The Eras of the HIV Epidemic
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1 The Eras of the HIV Epidemic nd Gen. HAART
2 2006: Disproportionate distribution of HIV
3 2006: Gates and Clinton at International AIDS conference announce increased funding and in-country work
4 2006: WHO revision of ART Guidelines
5 2006: Benefit of treatment in developed nations
6 2006: CDC recommends routine opt-out HIV testing
7 2006: 1 st 2-Class STR (Single Tablet Regimen) Atripla: 1 st significant reduction in pill burden
8 2006: 10 th PI Darunavir approved. New Standard = high efficacy in treatment experienced patients Clotet Lancet 2007; 369:1169
9 2006: Increased risk of osteoporosis T. Brown. Lipodystrophy meeting. Dublin 2005 T. Brown, R. Qaqish: AIDS 2006; 20:
10 2006: Immune activation from microbial translocation
11 2006: Accumulation of resistance mutations with continuation of partially suppressive ARV regimen
12 2006: Treatment interruptions increase death and disease
13 2006: Immune restoration determines disease progression CD4 Change from baseline: 25 cells/ml < 25 cells/ml Absolute CD4 Level on HAART: 200 cells/ml < 200 cells/ml
14
15 2007: 1500 international delegates convene to discuss prevention and treatment in the field
16 2007: Provider-initiated routine HIV testing recommended internationally
17 2007: International leaders revise pledge for ARV treatment of 5 million by 2010
18 2007: International vaginal micobicide trial halted for lack of efficacy
19 2007: Insulin resistance accompanies mitochondrial toxicity
20 2007: Lipoatrophy increases after 3 years zidovudine
21 2007: Lipoatrophy worse with certain NRTIs
22 2007: PREDICT 1 Study confirms HLA-B*5701 association with ABC hypersensitivity reaction Mallal S et al.4 th IAS; 2007; Sydney. Abstract WESS101.
23 2007: CD4 800 after 7 years if ART initiated at CD4 350 Gras JAIDS :
24 2007: 4 drugs no better than 3
25 2007: 1 st CCR5 Inhibitor Maraviroc
26 2007: VL suppression related to number of active ARV agents
27 2007: 1 st INSTI Raltegravir: Rapid VL Suppression Fully suppressive Salvage regimens available again JAIDS 2007 Oct 1;46(2):
28 Four drugs no bemer than three
29 2008: HIV and AIDS continue to rise in Japan
30 2008: International gains in ART: Steady but below target
31 2008: International AIDS conference: Focus on community involvement
32 2008: Increasing global perinatal transmission prevention
33 2008: Persistent increase in US HIV incidence : 54,000 new infections annually
34 2008: National HIV care quality measures approved National Committee for Quality Assurance Ambulatory Care Quality Alliance
35 2008: National HIV care quality measures approved 1. RetenNon in care two visits/year 2. CD4 measurement twice/year 3. GC / CT screening once/year 4. Syphilis screening once/year 5. InjecNon drug use screening once/year 6. High risk sex screening once/year 7. Tuberculosis screening once/year 8. HepaNNs B screening once ever 9. HepaNNs C screening once ever 10. Influenza immunizanon annually 11. Pneumococcal immunizanon once 12. HepaNNs B vaccinanon ordered 13. HepaNNs B vaccinanon completed 14. PCP prophylaxis if CD4 < ART prescribed if appropriate 16. Viral suppression system level 17. Viral suppression provider level
36 2008: 4th NNRTI: Etravirine: High VL suppression rate in DUET trial Katlama AIDS 2009; 23:2299
37 2008: Evaluating number of baseline mutations becomes new standard in treatment experienced
38 2008: ARV CHARTER score correlates with CNS VL Letendre. (2008). Archives of Neurology, 65(1),
39 2008: HIV persistence in GALT
40 2008: Durable persistence of viremia on HAART
41 2008: SMART: Continuous ART superior to interrupted ART Emery J Inf Dis 2008;197: ; Gill CID 2010;50:98 105
42 2008: Elite controller patient characteristics further elucidated
43 2008: Berlin patient functionally cured of HIV CROI 2008 Abstract 719
44
45 2009: Pope warns against condom use: WHO states Pope s comments dangerous
46 2009: India lifts ban against homosexutality
47 2009: US allows government funding of needle exchange programs
48 2009: HIV Vaccine still elusive US NIAID HIV Vaccine Trial Network
49 2009: Early ART beneficial during acute OIs Zolopa PLoS One 2009;4:e5575
50 2009: Residual viremia not reducible with current ARVs PNAS June 9, 2009 vol. 106 no
51 2009: CD4 restoration better with earlier ARV treatment
52 2009: Survival benefit when ART started at CD4 >500 NA ACCORD, Kitahata NEJM 2009;360:
53
54 2010: US lifts 22 year HIV travel ban Followed by South Korea, China and Namibia
55 2010: Treatment guidelines focus on co-morbid factors
56 2010: WHO guidelines closer to US guidelines
57 2010: increasing Non-AIDS cancers with prolonged survival
58 2010: Early ART during TB treatment increases survival and IRIS CAMELIA Study: Blanc, 18 th IAC 2010, Abstract THLBB106.
59 2010: Improved survival with earlier initiation even in resource limited settings Severe NEJM :
60 2010: Lower rate of resistance when ART started early (NRTI Exposed) (NNRTI_Exposed) (PI Exposed) Uy, JAIDS :450. Lodwick ArchIntMed 2010;170:410
61 2010: CCR5 enhanced trofile for maraviroc use
62 2010: 4 th Gen Ab/Ag test allows earlier HIV diagnosis
63 2010: INSTI intensification will not eradicate HIV McMahon D, CID 2010, 50 (6):
64 2010: PrEP Reduces MSM HIV Acquisition iprex study shows TDF-FTC reduces HIV infection rate by 44%
65
66 2011: cart Prevents Heterosexual HIV Transmission cart leads to 96% reduced risk of transmission to uninfected partners
67 2011: PrEP Prevents Heterosexual HIV Transmission and Acquisition HIV MEDICATIONS HIGHLY EFFECTIVE AS PROPHYLAXIS AGAINST HIV INFECTION TDF-2: TDF-FTC reduces HIV infection rate by 78% on treatment Failure Probability Time to Seroconversion (ITT Analysis) Placebo TDF/FTC Yrs Thigpen MC, et al. IAS Abstract WELBC01.
68 2011: Bone density change differs among ARVs McComsey, J Inf Dis 2011; 203:1791.
69 2011: Older aged patients do better when HAART initiated at higher CD4 BMJ, November 2011, 343
70 2011: Minority Resistance Variants (MV) Increase risk of initial failure Li, JAMA 2011; 305:1327.
71 2011: NNRTI NVP-extended release
72 2011: 5 th NNRTI: Rilpivirine receives selective approval
73 2011: 2 nd 2-class Single Tablet Regimen: Complera
74
75 EvoluYon of HIV treatment paradigms N R T I N N R T I P I AZT ddi d4t ABC TDF FTC ddc 3TC ddi-ec Epzicom Combivir Trizivir Truvada Atripla Complera NVP EFV ETV RPV DLV NVP-XR SQV hgc NFV APV ATV TPV RTV SQV sgc LPVr fapv DRV IDV T-20 MVC RAL No AZT Sequential..Early 3-drug HAART... Salvage HAART ART Mono-Tx Mono-NRTI (Recycled (Boosted High VL suppression and Dual-NRTI NRTIs) Prot.Inh.) success rates CD4 <500 CD4<200 CD4 <500, opt. >500
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