HIV / AIDS & Opportunistic Infections.
|
|
|
- Susan Harris
- 6 years ago
- Views:
Transcription
1 HIV / AIDS & Opportunistic Infections
2 Epidemiology ~85% know they are infected ~40% are receiving treatment 47,000 new diagnoses
3 22F presents for a follow-up appointment. She was just diagnosed with syphilis last week and treated with IM PCN. At that visit an HIV test was performed and returns with the result below. What is her likely diagnosis? A. HIV-1 infection B. HIV-2 infection C. Suspected HIV-1, but need to wait for confirmatory test result
4 Virtually all HIV in the U.S. = HIV-1 Who should be tested? HIV testing: HIV-1/2 Antigen and Antibodies, 4 th Gen, with Reflexes Reflex HIV-1/2 antibody differentiation test Reflex PCR for indeterminate/negative results CDC recommended screening test Better sensitivity within window period, faster TAT HIV-1/0/2 with Reflex HIV-1 WB
5 CDC Recommendations for HIV Testing in Laboratories
6 22F presents with fevers & sore throat for the past 3 days and now has developed diffuse macular rash starting today. Examination reveals T 39 0 C, pharyngeal erythema without exudate, small erythematous macular lesions on her chest. She reports exchanging sex for drugs and has had multiple partners over the past month. Which of the following test is optimal for diagnosis? A. HIV-1/0/2 with reflex HIV-1 WB B. HIV-1/2 antigen and antibodies, 4 th Gen, with reflexes C. HIV p24 antigen assay D. HIV quantitative RT-PCR E. Monospot (for EBV)
7 Window Period
8 22F is here for follow-up with new diagnosis of HIV after routine STI screening. She is without any symptoms. Exam unremarkable other than anxious appearing individual and white plaques on her soft palate. Routine blood tests are sent including CD4 count, HIV quantitative RT-PCR, and HIV genotype resistance testing. A TST is placed. Which of the following should be performed immediately? A. Pneumococcal vaccination with PPV23 B. Pap smear C. Start Trimethoprim/Sulfamethoxazole D. Start Trimethoprim/Sulfamethoxazole and Azithromycin E. Chest radiograph
9 Primary Care for HIV HIV-disease tests Serologic testing CD4 count and percentage Plasma HIV RNA (viral load) HIV resistance testing (genotype) Metabolic tests Fasting lipid profile Fasting glucose Urinalysis HIV-associated infections Viral hepatitis (A,B,C) STD screening Syphilis Gonorrhea/Chlamydia Tuberculosis screening HPV - cervical cancer screening Vaccinations PCV13 followed by PPV23 (>8 wks) HBV - if seronegative HAV - if MSM, IVDA HPV - males to age 26, if MSM MCV4 Adapted from Clin Infect Dis 2009; 49:651-81
10 22F is here for follow-up with new diagnosis of HIV after routine STI screening. She is without any symptoms. Exam unremarkable. Her CD4 count is 650 and VL 10,000 copies/ml. The remainder of her lab studies are normal including resistance testing. She is very interested in starting cart. She reports that she is in a heterosexual monogamous relationship. When is the ideal time to start cart for this patient? A. Start once CD4 count is < 200 B. Start once CD4 count is < 350 C. Start once CD4 count is < 500 D. Start now
11 2016 Guidelines
12 Prognosis 3-yr probability of AIDS = AIDS defining illness or death, not CD4<200
13 Natural Course of HIV Infection Primary Infection Seroconversion Plasma HIV RNA 10,000,000 1,000, ,000 10,000 1, Plasma RNA Copies CD4 Cells Intermediate Stage AIDS CD4 Cell Count 1, Weeks Up to 12 Years 2-3 Years
14 AIDS Defining Illnesses Candidiasis Esophageal Tracheal, bronchial Cervical Cancer, invasive Coccidioides disseminated Chronic diarrhea (>1 month) Cryptosporidia or Isospora Cryptococcus extrapulmonary CMV Retinitis Other (not liver, spleen, LN) HSV Chronic ulcer (>1 month) Pulmonary, esophageal Histoplasma disseminated HIV encephalopathy Kaposi s sarcoma Lymphoma (NHL) Burkitt s Immunoblastic Primary CNS Mycobacterium TB any Other disseminated/extrapulmonary Pneumonia Pneumocystis Recurrent bacterial (within 1 yr) PML NT Salmonella septicemia, recurrent Toxoplasmic encephalitis Wasting syndrome - HIV MMWR 1992; 41 (RR17)
15 Antiretrovirals Nucleoside RTI Abacavir (ABC) (Ziagen) Didanosine (ddi) (Videx) Emtricitabine (FTC) (Emtriva) Lamivudine (3TC) (Epivir) Stavudine (d4t) (Zerit) Tenofovir (TDF/TAF) Zidovudine (ZDV) (Retrovir) Non-Nucleoside RTI Efavirenz (EFV) (Sustiva) Etravirine (ETR) (Intelence) Nevirapine (NVP) (Viramune) Rilpivirine (RPV) (Edurant) Entry/Fusion Inhibitor Enfuvirtide (T20) (Fuzeon) Maraviroc (MVC) (Selzentry) Integrase Inhibitor Dolutegravir (DTG) (Tivicay) Elvitegravir (EVG) (Vitekta) Raltegravir (RAL) (Isentress) Protease Inhibitors Atazanavir (ATV) (Reyataz) Darunavir (DRV) (Prezista) Fosamprenavir (FPV) (Lexiva) Inidinavir (IDV) (Crixivan) Lopinavir/Ritonavir (LPV/r) (Kaletra) Nelfinavir (NFV) (Viracept) Ritonavir (RTV) (Norvir) Tipranavir (TPV) (Aptivus) Combivir Epzicom Trizivir Truvada/Descovy Evotaz Prezcobix Combinations (ZDV/3TC) (ABC/3TC) (ZDV/ABC/3TC) (TDF/FTC)/(TAF/FTC) (ATV/c) (DRV/c) Single Tablet Regimens Atripla Complera/Odefsey Stribild/Genvoya Triumeq (EFV/TDF/FTC) (RPV/TDF/FTC) (EVG/c/TDF/FTC) (DTG/ABC/3TC)
16 31M with HIV presents with fevers and progressive DOE x 4 weeks. Diagnosed with HIV about 10 years ago when he developed shingles. He never followed-up and has never been on cart. ABG is performed and demonstrates an A- a gradient of 35 mm Hg. Induced sputum for PJP DFA +. Which of the following is the best treatment for this patient? A. TMP-SMX B. TMP-SMX + prednisone C. TMP-SMX + prednisone + cart within 2 weeks D. TMP-SMX + acyclovir E. TMP-SMX + Vanco + Zosyn
17 Pneumocystis jiroveci Epidemiology 90% with CD4 < 200 or CD4% < 14% Thrush High risk for relapse Clinical Manifestations Subacute. Fever, cough, dyspnea. Hypoxemia. O2 desat with exercise. CXR butterfly pattern. Early - negative. Diagnosis Induced sputum 50-90% BAL 90-99% Direct immunofluorescent staining Non-specific: LDH, 1,3β-D-glucan Treatment IV/PO TMP-SMX IV Pentamidine Clindamycin + primaquine Atovaquone Prednisone for A-a 35, po 2 <70 Duration = 21 days Prophylaxis Primary CD4<200/14%, thrush, AIDS TMP-SMX, dapsone, aerosolized pentamidine, atovaquone Secondary Stop when CD4 > 200 x 3 months
18 61M presents with unsteadiness and ataxia for the past 2 months. Frequently bumping into things. Progressive HA. MRI performed. Subsequent work-up HIV+, CD Serum Toxoplasma IgG +, IgM neg. LP: 20 WBCs (90%L), G normal, P120. CSF cytology neg. CSF Cryptococcal Ag and PCRs for EBV, JCV and Toxoplasma are negative. Which is the next best step in management? A. Pyrimethamine-sulfadiazine B. TMP-SMX C. Repeat LP for more studies D. Brain biopsy E. Lipid amphotericin
19 Toxoplasma Encephalitis Epidemiology 80% have CD4 < % Toxoplasma IgG+ Undercooked meat, cat feces Clinical Manifestations HA, confusion, lethargy, seziures 70% with focal signs on neuro exam ~30% single lesion Diagnosis Ring enhancing hypodense 90% AIDS, Toxo IgG+, multiple lesions - 80% predictive value LP: cytology, EBV, JCV, Crypt Ag Toxo CSF PCR sensitivity 50% Definitive dx = brain bx Differential PCNSL (EBV) PML (JCV) Brain abscess (bacterial, TB, Crypto) Treatment Pyrimethamine/Sulfadiazine Pyrimethamine/Clindamycin 90% respond at 2 weeks Prophylaxis Primary CD4 < 100 & Toxo IgG + TMP-SMX, Pyrimeth/Dapsone Secondary Stop when CD4 > 200 x 6 months
20 38F presents with fevers and progressive HA x 2 weeks, now with lethargy and slurred speech. Diagnosed with HIV 10 years ago but never followed-up. On examination: lethargic but arousable, slurred speech, right CN6 palsy, Head CT normal. LP is performed and OP 55cm H 2 O. Which of the following is the best treatment for this patient? A. L Ampho + Flucytosine B. L Ampho + Flucytosine + LP C. L Ampho + Fluconazole D. L Ampho + Fluconazole + LP E. L Ampho + LP LAB RESULTS Serum CD4 count 35 Cryptococcal antigen 1:512 CSF WBC %L Gluc 31 Protein 67 India ink + encapsulated yeast
21 Cryptococcal Meningitis Epidemiology Disseminated CD4 < 100 Meningitis CD4 < 50 Endemic, soil + bird guano Clinical Manifestations Disseminated disease: pulmonary, blood, skin Acute/subacute meningoencephalitis Altered mental status, memory loss Elevated ICP > 75% Diagnosis Cryptococcal antigen 90+% sensitive (serum & CSF) India ink 60-80% sensitive Treatment Lipid amphotericin + flucytosine until CSF sterilization Follow with fluconazole maintenance Minimum duration of therapy = 1 year. Repeat LP for elevated ICP Major cause of morbidity and mortality first 10 weeks. Prophylaxis Primary NONE Secondary Fluconazole Minimum 1 year therapy Stop when CD4 > 100 x 3 months
22 34M presents with fevers, night sweats, watery diarrhea, diffuse abdominal pain and 20 lbs weight loss x 2 months. Diagnosed with HIV 10 years ago but never followed-up. Labs: CD4 18, WBC 2.1, Hb 7.5, Ferritin CT AP performed - diffuse LAN. AFB blood cultures reveal MAC. Which of the following is the best treatment for this patient? A. RIF + INH + PZA + EMB (RIPE) B. Clarithro + EMB C. Clarithro + EMB + rifabutin D. Azithro + RIPE E. Clarithro + EMB + cart
23 Disseminated MAC Epidemiology CD4 < 50 (usually less than 25) Ubiquitous in environment, water Clinical Manifestations Fevers, NS, weight loss, anemia Abd pain, diarrhea, intra-abd LAN, HSM, elevated alk phos Disseminated disease: spleen, LN, liver, intestines, and bone marrow. Lung involvement rare (< 10%). Diagnosis AFB blood culture 90-95% BM, LN, GI tract biopsy Can take up to 6 weeks to grow Treatment Clarithromycin + Ethambutol High mortality within 6 months cart essential for cure Add rifamycin if no plan for cart Minimum duration = 1 year Prophylaxis Primary CD4 < 50 Azithromycin Qweek Clarithromycin BID Secondary As per treatment Stop when CD4 > 100 x 3-6 months
24 29M diagnosed with AIDS (CD4 26) two months ago - asymptomatic. He was started on prophylaxis and cart. Now presents with fever, cough, pleurisy. CD CT chest - consolidation and hilar LAN. BAL negative bacterial, fungal, AFB cxs. Hilar LN biopsy - granulomas. Cx - MAC. Which of the following is the best treatment for this patient? A. Continue cart. Start Claritho/EMB. B. Stop cart. Start Clarithro/EMB. C. Continue cart. Start Clarithro/EMB and prednisone. D. Continue cart, no need to treat MAC E. Continue cart. Start RIPE.
25 Immune Reconstitution Inflammatory Syndrome Paradoxical Worsening of clinical or lab parameters despite CD4 counts and viral loads. Unmasking Inflammatory reaction to a subclinical (unrecognized) infection. Occurs in 10-25% of those initiating cart (weeks to months). Diagnosis: Low pretreatment CD4 count (< 100) Positive response to cart No evidence of OI treatment failure Temporal association with cart CID 2004; 38:
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
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
HIV MEDICATIONS AT A GLANCE. Atripla 600/200/300 mg tablet tablet daily. Complera 200/25/300 mg tablet tablet daily
HIV MEDICATIONS AT A GLANCE Generic Name Trade Name Strength DIN Usual Dosage Single Tablet Regimen (STR) Products Efavirenz/ Emtricitabine/ rilpivirine/ elvitegravir/ cobicistat/ alafenamide Emtricitabine/
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
Antiretrovial Crushable/Liquid Formulation Chart
Antiretrovial Crushable/Liquid Formulation Chart Eliza Dollard, PharmD; Nafeesa Chin-Beckford, PharmD; Laura Aragon, PharmD Last Updated: 04/2016 Agent How Supplied Crushable Status **Products listed in
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
THE HIV LIFE CYCLE. Understanding How Antiretroviral Medications Work
THE HIV LIFE CYCLE Understanding How Antiretroviral Medications Work DEFINITIONS Host: The animal or cell that another organism lives in. In HIV human CD4 T-cells are the host for HIV. Nucleus: The core
WOMENS INTERAGENCY HIV STUDY ANTIRETROVIRAL DOSAGE FORM SECTION A. GENERAL INFORMATION
WOMENS INTERAGENCY HIV STUDY ANTIRETROVIRAL DOSAGE FORM SECTION A. GENERAL INFORMATION A1. PARTICIPANT ID: ENTER NUMBER HERE - - - ONLY IF ID LABEL IS NOT AVAILABLE A2. VISIT #: A3. VERSION DATE: 1 0 /
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)
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
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
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
WOMEN'S INTERAGENCY HIV STUDY METABOLIC STUDY: MS01 SPECIMEN COLLECTION FORM
WOMEN'S INTERAGENCY HIV STUDY METABOLIC STUDY: MS01 SPECIMEN COLLECTION FORM ID LABEL HERE ---> VERSION DATE 10/01/07 - - - VISIT #: FORM COMPLETED BY: A1. DATE OF BLOOD DRAW: / / M D Y A2. Do you take
REIMBURSEMENT STATUS OF HIV MEDICATIONS IN ONTARIO
REIMBURSEMENT STATUS OF HIV MEDICATIONS IN ONTARIO Ont. Drug Distr. Ontario Drug Benefit/Trillium: Other Formulary (F/A) Limited Use (Section 16) Antiretrovirals AZT 100 mg capsules NRTIs (single): Abacavir,
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
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
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
treatment passport 1
treatment passport 1 Why keep a treatment history? Keeping a short record of your treatment history can help in many ways. It can help you understand your health and treatment. It can help if your doctor
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
ALABAMA S ADAP FORMULARY OFFERS 117 MEDICATIONS
ALABAMA S ADAP FORMULARY OFFERS 117 MEDICATIONS - 2014 Alabama s ADAP formulary offers a minimum of one medication from each HIV antiretroviral class approved by the U.S. Food and Drug Administration (FDA).
HIV medications HIV medication and schedule plan
Living with HIV (human immunodeficiency virus) It may be scary to find out that you re HIV-positive or have AIDS. Coping with this news may be difficult. Although HIV is a serious infection, people with
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
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
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
JULUCA (dolutegravir sodium-rilpivirine hydrochloride) oral tablet
JULUCA (dolutegravir sodium-rilpivirine hydrochloride) oral tablet Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific
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,
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
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
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
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
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,
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
HIV Management Update 2015
9/30/15 HIV Management Update 2015 Larry Pineda, PharmD, PhC, BCPS Visiting Assistant Professor Pharmacy Practice and Administrative Science ljpineda@salud.unm.edu Pharmacist Learning Objectives Describe
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.
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,
Addressing Pediatric Needs of the Most Neglected: next steps
Addressing Pediatric Needs of the Most Neglected: next steps An updated overview of DNDi Pediatric Focus Nathalie Strub Wourgaft (Medical Director) Janice Lee (HIV Pediatric Clinical Manager) A Fatal Imbalance
Daclatasvir (Daklinza ) Drug Interactions with HIV Medications
Daclatasvir/Sofosbuvir (Daklinza /Sovaldi TM ) Drug Interactions A Quick Guide for Clinicians April 2017 John J Faragon, PharmD, BCPS, AAHIVP Mechanism of Action and Route of Metabolism for Daclatasvir
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
A Fatal Imbalance. Tropical diseases: 18 new drugs (incl. 8 for malaria) 1.3% 21 new drugs for neglected diseases. Tuberculosis: 3 new drugs
ADDRESSING GAPS IN INNOVATION FOR NEGLECTED PATIENTS: DNDI ANDPEDIATRIC HIV/AIDS Rachel Cohen, Regional Executive Director, DNDi North America Proposals for a Global Innovation System that Responds to
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
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
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
INDEX. indications...11 initiation of metabolic and morphologic complications
Index 287 INDEX 3TC...245 246 3TC/FTC...66 67 Abacavir...68, 218 Abacavir + lamivudine...219 220 Abacavir + lamivudine + zidovudine...220 ABC...218 Absolute neutrophil counts (ANC)...136, 137 Acidosis,
Drug Treatment Program Update
Drug Treatment Program Update As of March 211 Drug Treatment Program Update A key component of the Centre s mandate is to monitor the impact of HIV/AIDS on British Columbia. The Centre provides essential
Epidemiology Testing Clinical Features Management
Jason Cronin, MD Epidemiology Testing Clinical Features Management In 1981, 1 the first cases of AIDS were identified among gay men in the US. However, scientists later found evidence that the disease
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
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,
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
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
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,
HIV. ACOI Board Review (No Disclosures)
HIV ACOI Board Review 2018 gerald.blackburn@beaumont.org (No Disclosures) 1.1 million HIV + in U.S.; (36.7 million worldwide) 1 in 7 unaware of their HIV +; many others in denial responsible for up
Prevention and Treatment of Selected Opportunistic Infections: A Guidelines Update
Prevention and Treatment of Selected Opportunistic Infections: A Guidelines Update Constance A. Benson, MD Professor of Medicine Division of Infectious Diseases University of California, San Diego Disclosures
HIV Infection & AIDS in Low- and Middle-Income Countries
GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 25: HIV Infection & AIDS in Low- and Middle-Income Countries Author P. Van de Perre, MD, PhD Chapter Editor Michelle Doll, MD, MPH Topic Outline Key Issues
HIV THERAPY STRATEGIES FOR THIRD LINE. issues to consider when faced with few drug options
STRATEGIES FOR THIRD LINE HIV THERAPY issues to consider when faced with few drug options A PUBLICATION FROM Information, Inspiration and Advocacy for People Living With HIV/AIDS MAY 2008 Most people living
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
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
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:
FORMULARY Virginia (VA) AIDS Drug Assistance Program (ADAP) LAST UPDATED: December At a Glance: VA ADAP Formulary
At a Glance: VA ADAP Formulary Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs) Non Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) Multi Class Combination Agents Protease Inhibitors
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
Medscape's Antiretroviral Pocket Guide for the Treatment of HIV Infection
Table 3. Characteristics of Nucleoside Reverse Transcriptase Inhibitors (NRTIs) Generic Name (Abbreviation) / Trade Name Abacavir (ABC) / Ziagen Trizivir with ZDV + 3TC Epzicom with 3TC Didanosine (ddi)
The Hospitalized HIV+ Patient
The Hospitalized HIV+ Patient Danny Toub MD dannyt@srheathcenters.org October 8, 2012 Santa Rosa Family Medicine Residency List 3 ways of risk-stratifying known or suspected HIV+ inpatients Perform differential
Page 1 of 5 ENLGLISH / ESPAÑOL / PORTUGUÉS / FRANÇAIS Share 3 Drug Chart for HIV Treatment CURRENT EDITION ABOUT SENSE BACK ISSUES MSMGF HOME CONTACT US There are a number of antiretroviral (ARV) medications
HIV/AIDS Update 2007
HIV/AIDS Update 2007 Joanne J. Orrick, Pharm.D., BCPS Clinical Assistant Professor University of Florida Faculty, Florida/Caribbean AIDS Education and Training Center orricjj@ufl.edu www.faetc.org orricjj@ufl.edu
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
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
Jonathan Cohn MD Wayne State University July 24,
Jonathan Cohn MD Wayne State University July 24, 2017 www.matecmichigan.org jcohn@med.wayne.edu Current HIV Test Sequence 4 th Generation Ag/Ab Combo > Differentiation Assay Abbott Architect Alere Determine
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
Objectives. HIV Treatment in Recently In 1996 the introduction of protease inhibitors decreasing the death rate of those infected by 50%.
Objectives Identify modes HIV transmission and methods of prevention. HIV Treatment in 2010 Lisa D. Inge, Pharm.D., BCPS, AAHIVE Assistant Director, Jacksonville Campus Clinical Assistant Professor University
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
Cerebral Toxoplasmosis in HIV-Infected Patients. Ahmed Saad,MD,FACP
Cerebral Toxoplasmosis in HIV-Infected Patients Ahmed Saad,MD,FACP Introduction Toxoplasmosis: Caused by the intracellular protozoan, Toxoplasma gondii. Immunocompetent persons with primary infection
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
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
Sculpting a Better Regimen: The ART of HIV Medications
Sculpting a Better Regimen: The ART of HIV Medications Kelly Peddy, PharmD, MPA Clinical Pharmacy Specialist - Ambulatory Care Memorial Hospital of South Bend November 30, 2017 For HealthTrust Members
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
Exploring HIV in 2017: What a pharmacist needs to know
Exploring HIV in 2017: What a pharmacist needs to know Lifecycle of the HIV virus a. HIV spread through mucous membrane contact, damaged tissue contact, or blood contact with: blood, semen, rectal fluids,
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
The New Agents: Management of Experienced Patients and Resistance. Joel E. Gallant, MD, MPH Johns Hopkins University School of Medicine
The New Agents: Management of Experienced Patients and Resistance Joel E. Gallant, MD, MPH Johns Hopkins University School of Medicine T.D. 45 year old man with HIV infection diagnosed in 2000 On multiple
The ART of Antiretroviral Therapy in Critically-ill Patients with HIV
The ART of Antiretroviral Therapy in Critically-ill Patients with HIV Tyler Finocchio, PharmD, BCPS PGY2 Critical Care Pharmacy Resident Avera McKennan Hospital & University Health Center February 10 th,
Third Agent Advantages Disadvantages. Component Tenofovir/emtricitabine (TDF/FTC) 300/200 mg (coformulated with EFV as Atripla) 1 tab once daily
Table I. Recommended and Alternative Antiretroviral Regimens (DHHS Guidelines, May 1, 2014) Recommended Regimens Nucleoside Analog Reverse Transcriptase Inhibitor (NRTI) Third Agent Advantages Disadvantages
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
0.14 ( 0.053%) UNAIDS 10% (94) ( ) (73-94/6 ) 8,920
0.14 UNAIDS 0.053% 2 250 60 10% 94 73 20 73-94/6 8,920 12 43 Public Health Service Task Force Recommendations 5-10% for Use of Antiretroviral Drugs in 10-20% Pregnant HIV-1-Infected Women for Maternal
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
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
Fluconazole dimenhydrinate, diphenhydramine. Raltegravir or dolutegravir with antacids
Supportive therapy Summary of interactions Table 1. Summary of potential interactions between antiretroviral agents and supportive therapy Interactions with enzyme inhibitors (protease inhibitors and elvitegravir/cobicistat)
Midwestern Underwriting Conference 2016
UNDERWRITING HIV: THE FAIRY TALE HAS BECOME REALITY Midwestern Underwriting Conference 2016 Jean-Marc Fix, FSA, MAAA VP, R&D, Optimum Re Insurance Co. AGENDA Where are we with HIV? The risk The ideal case
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
ABRIDGED ANTIRETROVIRAL TABLE: ADULT DOSING, DOSAGE FORM MODIFICATIONS, ADVERSE REACTIONS and INTERACTION POTENTIAL
NULOESIDE/TIDE REVERSE TRANSRIPTASE INHIBITORS (N(t)RTIs) Abacavir AB (Ziagen) Emtricitabine FT (Emtriva) Lamivudine 3T (Epivir) Tenofovir disoproxil fumarate TDF (Viread) Zidovudine AZT, ZDV (Retrovir)
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
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,
2015 OPSC Annual Convention. syllabus. February 4-8, 2015 Hyatt Regency Mission Bay San Diego, California
2015 OPSC Annual Convention syllabus February 4-8, 2015 Hyatt Regency Mission Bay San Diego, California SUNDAY, FEBRUARY 8, 2015: 10:00am - 11:00am Primary Care of the HIV Patient Presented by Jim Lee,
New Frontiers for Treatment Strategies for HIV Care
New Frontiers for Treatment Strategies for HIV Care Eric S. Daar, MD Chief, Division of HIV Medicine Harbor-UCLA Medical Center Professor of Medicine David Geffen School of Medicine at UCLA Disclosures:
Human Immunodeficiency Virus Infection A Modern Day Epidemic
Human Immunodeficiency Virus Infection A Modern Day Epidemic Frank Romanelli, PharmD, MPH, BCPS Assistant Dean and Associate Professor of Pharmacy Clinical Specialist in HIV/AIDS University of Kentucky
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
Antiretroviral Pregnancy Registry
Preterm Birth, low birth weight and fetal antiretroviral exposure: Estimated gestational age and birth weight data from singleton live births, 1989 through 31 January 2009 K. Beckerman, J. Albano, M. Martinez-Tristani,
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
1/18/2011. Handling TB and HIV. Fargo, North Dakota September 15-16, Treatment of TB in the HIV Co-Infected Patient
1/18/2011 Handling TB and HIV Co-Infection Fargo, North Dakota September 15-16, 2010 Treatment of TB in the HIV Co-Infected Patient Dean Tsukayama, MD September 15, 2010 1 Co-infection with TB and HIV
Clinical Manifestations of HIV
HIV Symptoms Diane Havlir, MD Professor of Medicine and Chief, HIV/AIDS Division University of California, San Francisco (UCSF) WorldMedSchool; July 2, 2013 1 Clinical Manifestations of HIV! Result from
Outline. A 41 Year-old Male COMMON PITFALLS IN HIV/AIDS MANAGEMENT: A CASE-BASED APPROACH. Q1: What anti-fungal regimen would you start?
Outline COMMON PITFALLS IN HIV/AIDS MANAGEMENT: A CASE-BASED APPROACH Considerations for antiretroviral use in patients with coinfections Concerning and how to manage drug-drug interactions ARV-other drugs
Approach to Co-infection with TB and HIV: 2011 Henry Fraimow, MD
Approach to Co-infection with TB and HIV: 2011 Henry Fraimow, MD Consultant, Southern N.J. Regional Chest Clinic New Jersey State TB Physician Advisory Board Cooper Univ. Hospital EIP Program TB and HIV