Case Presentation JF
|
|
- Anna Wilkins
- 6 years ago
- Views:
Transcription
1 Case Presentation
2 History, P/E and relevant labs Male 85 yo, HIV Dx 1996 (CD4-550, HIV-RNA 5000) referred for care 1999 PHx: syphilis, 50 pack-yr cigarettes Meds: none MSM, single, unemployed, previous multiple partners P/E tall & robust, BMI 25.6 HIV-RNA 100,000 copies; CD4-420 (15%), CD8-76%, CD4/ (N>1.0) Fasting lipids: TC 4.9 mmol/l, TG 2.19, HDL - 0.8, LDL 3.15, TC/HDL 6.1 HBV - immune, HCV - negative, VDRL - neg
3 Summary of initial status Clinically well Moderate immunosuppresion High nadir CD4 but increased HIV-RNA and low CD4/CD8 ratio Mild hypertriglyceridemia, low HDL c/w inflammatory dyslipidemia
4 Course 1999 Nelfinavir plus Combivir 2001 CMB plus Kaletra: VL < 50, CD ED, low free testosterone, Rx w andriol & viagra DXA-normal LS & FN BMD, Fat Mass Ratio 1.8 (N) 2004 EMG-mild peripheral neuropathy 2006 syphilis; CMB plus ATV/r, jaundice, change to SQV/r plus CMB; DLP (Rx w atorvastatin 10 mg) FRS- 20% (high), WC-103 cm ( = high risk for CVD) 2008 (Dx elsewhere, delay in notification) extrasystoles Echo- EF 40%, mild LV dysfunction- no Rx
5 Course 2010 abdominal pain, CT infrarenal AAA (5x4 cm) Cardiac - echo 25% EF Cath % obstruction c/w non-ischemic cardiomyopathy ( HIV, AZT) Multiple diuretics + beta-blockers, low BP, AF (CHADS 3) coumadin, ICD inserted LGI bleed, C & G scope negative KLT monotherapy (high CPE), CD f/u echo- EF 40%
6 Course 2013 increased TGs, RAL/KVX 2014 uncomplicated AAA repair Meds (non-hiv): tamsulosin, finasteride, furosemide, atorvastatin, apixaban, vitamin D, pantoprazole Concern from friend about driving (lives offisland) and poor self-care ( occ incontinent) MOCA-25/30, home visit from community clinic x1 then no f/u
7 Course 2015 CD4-800, Weight 97 kg, BMI 31 waist circumference 105 cm GFR > 60, postural hypotension (no falls), back pain (lumbar DDD), slow gait, using cane & wheelchair (convenient) still driving 2016 No c/o, says ok for ADL/IADL concern re short-term memory decline, MOCA-16 new iron def anemia, several months to arrange C-scope (negative), G-scope-??, transfusion Sept formal driving assessment arranged bathroom aids installed, friend supervising meals, limited community support
8 Active issues HIV: stable but low CD4/CD8 c/w persistent immunosuppression and immunosenescence (IRP) 2 clinical periods: HIV management - > 2010 comorbidities
9 Summary of status Co-morbidities: arrythmia, dilated cardiomyopathy, postop, anemia nyd, metabolic syndrome (abdominal obesity [WC> 102] + incr TG + low HDL), spine DDD, cognitive decline Multimorbidity (> 2 co-morbidities) Geriatric syndromes: frailty (Fried criteria 3 of slowness, weakness, low activity, exhaution, wt loss); increased risk of falls (NB use of NOAC); polypharmacy (2 ARVs, 6 others and 1 vitamin); social isolation; impaired functional status; cognitive decline Cognitive decline risks: age; abdominal obesity; low cardiac output; vascular (AF); ART; HAND
10 Question: What issues typical of older HIV patients does this person exhibit?
11 Factors affecting this patient s QOL Functional decline Physical dependence Decreased economic capacity Change in social activity Relationship with others
12 Frailty Heterogenous syndrome common in the elderly Decreased physiologic reserve, increases vulnerability to negative outcomes including loss of independence, requirement for supervised housing, increased morbidity and mortality Characterized by low endurance, poor strength, impaired balance, and low physical activity
13 Objective definition of frailty* as proposed by Fried et al Morley JE et al. The Aging Male 2005;8(3/4):135-40
14
15 Spectrum of neurocognitive disorders in HIV infection Normal Asymptomatic neurocognitive impairment (ANI) Mild neurocognitive decline (MND) HIV-associated dementia (HAD)
16 Proportion of HIV pts with neurocognitive impairment according to HAND criteria Dulioust A et al. CROI 09
17 Risk factors for cognitive decline in HIV patients Specific (HIV-related) Nadir CD4 Minimal CD4 increase on HAART HIV subtypes (increased risk with D) High serum/csf viral load Controversial: HAART with poor CSF penetration (strategic) treatment interruptions Chronic inflammatory state HIV infection possible role of GI tract immune system as an HIV reservoir Common (increased risk or occurring earlier) Increasing age (possibly) low education: limited reserve Vascular risks: increased risk of HPB and increased rates of cigarette smoking Lipids: increased cholesterol, (possibly) low HDL Diabetes Genetic predisposition (Apo-E4 homozygous) HCV
18 Alternative classification of dementia: Alzheimer disease (AD) and vascular dementia (VaD) fall on a continuous spectrum of disease Viswanathan A et al. Neurol 2009;72:368-74
19 Treatment outcomes: older pts often have lower pre-haart and plateau CD4 s but similar HIV-RNA post-haart (suggesting delayed Dx and better adherance) Median log 10 (HIV- RNA) evolution! Median CD4 + T cell count/mm 3 evolution Nogueras M et al. BMC Inf Dis 2006;6:159
20 HIV, Immunosenescence and Clinical Outcomes Serrano-Villar et al. HIV Med 2013
21 What about long-term effects of TFV in aging HIV patients? Bone demineralization Renal toxicity Role of TAF
HIV, Multimorbidity, and Frailty: what s going on? (with apologies to Marvin Gaye)
HIV, Multimorbidity, and Frailty: what s going on? (with apologies to Marvin Gaye) Julian Falutz MD, FRCPC Director Comprehensive HIV Aging Initiative Chronic Viral Illness Service Senior Physician, Division
More informationHIV & Aging: Evolving Clinical Considerations in the New Millennium
HIV & Aging: Evolving Clinical Considerations in the New Millennium Julian Falutz, MD, FRCP (C) Director, HIV Metabolic Clinic Immunodeficiency Treatment Centre Senior Physician Division of Geriatrics
More information2/10/2015. Switching from old regimens. HIV treatment revision: As simple as old versus new? What is an old regimen? What is an old regimen?
Switching from old regimens David Nolan Department of Immunology, Royal Perth Hospital, Western Australia Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia What is
More informationBHIVA Best of CROI Feedback Meetings. London Birmingham North West England Cardiff Gateshead Edinburgh
BHIVA Best of CROI Feedback Meetings London Birmingham North West England Cardiff Gateshead Edinburgh BHIVA Best of CROI Feedback Meetings 2010 COMPLICATIONS OF HIV DISEASE AND TREATMENT Overview Cardiovascular
More informationPIs are the real world answer for the chronic patient s management. Giovanni Guaraldi
PIs are the real world answer for the chronic patient s management Giovanni Guaraldi HIV MEDICATION TOXICITY Ageing with HIV: The clinical consequences AGEING Heart disease Kidney disease Liver disease
More informationCase Discussions: Treatment Strategies for High Risk Populations. Most Common Reasons for Referral to the Baylor Lipid Clinic
Case Discussions: Treatment Strategies for High Risk Populations Peter H. Jones MD, FNLA Associate Professor Methodist DeBakey Heart and Vascular Center Baylor College of Medicine Most Common Reasons for
More informationPowered by. HIV and Aging. A virtual platform for medical visits
HIV and Aging Jordi Puig Pla RN. Lluita Conta la Sida Foundation. Germans Trias University Hospital COMPREHENSIVE ASSESSMENT OF HIVINFECTED POPULATION AGED 60 YEARS OR OLDER Background The incidence of
More informationNo Conflict of Interest
No Conflict of Interest Aging and HIV Co-Morbidities: A Challenge for Engagement in Care Maria L Alcaide M.D. Division of Infectious Diseases University of Miami Miller School of Medicine Objectives Understand
More informationPrevalence of Comorbidities among HIV-positive patients in Taiwan
Prevalence of Comorbidities among HIV-positive patients in Taiwan Chien-Ching Hung, MD, PhD Department of Internal Medicine National Taiwan University Hospital, Taipei, Taiwan % of participants Comorbidity
More informationHIV and Ageing Challenges and Goals
HIV and Ageing Challenges and Goals Julian Falutz MD, FRCPC Associate Professor Director Comprehensive HIV-Aging Initiative Chronic Viral Illness Service & Division of Geriatrics McGill University Health
More informationCase Presentation. Moderator: Sharon Liu, DO Associate Internal Medicine Chief Austin Regional Clinic Austin, Texas
Case Presentation Moderator: Sharon Liu, DO Associate Internal Medicine Chief Austin Regional Clinic Austin, Texas Izzy (2006) 51 y/o Hispanic woman with a history of diabetes and obesity. Her diabetes
More informationDiabetes: Use of Adjunctive Therapy ACEs, ARBs, ASA & STATINs --Oh My! Veronica J. Brady, PhD, FNP-BC, BC-ADM, CDE Project ECHO April 19, 2018
Diabetes: Use of Adjunctive Therapy ACEs, ARBs, ASA & STATINs --Oh My! Veronica J. Brady, PhD, FNP-BC, BC-ADM, CDE Project ECHO April 19, 2018 Points to Ponder ASCVD is the leading cause of morbidity
More informationTreatment 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 informationIncreased and accelerated age-related complications in HIV-infected patients
Increased and accelerated age-related complications in HIV-infected patients Giovanni Guaraldi Università di Modena THE CHANGING SPECTRUM OF HIV CARE Pre- HAART 1996 Early- HAART 2005 Late- HAART Opportunistic
More informationManagement of DM in Older Adults: It s not all about sugar! Who needs treatment for DM? Peggy Odegard, Pharm.D., BCPS, CDE
Management of DM in Older Adults: It s not all about sugar! Peggy Odegard, Pharm.D., BCPS, CDE Who needs treatment for DM? 87 year old, frail male with moderately severe dementia living in NH with persistent
More informationFrailty and HIV: what is the evidence? Giovanni Guaraldi
Frailty and HIV: what is the evidence? Giovanni Guaraldi Disclosure Dr Guaraldi has served as a consultant for Bristol-Myers Squibb, Abbvie, Theratecnologies, Gilead Sciences, Inc, GlaxoSmithKline, Merck
More informationCentral Nervous System Penetration of ARVs: Does it Matter?
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Central Nervous System Penetration of ARVs: Does it Matter? Christina M. Marra, MD Neurology and Medicine (Infectious Diseases) University of Washington 15
More informationMedical Challenges of HIV/AIDS pandemic: The WHO perspective. SOLTHIS HIV Forum
Medical Challenges of HIV/AIDS pandemic: The WHO perspective SOLTHIS HIV Forum Marco Vitoria HIV/AIDS Department World Health Organization September 2013 Topic 2002 2003 2006 2010 2013 When to start 1
More informationModule 2. Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension
Module 2 Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension 1 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored,
More informationIntroduction to HIV and Aging
Introduction to HIV and Aging Sheree Starrett MD Medical Director - Rivington House June 27, 2008 Rivington House Objectives Know the demographics of aging and HIV Identify the similarities between aging
More informationFigure S1. Comparison of fasting plasma lipoprotein levels between males (n=108) and females (n=130). Box plots represent the quartiles distribution
Figure S1. Comparison of fasting plasma lipoprotein levels between males (n=108) and females (n=130). Box plots represent the quartiles distribution of A: total cholesterol (TC); B: low-density lipoprotein
More informationHIV monitoring and assessment in older adults
HIV monitoring and assessment in older adults BHIVA National Clinical Audit 2018 Dr Nadia Ekong on behalf of the BHIVA Audit and Standards Sub-Committee Background In 2016, 37.8% of people seen for HIV
More informationTreatment 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 informationClinical 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 informationHIV Neurology Persistence of Cognitive Impairment Despite cart
HIV Neurology Persistence of Cognitive Impairment Despite cart Victor Valcour MD PhD Professor of Medicine Memory and Aging Center, Dept. of Neurology University of California San Francisco, USA 8 th International
More informationGeriatric Preventive Care. Lee A. Jennings, MD, MSHS Reynolds Department of Geriatrics University of Oklahoma Health Sciences Center
Geriatric Preventive Care Lee A. Jennings, MD, MSHS Reynolds Department of Geriatrics University of Oklahoma Health Sciences Center Summary of Preventive Care Lifestyle Exercise Tobacco cessation Alcohol
More informationOverview of 2013 WHO consolidated ARV guidelines and update plans. Marco Vitoria HIV/AIDS Department WHO Geneva September 2014
AMDS ANNUAL STAKEHOLDERS AND PARTNERS MEETING Overview of 2013 WHO consolidated ARV guidelines and update plans Marco Vitoria HIV/AIDS Department WHO Geneva September 2014 AMDS ANNUAL STAKEHOLDERS AND
More informationInvestigating the effect of antiretroviral switch to tenofovir alafenamide on lipid profiles in people living with HIV within the UCD ID Cohort
Investigating the effect of antiretroviral switch to tenofovir alafenamide on lipid profiles in people living with HIV within the UCD ID Cohort A. Lacey 1, W. Tinago 1, E. Alvarez Barco 1, A.J. Macken
More informationHIV and Bone Disease: Through Thick and Thin! Pablo Tebas, MD
HIV and Bone Disease: Through Thick and Thin! Pablo Tebas, MD April 30 th, 2016 Disclosures I serve in an adjudication panel in a VZV vaccine study (Glaxo) I consult for Merck My research is supported
More informationHIGH BURDEN OF METABOLIC COMORBIDITIES IN A CITYWIDE COHORT OF HIV OUTPATIENTS
HIGH BURDEN OF METABOLIC COMORBIDITIES IN A CITYWIDE COHORT OF HIV OUTPATIENTS Evolving Health Care Needs of People Aging with HIV in Washington, DC Matthew E. Levy 1, Alan E. Greenberg 1, Rachel Hart
More informationHIV Update. On The Cutting Edge A Chronic Disease. Rhett M Shirley, MD
HIV Update On The Cutting Edge A Chronic Disease Rhett M Shirley, MD CDC Mid-point life expectancy estimates at age 20 years in three calendar periods, overall and by sociodemographic characteristics,
More informationSituación actual de los pacientes VIH+ Esteban Martínez Hospital Clínic Barcelona
Situación actual de los pacientes VIH+ Esteban Martínez Hospital Clínic Barcelona Mortality per 1 patient-years HIV infection has changed from a fatal disease into a chronic condition This means long-term
More informationThe Epidemiology of Stroke and Vascular Risk Factors in Cognitive Aging
The Epidemiology of Stroke and Vascular Risk Factors in Cognitive Aging REBECCA F. GOTTESMAN, MD PHD ASSOCIATE PROFESSOR OF NEUROLOGY AND EPIDEMIOLOGY JOHNS HOPKINS UNIVERSITY OCTOBER 20, 2014 Outline
More informationD:A:D: Cumulative Exposure to DRV/r Increase MI Risk
D:A:D: Cumulative Exposure to DRV/r Increase MI Risk 20.0-15.0-10.0-5.0-4.0-3.0-2.0-1.0- Unadjusted CVD rate ratios per 5 years additional exposure: ATV/r 1.25 [1.10-1.43] and DRV/r 1.93 [1.63-2.28] Adjusted*
More informationCaring for the ageing HIV infected patients: meeting the challenge
Caring for the ageing HIV infected patients: meeting the challenge Giovanni Guaraldi Università di Modena A geriatric definition of old-age: 65-75 YRS: Youngest old 76-84 YRS: Old >85: Oldest-old Corriere
More informationDisclosures. Obesity and Its Challenges: Outline. Outline 5/2/2013. Lan Vu, MD Division of Pediatric Surgery Department of Surgery
Obesity and Its Challenges: Bariatric Surgery: Why or Why Not I have nothing to disclose Disclosures Lan Vu, MD Division of Pediatric Surgery Department of Surgery Outline Growing obesity epidemic Not
More informationCase discussion: How do drugs/patients impact need and type of monitoring CASE 2
Case discussion: How do drugs/patients impact need and type of monitoring CASE 2 Marta Boffito Head of Clinical Trials, St. Stephen s Centre (SSAT) Consultant Physician, Chelsea and Westminster Foundation
More informationPreventing Cardiovascular Disease Stroke Primary Prevention Guidelines. John Potter Professor Ageing & Stroke Medicine University of East Anglia
Preventing Cardiovascular Disease Stroke Primary Prevention Guidelines John Potter Professor Ageing & Stroke Medicine University of East Anglia Preventing Cardiovascular Disease Stroke Primary Prevention
More informationPRESENTED BY BECKY BLAAUW OCT 2011
PRESENTED BY BECKY BLAAUW OCT 2011 Introduction In 1990 top 5 causes of death and disease around the world: Lower Respiratory Tract Infections Diarrhea Conditions arising during pregnancy Major Depression
More informationBEST PRACTICE MANAGEMENT: CARDIOVASCULAR RISKS
BEST PRACTICE MANAGEMENT: CARDIOVASCULAR RISKS Neil R Poulter ICCH, Imperial College London BHIVA: October 10th, 2008 Background CVD is the biggest single killer in the world CVD rates are increasing High
More informationCardiovascular Complications of HIV and Its Treatment
Cardiovascular Complications of HIV and Its Treatment FORMATTED: 11/6/15 Marshall J. Glesby, MD, PhD Professor of Medicine, Healthcare Policy and Research Weill Cornell College of Medicine New York, New
More informationChronic complications of HIV infection. An update Pablo Tebas, MD
Activity Code TM809 Chronic complications of HIV infection. An update 2014 Pablo Tebas, MD Learning Objectives Upon completion of this presentation, learners should be better able to: Identify and update
More informationATP IV: Predicting Guideline Updates
Disclosures ATP IV: Predicting Guideline Updates Daniel M. Riche, Pharm.D., BCPS, CDE Speaker s Bureau Merck Janssen Boehringer-Ingelheim Learning Objectives Describe at least two evidence-based recommendations
More informationMetabolic Syndrome. Shon Meek MD, PhD Mayo Clinic Florida Endocrinology
Metabolic Syndrome Shon Meek MD, PhD Mayo Clinic Florida Endocrinology Disclosure No conflict of interest No financial disclosure Does This Patient Have Metabolic Syndrome? 1. Yes 2. No Does This Patient
More informationBlood Pressure Measurement (children> 3 yrs)
Blood Pressure Measurement (children> 3 yrs) If initial BP elevated, repeat BP manually 2x and average, then classify Normal BP Systolic and diastolic
More informationHIV and Metabolic Cases
HIV and Metabolic Cases Amita Gupta MD, MHS Associate Professor of Medicine & International Health Deputy Director Johns Hopkins Center for Clinical Global Health Disclosures None Receive grant funding
More informationMetabolic Syndrome and Chronic Kidney Disease
Metabolic Syndrome and Chronic Kidney Disease Definition of Metabolic Syndrome National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Abdominal obesity, defined as a waist circumference
More informationBHIVA Workshop: When to Start. Dr Chloe Orkin Dr Laura Waters
BHIVA Workshop: When to Start Dr Chloe Orkin Dr Laura Waters Aims To use cases to: Review new BHIVA guidance Explore current data around when to start To discuss: Medical decisions, pros and cons Luigi
More informationSECONDARY PREVENTION OF CORONARY HEART DISEASE AND ISCHAEMIC STROKE/TIA
PRIMARY PREVENTION OF CHD AND STROKE IN HIGH RISK PATIENTS Random non fasting test for total cholesterol, HDL cholesterol (TC:HDL ratio) and LFTs If cholesterol > 7.5 mmol/l or LDL C 5mmol/l exclude secondary
More informationDisclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease
Disclosures Diabetes and Cardiovascular Risk Management Tony Hampton, MD, MBA Medical Director Advocate Aurora Operating System Advocate Aurora Healthcare Downers Grove, IL No conflicts or disclosures
More informationHIV 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 informationRisk Factors for Heart Disease
Risk Factors for Heart Disease Risk Factors we cannot change (Age, Gender, Family History) Risk Factors we can change (modifiable) Smoking Blood pressure Cholesterol Diabetes Inactivity Overweight Stress
More informationReport Back from CROI 2010
Report Back from CROI 2010 Conference on Retroviruses and Opportunistic Infections Edwin Charlebois, MPH PhD Associate Professor of Medicine Department of Medicine University of California, San Francisco
More informationPitavastatin 4 mg vs. Pravastatin 40 mg in HIV Dyslipidemia: Post- Hoc Analysis of the INTREPID Trial Based on the Independent CHD Risk Factor for Age
Pitavastatin 4 mg vs. Pravastatin 40 mg in HIV Dyslipidemia: Post- Hoc Analysis of the INTREPID Trial Based on the Independent CHD Risk Factor for Age Craig A. Sponseller, Masaya Tanahashi, Hideki Suganami,
More informationCCS/CAIC/CSCS Position Statement on Revascularization Multi-vessel CAD. Teo et al, Canadian Journal of Cardiology 2014;30:
CCS/CAIC/CSCS Position Statement on Revascularization Multi-vessel CAD Teo et al, Canadian Journal of Cardiology 2014;30: 1482-1491 Parallel Paper: Canadian Cardiovascular Society Guidelines for the Diagnosis
More informationPhysical Function & Frailty in HIV
Physical Function & Frailty in HIV Kristine M. Erlandson, MD Assistant Professor University of Colorado Divisions of Infectious Diseases & Geriatric Medicine Research funding through the National Institutes
More informationFactors Associated with Limitations in Daily Activity Among Older HIV+ Adults
Factors Associated with Limitations in Daily Activity Among Older HIV+ Adults KM Erlandson, K Wu, R Kalayjian, S Koletar, B Taiwo, FJ Palella Jr, K Tassiopoulos and the A5322 Team Background Growing burden
More informationGUIDELINES FOR DYSLIPIDEMIA MANAGEMENT AND EDUCATION THROUGH NOVA SCOTIA DIABETES CENTRES
GUIDELINES FOR DYSLIPIDEMIA MANAGEMENT AND EDUCATION THROUGH NOVA SCOTIA DIABETES CENTRES Prepared by DCPNS Action Committee Dr. Lynne Harrigan Brenda Cook Peggy Dunbar Bev Harpell with the assistance
More informationWomen and Vascular Disease
Women and Vascular Disease KEVIN F. REBECK PA-C VASCULAR TRANSPLANT SURGERY 1 The Scope of the Problem One woman dies every minute from cardiovascular disease in the U.S.! The Scope of the Problem CVD
More informationHIV 101: Overview of the Physiologic Impact of HIV and Its Diagnosis Part 2: Immunologic Impact of HIV and its Effects on the Body
HIV 101: Overview of the Physiologic Impact of HIV and Its Diagnosis Part 2: Immunologic Impact of HIV and its Effects on the Body Melissa Badowski, PharmD, BCPS, AAHIVP Clinical Assistant Professor University
More informationSupplemental Table S2: Subgroup analysis for IL-6 with BMI in 3 groups
Supplemental Table S1: Unadjusted and Adjusted Hazard Ratios for Diabetes Associated with Baseline Factors Considered in Model 3 SMART Participants Only Unadjusted Adjusted* Baseline p-value p-value Covariate
More informationHIV long term complications
HIV- 2015 long term complications 4th Asian Conference on Hepatitis & AIDS 22-23 May 2015, Xi'an, China Kees Brinkman Amsterdam The Netherlands NL 2012: known 17.000 (0,1%) treatment 85% (all) China 2011:
More informationCASE STUDIES IN ADVANCED HEART FAILURE
CASE STUDIES IN ADVANCED HEART FAILURE Navin Rajagopalan, MD Director, Congestive Heart Failure Medical Director, Cardiac Transplantation Gill Heart Institute, Cardiovascular Medicine DISCLOSURES NOTHING
More informationSecondary prevention and systems approaches: Lessons from EUROASPIRE and EUROACTION
Secondary prevention and systems approaches: Lessons from EUROASPIRE and EUROACTION Dr Kornelia Kotseva National Heart & Lung Insitute Imperial College London, UK on behalf of all investigators participating
More informationEndocrinopathy and Leukocyte Telomere Length in HIV+ Individuals in the CARMA Cohort
Endocrinopathy and Leukocyte Telomere Length in HIV+ Individuals in the CARMA Cohort Kristen M. Sokalski, Alice Mai, Jackson Chu, Hélène Côté, Evelyn J. Maan, Arianne Albert, Neora Pick, Deborah Money,
More informationHow would you manage Ms. Gold
How would you manage Ms. Gold 32 yo Asian woman with dyslipidemia Current medications: Simvastatin 20mg QD Most recent lipid profile: TC = 246, TG = 100, LDL = 176, HDL = 50 What about Mr. Williams? 56
More informationEugene Barrett M.D., Ph.D. University of Virginia 6/18/2007. Diagnosis and what is it Glucose Tolerance Categories FPG
Diabetes Mellitus: Update 7 What is the unifying basis of this vascular disease? Eugene J. Barrett, MD, PhD Professor of Internal Medicine and Pediatrics Director, Diabetes Center and GCRC Health System
More informationWho and When to Refer for a Heart Transplant
Who and When to Refer for a Heart Transplant Dr Jayan Parameshwar Consultant Cardiologist Papworth Hospital BSH 24 th November 2017 BSH Annual Autumn Meeting 2017 Presentation title: Who and when to refer
More informationDEPRESCRIBING IN THE ELDERLY
DEPRESCRIBING IN THE ELDERLY G E R I A T R I C S R E F R E S H E R D A Y W E D N E S D A Y, A P R I L 5 TH, 2 0 1 7 V É R O N I Q U E F R E N C H M E R K L E Y, M D, C C F P ( C O E ) B R U Y È R E C O
More informationThe Graying of HIV A Growing Population and a Chronic Disease. Dorcas Baker, RN, BSN, ACRN, MA Johns Hopkins AETC Site Director June 9, 2014
The Graying of HIV A Growing Population and a Chronic Disease Dorcas Baker, RN, BSN, ACRN, MA Johns Hopkins AETC Site Director June 9, 2014 Introduction The aging face of HIV/AIDS is attributed to two
More information8:30-10:30 WS #4: Cardiology :00-13:00 WS #11: Cardiology 101 (Repeated)
Professor Ralph Stewart Cardiologist Auckland City Hospital Green Lane Cardiovascular Research Unit Auckland Heart Group Fiona Stewart Cardiologist Green Lane Hospital National Women's Hospital Professor
More informationEPIDEMIOLOGY, CLINICAL FEATURES AND OUTCOME OF ACUTE HEPATITIS C IN HIV-POSITIVE PATIENTS: PRESENTATION OF OUR EXPERIENCE
EPIDEMIOLOGY, CLINICAL FEATURES AND OUTCOME OF ACUTE HEPATITIS C IN HIV-POSITIVE PATIENTS: PRESENTATION OF OUR EXPERIENCE E. Angeli, A. Mainini, C. Atzori, G. Gubertini and G. Rizzardini II Dept. Infectious
More informationThe Metabolic Syndrome: Is It A Valid Concept? YES
The Metabolic Syndrome: Is It A Valid Concept? YES Congress on Diabetes and Cardiometabolic Health Boston, MA April 23, 2013 Edward S Horton, MD Joslin Diabetes Center Harvard Medical School Boston, MA
More informationAgeing with HIV. Moderator: Georg Behrens, Germany. Silvia Nozza, Italy Adrian Curran, Spain
Ageing with HIV Moderator: Georg Behrens, Germany Silvia Nozza, Italy Adrian Curran, Spain Italian Data from ISS In 2015 in Italy 650 new HIV infections occurred in people more than 50 years old Most of
More informationGet a Statin or Not? Learning objectives. Presentation overview 4/3/2018. Treatment Strategies in Dyslipidemia Management
Get a Statin or Not? Treatment Strategies in Dyslipidemia Management Michelle Chu, PharmD, BCACP, CDE Assistant Professor of Clinical Pharmacy, USC School of Pharmacy Sahar Dagher, PharmD Virtual Care
More informationHIV and Brain Func.on. Tristan J Barber Research Physician St Stephen s AIDS Trust Chelsea and Westminster Hospital
HIV and Brain Func.on Tristan J Barber Research Physician St Stephen s AIDS Trust Chelsea and Westminster Hospital HIV and the Brain When can HIV affect the brain? Seroconversion Long term infected (not
More informationFrailty and the Risk of Falls in HIV- Infected Older Adults in the ACTG A5322 Study
Frailty and the Risk of Falls in HIV- Infected Older Adults in the ACTG A5322 Study Katherine Tassiopoulos, Mona Abdo, Susan L. Koletar, Frank Palella, Babafemi Taiwo, and Kristine M. Erlandson for the
More informationCardiovascular Health Practice Guideline Outpatient Management of Coronary Artery Disease 2003
Authorized By: Medical Management Guideline Committee Approval Date: 12/13/01 Revision Date: 12/11/03 Beta-Blockers Nitrates Calcium Channel Blockers MEDICATIONS Indicated in post-mi, unstable angina,
More informationDifferential diagnosis between depression and neurocognitive impairment in HIV-infected persons
Differential diagnosis between depression and neurocognitive impairment in HIV-infected persons Dr. Adriana Carvalhal, MD, MSc, PhD University of Toronto - Canada Disclosure Research: Canadian Institute
More informationHIV and the Aging Patient: Managing Co-morbidities. Heather Free, PharmD, AAHIVP
HIV and the Aging Patient: Managing Co-morbidities Heather Free, PharmD, AAHIVP Objectives Review HIV/AIDS statistics within the United States Define HIV and Aging and life expectancy List treatment issues
More informationMetabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk
Metabolic Syndrome Update 21 Marc Cornier, M.D. Associate Professor of Medicine Division of Endocrinology, Metabolism & Diabetes University of Colorado Denver Denver Health Medical Center The Metabolic
More informationRISK FACTORS OR COMPLICATIONS AND RECOMMENDED TREATMENT GOALS AND FREQUENCY OF EVALUATION FOR ADULTS WITH DIABETES
RISK FACTORS OR COMPLICATIONS AND RECOMMENDED TREATMENT GOALS AND FREQUENCY OF EVALUATION FOR ADULTS WITH DIABETES Risk Factors or Complications Glycemic Control Fasting & Capillary Plasma Glucose Anti-platelet
More informationFrailty. Nicholas Butler MD, MBA Department of Family Medicine University of Iowa
Frailty Nicholas Butler MD, MBA Department of Family Medicine University of Iowa Doris 84 yo female who comes into your clinic with her daughter. She complains of feeling increasingly fatigued and just
More informationHIV and Dementia. London Dementia Clinical Network 14 June Dr Patricia McNamara MB BCh BAO MRCP PhD. Locum Consultant Neurologist, NHNN
HIV and Dementia London Dementia Clinical Network 14 June 2018 Dr Patricia McNamara MB BCh BAO MRCP PhD Locum Consultant Neurologist, NHNN Patricia.mcnamara2@nhs.net History of HIV Infection HIV 36 million
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Solomon SD, Uno H, Lewis EF, et al. Erythropoietic response
More informationPage 1. Disclosures. Background. No disclosures
Population-Based Lipid Screening in the Era of a Childhood Obesity Epidemic: The Importance of Non-HDL Cholesterol Assessment Brian W. McCrindle, Cedric Manlhiot, Don Gibson, Nita Chahal, Helen Wong, Karen
More informationFuture challenges for clinical care of an ageing population infected with HIV: a geriatric -HIV modelling study
Future challenges for clinical care of an ageing population infected with HIV: a geriatric -HIV modelling study Guaraldi G 1, De Francesco D 2, Malagoli A 1, Theou O 3, Zona S 1, Carli F 1, Dolci G 1,
More informationNora Goldschlager, M.D. SFGH Division of Cardiology UCSF
CLASSIFICATION OF HEART FAILURE Nora Goldschlager, M.D. SFGH Division of Cardiology UCSF DISCLOSURES: NONE CLASSIFICATION C OF HEART FAILURE NYHA I IV New paradigm Stage A: Pts at high risk of developing
More informationHIV and Co-morbidities November 18, 2013, 3:10 pm Abstract Number 141
Low omega-3 index in erythrocytes is a risk factor for progression of atherosclerosis in people living with HIV Bianca M Arendt, M Smieja, IE Salit, DWL Ma, F Smaill, D Elston, E Lonn, Johane P Allard
More informationMyAction Couple: Primary Prevention Case Study. Teresa Mackay, Rhian Houghton, Tim Grove
MyAction Couple: Primary Prevention Case Study Teresa Mackay, Rhian Houghton, Tim Grove Reason for Referral and Patient Demographics Referral Mr Smith Referred by GP High CVD 34.5% QRISK Hypertension (155/92)
More informationHEART FAILURE: PHARMACOTHERAPY UPDATE
HEART FAILURE: PHARMACOTHERAPY UPDATE 3 HEART FAILURE REVIEW 1 5.1 million x1.25 = 6.375 million 40 years old = MICHAEL F. AKERS, PHARM.D. CLINICAL PHARMACIST CENTRACARE HEALTH, ST. CLOUD HOSPITAL HF Diagnosis
More informationAmerican Diabetes Association 2018 Guidelines Important Notable Points
American Diabetes Association 2018 Guidelines Important Notable Points The Standards of Medical Care in Diabetes-2018 by ADA include the most current evidencebased recommendations for diagnosing and treating
More informationOptimizing Health While Aging with HIV
Slide 1 Optimizing Health While Aging with HIV Todd T. Brown, MD, PhD Division of Endocrinology and Metabolism Johns Hopkins University Unfortunately, We are Not Slide 2 Immortal But How Do We Want to
More informationProgress toward Universal ART Access: Innovations and Treatment 2.0. Marco Vitoria World Health Organization September 2013
Progress toward Universal ART Access: Innovations and Treatment 2.0 Marco Vitoria World Health Organization September 2013 The need for scalable, more efficient treatment models Simpler drugs Point of
More informationFat redistribution on ARVs: dogma versus data
Fat redistribution on ARVs: dogma versus data Gary Maartens Division of Clinical Pharmacology UNIVERSITY OF CAPE TOWN IYUNIVESITHI YASEKAPA UNIVERSITEIT VAN KAAPSTAD Half of what we are going to teach
More informationCardiovascular Disease After Spinal Cord Injury: Achieving Best Practice. Suzanne Groah, MD, MSPH Walter Reed Army Medical Center February 12, 2010
Cardiovascular Disease After Spinal Cord Injury: Achieving Best Practice Suzanne Groah, MD, MSPH Walter Reed Army Medical Center February 12, 2010 CAVEAT LECTOR 2 CVD-related Mortality in Aging SCI GU
More informationPrimary Care Approach for Evaluating the Risk of Falls with Elderly Patients. Danielle Hansen, DO, MS (Med Ed), MHSA
Primary Care Approach for Evaluating the Risk of Falls with Elderly Patients Danielle Hansen, DO, MS (Med Ed), MHSA Clinical Assistant Professor, LECOM Associate Director, LECOM Institute for Successful
More informationCVD Prevention, Who to Consider
Continuing Professional Development 3rd annual McGill CME Cruise September 20 27, 2015 CVD Prevention, Who to Consider Dr. Guy Tremblay Excellence in Health Care and Lifelong Learning Global CV risk assessment..
More informationABCD and Renal Association Clinical Guidelines for Diabetic Nephropathy-CKD. Management of Dyslipidaemia and Hypertension in Adults Dr Peter Winocour
ABCD and Renal Association Clinical Guidelines for Diabetic Nephropathy-CKD. Management of Dyslipidaemia and Hypertension in Adults Dr Peter Winocour Dr Indranil Dasgupta Rationale No national practical
More informationPREDIABETES TESTING SERVICES
PREDIABETES TESTING SERVICES ASSESSING DIABETES RISK IN ASYMPTOMATIC ADULTS Depending upon population characteristics, up to 70% of individuals with prediabetes will ultimately progress to diabetes at
More information