Tobin L. Brown, RN, BScN, ACRN March 16, 2012

Transcription

1 Tobin L. Brown, RN, BScN, ACRN March 16, 2012

2 New treatment guidelines New medications PrEP update Research findings Aging

3 Mathematical calculation, like pack years for smoking created by AIDS Research Network of Integrated Clinical Systems to draw associated between viral copy years and mortality. Bottom line: greater exposure to HIV virus over time is an independent predictor of death Supports ideas that viremia is harmful even when CD4 count is >200 Effects of viremia, immune activation and inflamation can be proven

4 Initiate ARV s if CD4 < 350, recommend treatment start when CD4 between Initiate treatment, regardless of CD4 if: HIV associated neuropathy, and HBV coinfection Treatment of all HIV + pregnant women with the goal to prevent perinatal transmission Panel on Antiviral Guidelines for Adults and Adolescents. Guidelines for the use of antretroviral agents in HIV-1- infected adults and adolescents. Department of Health and Human Services. October 14, 2011.

5 Complera: ripliverine 25 mg/emtricitabine 200 mg/ tenofovir 300 mg Comparable to sustiva- Fewer neuro side effects

6 No longer requires refrigeration Will be automatically substituted by pharmacy now that finally approved by ODB Should reduce further GI complications To be taken with food

7 Raltegravir 400 mg twice daily plus Truvada once daily -fewer drug interactions than most PI s -more lipid neutral

8 New Tenofovir pro-drug with superior drug efficacy The quad pill: Elivegravir (integrase), and new boosting agent cobicistat, Emtricitabine, and Tenofovir (or new pro-drug) New integrase inhibitor Dolutegravir for those with extensive drug resistance

9 FEM-PrEP: study halted April, 2011 due to similar infection rate in both FTC/3TC & placebo arm -Importance of adherence PARTNERS PrEP Study: 4700 HIV discordant couples Kenya/Uganda comparing 2 ARV/1ARVplacebo arm d/c and participants offered PrEP Points for discussion: cost, adherence requirement?

10 For use in confirmed HIV negative with regular HIV testing and assessment PrEP should only be taken by individuals for whom it has been ordered Not to be used in pregnant or breastfeeding women Must be taken DAILY!

11 2011 breakthrough of the year!! Demonstrated antiretrovial medication can treat as well as prevent transmission of HIV Ongoing since 2005 with >1700 heterosexual couples several African countries, Thailand, and US. (Slated to end 2015.) Independent review found 28 transmissions in the wait for treatment arm, and only 1 in the immediate treatment arm

12 When used with other prevention methods a great leap forward! Scale up proven prevention methods such as routine HIV testing, knowing HIV status, early treatment initiation, consistent condom use, clean needle exchange, adult male circumcision as indicated, PMTC transmission and eventually PrEP, microbicides and other female controlled prevention, preventative vaccine(s) Limitations of this study for application of findings to MSM and needle sharing individuals

13 University of Western Ontario announced development of a vaccine Approved by FDA to begin human clinical trials SAV001: genetically modified, inactivated whole virus Phase 1-begins Jan/12 30 HIV positive people safety Phase 2-examines immune responses in humans-approx 600 high risk HIV negative people Phase 3-determine efficacy of the vaccine-6000 HIV negative volunteers at high risk

14 Diligent monitoring of cardiovascular risk factors: BP, cholesterol Pro-active approach to healthcare colon cancer screening, updated vaccinations, bone density tests, PAP smears for women, age appropriate breast screening, vision and dental assessment, treatment of HCV/HBV as indicated, early and ongoing antiviral therapy, mental health services to address age related depression/cognition changes

15 Smoking is the single most important risk factor for lung cancer in HIV infected individuals. Equates to 14-fold increase in risk to develop lung cancer (no link between low CD4 and previous AIDS defining lung disease) Exercise, diet, ETOH, non-prescribed medications

16 Decreased serotonin levels, cardiovascular flow, endorphins Poor sleep hygiene Mental Health and HIV 50% more likely to have mental health issue than control

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