CNS Toxicity of Integrase Inhibitors Myth or Reality? Ignacio Pérez Valero Unidad de VIH. Hospital U. La Paz
|
|
- Geraldine Turner
- 6 years ago
- Views:
Transcription
1 CNS Toxicity of Integrase Inhibitors Myth or Reality? Ignacio Pérez Valero Unidad de VIH. Hospital U. La Paz
2 Question for the audience Do you think that any integrase inhibitor drug produce CNS adverse events?
3 CNS neurotoxicity is common to all antiretroviral drugs Neuronal integrity Neuronal damage Produced by ATV Neuronal damage Produced by EFV CNS toxicity impairs normal functioning of the brain Liner et al. CROI Abst 435.
4 Toxicity Index (log TC 50 / plasma conc) Some antiretrovirals achieved neurotoxic concentrations in the CSF (MAP-2 toxicity) 2 1,5 1 More Toxic Less Toxic 0,5 0-0,5 ABC ddc DDI FTC TDF 3TC AZT EFV ETR NVP APV ATV DRV RTV MVC -1-1,5-2 Robertson K et al. J Neurovirol 2012;18(5):
5 Clinical Case Report (I) Mr. J is a well educated man of 61 years old He was diagnosed of HIV in 2009 (unknown origin) due to a wasting syndrome, subacute diarrhea and an oral candidiasis. At that time he has a CD4 nadir of 30 cells and started ART with TDF/FTC + ATV + RIT and received empiric therapy with metronidazole and ganciclovir (diarrhea) The patient did not refer ART-related tolerability issues. Real Case from our Cohort
6 Clinical Case Report (II) He was doing well with prescribed medication, the diarrhea was resolved and he started to win weigh. Despite clinical recovering, the patients persist with low level viremia for several moths (without evidence of resistance mutations) despite high adherence rates. For that reason we decided to switch ART to TDF/FTC/EFV in March Real Case from our Cohort
7 Question for the audience Do you think TDF/FTC/EFV was a good option from a CNS-safety perspective?
8 EFV, a drug with a narrow therapeutic window: The paradigm of CNS neurotoxicity 130 patients with HAART based on EFV during >3 months 226 samples obtained with a concentration range between ( ) Therapeutical EFV range between ((4μg/L) CNS EFV-related toxicity : 0% 6% 22% Marzolini C et al. AIDS 2001;15:71-5
9 Long-term CNS effects of EFV use: ACTG 5097s Progressive neurocognitive worsening at 168 weeks Early high and long-term mild increases in EFV-related symptoms Score Neurocognitive Score EFV-related symptoms Score Clifford DB et al. HIV Clin Trials 2009;10:343 55
10 Mollan KR et al. Ann Intern Med 2014;161:308 18
11 Aging increases EFV in CSF and therefore old patients are more likely to have toxic EFV levels in CSF 71 patients/samples on EFV and 98 on ATV-based ART Patients had similar characteristics and similar overall neurocognitive performance Aging affects efavirenz concentrations but not protease inhibitor concentrations in CSF Croteau D. et al. CROI 2012, abstract 592.
12 Clinical Case Report (III) EFV tolerance was good except for mild sleep disturbances. Patient maintained occasional low-level viremia rebounds despite ART switch. In Feb 2015, our pharmacy decided to split TDF/FTC/EFV into TDF/FTC + generic EFV. After that switch the patient started with diarrhea and moderate sleep disturbances. Then, we decided to switch to ABC/3TC/DTG trying improve HIV control and ART-related tolerability. Real Case from our Cohort
13 Switch to DTG in patients experiencing EFV-related CNS adverse events CNS TOXICITY BL W4 12 W post-switch IS DS Proportion of patients with grade 2-3 CNS AE IS DS Bracchi M et al. HIV Glasgow P209
14 Clinical Case Report (IV) Two weeks after switching to ABC/3TC/DTG the patient came to our clinic without an appointment. He was very nervous and anxious. After starting the new ART he started with recurrent nightmares. He was unable to recognize when he was awake or sleep. He though we were trying to do experiments with him. Real Case from our Cohort
15 Clinical Case Report (V) At the beginning we though that these symptoms could be associated with ABC and therefore we switched ART to TDF/FTC + DTG. Real Case from our Cohort
16 Neuronal toxicity has been associated with thymidine NRTIs use, including abacavir Objective: Measure NRTIs CNS mitochondrial toxicity using MRS (NAA) Patients: 18 HIV+ using d4t+/-ddi 14 HIV+ using AZT+3TC 16 HIV+ without HAART 17 HIV - controls * * Abacavir was also independently associated with NAA reduction Schweinsburg BC et al. J Neurovirol 2005;11:
17 Clinical Case Report (VI) The patient experience a mild improvement of symptoms after the switch but he demand us to return to TDF/FTC/EFV. We switched ART back to TDF/FTC/EFV. One month after the switch the patient was again completely recovery and asymptomatic. Real Case from our Cohort
18 Question for the audience Are you seeing similar or less intense cases of CNS AE related with DTG use?
19 CNS adverse events in naïve HIV patients in Clinical Trials Querencia R et al. HIV Glasgow 2016.
20 CNS adverse events change in patients on any conventional ART who continued therapy or switched to ABC/3TC/DTG Koteff J et al. EACS 2015
21 Reasons for discontinuation after switching to ABC/3TC/DTG in the STRIVING Trial Koteff J et al. EACS 2015
22 DTG adverse events in naïve and experienced HIV patients: Liverpool Hospital Experience All suffered severe side effects (anxiety, depression, paranoia and personality change) but only one patient suffered severe CNS disturbance with new suicidal ideation and self-harm. Fernandez C et al. HIV Glasgow P212
23 DTG adverse events in clinical practice: Ramon y Cajal Hospital Experience 837 patients on DTG-based ART were analyzed 104 stopped DTG (12.4%). 36 due to toxicity (4.3%) 69.4% of all AE-related discontinuations were due to CNS AE Vivancos-Gallego MJ et al. HIV Glasgow P212
24 DTG CSF concentrations in the ING Trial CSF DTG levels were 90-fold and 66-fold above the IC 50 (0.2 ng/ml) at weeks 2 and 16 respectively (RTG exceeded the IC50 by 4.5-fold) Letendre et al. CID /cid/ciu477
25 Relation between DTG plasma-trough concentrations and CNS side-effects in Japanese HIV patients 101 Japanese HIV-infected patients taking DTG ( ) % of Adverse events P<0.05 1,34 1,06 37% 21% 8% 6% 3% Any AE CNS AE Headache Insomnia Irritability CNS AE Non-CNS AE Correlations between [DTG] and UGT1A1 Genetic polymorphisms were not observed * DTG concentrations in mcg/ml Yagura H et al. HIV Glasgow P312
26 Levels of DTG seem to increase with aging Calcagno A et al. HIV Glasgow P212
27 High Rates of CNS AE leading to DTG discontinuation in Women and older patients n = 985 Sabrinski M et al. HIV Glasgow 2016
28 Question for the audience Is CNS toxicity only associates with DTG or there is a class-effect for all the Integrase Inhibitors?
29 Comparison of changes in CNS AE in patients starting integrase inhibitor (compared to an EFV-based ART) Adverse Events in >10% Patients at Week 96 33% TDF/FTC/EFV ABC/3TC/DTG 26% 28% TDF/FTC/EFV TDF/FTC/ELV/COBI 16% 7% 7% 6% 10% 7% 15% 16% 11% Dizziness Abnormal dreams Insomnia Dizziness Abnormal dreams Insomnia Adverse Events in >5% Patients at 5 Yrs. 35% TDF/FTC + EFV TDF/FTC + RTG 13% 8% 7% 8% 7% Dizziness Abnormal dreams Insomnia Walmsley S, et al. JAIDS 2015;70:515-9 Rockstroh JK et al. JAIDS 2013;63:77.85 Zolopa A et al. JAIDS 2013;63:96-100
30 Proportion of patients treated with INSTI (%) Rates of AE in patients starting integrase inhibitors in clinical practice Raltegravir (n=553) Elvitegravir-cobi (n = 395) Dolutegravir (n = 519) 0 Any ADR CNR GI Liver Skin General Other ADR symptom category Lepik KJ et al. HIV Glasgow TUPEB256
31 Rates of AE (and CNS AE) leading to Integrase Inhibitor discontinuation during the first 12 months of use Sabrinski M et al. HIV Glasgow 2016
32 Thanks for your attention
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
More informationEfavirenz vs dolutegravir for 1st line ART: Is it time to change? The argument AGAINST. Graeme Meintjes University of Cape Town
Efavirenz vs dolutegravir for 1st line ART: Is it time to change? The argument AGAINST Graeme Meintjes University of Cape Town Benefits of dolutegravir Superior efficacy in SINGLE trial Side effect profile
More informationHIV Treatment Update. Anton Pozniak Consultant Physician, Director of HIV Services Chelsea and Westminster Hospital, London
HIV Treatment Update Anton Pozniak Consultant Physician, Director of HIV Services Chelsea and Westminster Hospital, London Guidelines Nuke sparing Nukes Efavirenz placement as the gold standard ARV Role
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 informationHIV 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
More informationAntiretroviral Therapy: What to Start
FLOWED: 05-14-2015 Chicago, IL: May 18, 2015 Antiretroviral Therapy: What to Start Eric S. Daar, MD Professor of Medicine David Geffen School of Medicine University of California Los Angeles Los Angeles,
More informationCase # 1. Case #1 (cont d)
Antiretroviral Therapy Management: Expert Panel Discussion George Beatty Susa Coffey Steve O Brien December 3, 2011 Moderated by Annie Luetkemeyer Case # 1 38 y.o. man, CD4 =350, VL=340K, new to your clinic
More informationPrima linea: dovremmo evitare i PI nella terapia di prima linea per i loro effetti non desiderati? Giuseppina Liuzzi
6 th INFECtivology TOday Paestum 15-16 -17 maggio 2014 Prima linea: dovremmo evitare i PI nella terapia di prima linea per i loro effetti non desiderati? Giuseppina Liuzzi Istituto Nazionale per le Malattie
More informationThe 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
More informationSafety of Current Antiretroviral Therapy on the CNS Scott Letendre, M.D.
Safety of Current Antiretroviral Therapy on the CNS Scott Letendre, M.D. Professor of Medicine and Psychiatry University of California, San Diego Disclosures Research funds were paid to UC San Diego on
More informationPediatric 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
More informationSTRIBILD (aka. The Quad Pill)
NORTHWEST AIDS EDUCATION AND TRAINING CENTER STRIBILD (aka. The Quad Pill) Brian R. Wood, MD Medical Director, NW AETC ECHO Assistant Professor of Medicine, University of Washington Presentation prepared
More informationMore Options, Some Opinions Initial Therapies for HIV Judith S. Currier, MD
More Options, Some Opinions Initial Therapies for HIV Judith S. Currier, MD More Options, Some Opinions: Initial Therapies for HIV Judith S. Currier, MD University of California Los Angeles Los Angeles,
More informationPharmacological 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
More informationCases from the Clinic(ians): Case-Based Panel Discussion
Cases from the Clinic(ians): Case-Based Panel Discussion Michael S. Saag, MD Professor of Medicine The University of Alabama at Birmingham EDITED: 03-12-14 Learning Objectives After attending this presentation,
More informationHIV - 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
More informationResistance to Integrase Strand Transfer Inhibitors
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Resistance to Integrase Strand Transfer Inhibitors David Spach, MD Clinical Director, Northwest AETC Professor of Medicine, Division of Infectious Diseases
More informationART 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:
More informationThe next generation of ART regimens
The next generation of ART regimens By Gary Maartens Presented by Dirk Hagemeister Division of Clinical Pharmacology UNIVERSITY OF CAPE TOWN IYUNIVESITHI YASEKAPA UNIVERSITEIT VAN KAAPSTAD Current state
More informationAntiretroviral Treatment Strategies: Clinical Case Presentation
Antiretroviral Treatment Strategies: Clinical Case Presentation Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan Chia-Jui, Yang M.D Disclosure No conflicts of interests.
More informationWhat's new in the WHO ART guidelines How did markets react?
WHO 2013 ARV Guidelines What's new in the WHO ART guidelines How did markets react? Dr. J. Perriëns Coordinator, HIV Technology and Commodities HIV department, WHO, Geneva When to start in adults Starting
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 informationStatistical issues in HIV trial design. Andrew Hill Senior Visiting Research Fellow Liverpool University
Statistical issues in HIV trial design Andrew Hill Senior Visiting Research Fellow Liverpool University Type 1 error It is statistically significant! (after 100 different statistical tests) Type 1 error:
More informationDolutegravir: Pros and Cons (Are There Any Cons?)
Mountain West AIDS Education and Training Center Dolutegravir: Pros and Cons (Are There Any Cons?) Brian R. Wood, MD Assistant Professor of Medicine, University of Washington Medical Director, MW AETC
More informationANTIRETROVIRAL TOXICITY Strategies for prevention and treatment
ANTIRETROVIRAL TOXICITY Strategies for prevention and treatment Francisco Antunes Professor da Faculdade de Medicina da Universidade de Lisboa e Director do Serviço de Doenças Infecciosas do Hospital de
More informationAre the current doses of ARV correct. Richard Elion MD Associate Adjunct Clinical Professor of Medicine Johns Hopkins School of Medicine
Are the current doses of ARV correct Richard Elion MD Associate Adjunct Clinical Professor of Medicine Johns Hopkins School of Medicine Can we lower doses of HIV meds safely? Consensus Panel in Alexandria
More informationThe Eras of the HIV Epidemic
The Eras of the HIV Epidemic 1930-1980 1981-1986 1987-1995 1996-2005 2nd Gen. HAART 2006-2011 2006: Disproportionate distribution of HIV 2006: Gates and Clinton at International AIDS conference announce
More informationComprehensive 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
More informationThe Use of Integrase Inhibitors In Latin America: From Guidelines to the Real World Ernesto Martínez B., MD Internal Medicine, Infectious Diseases
De afbeelding kan niet worden weergegeven. The Use of Integrase Inhibitors In Latin America: From Guidelines to the Real World Ernesto Martínez B., MD Internal Medicine, Infectious Diseases DISCLOSURE
More informationDisclosures. 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
More informationThird 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
More informationProfessor José Arribas
19 th Annual Conference of the British HIV Association (BHIVA) Professor José Arribas Hospital La Paz, Madrid, Spain 16-19 April 2013, Manchester Central Convention Complex Can we live without nucleosides?
More informationWhat are the most promising opportunities for dose optimisation?
What are the most promising opportunities for dose optimisation? Andrew Hill Liverpool University, UK Global Financial Crisis How can we afford to treat 15-30 million people with HIV in the future? Lowering
More informationVirological suppression and PIs. Diego Ripamonti Malattie Infettive - Bergamo
Virological suppression and PIs Diego Ripamonti Malattie Infettive - Bergamo Ritonavir-boosted PIs Boosted PIs: 3 drugs in one The intrinsic antiretroviral activity Viral suppression and high baseline
More informationEfficacy and Safety of Doravirine 100mg QD vs Efavirenz 600mg QD with TDF/FTC in ART-Naive HIV-Infected Patients: Week 24 Results
Efficacy and Safety of Doravirine 1mg QD vs Efavirenz 6mg QD with TDF/FTC in ART-Naive HIV-Infected Patients: Week 24 Results Jose M. Gatell, Francois Raffi, Andreas Plettenberg, Don Smith, Joaquin Portilla,
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 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 informationIntegrase Inhibitors in the Treatment HIV-Infection. Andrew Zolopa, MD Stanford University
Integrase Inhibitors in the Treatment HIV-Infection Andrew Zolopa, MD Stanford University 1 IAS-USA 212 Guidelines Updated Recommendations When to start ART is now recommended for all patients, regardless
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 informationDidactic 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,
More informationDisclosures (last 12 months)
HIV Research What s in the Pipeline? Samir K. Gupta, MD, MS Division of Infectious Diseases Indiana University School of Medicine Disclosures (last 12 months) Independent research grant funding by NIH/NHLBI,
More informationSusan 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
More informationOptimizing 2 nd and 3 rd Line Antiretroviral Therapy in Children and Adolescents
Optimizing 2 nd and 3 rd Line Antiretroviral Therapy in Children and Adolescents Victor Musiime, MBChB, MMED, PhD Senior Lecturer, Makerere University Investigator, Joint Clinical Research Centre (JCRC)
More informationManagement of patients with antiretroviral treatment failure: guidelines comparison
The editorial staff Management of patients with antiretroviral treatment failure: guidelines comparison A change of therapy should be considered for patients if they experience sustained rebound in viral
More informationSwitching antiretroviral therapy to safer strategies based on integrase inhibitors
Switching antiretroviral therapy to safer strategies based on integrase inhibitors Dr Paddy Mallon UCD HIV Molecular Research Group UCD School of Medicine paddy.mallon@ucd.ie UCD School of Medicine & Medical
More informationReal Life Experience of Dolutegravir and Lamivudine Dual Therapy As a Switching Regimen in HIVTR Cohort
Real Life Experience of Dolutegravir and Lamivudine Dual Therapy As a Switching Regimen in HIVTR Cohort Yagci-Caglayik D 1, Gokengin D 2, Inan A 3, Ozkan-Ozdemir H 4, Inan D 5, Akbulut A 6, Korten V 1,
More informationAdult Guidelines. Sipho Dlamini. Division of Infectious Diseases & HIV Medicine University of Cape Town Groote Schuur Hospital
Adult Guidelines Sipho Dlamini Division of Infectious Diseases & HIV Medicine University of Cape Town Groote Schuur Hospital Cape Town CME 3 rd June 2017 Sports Science Institute, Newlands Outline of talk
More information0% 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
More informationSELECTING 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
More informationDisclosures. Introduction to ARV Drug Resistance New Clinicians Workshop. Introduction. ARS Question 12/6/2017
Disclosures Introduction to ARV Drug Resistance New Clinicians Workshop I have no disclosures Susa Coffey, MD Division of HIV, ID and Global Medicine ARS Question Which resistance test do you order for
More information2 nd Line Treatment and Resistance. Dr Rohit Talwani & Dr Dave Riedel 12 th June 2012
2 nd Line Treatment and Resistance Dr Rohit Talwani & Dr Dave Riedel 12 th June 2012 Overview Basics of Resistance Treatment failure Strategies to manage treatment failure Mutation Definition: A change
More informationA case, and some pharmacological considerations. from the perspective of a virologist. Anna Maria Geretti University of Liverpool, United Kingdom
A case, and some pharmacological considerations. from the perspective of a virologist Anna Maria Geretti University of Liverpool, United Kingdom 1 Case History: Mr RS 53-year-old male Diagnosed HIV positive
More informationHIV and the Central Nervous System Impact of Drug Distribution Scott L. Letendre, MD. Professor of Medicine University of California, San Diego
HIV and the Central Nervous System Impact of Drug Distribution Scott L. Letendre, MD Professor of Medicine University of California, San Diego Disclosures Grant/research support Abbvie Gilead Sciences
More informationAging and Antiretroviral Neurotoxicity Scott Letendre, M.D.
Aging and Antiretroviral Neurotoxicity Scott Letendre, M.D. Professor of Medicine and Psychiatry University of California, San Diego Disclosures Research funds were paid to UC San Diego on behalf of Dr.
More informationAntiretroviral Drugs
Antiretroviral Drugs Dr Paddy Mallon UCD HIV Molecular Research Group Associate Dean for Research and Innovation UCD School of Medicine and Medical Science paddy.mallon@ucd.ie UCD School of Medicine &
More informationThe Dawn of the TLD Era
The Dawn of the TLD Era 20th September 2018 Mark Siedner Africa Health Research Institute Harvard Medical School Outline: A Primer on Dolutegravir Do we really need more HIV drugs? The case for a new first-line
More informationL infettivologia del 3 millennio: AIDS ed altro
L infettivologia del 3 millennio: AIDS ed altro VI Convegno Nazionale 15-16 -17 maggio 2014 Centro Congressi Hotel Ariston Paestum (SA) Nuove molecole ad azione anti-hiv Annalisa Saracino Clinica Malattie
More informationStarting 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,
More informationDidactic Series. CROI New Antiretroviral Therapies. Daniel Lee, MD Clinical Professor of Medicine UCSD Medical Center Owen Clinic July 14, 2016
Didactic Series CROI 2016 - New Antiretroviral Therapies Daniel Lee, MD Clinical Professor of Medicine UCSD Medical Center Owen Clinic July 14, 2016 This project is supported by the Health Resources and
More informationThe 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
More informationClinical Pharmacology Related Considerations.
Clinical Pharmacology Related Considerations. David Back University of Liverpool UK David Back University of Liverpool Disclosures Honoraria received for advisory boards and lectures from AbbVie, BMS,
More informationHIV 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
More informationFirst line ART Rilpirivine A New NNRTI. Chris Jack Physician, Durdoc Centre ethekwini
First line ART Rilpirivine A New NNRTI Chris Jack Physician, Durdoc Centre ethekwini Overview: Rilpirivine an option for ARV Naïve patients History Current guidelines Efficacy and Safety Tolerability /
More informationCrafting an ART Regimen for Initiation or Salvage: Are NRTI s Necessary?
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Crafting an ART Regimen for Initiation or Salvage: Are NRTI s Necessary? Brian R. Wood, MD Assistant Professor of Medicine, University of Washington Medical
More informationHIV-1-infected Males and Females under Less-Drug Regimens Achieve Antiretroviral Levels above the Inhibitory Concentration in the Genital Tract.
HIV-1-infected Males and Females under Less-Drug Regimens Achieve Antiretroviral Levels above the Inhibitory Concentration in the Genital Tract. Sandrine LEFEUVRE, Julie BOIS-MAUBLANC, Camélia GUBAVU,
More informationClinical skills building - HIV drug resistance
Clinical skills building - HIV drug resistance Richard Lessells Clinical case 44-year old HIV-positive male HIV diagnosis 2010 Pre-treatment CD4+ count not known Initiated first-line ART (TDF/FTC/EFV)
More informationSelecting 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,
More informationThis graph displays the natural history of the HIV disease. During acute infection there is high levels of HIV RNA in plasma, and CD4 s counts
1 2 This graph displays the natural history of the HIV disease. During acute infection there is high levels of HIV RNA in plasma, and CD4 s counts decreased. This period of acute infection or serocnversion
More informationSusan 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
More informationSimplifying 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
More informationINTERGRASE INHIBITORS- WHAT S NEW?
INTERGRASE INHIBITORS- WHAT S NEW? Professor Margaret Johnson Royal Free London Foundation Trust October 2018 Targeting the HIV life-cycle NEW HIV VIRON MATURATION CO-RECEPTOR BINDING FUSION BUDDING CD4
More informationCriteria 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
More informationDisclosures. Introduction to ARV Drug Resistance New Clinicians Workshop 12/9/16. Introduction. ARS Question
Disclosures Introduction to ARV Drug Resistance New Clinicians Workshop I have no disclosures Susa Coffey, MD Division of HIV, ID and Global Medicine ARS Question Which resistance test do you order for
More informationVIKING STUDIES Efficacy and safety of dolutegravir in treatment-experienced subjects
VIKING STUDIES Efficacy and safety of dolutegravir in treatment-experienced subjects IL/DLG/0040/14 June 2014 GSK (Israel) Ltd. Basel 25, Petach Tikva. Tel-03-9297100 Medical information service: il.medinfo@gsk.com
More informationResistance Analyses of Integrase Strand Transfer Inhibitors within Phase 3 Clinical Trials of Treatment-Naive Patients
Viruses 2014, 6, 2858-2879; doi:10.3390/v6072858 Review OPEN ACCESS viruses ISSN 1999-4915 www.mdpi.com/journal/viruses Resistance Analyses of Integrase Strand Transfer Inhibitors within Phase 3 Clinical
More informationHIV 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
More informationIntegrase Strand Transfer Inhibitors on the Horizon
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Integrase Strand Transfer Inhibitors on the Horizon David Spach, MD Clinical Director, Northwest AETC Professor of Medicine, University of Washington Presentation
More informationThe 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
More informationNorthwest 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
More informationContinuing 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
More informationUpdate on HIV Drug Resistance. Daniel R. Kuritzkes, MD Division of Infectious Diseases Brigham and Women s Hospital Harvard Medical School
Update on HIV Drug Resistance Daniel R. Kuritzkes, MD Division of Infectious Diseases Brigham and Women s Hospital Harvard Medical School Learning Objectives Upon completion of this presentation, learners
More informationACTHIV 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
More informationPharmacologic Characteristics and Delivery Options for Integrase Inhibitors
Pharmacologic Characteristics and Delivery Options for Integrase Inhibitors Courtney V. Fletcher, Pharm.D. Dean, College of Pharmacy Professor, Department of Pharmacy Practice and Division of Infectious
More informationIntegrase Inhibitor Based Antiretroviral Therapy in Botswana; a Case Report
Detection of Four-Class Resistant HIV-1C in a patient on Integrase Inhibitor Based Antiretroviral Therapy in Botswana; a Case Report Kaelo K. Seatla MPhil / PhD Student Supervisors: Dr. Simani Gaseitsiwe
More informationDr Carole Wallis, PhD Medical Director, BARC-SA Head of the Specialty Molecular Division, Lancet Laboratories, South Africa
Dr Carole Wallis, PhD Medical Director, BARC-SA Head of the Specialty Molecular Division, Lancet Laboratories, South Africa Transmitted drug resistance Resistance patterns in first-line failures in adults
More informationUpdate 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:
More informationUnmet needs and challenges of current ART in South Africa. Michelle Moorhouse 21 Nov 2015
Unmet needs and challenges of current ART in South Africa Michelle Moorhouse 21 Nov 2015 SA Snapshot Òct 2015 6-7 million HIV-positive: 18% world total, 25% of Southern Africa 3.2 on first line ART: consume
More informationManagement of Treatment-Experienced Patients: New Agents and Rescue Strategies. Joel E. Gallant, MD, MPH Johns Hopkins University School of Medicine
Management of Treatment-Experienced Patients: New Agents and Rescue Strategies Joel E. Gallant, MD, MPH Johns Hopkins University School of Medicine When to Modify Therapy! Studies to date show better responses
More informationSelected 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
More informationSecond-Line Therapy NORTHWEST AIDS EDUCATION AND TRAINING CENTER
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Second-Line Therapy David Spach, MD Clinical Director, Northwest AETC Professor of Medicine, Division of Infectious Diseases University of Washington Presentation
More informationNew HIV EACS and Italian Guidelines
Original Article HIV correlated pathologies and other infections Marco Borderi New HIV EACS and Italian Guidelines Infectious Disease Unit - S. Orsola-Hospital - University of Bologna Corresponding author:
More informationHIV Update Allegra CPD Day Program Port Elizabeth Dr L E Nojoko
HIV Update 2014 Allegra CPD Day Program Port Elizabeth 12-02-2014 Dr L E Nojoko Global estimates for adults and children 2011 People living with HIV 34.0 million [31.4 million 35.9 million] New HIV infections
More informationHIV in the Brain MANAGING COMORBIDITIES IN PATIENTS WITH HIV
HIV in the Brain MANAGING COMORBIDITIES IN PATIENTS WITH HIV Shibani S. Mukerji MD, PhD Massachusetts General Hospital, Division of Immunologic, Inflammatory and Infectious Neurological Diseases Dana-Farber
More informationHIV and contraception the latest recommendations
1 8-11 June 2015, Chiang-Mai HIV and contraception the latest recommendations Mary Lyn Gaffield, Sharon Phillips, Rachel Baggaley, Petrus Steyn, and Marleen Temmerman 2 Medical eligibility criteria for
More informationAnumber of clinical trials have demonstrated
IMPROVING THE UTILITY OF PHENOTYPE RESISTANCE ASSAYS: NEW CUT-POINTS AND INTERPRETATION * Richard Haubrich, MD ABSTRACT The interpretation of a phenotype assay is determined by the cut-point, which defines
More informationAntiretroviral Therapy in Joel Gallant, MD, MPH Johns Hopkins University School of Medicine
Antiretroviral Therapy in 2013 Joel Gallant, MD, MPH Johns Hopkins University School of Medicine When to Start When to Start: DHHS Guidelines, February 2013 ART recommended for all HIV+ individuals to
More informationWhen 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
More informationART for HIV Prevention:
ART for HIV Prevention: KENNETH H. MAYER, M.D. Brown University/The Fenway Institute August 22, 2009 APPROACHES TO PREVENT HIV TRANSMISSION DECREASE SOURCE OF INFECTION Barrier Protection Treat STI Antiretroviral
More informationCOMPREHENSIVE 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)
More informationSingle Pill Combinations Versus Generics: Prescribing Practices in a New Healthcare Era
Activity Code FM285 Single Pill Combinations Versus Generics: Prescribing Practices in a New Healthcare Era Monica Gandhi MD, MPH Clinic Director, Ward 86 HIV Clinic, SFGH/UCSF Learning Objectives Upon
More information