alexis Dominic Chow, MD, PhD, MPH, Hawaii Center for AIDS Kunane Dreier, Prevention, Life Foundation Kekoa Kealoha, Hawaii Island HIV/AIDS Foundation Alexis Charpentier, Harm Reduction Services Branch, Hawaii

More information

The Science behind Preexposure Prophylaxis (PrEP) Yunus Moosa Department of Infectious Diseases UKZN

The Science behind Preexposure Prophylaxis (PrEP) Yunus Moosa Department of Infectious Diseases UKZN The Science behind Preexposure Prophylaxis (PrEP) Yunus Moosa Department of Infectious Diseases UKZN 1 Ongoing HIV transmission despite expanding access to ART SA 18 16 14 12 10 8 6 4 2 0 Treatment exposure

More information

Guidelines for Implementing Pre-Exposure Prophylaxis For The Prevention of HIV in Youth Peter Havens, MD MS Draft:

Guidelines for Implementing Pre-Exposure Prophylaxis For The Prevention of HIV in Youth Peter Havens, MD MS Draft: Guidelines for Implementing Pre-Exposure Prophylaxis For The Prevention of HIV in Youth Peter Havens, MD MS Draft: 10-2-2015 Clinical studies demonstrate that when a person without HIV infection takes

More information

Pre-exposure Prophylaxis. Robert M Grant October 2014

Pre-exposure Prophylaxis. Robert M Grant October 2014 Pre-exposure Prophylaxis Robert M Grant October 2014 The HIV Pandemic 2.3 Million New HIV Infections in 2012 39% in Young People (ages 15-24) The HIV Pandemic 1.6 Million Started Therapy in 2012 1.4 New

More information

Update on ARV based PrEP

Update on ARV based PrEP Update on ARV based PrEP Z Mike Chirenje MD FRCOG University of Zimbabwe, College of Health Sciences, Dept. of Obstetrics and Gynaecology Avondale, Harare, Zimbabwe chirenje@uz-ucsf.co.zw Controlling HIV

More information

Pre-Exposure Prophylaxis (PrEP) A Biomedical Intervention Prevention with Negatives Antiretroviral Prevention

Pre-Exposure Prophylaxis (PrEP) A Biomedical Intervention Prevention with Negatives Antiretroviral Prevention Pre-Exposure Prophylaxis (PrEP) A Biomedical Intervention Prevention with Negatives Antiretroviral Prevention New and Emerging Biomedical HIV Prevention Interventions Vaccines Vaginal microbicides Pre-exposure

More information

Strategic use of antiretroviral drugs to prevent HIV transmission

Strategic use of antiretroviral drugs to prevent HIV transmission Strategic use of antiretroviral drugs to prevent HIV transmission 22th Tunisian Congress of Infectious Diseases 2nd Congress of Federation of Arab Societies of Clinical Microbiology and Infectious Diseases

More information

PREPARING FOR PREP: FROM KEY POPULATIONS THEORY TO PRACTICE. Dr Oscar Radebe

PREPARING FOR PREP: FROM KEY POPULATIONS THEORY TO PRACTICE. Dr Oscar Radebe PREPARING FOR PREP: FROM THEORY TO PRACTICE KEY POPULATIONS Dr Oscar Radebe PrePARINGFOR THE END OF HIV Until recently there has been exciting new advances in clinical research focusing on HIV prevention

More information

Find both sets of guidelines on nyc.gov by searching HIV PrEP and PEP. Per CDC Guidelines, PrEP may be appropriate for the following populations:

Find both sets of guidelines on nyc.gov by searching HIV PrEP and PEP. Per CDC Guidelines, PrEP may be appropriate for the following populations: PrEP Provider FAQs 1. What is PrEP? PrEP is short for pre-exposure prophylaxis. It is the use of antiretroviral medication to prevent acquisition of HIV infection. PrEP is used by HIV uninfected people

More information

Pre-Exposure Prophylaxis (PrEP) for HIV Infection

Pre-Exposure Prophylaxis (PrEP) for HIV Infection Pre-Exposure Prophylaxis (PrEP) for HIV Infection Jeffrey D. Klausner, MD, MPH Professor of Medicine and Public Health University of California Los Angeles Attending Physician UCLA Center AIDS Research

More information

PrEP for Women: HIV Prevention in Family Planning Settings

PrEP for Women: HIV Prevention in Family Planning Settings National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention PrEP for Women: HIV Prevention in Family Planning Settings Dawn K. Smith, MD, MS, MPH Division of HIV/AIDS Prevention dsmith1@cdc.gov

More information

Pre-exposure prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) FACTSHEET Pre-exposure prophylaxis (PrEP) Summary Pre-exposure prophylaxis, or PrEP, is a way for an HIV-negative person who is at risk of HIV infection to reduce their risk of becoming infected with HIV.

More information

HIV Reproductive Health: Conception Options in the Era of PrEP

HIV Reproductive Health: Conception Options in the Era of PrEP HIV Reproductive Health: Conception Options in the Era of PrEP Meg Sullivan, MD Director, HIV Clinical Programs, Section of Infectious Diseases Boston Medical Center Boston University School of Medicine

More information

Welcome to the National Association of County and City Health Officials Webinar on PrEP and Local Health Departments

Welcome to the National Association of County and City Health Officials Webinar on PrEP and Local Health Departments Welcome to the National Association of County and City Health Officials Webinar on PrEP and Local Health Departments There are two options for accessing the audio portion of this webinar: (1) Using your

More information

Update on PrEP progress: WHO/UNAIDS challenges and actions

Update on PrEP progress: WHO/UNAIDS challenges and actions Update on PrEP progress: WHO/UNAIDS challenges and actions Kevin R. O'Reilly Prevention in the Health Sector, HIV/AIDS Department, WHO HQ Outline Review current status of PrEP Planning for PrEP Pre-exposure

More information

Fertility Desires/Management of Serodiscordant HIV + Couples

Fertility Desires/Management of Serodiscordant HIV + Couples Fertility Desires/Management of Serodiscordant HIV + Couples William R. Short, MD, MPH Assistant Professor of Medicine Division Of Infectious Diseases Jefferson Medical College of Thomas Jefferson University

More information

PrEP Home Checklist v1.0

PrEP Home Checklist v1.0 PrEP Home Checklist v1.0 Every Visit o Risk Reduction Counseling o Appropriate referrals and follow-ups (SW, Pharmacy, et al.) o For those on PrEP: o Assessment of PrEP adherence, side effects, ongoing

More information

Combination prevention: Public health and human rights imperatives

Combination prevention: Public health and human rights imperatives Combination prevention: Public health and human rights imperatives Gottfried Hirnschall, MD MPH HIV/AIDS Department WHO, Geneva London, June 11, 2012 Outline The epidemic and response What is combination

More information

PrEP Dosing Strategies

PrEP Dosing Strategies PrEP Dosing Strategies Outline o Background PrEP absorption and tissue penetration o Oral versus topical o Lead in and lead out dosing Time to protection o Cycling on and off PrEP o Balancing toxicity

More information

PrEP for HIV Prevention. Adult Clinical Guideline from the New York State Department of Health AIDS Institute

PrEP for HIV Prevention. Adult Clinical Guideline from the New York State Department of Health AIDS Institute PrEP for HIV Prevention Adult Clinical Guideline from the New York State Department of Health AIDS Institute www.hivguidelines.org Purpose of the PrEP Guideline Raise awareness of PrEP among healthcare

More information

PRE-EXPOSURE PROPHYLAXIS FOR HIV: EVIDENCE AND GENDER CONSIDERATIONS. Jean R. Anderson M.D. Director, Johns Hopkins HIV Women s Health Program

PRE-EXPOSURE PROPHYLAXIS FOR HIV: EVIDENCE AND GENDER CONSIDERATIONS. Jean R. Anderson M.D. Director, Johns Hopkins HIV Women s Health Program PRE-EXPOSURE PROPHYLAXIS FOR HIV: EVIDENCE AND GENDER CONSIDERATIONS Jean R. Anderson M.D. Director, Johns Hopkins HIV Women s Health Program Disclosures None Objectives Review the evidence regarding the

More information

Overview of ARV-based prevention trials

Overview of ARV-based prevention trials Overview of ARV-based prevention trials Catherine Hankins BA MD MSc CCFP FRCPC Deputy Director, Science Amsterdam Institute for Global Health and Development; Department of Global Health, Academic Medical

More information

PrEP and npep for HIV Prevention. Harry Rosado-Santos MD, FACP Associate Professor UU School of Medicine

PrEP and npep for HIV Prevention. Harry Rosado-Santos MD, FACP Associate Professor UU School of Medicine PrEP and npep for HIV Prevention Harry Rosado-Santos MD, FACP Associate Professor UU School of Medicine Case Study A 26 y/o M presents for routine asymptomatic screening for sexually transmitted infections

More information

HIV Epidemiology, LGBT Health Disparities: Implications for Clinical Practice

HIV Epidemiology, LGBT Health Disparities: Implications for Clinical Practice HIV Epidemiology, LGBT Health Disparities: Implications for Clinical Practice April 23, 2013 Harvey Makadon, MD Director, The National LGBT Health Education Center Clinical Professor of Medicine, Harvard

More information

PEP, PREP, HPTN052 and MLN2238

PEP, PREP, HPTN052 and MLN2238 PEP, PREP, HPTN052 and MLN2238 Understanding the alphabet soup of HIV prevention and cure strategies Christina G Rivera, PharmD, BCPS Pharmacy Grand Rounds August 15, 2017 2017 MFMER slide-1 Presentation

More information

Modernization of North Carolina s HIV control measures

Modernization of North Carolina s HIV control measures Modernization of North Carolina s HIV control measures North Carolina Division of Public Health Victoria Mobley, MD MPH Evelyn Foust, MPH CPM Agenda Introduction Summary of scientific evidence used to

More information

Important Safety Information About TRUVADA for a Pre-exposure Prophylaxis (PrEP) Indication. For Healthcare Providers

Important Safety Information About TRUVADA for a Pre-exposure Prophylaxis (PrEP) Indication. For Healthcare Providers Important Safety Information About TRUVADA for a Pre-exposure Prophylaxis (PrEP) Indication For Healthcare Providers About TRUVADA for a PrEP Indication INDICATION AND PRESCRIBING CONSIDERATIONS TRUVADA,

More information

QUESTIONS AND ANSWERS ABOUT PARTNERS PrEP AND VOICE

QUESTIONS AND ANSWERS ABOUT PARTNERS PrEP AND VOICE CONTACT: Lisa Rossi +1-412-641-8940 +1-412- 916-3315 (mobile) rossil@upmc.edu QUESTIONS AND ANSWERS ABOUT PARTNERS PrEP AND VOICE 1. What is the Partners PrEP study? The Partners PrEP Study is a double-blind,

More information

Guidelines for PrEP in PWID

Guidelines for PrEP in PWID Guidelines for PrEP in PWID Any use of injection drugs (past 6 months) AND Any sharing of injection equipment OR participation in methadone, naloxone, or buprenorphine treatment program (past 6 months)

More information

Overcoming Structural Barriers to HIV Prevention

Overcoming Structural Barriers to HIV Prevention Overcoming Structural Barriers to HIV Prevention October 30, 2013 Harvey J. Makadon MD Director of Professional Education The National LGBT Health Education Center The Fenway Institute, Fenway Health Clinical

More information

Sexually Transmitted Infections in Vulnerable Groups. Kevin Rebe

Sexually Transmitted Infections in Vulnerable Groups. Kevin Rebe Sexually Transmitted Infections in Vulnerable Groups Kevin Rebe Definition: Key Populations Key populations are: Defined groups who, due to specific higher-risk behaviours, are at increased Men risk who

More information

Pre-Exposure Prophylaxis (PrEP) Stefanie La Manna, PhD, MPH, APRN, FNP-C, AGACNP-BC October 12, 2018

Pre-Exposure Prophylaxis (PrEP) Stefanie La Manna, PhD, MPH, APRN, FNP-C, AGACNP-BC October 12, 2018 Pre-Exposure Prophylaxis (PrEP) Stefanie La Manna, PhD, MPH, APRN, FNP-C, AGACNP-BC October 12, 2018 Disclosures I have no financial disclosures to report Objectives Identify the need for HIV prevention

More information

HIV Clinical Update- HIV prevention

HIV Clinical Update- HIV prevention HIV Clinical Update- HIV prevention 18 th Australian and New Zealand Conference on Haemophilia and Rare Bleeding Disorders, Melbourne October 13 th 2017 Edwina Wright Disclosures None in the past 12 months

More information

WHO s early release guidelines on PrEP: implications for emtct. Dominika Seidman, MD October 13, 2015

WHO s early release guidelines on PrEP: implications for emtct. Dominika Seidman, MD October 13, 2015 WHO s early release guidelines on PrEP: implications for emtct Dominika Seidman, MD October 13, 2015 Outline Evidence behind WHO early release guidelines on PrEP PrEP eligibility according to the WHO Rationale

More information

Post-Sexual Exposure Prophylaxis (npep)

Post-Sexual Exposure Prophylaxis (npep) Projeto Praça Onze Universidade Federal do Rio de Janeiro Post-Sexual Exposure Prophylaxis (npep) Mauro Schechter Principal Investigator, Projeto Praça Onze Professor of Infectious Diseases Universidade

More information

PrEP: State of the ART

PrEP: State of the ART PrEP: State of the ART Kenneth H. Mayer, M.D. Fenway Health Beth Israel Deaconess Medical Center Harvard Medical School & School of Public Health Disclosure: Unrestricted research/educational grants from

More information

PREVENTION OF HIV IN THE TIMES OF PREP. Daniela Chiriboga, MD Florida Department of Health in Polk County

PREVENTION OF HIV IN THE TIMES OF PREP. Daniela Chiriboga, MD Florida Department of Health in Polk County PREVENTION OF HIV IN THE TIMES OF PREP Daniela Chiriboga, MD Florida Department of Health in Polk County MAKING THE CASE FOR PREVENTION The Epidemic in Florida Population in 2014: 19.6 million (3 rd in

More information

If you are a man that ONLY has sex with women this may not be the brochure for you.

If you are a man that ONLY has sex with women this may not be the brochure for you. If you are a man that ONLY has sex with women this may not be the brochure for you. To find resources that best meet your needs check out the following website: http://www.cdc.gov/men Whether you are gay,

More information

Microbicides and Antiretroviral Therapy

Microbicides and Antiretroviral Therapy Microbicides and Antiretroviral Therapy Kenneth H. Mayer, M.D. Fenway Health/Beth Israel Deaconess Hospital/Harvard Medical School Infected Genital Leukocytes and Cell-Associated Virus Transmission October

More information

Biomedical Prevention Update Thomas C. Quinn, M.D.

Biomedical Prevention Update Thomas C. Quinn, M.D. Biomedical Prevention Update Thomas C. Quinn, M.D. Associate Director of International Research National Institute of Allergy and Infectious Diseases Director, Johns Hopkins Center for Global Health Global

More information

ETHICS IN HIV PREVENTION RESEARCH IN THE NEW ERA OF

ETHICS IN HIV PREVENTION RESEARCH IN THE NEW ERA OF ETHICS IN HIV PREVENTION RESEARCH IN THE NEW ERA OF PrEP MTN Regional Meeting Cape Town 20 September 2017 Dhevium Govender South African Medical Research Council HIV Prevention Research Unit Quality/Regulatory

More information

PrEP Integration into Primary Care

PrEP Integration into Primary Care PrEP Integration into Primary Care Linking HIV/AIDS prevention to primary care K A M L A S A N A S I - B H O L A, M D SC Primary Healthcare Association's 23rd Annual Clinical Network Retreat Sunday, June

More information

Pre-Exposure Prophylaxis for HIV: The Basics and Beyond

Pre-Exposure Prophylaxis for HIV: The Basics and Beyond Pre-Exposure Prophylaxis for HIV: The Basics and Beyond Kevin L. Ard, MD, MPH National LGBT Health Education Center, Fenway Institute Infectious Disease Division, Massachusetts General Hospital Disclosure

More information

ART and Transmission. Martin Fisher. Brighton and Sussex University Hospitals, UK

ART and Transmission. Martin Fisher. Brighton and Sussex University Hospitals, UK ART and Transmission Martin Fisher Brighton and Sussex University Hospitals, UK 11th Advanced HIV Course Aix-en-Provence 2013 New HIV diagnoses by exposure group: United Kingdom, 2002 2011 1 Predicted

More information

TRUVADA for a Pre-exposure Prophylaxis (PrEP) Indication. Training Guide for Healthcare Providers

TRUVADA for a Pre-exposure Prophylaxis (PrEP) Indication. Training Guide for Healthcare Providers TRUVADA for a Pre-exposure Prophylaxis (PrEP) Indication Training Guide for Healthcare Providers About TRUVADA for a PrEP indication to reduce the risk of sexually acquired HIV-1 infection in high-risk

More information

HIV & Condomless Sex - What is the Risk? Why Not? Alan J. Taege, MD Assistant Professor of Medicine Department of Infectious Disease Cleveland Clinic

HIV & Condomless Sex - What is the Risk? Why Not? Alan J. Taege, MD Assistant Professor of Medicine Department of Infectious Disease Cleveland Clinic HIV & Condomless Sex - What is the Risk? Why Not? Alan J. Taege, MD Assistant Professor of Medicine Department of Infectious Disease Cleveland Clinic Yes No What s Going on Out There? Condomless Sex among

More information

Fast-Track Your PrEP Knowledge. Jonathan Fritz PrEP Coordinator MDHHS Division of HIV and STD Programs

Fast-Track Your PrEP Knowledge. Jonathan Fritz PrEP Coordinator MDHHS Division of HIV and STD Programs Fast-Track Your PrEP Knowledge Jonathan Fritz PrEP Coordinator MDHHS Division of HIV and STD Programs Session objectives Increase knowledge of the basics of PrEP and clinical procedures Identify financial

More information

Pre-exposure prophylaxis : Systemic and topical. Linda-Gail Bekker The Desmond Tutu HIV Centre UCT SA HIV ClniciansSociety Conference 2012

Pre-exposure prophylaxis : Systemic and topical. Linda-Gail Bekker The Desmond Tutu HIV Centre UCT SA HIV ClniciansSociety Conference 2012 New biomedical technologies. Pre-exposure prophylaxis : Systemic and topical. Linda-Gail Bekker The Desmond Tutu HIV Centre UCT SA HIV ClniciansSociety Conference 2012 And the last parachute goes to..

More information

Practice Steps for Implementation of Guidelines Recommendations The guideline recommendations are shown schematically -

Practice Steps for Implementation of Guidelines Recommendations The guideline recommendations are shown schematically - ASK SCREEN Test for HIV and STI Practice Steps for Implementation of Guidelines Recommendations The guideline recommendations are shown schematically - Routinely obtain a thorough sexual history from all

More information

HIV Prevention Pearls

HIV Prevention Pearls HIV Prevention Pearls Meghan Rothenberger, MD Assistant Professor Division of Infectious Diseases University of Minnesota Director, Youth and AIDS Projects October 27, 2017 Disclosure Information I have

More information

Understanding the Results of VOICE

Understanding the Results of VOICE CONTACT: Lisa Rossi +1-412- 916-3315 (mobile) or +27-(0)73-323-0087 (through 7 March) rossil@upmc.edu About VOICE Understanding the Results of VOICE VOICE Vaginal and Oral Interventions to Control the

More information

Prescribing Pre-Exposure Prophylaxis for HIV Prevention: Barriers and Biases Among Healthcare Providers

Prescribing Pre-Exposure Prophylaxis for HIV Prevention: Barriers and Biases Among Healthcare Providers Prescribing Pre-Exposure Prophylaxis for HIV Prevention: Barriers and Biases Among Healthcare Providers Sarah K. Calabrese, PhD YACS Thursday, January 23 rd, 2014 Talk Outline 1. PrEP Background What it

More information

PrEP efficacy the evidence

PrEP efficacy the evidence PrEP efficacy the evidence Dr Michael Brady Consultant, HIV and Sexual Health King s College Hospital, London Medical Director Terrence Higgins Trust PrEP Pre-exposure prophylaxis Tenofovir and emtricitabine

More information

A Sex-informed Framework for HIV Prevention. Robert M. Grant, M.D., M.P.H. Betty Jean and Hiro Ogawa Endowed Investigator

A Sex-informed Framework for HIV Prevention. Robert M. Grant, M.D., M.P.H. Betty Jean and Hiro Ogawa Endowed Investigator A Sex-informed Framework for HIV Prevention Robert M. Grant, M.D., M.P.H. Betty Jean and Hiro Ogawa Endowed Investigator Disclosures Gilead Sciences donated study medication to US NIH for trials that I

More information

Emtricitabine/Tenofovir Disoproxil Fumarate 200 mg/300 mg for HIV-1 Pre-exposure Prophylaxis (PrEP) Training Guide for Healthcare Providers

Emtricitabine/Tenofovir Disoproxil Fumarate 200 mg/300 mg for HIV-1 Pre-exposure Prophylaxis (PrEP) Training Guide for Healthcare Providers Emtricitabine/Tenofovir Disoproxil Fumarate 200 mg/300 mg for HIV-1 Pre-exposure Prophylaxis (PrEP) Training Guide for Healthcare Providers About emtricitabine/tenofovir disoproxil fumarate for HIV-1 PrEP

More information

Condomless Sex: Was the Swiss statement correct in 2008? Renslow Sherer University of Chicago

Condomless Sex: Was the Swiss statement correct in 2008? Renslow Sherer University of Chicago Condomless Sex: Was the Swiss statement correct in 2008? Renslow Sherer University of Chicago Disclosures and Objectives Disclosures Advisory Board Yes Gilead Sciences A PLWHIV on ART w/ VL < 50, as per

More information

PrEP for Women. Together, we can change the course of the HIV epidemic one woman at a time.

PrEP for Women. Together, we can change the course of the HIV epidemic one woman at a time. PrEP for Women Together, we can change the course of the HIV epidemic one woman at a time. #onewomanatatime #thewellproject What Is PrEP? PrEP stands for Pre- Exposure Prophylaxis: Prophylaxis: Taking

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

The Role of TAF in PrEP. Dr. Garrett has nothing to disclose

The Role of TAF in PrEP. Dr. Garrett has nothing to disclose The Role of TAF in PrEP KATY GARRETT, PHARMD UNIVERSITY OF NORTH CAROLINA Dr. Garrett has nothing to disclose Outline PrEP Efficacy Adherence among populations Pharmacokinetic and pharmacodynamics relationship

More information

PREP IN PRIMARY CARE TRACY SALAMEH RN, BSN, ACRN HIV CLINICAL SPECIALIST DAKOTA AIDS EDUCATION AND TRAINING CENTER

PREP IN PRIMARY CARE TRACY SALAMEH RN, BSN, ACRN HIV CLINICAL SPECIALIST DAKOTA AIDS EDUCATION AND TRAINING CENTER PREP IN PRIMARY CARE TRACY SALAMEH RN, BSN, ACRN HIV CLINICAL SPECIALIST DAKOTA AIDS EDUCATION AND TRAINING CENTER THE NEED FOR CONTINUED HIV PREVENTION Estimated new HIV infections in the US for the most

More information

Attendees will be able to:

Attendees will be able to: A. Kay Kalousek, DO, MS, FACOFP kaysdroid@gmail.com April 21, 2017 Attendees will be able to: List strategies for prevention of HIV infection Explain the pharmacology of TDF/FTC related to PrEP Assess

More information

Multiple choice questions: ANSWERS

Multiple choice questions: ANSWERS Multiple choice questions: ANSWERS Chapter 1. Diagnosis and promotion of serostatus awareness in sub-saharan Africa 1. Antiretroviral therapy reduces HIV transmission from a HIV- positive person to a susceptible

More information

Profilaxis Antiretroviral para la Prevención de la Infección VIH

Profilaxis Antiretroviral para la Prevención de la Infección VIH 1 Profilaxis Antiretroviral para la Prevención de la Infección VIH TAR precoz HIV + en pareja discordante Profilaxis pre exposición (PrEP) Celia Miralles Unidad de VIH H.lXeral Cies (CHUVI) Vigo 2 1 2

More information

HIV & THE MEDICAL HOME A NEW FRONT FOR GETTING TO ZERO. Brent K. Sugimoto, MD, MPH Kaiser Permanente. 29th Annual East Bay HIV Update June 3, 2016

HIV & THE MEDICAL HOME A NEW FRONT FOR GETTING TO ZERO. Brent K. Sugimoto, MD, MPH Kaiser Permanente. 29th Annual East Bay HIV Update June 3, 2016 HIV & THE MEDICAL HOME A NEW FRONT FOR GETTING TO ZERO 29th Annual East Bay HIV Update June 3, 2016 Brent K. Sugimoto, MD, MPH Kaiser Permanente Photo Credit: C. GoldsmithContent Providers: CDC/ C. Goldsmith,

More information

Evolving HIV Treatment Paradigms What we need to know

Evolving HIV Treatment Paradigms What we need to know Evolving HIV Treatment Paradigms What we need to know Benjamin Young International Association of Providers of AIDS Care Washington, DC, USA Evolving HIV Treatment Paradigms When/who to treat Better medicines

More information

THIS ACTIVITY HAS EXPIRED. CME CREDIT IS NO LONGER AVAILABLE

THIS ACTIVITY HAS EXPIRED. CME CREDIT IS NO LONGER AVAILABLE THIS ACTIVITY HAS EXPIRED. CME CREDIT IS NO LONGER AVAILABLE The following content is provided for informational purposes only. Continuing CE Education HIV PRE-EXPOSURE PROPHYLAXIS: A REVIEW Release Date:

More information