Epidemiology Testing Clinical Features Management
|
|
|
- Emily Moody
- 5 years ago
- Views:
Transcription
1 Jason Cronin, MD
2
3 Epidemiology Testing Clinical Features Management
4 In 1981, 1 the first cases of AIDS were identified among gay men in the US. However, scientists later found evidence that the disease existed in the world as early as Evolved from simian immunodeficiency virus (SIV) The first documented case of HIV was traced back to 1959 using preserved blood samples, which were analyzed in Globally 35.3 million people living with HIV/AIDS, 25 million in sub-saharan Africa 2.3 million new infections/year 1.6 million deaths due to AIDS/year 1.2 million individuals in the U.S. living with HIV/AIDS 1. UNAIDS Report on the Global AIDS Epidemic.
5 1981 -First cluster of homosexual men with pneumocystis and Kaposi s sarcoma 1983 Identification of retrovirus eventually known as HIV First serologic test for HIV zidovudine (AZT) approved 1996 First combination regimen (AZT, lamivudine, indinavir) N Engl J Med 1997; 337:
6
7
8
9 Living 64 % MSM, 10% IDU 274 New cases/year last 15 years Increased rates year olds since 2006 Counties with Highest Number People Living with HIV/AIDS County Number Multnomah 3076 Washington 569 Marion 372 Clackamas 357 Lane 301 Jackson 161 Deschuttes 91 Linn 63 Douglas 62 Epidemiologic Profile of HIV/AIDS in Oregon, public.health.oregon.gov/diseasesconditions/communicabled isease/diseasesurveillancedata/hivdat Josephine 58
10
11 Modes of transmission Sexual IVDA Transfusions (pre-1985, post /1-2 million) Maternal-fetal transmission Occupational
12 Note: For comparison with data for 1999 and later years, data for were modified to account for ICD-10 rules instead of ICD-9 rules.
13 Continuous ART arms of SMART and ESPRIT trials Non-IDU aged 2-70 T cells >350, VL undetectable or very low No increase in mortality for subgroup with T cells >500 compared with control 47 Causes of Death Cardiovascular Disease Non-AIDS Malignancy AIDS-related Other AIDS 2013, 27:
14 CDC Prior Recommendations: Targeted testing based on risk factors ER screening studies found as many as 43% of positive tests were in individuals with no traditional risk factors Reduced transmission and long-term morbidity due to earlier diagnosis Cost-effective even with relatively lowprevalence rates (1/1000)
15 Routine, voluntary testing for all persons (Some groups recommend 75) at all points of care Annual repeat testing for individuals in higher risk groups (such as high risk sexual behavior, IVDU) Opt-out screening with opportunity to answer questions and decline No specific informed consent recommended
16 HIV antibody ELISA Rapid tests Western blot Combined antibody-antigen HIV Viral RNA
17 Types of HIV tests HIV Test 4 th Generation Laboratory Tests Architect HIV Ag/Ab Combo 6.2 (3.5, 8.5) GS HIV Combo Ag/Ab EIA 7.4 (3.8, 11.0) 3 rd Generation Laboratory Tests ADVIA Centaur HIV 1/O/2 9.9 (7.7, 12.0) Vitros anti-hiv (8.7, 12.1) GS HIV-1/HIV-2 Plus O EIA 13.7 (11.3, 16.1) Number of days test positive after RNA detectable Median (95% CL) 3 rd Generation Rapid Test UniGold Recombigen HIV 21.6 (17.5, 27.8) 2 nd Generation Rapid Tests INSTI HIV-1 Antibody 13.5 (11.3, 14.8) Multispot HIV-1/ (14.5, 18.9) DDP HIV-1/ (14.0, 21.5) Reveal G2 HIV (16.5, 20.0) Clearview Complete HIV-1/ (17.5, 23.4) Clearview HIV-1/2 STATPAK 20.3 (17.4, 25.4) Oraquick Advance HIV-1/ (18.2, 29.9) Class Interval 4 th -Generation Laboratory Tests 6.8 (3.7, 9.7) 3 rd -Generation Laboratory Tests 11.4 (9.7, 13.4) 2 nd -Generation Rapid Tests 18.5 (16.0, 21.6) Western Blot Laboratory Test 24.3 (18.8, 31.0)
18 OraQuick In-Home HIV Test
19
20 Symptoms Primary Clinical Latency Long-Term Nonprogressors (4-7%, At least 10 years CD4>500) Elite Controllers (Absent or very low viremia, 1/300 patients) HIV-associated symptoms AIDS Indicator Conditions Other Comorbidities
21 Viral load CD4 count Genetic Background Long-Term Nonprogressors (4-7%, At least 10 years CD4>500) Elite Controllers (Absent or very low viremia, 1/300 patients)
22
23 Incubation 2-4 weeks Fever Axillary, occipital, cervical lymphadenopathy Sore throat, shallow mucosal ulceration Maculopapular rash Lymphopenia, abnormal LFT s common HIV antibody negative, viral load very high
24 Thrush Persistent vaginal candidiasis Oral hairy leukoplakia Herpes zoster involving two episodes or multidermatomal Peripheral neuropathy Bacillary angiomatosis Cervical dysplasia Cervical carcinoma in situ Constitutional symptoms (fever or diarrhea >1 mo) Idiopathic thrombocytopenic purpura Pelvic inflammatory disease Listeriosis
25 CD4>200 Bacterial infections, multiple or recurrent* Cervical cancer, invasive Kaposi sarcoma Lymphoma, Burkitt (or equivalent term) Lymphoma, immunoblastic (or equivalent term) Pneumonia, recurrent CD4<200 Candidiasis of bronchi, trachea, or lungs Candidiasis of esophagus Coccidioidomycosis, disseminated or extrapulmonary Cryptococcosis, extrapulmonary Encephalopathy, HIV related Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex* Herpes simplex: chronic ulcers (>1 month's duration) or bronchitis, pneumonitis, or esophagitis (onset at age >1 month) Histoplasmosis, disseminated or extrapulmonary Mycobacterium tuberculosis of any site, pulmonary, disseminated, or extrapulmonary Pneumocystis jirovecii pneumonia Wasting syndrome attributed to HIV Salmonella septicemia, recurrent Toxoplasmosis of brain, onset at age >1 month Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary CD4<50 Cryptosporidiosis, chronic intestinal (>1 month's duration) Cytomegalovirus disease (other than liver, spleen, or nodes), onset at age >1 month Cytomegalovirus retinitis (with loss of vision) Isosporiasis, chronic intestinal (>1 month's duration) Lymphoma, primary, of brain Mycobacterium, other species or unidentified species, disseminated or extrapulmonary Progressive multifocal leukoencephalopathy
26 4% 2% 2% 2% 2% 1% 1% 3% 3% 4% 5% 5% 11% 42% Pneumocystis Esophageal Candidiasis Wasting Kaposi's Disseminated M. avium Tuberculosis CMV Dementia Recurrent pneumonia Toxoplasmosis Immunoblastic lymphoma Cryptosporidiosis 11% 15% Burkitt's lymphoma Disseminated histoplasmosis Invasive cervical cancer Chronic herpes simplex
27 Malignancies Cardiovascular Coinfections Complex Pathogenesis Immune factors Behavioral factors Medication toxicity
28 Condition Non-AIDS Defining Malignancies Approximate risk Notes Hodgkin s Lymphoma 15 to 30x Increased unfavorable histology and advanced disease Plasma Cell Disorders 4.5x 2.5% MGUS Younger Age Hepatocellular 3.8x Coinfection with hepatitis C/B Lung cancer 2-4x More likely metastatic, less tobacco exposure Anogenital HPV Head and Neck 2-3x Younger Esophagus/Stomach 1.4,1.69x Cardiovascular Total 6.76 men, 2.47 women Both effect of HAART as well as direct effects on endothelium Controlled for other factors Diabetes x for HIV men on HAART Protease Inhibitors NRTI s
29 1996 all with CD4+ <500 or CD4 >500 and VL >30, initiate if VL >10,000 copies/ml 2000 CD4+ <350, or VL >30,000, or CD and VL 5k-30k 2002 CD4 <200, otherwise clinical judtgment 2003 CD4 <200, offer if , clinical judgment >350 and VL >55, <200, offer , most defer >350 and VL > 100k 2008 CD4 <350, otherwise consider 2009 CD4 <500, otherwise consider
30 More effective regimens More convenient regimens Better tolerated therapy Less long-term toxicity Better immune recovery Lower rates of resistance More treatment options Concerns for uncontrolled viremia Decrease HIV transmission Lack of RCT data supporting early Rx Potential drug toxicity Drug and monitoring cost Potential negative impact on QOL
31 Everyone, regardless of CD4 count Urgency of starting may depend on other factors such as patient readiness, presence of AIDS or AIDS-related comorbidities, pregnancy Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at
32 NRTI Abacavir (ABC) Didanosine (ddi) Emtricitabine (FTC) Lamivudine (3TC) Stavudine (d4t) Tenofovir (TDF) Zidovudine (AZT, ZDV) NNRTI Delavirdine (DLV) Efavirenz (EFV) Etravirine (ETR) Nevirapine (NVP) Rilpivirine (RPV) PI Atazanavir (ATV) Darunavir (DRV) Fosamprenavir (FPV) Indinavir (IDV) Lopinavir (LPV) Nelfinavir (NFV) Ritonavir (RTV) Saquinavir (SQV) Tipranavir (TPV) Integrase Inhibitor (II) Dolutegravir (DTG) Elvitegravir* (EVG) Raltegravir (RAL) Fusion Inhibitor Enfuvirtide (ENF, T-20) CCR5 Antagonist Maraviroc (MVC) * EVG currently available only in coformulation with cobicistat (COBI)/ TDF/FTC May
33 NNRTI-Based Regimen EFV/TDF/FTC 1 (AI) PI-Based Regimens (in alphabetical order) ATV/r + TDF/FTC 1 (AI) DRV/r (once daily) + TDF/FTC1 (AI) INSTI-Based Regimen DTG plus ABC/3TC (AI) only for patients who are HLA-B*5701 negative DTG plus TDF/FTC (A1) EVG/cobi/TDF/FTC only for patients with pre-art CrCl>70 ml/min (A1) RAL plus TDF/FTC (A1) In addition to above, following regimens recommended only for patients with pre-art plasma HIV RNA <100,000 copies/ml NNRTI-Based Regimen EFV plus ABC/3TC (A1) only for patients who are HLA-B*5701 negative RPV/TDF/FTC onlyfor patients with CD4 count >200 PI-Based Regimens (in alphabetical order) ATV/r plus ABC/3TC Panel on Antiretroviral (A1) only Guidelines for patients for Adults and who Adolescents. are HLA-B*5701 Guidelines for the negative use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at
34 Fusion inhibitors Protease inhibitors Entry inhibitors Integrase inhibitors NRTI s NNRTI s
35 Condition NRTI s NNRTI s PI s Integrase Inhibitors Dyslipidemia D4T, AZT, ABC EFV All, ATV, DRV are less EVG/cobi/TD F/FTC Nephrotoxicity TDF EVG/cobi/TD F/FTC Insulin Resistance D4T, AZT, DDI IDV, LPV-rit Cardiovascular ABC, DDI Older PI s, limited data on ATV, DRV Lactic Acidosis Toxicity of Antiretrovirals D4T, AZT, DDI Lipodysrophy D4T, AZT??? Decreased bone density TDF Neuropsychiatr ic D4T/DDI/AZ T PN EFV depression, insomnia, vivid dreams Insomnia
36 Medical comorbidities AIDS-associated Non-AIDS associated Coinfections (hepatitis C, hepatitis B, Other STD s) Substance dependence and abuse, including tobacco Psychosocial Mental health Relational strain due to diagnosis Economic
37 Multidisciplinary Approach HIV Provider Case Management HIV-trained pharmacist Primary Care Provider Patient Mental Health Provider Other Specialty Care Family/Social support network Addiction Recovery
38 Little change in new cases despite current preventative measures AND increased in some subgroups Large scale trials in multiple populations showing benefit without emergence of resistance Now recommended by CDC for certain higher risk groups as one preventative option
39 Study Drug Population Results Notes Pre-exposure Prophylaxis Initiative (iprex) TDF-FTC Partners-PrEP TDF TDF-FTC 2499 HIVseronegative MSM 4758 discordant heterosexual couples in Africa TDF2 TDF-FTC 1200 heterosexual women TDF-FTC 2413 IVDU Thailand 100 infected, (36 I, 64 placebo) TDF-3TC with 75% reduced risk 62% reduced risk 50 infected (17 intervention, 33 placebo), 49% reduction Drug detected in only 9% of treatment arm Lancet June;381 (9883): N. Engl J Med. 2010;363(27):2587 N Engl J Med. 2012;367(5):399
40 MSM: Non-monogamous sexual activity past 6 months involving unprotected anal intercourse or recent bacterial STI Heterosexual: Infrequent condom use with partners of unknown HIV status expected high risk for HIV, recent bacterial STI Discordant couples where infected partner not well-controlled Active IV drug users with history sharing needles Preexposure Prophylaxis for the Prevention of HIV Infection in the United States 2014 Clinical Practice Guideline
41
Comprehensive Guideline Summary
Comprehensive Guideline Summary Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents AETC NRC Slide Set Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and
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:
HIV Diagnosis and Management 2015 Update. Faria Farhat, MD MedStar Washington Hospital Center
HIV Diagnosis and Management 2015 Update Faria Farhat, MD MedStar Washington Hospital Center Objectives Describe the epidemiology and pathogenesis of HIV infection Highlight HIV diagnosis algorithm and
The use of antiretroviral agents during pregnancy in Canada and compliance with North-American guidelines
The use of antiretroviral agents during pregnancy in Canada and compliance with North-American guidelines I. Boucoiran, T. Lee, K. Tulloch, L. Sauve, L. Samson, J. Brophy, M. Boucher and D. Money For and
Measure #161: HIV/AIDS: Adolescent and Adult Patients with HIV/AIDS Who Are Prescribed Potent Antiretroviral Therapy
Measure #161: HIV/AIDS: Adolescent and Adult Patients with HIV/AIDS Who Are Prescribed Potent Antiretroviral Therapy 2012 PHYSICIAN QUALITY REPTING OPTIONS F INDIVIDUAL MEASURES: REGISTRY ONLY DESCRIPTION:
Susan L. Koletar, MD
HIV/AIDS Susan L. Koletar, MD Division Director, Infectious Diseases Professor of Internal Medicine Department of Internal Medicine The Ohio State University Wexner Medical Center HIV through the Decades
Susan L. Koletar, MD
HIV/AIDS Susan L. Koletar, MD Division Director, Infectious Diseases Professor of Internal Medicine Department of Internal Medicine The Ohio State University Wexner Medical Center HIV through the Decades
Continuing Education for Pharmacy Technicians
Continuing Education for Pharmacy Technicians HIV/AIDS TREATMENT Michael Denaburg, Pharm.D. Birmingham, AL Objectives: 1. Identify drugs and drug classes currently used in the management of HIV infected
I. HIV Epidemiology. HIV Infection A Primer. Objectives. Disclosures 7/18/2014
Objectives HIV Infection A Primer Discuss the worldwide and domestic epidemiology of HIV infection Review HIV Biology Review HIV Transmission and Prevention Review HIV diagnosis Describe the approaches
HIV in in Women Women
HIV in Women Susan L. Koletar, MD The Ohio State University How Many of These Women Have HIV? Answer: I don t really know Google Search: Photos of Groups of Women Pub Med Search: HIV and Women 22,732
Pediatric HIV Infection and the Medical Management of Pregnant Women infected with HIV. Ernesto Parra, M.D., M.P.H.
Pediatric HIV Infection and the Medical Management of Pregnant Women infected with HIV Ernesto Parra, M.D., M.P.H. Adjunct Associate Professor UTHSCSA Department of Pediatrics and Family and Community
Pharmacological considerations on the use of ARVs in pregnancy
Pharmacological considerations on the use of ARVs in pregnancy 11 th Residential Course on Clinical Pharmacology of Antiretrovirals Torino, 20-22 January 2016 Prof. David Burger, PharmD, PhD david.burger@radboudumc.nl
The Global HIV Epidemic. Jerome Larkin, MD
The Global HIV Epidemic Jerome Larkin, MD Outline Global Epidemiology Natural History of HIV Antiretroviral Therapy Malaria Tuberculosis Prevention of Mother to Child Transmission Post-Exposure Prophylaxis
Overview of HIV WRAIR- GEIS 'Operational Clinical Infectious Disease' Course
Overview of HIV WRAIR- GEIS 'Operational Clinical Infectious Disease' Course UNCLASSIFIED Acknowledgments - Dr. Christina Polyak - Dr. Julie Ake Disclaimer The views expressed in this presentation are
Sasisopin Kiertiburanakul, MD, MHS
What s Newin Antiretroviral Therapy? Sasisopin Kiertiburanakul, MD, MHS Division of Infectious Diseases Department of Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University Rotating RCPT,
Criteria for Oral PrEP
Oral PrEP New Drugs Roy M. Gulick, MD, MPH Chief, Division of Infectious Diseases Professor of Medicine Weill Medical College of Cornell University New York City Safe Criteria for Oral PrEP Penetrates
When to Start ART. Reduction in HIV transmission. ? Reduction in HIV-associated inflammation and associated complications» i.e. CV disease, neuro, etc
When to Start ART Exact CD4 count at which to initiate therapy not known, but evidence points to starting at higher counts Current recommendation: ART for all patients with CD4 count of
0% 0% 0% Parasite. 2. RNA-virus. RNA-virus
HIV/AIDS and Treatment Manado, Indonesia 16 november HIV [e] EDUCATION HIV is a 1. DNA-virus 2. RNA-virus 3. Parasite 0% 0% 0% DNA-virus RNA-virus Parasite HIV HIV is a RNA-virus. HIV is an RNA virus which
HIV Overview. Mary Marovich, MD, DTMH Division of Retrovirology Walter Reed Army Ins?tute of Research US Military HIV Research Program
HIV Overview Mary Marovich, MD, DTMH Division of Retrovirology Walter Reed Army Ins?tute of Research US Military HIV Research Program www.hivresearch.org 1 Outline HIV Virology, Transmission, and Pathogenesis
Overview of HIV. LTC Paige Waterman
Overview of HIV LTC Paige Waterman Outline Background and Epidemiology HIV Virology, Transmission, and Pathogenesis Acute HIV infection HIV Diagnostics Management of Health Care Personnel Exposed to HIV
/AIDS HIV/ HIV Overview. Nelson L. Michael, MD, PhD Division of Retrovirology Walter Reed Army Institute of Research US Military HIV Research Program
/AIDS HIV/ HIV Overview Nelson L. Michael, MD, PhD Division of Retrovirology Walter Reed Army Institute of Research US Military HIV Research Program www.hivresearch.org 1 WRAIR Tropical Medicine Course
POST-EXPOSURE PROPHYLAXIS, PRE-EXPOSURE PROPHYLAXIS, & TREATMENT OF HIV
POST-EXPOSURE PROPHYLAXIS, PRE-EXPOSURE PROPHYLAXIS, & TREATMENT OF HIV DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none
Update on Antiretroviral Treatment for HIV Infection 2008
Update on Antiretroviral Treatment for HIV Infection 2008 Janet Gilmour MD FRCP(C) Clinical Associate Professor of Medicine University of Calgary November 2008 Disclosure and Acknowledgements Disclosure:
HIV/AIDS HIV/AIDS: Outline. Morbidity and Mortality Weekly Report (MMWR)
HIV/AIDS: Outline HIV/AIDS 2013 Roy M. Gulick, MD, MPH Professor of Medicine Chief, Division of Infectious Diseases Weill Medical College of Cornell University New York City January 31, 2013 Epidemiology
QUARTERLY HIV/AIDS SURVEILLANCE REPORT
QUARTERLY HIV/AIDS SURVEILLANCE REPORT San Francisco Department of Public Health HIV/AIDS Cases Reported Through September 2010 Contents Page Surveillance Summary..... 1 Table 1: Adult/Adolescent HIV/AIDS
TORONTO GENERAL HOSPITAL HIV AMBULATORY CARE ROTATION
TGH - ambulatory rotation page 1 of 5 TORONTO GENERAL HOSPITAL HIV AMBULATORY CARE ROTATION SITE: Immunodeficiency Clinic, Toronto General Hospital, University Health Network Location: 13 th floor, Norman
The ART of Managing Drug-Drug Interactions in Patients with HIV
The ART of Managing Drug-Drug Interactions in Patients with HIV Bradley L. Smith, Pharm.D. smith.bradley1@mayo.edu Pharmacy Grand Rounds December 19, 2017 2017 MFMER slide-1 Presentation Objectives Describe
COMPREHENSIVE ANTIRETROVIRAL TABLE: ADULT DOSING, DOSAGE FORM MODIFICATIONS, ADVERSE REACTIONS and INTERACTION POTENTIAL
Generic Name COMPREHENSIVE ANTIRETROVIRAL TABLE: NUCLOESIDE/TIDE REVERSE TRANSCRIPTASE INHIBITORS (N(t)RTIs) Abacavir ABC (Ziagen) Didanosine ddi (Videx EC) Emtricitabine FTC (Emtriva) Lamivudine 3TC (Epivir)
medical monitoring: clinical monitoring and laboratory tests
medical monitoring: clinical monitoring and laboratory tests Purpose of monitoring Check on the physical, psychological and emotional condition of the patient Detect other treatable conditions Identify
I S H P S p r i n g C o n f e r e n c e Megan Koyle, PharmD Elaine Nguyen, PharmD, MPH, BCPS
I S H P S p r i n g C o n f e r e n c e 2 0 1 5 Megan Koyle, PharmD Elaine Nguyen, PharmD, MPH, BCPS Objectives Increase foundational knowledge of HIV/AIDS through greater awareness of epidemiology, pathophysiology,
HIV basics. Katya Calvo Medical Director of Antimicrobial Stewardship
HIV basics Katya Calvo Medical Director of Antimicrobial Stewardship Learning Objectives 1. Review of HIV epidemiology worldwide and locally 2. Review of recommendations on whom to screen 3. Work up of
Overview of HIV. Christina Polyak, MD, MPH. Research Physician. U.S. Military HIV Research Program, Walter Reed Army Institute of Research
Overview of HIV Christina Polyak, MD, MPH Research Physician U.S. Military HIV Research Program, Walter Reed Army Institute of Research The views expressed are those of the authors and should not be construed
Northwest AIDS Education and Training Center Educating health care professionals to provide quality HIV care
Northwest AIDS Education and Training Center Educating health care professionals to provide quality HIV care www.nwaetc.org The Northwest AIDS Education and Training Center (NW AETC), located at the University
HIV Update Objectives. Epidemiology. Epidemiology, Transmission and Natural History. Transmission Risk by Exposure. Transmission 9/29/2014
Objectives HIV Update 2014 Jay Sizemore, MD, MPH Medical Director Chattanooga CARES Assistant Professor UTCOM Chattanooga 2October 2014 Review HIV epidemiology and screening/testing guidelines Discuss
http://www.savinglivesuk.com/ HIV Awareness Study Morning 24 th November 2017 Agenda HIV Basics & Stages of HIV HIV Testing, Health Advising & Sexual Health Saving Lives Antiretroviral Medication Antenatal/Postnatal
Selected Issues in HIV Clinical Trials
Selected Issues in HIV Clinical Trials Judith S. Currier, M.D., MSc Professor of Medicine Division of Infectious Diseases University of California, Los Angeles Issues Evolving Global and Domestic Epidemic
QUARTERLY AIDS SURVEILLANCE REPORT
QUARTERLY AIDS SURVEILLANCE REPORT San Francisco Department of Public Health AIDS Cases Reported Through June 2010 0 Contents Page Surveillance Summary..... 1 Table 1: Adult/Adolescent AIDS Cases by Transmission
Title: Revision of the Surveillance Case Definition for HIV Infection and AIDS Among children age > 18 months but < 13 years
06-ID-02 Committee: Infectious Disease Title: Revision of the Surveillance Case Definition for HIV Infection and AIDS Among children age > 18 months but < 13 years Statement of problem: Advances in HIV
COMPREHENSIVE ANTIRETROVIRAL TABLE: ADULT DOSING**, DOSAGE FORM MODIFICATIONS, ADVERSE REACTIONS and INTERACTION POTENTIAL
COMPREHENSIVE ANTIRETROVIRAL TABLE: NUCLOESIDE/TIDE REVERSE TRANSCRIPTASE INHIBITORS (N(t)RTIs) Abacavir ABC (Ziagen) Didanosine ddi (Videx EC) Emtricitabine FTC (Emtriva) Lamivudine 3TC (Epivir) Stavudine
Matters of the HAART: An Update on Current Treatment Options for HIV
Matters of the HAART: An Update on Current Treatment Options for HIV Jason Alegro, PharmD, BCPS Assistant Professor of Clinical Sciences, Roosevelt University Infectious Diseases Clinical Pharmacy Specialist,
10/17/2015. Chapter 55. Care of the Patient with HIV/AIDS. History of HIV. HIV Modes of Transmission
Chapter 55 Care of the Patient with HIV/AIDS All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. History of HIV Remains somewhat obscure The earlier
INTEGRATING HIV INTO PRIMARY CARE
INTEGRATING HIV INTO PRIMARY CARE ADELERO ADEBAJO, MD, MPH, AAHIVS, FACP NO DISCLOSURE 1.2 million people in the United States are living with HIV infection and 1 in 5 are unaware of their infection.
Selected Issues in HIV Clinical Trials
Selected Issues in HIV Clinical Trials Judith S. Currier, M.D., MSc Professor of Medicine Division of Infectious Diseases University of California, Los Angeles Issues Evolving Global and Domestic Epidemic
HIV Treatment: New and Veteran Drugs Classes
HIV Treatment: New and Veteran Drugs Classes Jonathan M Schapiro, MD National Hemophilia Center Stanford University School of Medicine Rome, March 2013 Overview Many excellent antiretroviral agents are
HIV Pharmacology 101ish - 202ish: New HIV Clinicians Workshop
HIV Pharmacology 101ish - 202ish: New HIV Clinicians Workshop Parya Saberi, PharmD, MAS The Medical Management of HIV/AIDS December 2012 Objectives What are commonly used ARVs and where do they work in
Nothing to disclose.
Lisa G. Winston, MD University of California, San Francisco San Francisco General Hospital HIV UPDATE FOR THE PRIMARY CARE PROVIDER Nothing to disclose. 1 Outline Epidemiology Screening / testing for HIV
Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) in the Long Term Care Setting Part 2: HIV Medications
Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) in the Long Term Care Setting Part 2: HIV Medications Carrie Allen PharmD, CGP, BCPS, BCPP, CCHP Overview - Part 2: HIV
An HIV Update Jan Clark, PharmD Specialty Practice Pharmacist
An HIV Update - 2019 Jan Clark, PharmD Specialty Practice Pharmacist 2 The goal of this program is to provide a review and update of HIV care and to provide a forum for discussing the current local and
HIV Update: What the Hospital-Based Provider Should Know
HIV Update: What the Hospital-Based Provider Should Know Steven C. Johnson M.D. Division of Infectious Diseases, University of Colorado School of Medicine October 6, 2011 45 year old female Case Study
Approach to a Patient Newly Diagnosed with HIV, Including ART Basics Rajesh T. Gandhi, M.D.
Approach to a Patient Newly Diagnosed with HIV, Including ART Basics Rajesh T. Gandhi, M.D. Disclosures: grant support from Gilead, Roche, EBSCO Objectives Apply current guidelines to initial evaluation
HIV 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
The Future of HIV: Advances in Drugs and Research. Shauna Gunaratne December 17, 2018
The Future of HIV: Advances in Drugs and Research Shauna Gunaratne December 17, 2018 Overview Epidemiology Science of HIV How HIV treatment and management have changed over the years New medicines and
Preventing Mother to Child HIV Transmission: Are We There Yet?!'
Preventing Mother to Child HIV Transmission: Are We There Yet?!' 2017 Michigan Clincal Nursing Conference for HIV and STD Care May 18, 2017 Frankenmuth MI 1 Theodore B. Jones, MD Maternal Fetal Medicine
Mortality Rates Among People With HIV, Long on the Wane, Continue to Drop HIV Medicine Feb 2013
John F. White III, MD, MBA, FLMI VP and Medical Director American National Insurance Company 1 Mortality Rates Among People With HIV, Long on the Wane, Continue to Drop HIV Medicine Feb 2013 2 1 3 My Opinions
HIV/AIDS Prenatal Care for HIV+ Mothers. 1. Algorithm for Prenatal Screening & Care (Antepartum)
1. Algorithm for Prenatal Screening & Care (Antepartum) 2. Algorithm for Prenatal HIV Screening and Care (Mother refuses screening) 3. Algorithm for Intrapartum Care 4. Prenatal Care for HIV+ Mothers a.
HIV - Therapy Principles
HIV - Therapy Principles Manuel Battegay and Christine Katlama Basel, Switzerland and Paris, France Disclosure MB has received honoraria for advisory board participation from Gilead, MSD, Pfizer, ViiV
Simplifying HIV Treatment Now and in the Future
Simplifying HIV Treatment Now and in the Future David M. Hachey, Pharm.D., AAHIVP Professor Idaho State University Department of Family Medicine Nothing Disclosure 1 Objectives List current first line
HIV for the Non-ID Pharmacist
Disclosures HIV for the Non-ID Pharmacist I have nothing to disclose at this time Carmen Faulkner-Fennell, PharmD, BCPS (AQ-ID) Clinical Pharmacy Specialist--Infectious Diseases Greenville Hospital System
ACTHIV 2018: A State-of-the-Science Conference for Frontline Health Professionals
Initial Therapy for Antiretroviral Naïve HIV Infected Patients Michelle Cespedes, MD, MS Associate Professor of Medicine Division of Infectious Disease Icahn School of Medicine at Mount Sinai Disclosures
The Italian AIDS Epidemic Supports The Chemical AIDS Theory. Daniele Mandrioli
The Italian AIDS Epidemic Supports The Chemical AIDS Theory Daniele Mandrioli EPIDEMIOLOGY France Population: 65.073.482 AIDS Incidence: 16/million Germany Population: 82.438.000 AIDS Incidence: 4/million
Didactic Series. Switching Regimens in the Setting of Virologic Suppression
Didactic Series Switching Regimens in the Setting of Virologic Suppression Craig Ballard, PharmD, AAHIVP UC San Diego Health Owen Clinic June 14 th, 2018 1 Learning Objectives 1) Describe DHHS guidelines
NON-OCCUPATIONAL POST EXPOSURE PROPHYLAXIS IN HIV PREVENTION. Jason E. Vercher, PA-C, AAHIVM
NON-OCCUPATIONAL POST EXPOSURE PROPHYLAXIS IN HIV PREVENTION Jason E. Vercher, PA-C, AAHIVM Disclosures No disclosures to report Learning Objectives q Identify Individuals who would benefit from non-occupational
Didactic Series. Update: 2012 HIV Treatment Guidelines. Daniel Lee, MD August 30, 2012
Didactic Series Update: 2012 HIV Treatment Guidelines Daniel Lee, MD August 30, 2012 ACCREDITATION STATEMENT: University of California, San Diego School of Medicine is accredited by the Accreditation Council
HUMAN IMMUNODEFICIENCY VIRUS (HIV) NON-IMMEDIATE NOTIFICATION STD PROGRAM. Version
1 HUMAN IMMUNODEFICIENCY VIRUS (HIV) NON-IMMEDIATE NOTIFICATION STD PROGRAM Event Name: Event Time Period: ADULT HIV 900 (AIDS.gov 12/31/2015) HIV Lifelong HIV (human immunodeficiency virus) is a retrovirus
Selecting an Initial Antiretroviral Therapy (ART) Regimen
Selecting an Initial Antiretroviral Therapy (ART) Regimen An HIV Diagnosis is a Call to Action In support of the NYSDOH AIDS Institute s January 2018 call to action for patients newly diagnosed with HIV,
Overview of HIV WRAIR- GEIS 'Operational Clinical Infectious Disease' Course
Overview of HIV WRAIR- GEIS 'Operational Clinical Infectious Disease' Course The opinions or assertions contained herein are the private views of the author, and are not to be construed as official, or
SELECTING THE BEST ART FOR EACH PATIENT
SELECTING THE BEST ART FOR EACH PATIENT Corklin R Steinhart, MD, PhD Head, Global Medical Directors ViiV Healthcare CNVX/HIVP/0025/16 5th Asian Conference on Hepatitis & AIDS 第五届亚洲肝炎与艾滋病学术会议 28-29 May
Structured Treatment Interruption in HIV Positive Patients. Leah Jackson, BScPhm Pharmacy Resident HIV Rotation January 23, 2007
Structured Treatment Interruption in HIV Positive Patients Leah Jackson, BScPhm Pharmacy Resident HIV Rotation January 23, 2007 Objectives To become re-acquainted with the basics of HAART for HIV infection
Switching ARV Regimens: Managing Toxicity and Improving Tolerability; Switches & Class-Sparing Approaches
Switching ARV Regimens: Managing Toxicity and Improving Tolerability; Switches & Class-Sparing Approaches Harry W. Lampiris, MD Chief, Infectious Disease Section, San Francisco VA Medical Center Professor
Starting and Switching ART: 2016
Starting and Switching ART: 2016 Luke Jerram Rajesh T. Gandhi, M.D. Massachusetts General Hospital Harvard Medical School Disclosures: grant support from EBSCO, Gilead, Merck, Viiv Thanks to Henry Sunpath,
Page 1. Outline. Outline. Building specialized knowledge: HIV. Biological interactions. Social aspects of the epidemic. Programmatic actions
Harvard-Brazil Collaborative Public Health Field Course January 2014 Lecture # 8 Building specialized knowledge: HIV Aluisio Segurado Department of Infectious Diseases School of Medicine, University of
20 Years of Tears and Triumphs
20 Years of Tears and Triumphs A Clinical Research Nurse s Perspective on HIV/AIDS Bobi Keenan, RN, ACRN Clinical Research Nurse UC Irvine Dept. of Medicine/Infectious Diseases Objectives 1. Understand
Antiretroviral Dosing in Renal Impairment
Protease Inhibitors (PIs) Atazanavir Reyataz hard capsules 300 mg once daily taken with ritonavir 100 mg once daily No dosage adjustment is needed for atazanavir in renal impairment Atazanavir use in haemodialysis
HIV Treatment: State of the Art 2013
HIV Treatment: State of the Art 2013 Daniel R. Kuritzkes, MD Chief, Division of Infectious Diseases Brigham and Women s Hospital Professor of Medicine Harvard Medical School Success of current ART Substantial
Disclosures. Update on HIV Drug Therapy: A Case based Discussion. Case # 1: Dr. Grant has received grant support from BMS, Gilead, Janssen, and Viiv
Disclosures Update on HIV Drug Therapy: A Case based Discussion Dr. Grant has received grant support from BMS, Gilead, Janssen, and Viiv Philip Grant Assistant Professor Division of Infectious Diseases
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
The HIV Program UNIT 2 HIV CURRICULUM PARTICIPANT S MANUAL
T F A R D UNIT 2 The HIV Program UNIT 2 BACKGROUND The HIV Program Poverty and lack of access to basic human rights such as adequate nutrition compound the devastating effects of HIV on communities. Comprehensive
HIV Update. Divya Ahuja, MD Associate Professor of Medicine University of South Carolina School of Medicine
HIV Update Divya Ahuja, MD Associate Professor of Medicine University of South Carolina School of Medicine Rates of Diagnoses of HIV Infection among Adults and Adolescents, 2012 United States and 6 Dependent
OI prophylaxis When to start, when to stop. Eva Raphael, MD MPH Family and community medicine, pgy-2 University of California, San Francisco
OI prophylaxis When to start, when to stop Eva Raphael, MD MPH Family and community medicine, pgy-2 University of California, San Francisco Learning Objectives o Recognize when to start OI prophylaxis
Pediatric HIV Update NORTHWEST AIDS EDUCATION AND TRAINING CENTER
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Pediatric HIV Update Christian B. Ramers, MD, MPH Assistant Medical Director, Family Health Centers of San Diego HIV/HCV Distance Education Specialist - NWAETC,
HIV Testing. HIV Symposium Patient Jane. Outline: 4/13/2010. What are your primary concerns for this patient?
Patient Jane HIV Symposium 2010 Jess Fogler Waldura, MD Mina Matin, MD National HIV AIDS Clinicians Consultation Center San Francisco General Hospital University of California, San Francisco Referral from
Chapter 22. Autoimmune and Immunodeficiency Diseases
Chapter 22 Autoimmune and Immunodeficiency Diseases Autoimmune Diseases Failures of self-tolerance Immune system fails to distinguish selfantigens from foreign antigens This results in the immune system
PHCP 403 by L. K. Sarki
PHCP 403 by L. K. Sarki objectives To gain insight into the epidemiology of HIV To gain basic understanding of the etiology of HIV disease To know the clinical manifestations of the disease To gain a basic
Nobel /03/28. HIV virus and infected CD4+ T cells
Mechanism of HIV drug resistance. Rodrigo Brindeiro / Amilcar Tanuri Laboratório de Virologia Molecular UFRJ 2 -Asso ciate Research Scientist, Internatio nal Center fo r Aids Care and Treatment Programs-ICAP,
TB Intensive Tyler, Texas December 2-4, Tuberculosis and HIV Co-Infection. Lisa Y. Armitige, MD, PhD. December 4, 2008.
TB Intensive Tyler, Texas December 2-4, 2008 Tuberculosis and HIV Co-Infection Lisa Y. Armitige, MD, Ph.D. December 4, 2008 Tuberculosis and HIV Co Infection Lisa Y. Armitige, MD, PhD Assistant Professor
Doctor, I Have Strep Throat. Nancy W Weber D.O. FACOEP FACEP MBA Sparrow/MSU Emergency Medicine Residency October 22, 2018
Doctor, I Have Strep Throat Nancy W Weber D.O. FACOEP FACEP MBA Sparrow/MSU Emergency Medicine Residency October 22, 2018 Disclosures None The Patient: 41YOF CC: Sore throat x 3 days HPI: Sore throat increasing
Human Immunodeficiency Virus (HIV)
HIV INFECTION! Human Immunodeficiency Virus (HIV) Infects human cells and causes gradual loss of immune system function, and these immune alterations predispose to the opportunistic infections, neoplasms,
Approach for the Newly Diagnosed HIV Positive Patient
Approach for the Newly Diagnosed HIV Positive Patient Jason E. Farley, PhD, MPH, ANP-BC, FAAN, AACRN Associate Professor & NP, Johns Hopkins University School of Nursing & Medicine Director, AETC Adult-Gerontology
Didactic Series. CROI 2014 Update. March 27, 2014
Didactic Series CROI 2014 Update Christian Ramers, MD, MPH Family Health Centers of San Diego Ciaccio Memorial Clinic Jacqueline Peterson Tulsky, MD UCSF Positive Health Program at SFGH Medical Director,
HIV Clinical Nurse Specialist CCDHB Wellington
RN James Rice-Davies HIV Clinical Nurse Specialist CCDHB Wellington 11:00-11:55 WS #88: Undiagnosed HIV in Your Practice 12:05-13:00 WS #99: Undiagnosed HIV in Your Practice (Repeated) HIV- Undiagnosed
TB/HIV Co-Infection. Tuberculosis and HIV
TB Intensive Tyler, Texas June 2-4, 2010 TB/HIV Co-Infection Lisa Y Armitige, MD, PhD June 3, 2010 Tuberculosis and HIV Co-Infection Lisa Y Armitige, MD, PhD Medical Consultant Heartland National TB Center
2/10/2015. 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
HIV Drugs and the HIV Lifecycle
HIV Drugs and the HIV Lifecycle Together, we can change the course of the HIV epidemic one woman at a time. #onewomanatatime #thewellproject All HIV drugs work by interrupting different steps in HIV's
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents Visit the AIDSinfo website to access the most up-to-date guideline. Register for e-mail notification of guideline
NEW PATIENT REGISTRATION
NEW PATIENT REGISTRATION Hospital No. Date of Visit : / / Surname : First Name : Date of birth : / / Country of Birth : Sex : Male Female Transman Transwoman Other (please specify): Is this patient from
MEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 03/07/18 SECTION: DRUGS LAST REVIEW DATE: 02/19/19 LAST CRITERIA REVISION DATE: ARCHIVE DATE:
FUZEON (enfuvirtide) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs
Fundamentals of Antiretroviral Therapy
Fundamentals of Antiretroviral Therapy Southeast AIDS Education & Training Center HIV Clinical Overview 12 May 2016 Todd Hulgan, MD, MPH Department of Medicine, Division of Infectious Diseases Vanderbilt
Antiretroviral Therapy
Antiretroviral Therapy Scott M. Hammer, M.D. 1986 1990 ZDV monorx 1990 1995 Alternative NRTI monorx Combination NRTI Rx Introduction of NNRTI s Antiretroviral resistance Pathogenetic concepts Evolution
ANTIRETROVIRAL TREATMENTS (Part 1of
CCR5 CO-RECEPTOR ANTAGONISTS maraviroc (MVC) Selzentry 25mg, 75mg, FUSION INHIBITORS 20mg/mL ANTIRETROVIRAL TREATMENTS (Part 1of 5) oral soln enfuvirtide (ENF, T-20) Fuzeon 90mg/mL pwd for SC inj after
Principles of Antiretroviral Therapy
Principles of Antiretroviral Therapy Ten Principles of Antiretroviral Therapy Skills Building Workshop: Clinical Management of HIV Infection and Antiretroviral Therapy, 11 th ICAAP, November 21st, 2011,