Summary I: TB, Opportunistic Infections, HCV/HBV Co-Infections, HPV, STI & Tumors
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1 La Pedrera, Barcelona March 13 th 2018 Summary I: TB, Opportunistic Infections, HCV/HBV Co-Infections, HPV, STI & Tumors Dr. José M. Miró Infectious Diseases Service Hospital Clinic - IDIBAPS University of Barcelona Barcelona (Spain) address: jmmiro@ub.edu
2 Abstracts - CROI 2018 Accepted, 1105 (51%) - Oral, 114 (10%) - Poster, 991 (90%) Hepatitis, 91 (8%) Tuberculosis, 46 (4%) Cryptococcal meningitis + OIs 51 (5%) STI / HPV, 43 (4%) Cancer, 68 (6%)
3 TB/OIs, HCV/HBV, STI/HPV & Tumors Tuberculosis Cryptococcal meningitis Other Infections IRIS HCV/HBV coinfection HPV/STI Cancer
4 JoAnne L. Flynn, CROI 2018
5 JoAnne L. Flynn, CROI 2018
6 RCT ONE MONTH OF RIFAPENTINE/ISONIAZID TO PREVENT TB IN PEOPLE WITH HIV: BRIEF-TB/A5279 RCT (#37LB) Rifapentine + Isoniazid, 1 month = Isoniazid, 9 months
7 ONE MONTH OF RIFAPENTINE/ISONIAZID TO PREVENT TB IN PEOPLE WITH HIV: BRIEF-TB/A5279 RCT (#37LB)
8 ONE MONTH OF RIFAPENTINE/ISONIAZID TO PREVENT TB IN PEOPLE WITH HIV: BRIEF-TB/A5279 RCT (#37LB)
9 RCT OF SAFETY OF ISONIAZID PREVENTIVE THERAPY DURING OR AFTER PREGNANCY (#142LB) First RCT to focus on IPT in HIV-infected pregnant and postpartum women at high risk of developing TB
10 RCT OF SAFETY OF ISONIAZID PREVENTIVE THERAPY DURING OR AFTER PREGNANCY (#142LB)
11 RCT OF SAFETY OF ISONIAZID PREVENTIVE THERAPY DURING OR AFTER PREGNANCY (#142LB)
12 RCT OF SAFETY OF ISONIAZID PREVENTIVE THERAPY DURING OR AFTER PREGNANCY (#142LB)
13 RCT OF SAFETY OF ISONIAZID PREVENTIVE THERAPY DURING OR AFTER PREGNANCY (#142LB)
14 RCT OF SAFETY OF ISONIAZID PREVENTIVE THERAPY DURING OR AFTER PREGNANCY (#142LB)
15 RCT OF SAFETY OF ISONIAZID PREVENTIVE THERAPY DURING OR AFTER PREGNANCY (#142LB)!
16 URINE-BASED SCREENING FOR TUBERCULOSIS: A RCT IN HIV-POSITIVE INPATIENTS (#38LB)
17 URINE-BASED SCREENING FOR TUBERCULOSIS: A RCT IN HIV-POSITIVE INPATIENTS (#38LB)
18 URINE-BASED SCREENING FOR TUBERCULOSIS: A RCT IN HIV-POSITIVE INPATIENTS (#38LB)
19 STATIS RCT: SYSTEMATIC vs. TEST-GUIDED TUBERCULOSIS TREATMENT (#29LB) The trial was conducted in Côte d'ivoire, Uganda, Cambodia and Vietnam (African and Asian countries). ART-naïve HIV-1 infected adults with CD4<100 cells/µl ready to start ART were randomly assigned to either ART + extensive TB screening using Xpert MTB/RIF and urine LAM (arm 1) or ART + systematic empirical TB treatment (4HRZE/2HR) (arm 2) participants were included (arm 1: 525; arm 2: 522; 56% from Africa; 44% from South-East Asia). The W24 hazard ratio of events between arm 2 vs. arm 1 was 0.93 (95% CI ) for death or IBD, 0.92 ( ) for death alone, 1.14 ( ) for IBD alone and 2.70 ( ) for grade 3-4 drug-related toxicity. Systematic TB treatment is not superior to extensive TB screening in ART-naïve adults ready to start ART with CD4<100/µl.
20 SAFETY AND EFFICACY OF DOLUTEGRAVIR-BASED ART IN TB/HIV COINFECTED ADULTS AT WEEK 24 (#33) DTG-based ART = EFV-based ART TB Disease RIF-based TB treatment
21 SAFETY AND EFFICACY OF DOLUTEGRAVIR-BASED ART IN TB/HIV COINFECTED ADULTS AT WEEK 24 (#33)
22 SAFETY AND EFFICACY OF DOLUTEGRAVIR-BASED ART IN TB/HIV COINFECTED ADULTS AT WEEK 24 (#33)
23 SAFETY AND EFFICACY OF DOLUTEGRAVIR-BASED ART IN TB/HIV COINFECTED ADULTS AT WEEK 24 (#33)
24 Tuberculosis Pearls #767 IMPROVED SENSITIVITY OF A NOVEL RECOMBINANT PROTEIN SKIN TEST FOR THE DIAGNOSIS OF TB. #772 C-REACTIVE PROTEIN (CRP) TO SCREEN FOR HIV- ASSOCIATED TUBERCULOSIS IN SOUTH AFRICA. #773 PLASMA INDOLEAMINE 2, 3-DIOXYGENASE (IDO)*, A BIOMARKER FOR TUBERCULOSIS DISEASE IN HIV INFECTION * IDO is an immunoregulatory enzyme that breaks down tryptophan (Trp) to metabolites known as kynurenines (Kyns) and the ratio of Kyn to Trp is very useful for TB diagnosis: PPV 89% & NPV 100%. Adu-Gyamfi CG ET AL. Clin Infect Dis. 2017; 65:
25 TB/OIs, HCV/HBV, STI/HPV & Tumors Tuberculosis Cryptococcal meningitis Other Infections IRIS HCV/HBV coinfection HPV/STI Cancer
26 RCT HIGHER HIGH DOSE FLUCONAZOLE FOR THE TREATMENT OF CRYPTOCOCCAL MENINGITIS (#35)
27 RCT HIGHER DOSE FLUCONAZOLE FOR THE TREATMENT OF CRYPTOCOCCAL MENINGITIS (#35)
28 RCT HIGHER DOSES FLUCONAZOLE FOR THE TREATMENT OF CRYPTOCOCCAL MENINGITIS (#35) 1,600 mg oral FLU is the most effective dose and safer than 2,000 mg, although less effective than AMB!!!
29
30 ASTRO-CM RCT ADJUNCTIVE SERTRALINE IN HIV- ASSOCIATED CRYPTOCOCCAL MENINGITIS (#36) Amphotericin B 7-14 days plus fluconazole starting at 800 mg daily. Sertraline: 400 mg/day for 2 weeks, followed by 200 mg/day for 10 weeks.
31 ASTRO-CM RCT ADJUNCTIVE SERTRALINE IN HIV- ASSOCIATED CRYPTOCOCCAL MENINGITIS (#36) Sertraline did not reduce mortality among patients with HIV-associated cryptococcal meningitis
32 TB/OIs, HCV/HBV, STI/HPV & Tumors Tuberculosis Cryptococcal meningitis Other Infections IRIS HCV/HBV coinfection HPV/STI Cancer
33 CMV VIREMIA AND DISEASE IN PATIENTS WITH ADVANCED HIV INFECTION: A PROSPECTIVE STUDY (N=49) (#801) Prevalence CMV viremia CMV EOD (only 1 case) CMV Rx is not necessary
34 TB/OIs, HCV/HBV, STI/HPV & Tumors Tuberculosis Cryptococcal meningitis Other Infections IRIS HCV/HBV coinfection HPV/STI Cancer
35 Integrase Inhibitor-based ART regimens are a Risk Factor for IRIS in CROI 2017 OR (95%CI) Dutch cohort* French cohort** 3.25 ( ) 1.99 ( ) *CROI 2017 # 731 (ATHENA) & **CROI 2017 # 732 (Dat AIDS Study Group)
36 IMPACT OF RALTEGRAVIR INTENSIFICATION OF FIRST-LINE ART ON IRIS IN THE REALITY TRIAL (#23)
37 IMPACT OF RALTEGRAVIR INTENSIFICATION OF FIRST-LINE ART ON IRIS IN THE REALITY TRIAL (#23)
38 IMPACT OF RALTEGRAVIR INTENSIFICATION OF FIRST-LINE ART ON IRIS IN THE REALITY TRIAL (#23)
39 IMPACT OF RALTEGRAVIR INTENSIFICATION OF FIRST-LINE ART ON IRIS IN THE REALITY TRIAL (#23)
40 IMPACT OF RALTEGRAVIR INTENSIFICATION OF FIRST-LINE ART ON IRIS IN THE REALITY TRIAL (#23) RALTEGRAVIR intensification did not increase IRIS incidence
41 TB-IRIS: INSPIRING Trial (#33) DOLUTEGRAVIR ART did not increase TB-IRIS incidence
42 IRIS: OPTIMAL Trial (#495) INSTI based ART did not increase IRIS incidence in OPTIMAL RCT
43 PCP-IRIS RISK FACTORS (#795) IRIS occurred in 12 of 97 German patients (12.4%) There were no significant differences regarding other parameters including death, initial CD4 count or time between start of PCP therapy and ART.
44 KS-IRIS (#133)
45 KS-IRIS (#133)
46 KS-IRIS (#133)
47 TB/OIs, HCV/HBV, STI/HPV & Tumors Tuberculosis Cryptococcal meningitis Other Infections IRIS HCV/HBV coinfection HPV/STI Cancer
48 TasP in Switzerland: The Swiss HCVree Trial (#81LB)
49 INTERNATIONAL vs. DOMESTIC HCV TRANSMISSION IN MSM (#130) Foreing-to-Swiss transmission was estimated to range between 24% and 62%
50 LOW RATES OF SPONTANEOUS CLEARANCE OF ACUTE HCV COINFECTION (#129)
51 8 WEEKS OF GRAZOPREVIR/ELBASVIR FOR ACUTE HCV: A MULTICENTER RCT (DAHHS 2) (#128)
52 8 WEEKS OF GRAZOPREVIR/ELBASVIR FOR ACUTE HCV: A MULTICENTER RCT (DAHHS 2) (#128) 94%-98% SVR12
53 RETREATMENT OF HEPATITIS C INFECTION IN PATIENTS WHO FAILED GLECAPREVIR/PIBRENTASVIR (#128)
54 RETREATMENT OF HEPATITIS C INFECTION IN PATIENTS WHO FAILED GLECAPREVIR/PIBRENTASVIR (#128)
55 RETREATMENT OF HEPATITIS C INFECTION IN PATIENTS WHO FAILED GLECAPREVIR/PIBRENTASVIR (#128)
56 HIGH INCIDENCE OF HCV REINFECTION IN MSM IN THE GECCO COHORT (#128) Out of 2,074 patients, 41(1.97%) were identified with an HCV reinfection. Reinfection occurred within a median of 63 weeks (range16-180) after end-of-treatment response.
57 Hepatitis Pearls #637 POTENTIAL FOR SERUM MICRO-RNAs TO PREDICT FIBROSIS REGRESSION DURING HBV TREATMENT. #639 CIRCULATING MICRO-RNAs IN HIV PATIENTS REVEAL SPECIFIC SIGNATURES FOR LIVER DAMAGE #640 MICRO-RNA PROFILE OF HCV SPONTANEOUS CLEARANCE INDIVIDUALS SHOW PREVIOUS HCV INFECTION
58 Hepatitis Pearls : EXPANDING HOPE HIV D+/R+ Transplants (HOPE action) N = 24, KT 14, LT 10 All patients survived with good graft function HCV D+/R- Kidney transplantation (EXPANDER Trial) N=10 cases All cases received DAA: GZR/EBR±SOF SVR 100%, HCV Ab + 50% (SC) Safe 100% (No D/C) Christine Durand, CROI 2018 *Durand C et al. Ann Intern Med Mar 6. doi: /M
59 TB/OIs, HCV/HBV, STI/HPV & Tumors Tuberculosis Cryptococcal meningitis Other Infections IRIS HCV/HBV coinfection HPV/STI Cancer
60 2014 WHO Guidelines Single visit screen-and-treat using cryotherapy Loop electrosurgical excision procedure (LEEP) is an alterative for women not eligible for cryotherapy. Conditional recommendations for the optimal treatment to prevent cancer. 1. Santesso N, et al. International Journal of Gynecology and Obstetrics World Health Organization Guidelines for treatment of cervical intraepithelial neoplasia 2 3 and screen-and-treat strategies to prevent cervical cancer the Guideline Support Group : Int J Gynecol Obstet
61 ACTG 5282: HPV TEST & TREAT vs. CYTOLOGY-BASED CERVICAL CANCER PREVENTION IN HIV+ WOMEN (#134)
62 ACTG 5282: HPV TEST & TREAT vs. CYTOLOGY-BASED CERVICAL CANCER PREVENTION IN HIV+ WOMEN (#134)
63 ACTG 5282: HPV TEST & TREAT vs. CYTOLOGY-BASED CERVICAL CANCER PREVENTION IN HIV+ WOMEN (#134)
64 ACTG 5282: HPV TEST & TREAT vs. CYTOLOGY-BASED CERVICAL CANCER PREVENTION IN HIV+ WOMEN (#134) HPV test-and-treat was not associated with better outcomes as compared to a single round of cytology-based screening
65 INCIDENT HIV, HEPATITIS C AND OTHER STI IN DAILY vs. EVENT-DRIVEN PrEP USERS (#1026)
66 PRIOR SYPHILIS PROTECTS AGAINST T. PALLIDUM DISSEMINATION IN REPEAT INFECTION (#798)
67 SYPHILIS TREATMENT WITH DOXYCYCLINE IN HIV-INFECTED PATIENTS (#796)
68 TB/OIs, HCV/HBV, STI/HPV & Tumors Tuberculosis Cryptococcal meningitis Other Infections IRIS HCV/HBV coinfection HPV/STI Cancer
69 STATIN EXPOSURE IS ASSOCIATED WITH DECREASED RISK OF CANCER (#132)
70 STATIN EXPOSURE IS ASSOCIATED WITH DECREASED RISK OF CANCER (#132)
71 STATIN EXPOSURE IS ASSOCIATED WITH DECREASED RISK OF CANCER (#132)
72 STATIN EXPOSURE IS ASSOCIATED WITH DECREASED RISK OF CANCER (#132)
73 STATIN EXPOSURE IS ASSOCIATED WITH DECREASED RISK OF CANCER (#132)
74 STATIN EXPOSURE IS ASSOCIATED WITH DECREASED RISK OF CANCER (#132) Statin exposure is associated with lower risk of cancer independent of HIV status.
75 Cancer Pearls #651 STILL HIGH RISK OF VIRUS-RELATED CANCER DESPITE 20 YEARS OF cart IN ICONA COHORT #644 FAILURE RATE OF ULTRASOUND SURVEILLANCE OF HEPATOCELLULAR CARCINOMA IN HIV+ PATIENTS #669 PRESENTATION AND OUTCOME OF BIOPSY- PROVEN HEPATOCELLULAR CARCINOMA BY HIV STATUS
76 Acknowledgements J. Baker C. Boesecke D.A. Braun R. Chaisson M. Colombo K. Dooley C. Durand J.L. Flynn A. Gupta S.P. Koenig J.M. Llibre N. Merchante J. Schillinger T. Sterling
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