Post exposure prophylaxis following exposure to HIV. Paul Benn Mortimer Market Centre, Camden PCT HIVPA study day Tuesday 18 th November 2008 SOAS
|
|
- Warren Blaise Roberts
- 6 years ago
- Views:
Transcription
1 Post exposure prophylaxis following exposure to HIV Paul Benn Mortimer Market Centre, Camden PCT HIVPA study day Tuesday 18 th November 2008 SOAS
2 Overview Hypothesis PEP? Awareness & uptake PEP/PEPSE Ensuring appropriate and timely PEP/PEPSE Tolerability & completion PEP/PEPSE Current guidelines Special circumstances: cases Effect of PEPSE on sexual behaviour? Future surveillance/research
3 Dynamics following exposure to HIV
4 The risk of HIV transmission Type of exposure X Risk source is HIV+
5 Risk of exposure Type of exposure Needle-stick injury Sharing injecting equipment Mucous membrane exposure Receptive anal intercourse Receptive vaginal intercourse Insertive vaginal intercourse Insertive anal intercourse Receptive oral sex Estimated risk of HIV transmission 0.3% 0.67% 0.09% 0.1 3% % % 0.06% %
6 Calculating the risk of HIV transmission Needle stick injury HIV positive 100% X 0.3% = 3/1000
7 The risk of HIV transmission Infectiousness of source Susceptibility of individual
8 Other factors: occupational Exposure characteristics Source characteristics Viral factors
9 Other factors: occupational Exposure characteristics - Depth Visible blood Vessel Type of fluid Source characteristics - HIV status if unknown load Primary infection/aids Known resistance Plasma viral
10 Other factors: occupational AZT 0.2 AIDS 6.4 Vessel 5.1 Visible blood 5.2 Deep OR Cardo DM et al. N. Engl. J Med 1997; 337:1485
11 Other factors: sexual (infectiousness of source) Viral factors Circumcision STI s
12 Other factors: sexual (susceptibility of host) Genetic PEP & PrEP Microbicides Genital tract
13 Does PEP work? Animal studies Human studies Vertical transmission
14 Does PEP work? Individual Population
15 Time to initiation and duration of PEP Tenofovir PEP in macaques Time to PEP (hours) Duration of PEP (days) Number protected /4 (100%) /4 (50%) /4 (25%) /4 (0%) /4 (50%) /4 (100%) Tsai CC et al. J Virol 98; 72:
16 Evidence human: Occupational exposure AZT 0.2 AIDS 6.4 Vessel 5.1 Visible blood 5.2 Deep OR Cardo DM et al. N. Engl. J Med 1997; 337:1485
17 Failures of PEP & PEPSE?
18 Occupationally acquired HIV (2002) USA Europe (UK) Rest of world Documented cases HIV (5) 14 Possible cases HIV (14) 14 PEP failures : late presentation, insufficient duration/dose, resistant virus
19 Seroconversion following non-occupational PEP against HIV 7/702 (1%, 95% CI 0.4 2%) Unprotected receptive anal intercourse Late presentation; poor adherence Ongoing risk behaviour M E Roland et al. CID 2005:41;
20 What is the awareness & uptake of PEP & PEPSE?
21 Postal survey awareness PEP among junior doctors 1998 (n=350) M Y Chen et al. Sex Trans Infec 2001; 77: /273 (93%) had heard of PEP 23/273 (8%) could name the specific drugs 89/273 (33%) PEP should be initiated < 1 hour 208/273 (76%) reported at least one potential exposure 49/273 (18%) had sought advice about PEP
22 HPA: Occupational exposure to HIV infected source 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% N= PEP No PEP Unknown
23 PEP following occupational exposure to HIV Mortimer Market Centre No Occupational Sexual Non occupational Not specified
24 Awareness of PEPSE among MSM 2003 (n=14,000) Ford Hickson: Sigma Research % Heard of PEP Sought PEP Taken PEP
25 THT/CHAPS PEP Campaigns July 2004 Promote PEP MSM Brighton/London Information Self assessment tool Pathways November 2006 BME
26 Increase in awareness of PEPSE among MSM (n=16,000) Ford Hickson: Sigma Research % Heard of PEP Sought PEP Taken PEP
27 PEP following sexual exposure to HIV Mortimer Market Centre No Occupational Sexual Non occupational Not specified
28 Ensuring appropriate and timely PEP & PEPSE?
29 Avoiding exposure- universal precautions Safe handling sharps and needles Gloves Protective eyewear Education and training
30 Factors contributing to accidental exposures Equiptment related HCW related Procedure related Patient related Non compliance with UP %
31 Preventable exposures No % preventable Ward A&E ITU Theatre After procedure Other
32 Time to initiation of PEP 2005 (n=189) 6% 5% 34% 55% < 1 hour 1-24 hours hours >72 hours
33 Duration of PEP when source tests HIV negative (n=82) day 2-7 days 8 or more days 10
34 Avoiding PEP: POCT HIV tests EIA Ora quick & EIA p 1/1/03 10/7/03 11/7/03 31/12/03 Number HCW exposures Number of pep doses taken 3.8 (0-6) 1.2 (0-3) Cost per exposure N/A (USD) Landrum ML et al. Infect Control Hosp Epidemiol. 2005; 26(9):
35 Ensuring appropriate and timely PEP Awareness Trust policy/care pathways 24 hour access Training Use of POCT
36 Pilot POCT at MMC for MSM requesting PEP following sexual exposure to HIV n=198 Use of Abbott Determine and INSTI HIV POCT 9/198 (4.5%) positive at baseline confirmed by HIV Ag/Ab avoided unnecessary PEP 1/198 (0.5%) false reaction INSTI
37 Tolerability & completion PEP/PEPSE
38 PEP following occupational exposure Parkin J M et al (Lancet 2000, 355; 29: 722-3) 28 HCWs 15/28 (53.6%) completed 4 weeks 6/19 (31.6%) indinavir-based regimen required more than 2 weeks off work
39 Patients prescribed PEP at the MMC 1/97-11/99 Benn P et al (Lancet, 2001; 357: 687-8) occupational (n=44) sexual (n=40) median time to PEP (hours): completion rates: 2 (range 1-48) 23 (range 9-192) 19/40 (48%) 24/39 (62%)
40 Completion rates 4 weeks PEP (%) % completing nevirapine protease inhibitor AZT/3TC n=57 n=19 n=7
41 Adverse Events (%) % of PEP recipients nevirapine protease inhibitor AZT/3TC minor AE major AE
42 Risk:Benefit Analysis Risk of transmission Risk of PEP
43 NONOPEP study Prospective descriptive study of the use PEP following non-occupational exposure to HIV infection 10 centres November June 2005 Follow-up 6/12 N=333 (93% followed sexual exposure)
44 NONOPEP Median time to initiation of PEP Median time hours (range) Sexual n=309 Mucous membrane n=10 Needle-stick n=14 24 (0.3-72) 21 ( ) 4 (1-63)
45 NONOPEP Completion and adherence to PEP (n=333) % completed 28/7 % % missed at least 1 dose 32% LTFU Completed 100% adherence Completed missed at least 1 dose Completed adherence data missing Stopped early LTFU
46 NONOPEP Completion rates (%) among individuals returning for F/U according to PEP regimen % AZT/3TC/NFV D4T/3TC/NFV Other* N=
47 NONOPEP Tolerability of PEPSE 132/225 (59%) reported at least 1 side effect 50/189 (27%) required at least one day off work, mean 7 days (range 1 30). 137/201 (68%) reported some degree of psychological disturbance while receiving PEP.
48 Guidelines
49 International guidelines US (CDC) Europe UK Australia When? 72 hours 72 hours 72 hours 72 hours What? 2 or 3 drugs 3 drugs 3 drugs 2 or 3 drugs How long? 28 days 28 days 28 days 28 days Who? Source HIV+ or from risk group Source HIV+ or from risk group Source HIV+ or from risk group Source HIV+ or from risk group
50 UK guidelines: Situations in which PEP would be considered Exposure Source HIV+ Source Prevalence high (>10%) Source Prevalence low Receptive anal sex R R C Insertive anal sex R C Receptive vaginal sex R C Insertive vaginal sex R C Fellatio with ejaculation C C Fellatio without ejaculation Splash semen into eye C Cunnilingus
51 UK guidelines: Situations in which PEP would be recommended Exposure Source HIV+ Source Prevalence high (>10%) Source Prevalence low Receptive anal sex R 3 /100 R 3 /1000 C Insertive anal sex R 1/1000 C Receptive vaginal sex Insertive vaginal sex Fellatio with ejaculation R R C 1/1000 1/1000 C C C Fellatio without ejaculation Splash semen into eye C Cunnilingus
52 UK guidelines: Situations in which PEP would be considered Exposure Source HIV+ Source Prevalence high (>10%) Source Prevalence low Receptive anal sex R R C Insertive anal sex Receptive vaginal sex R R C C 1/ /10000 Insertive vaginal sex R C 1/10000 Fellatio with ejaculation C 4 /10000 C 1/10000 Fellatio without ejaculation Splash semen into eye C Cunnilingus
53 Previous DoH & BASHH guidelines DOH 2/04: AZT/3TC/Nelfinavir 28/7 BASHH 04: TI # + PI (boosted PI)* 28/7 # AZT/3TC or D4T/3TC or TDF/3TC or TDF/FTC Nelfinavir, Lopinavir, Fosamprenavir or Saquinavir
54 Previous DoH & BASHH guidelines DOH 2/04: AZT + 3TC + rpi 28/7 BASHH 04: TI # + PI (boosted PI)* 28/7 # AZT/3TC or D4T/3TC or TDF/3TC or TDF/FTC Lopinavir, Fosamprenavir or Saquinavir
55 Pan London PEP/SE regimens units using three different regimens 5 different durations of starter packs (range 1-7) Some trusts using longer 28 days?discarding additional medication Variation in cost from 517 to 745 per PEP/SE course
56 Current DoH & BASHH guidelines DOH 2008: Truvada & Lopinavir 28/7 BASHH 04: TI # + PI (boosted PI)* 28/7 # AZT/3TC or D4T/3TC or TDF/3TC or TDF/FTC Lopinavir, Fosamprenavir or Saquinavir
57 Key changes DoH guidelines in 2008 Truvada and kaletra: 28/7 Testing source: result available within 8 hours (max 24) Cut off 72 hours Follow up testing at 3 months after completion of PEP
58 Pan London approach in 2008? Standardised regimen Standardised cost Central packaging (blister packs) Standardised patient information sheet
59 Key considerations for which regimen? Individualise Potency Pill burden Tolerability Standardise Starter packs Storage Anxiety Adherence Drug-drug interactions Drug penetration Medical conditions Resistance
60 Key considerations for which regimen? Individualise Potency Pill burden Tolerability Adherence Drug-drug interactions Drug penetration Medical conditions Resistance
61 Female Genital Tract Exposure (percent of blood plasma) Dumond et al. Abstract 129, 13 th CROI 0 200% 400% 600% ddi (100%) IDV (200%) 3TC (400%) FTC (600%) SQV(ND) ZDV (200%) TDF (400%) EFV (0.6%) ABC (150%) d4t (4%) RTV (20%) DLV (20%) ATV (30%) LPV (30%) ABC (40%) APV (50%) NVP (80%) TI PI NTI
62 Female Genital Tract Exposure (percent of blood plasma) Dumond et al. Abstract LB 135, 14 th CROI 0 200% 400% 600% ddi (100%) IDV (200%) 3TC (400%) FTC (600%) SQV(ND) ZDV (200%) TDF (400%) EFV (0.6%) ABC (150%) d4t (4%) RTV (20%) DLV (20%) MVC (400%) ATV (30%) LPV (30%) ABC (40%) APV (50%) NVP (80%) CCR5 TI PI NTI
63 Other considerations for which regimen? 4 case studies
64 Case 1 MSM attended A&E 1/7 ago following an episode of UPRAI with a known HIV+ partner. Diagnosed 10 years ago and has taken several combinations ART previously Started standard regimen of Truvada Kaletra What do you want to know?
65 Case 1 (2) CD4? Viral load? Which regimen? Resistance profile?
66 Case 1 (3) CD4 600 Viral load Previous regimens 3200 copies/ml CBV EFV Resistance profile RT 184V K103N PI Nil Do you change his PEP?
67 Case 1 (4) CD4 600 Viral load Previous regimens Resistance profile 3200 copies/ml Triple class experienced Extensive triple class resistance Do you change his PEP?
68 Resistance Undiagnosed prevalence 5-10% Untreated (check baseline resistance test) On treatment (majority will have VL < 50) On treatment with known resistant virus
69 % UK Surveillance Resistance N= 4454 Treatment naïve (316 recently infected) Dunn et al. AIDS 2007; 21(8): N= Any TI NTI PI
70 Resistance Undiagnosed prevalence 5-10% Untreated (check baseline resistance test) On treatment (majority will have VL < 50, resistance unlikely) On treatment with known resistant virus chase result
71 Case 2 MSM attended A&E 1/7 ago following an episode of UPIAI with a known HIV+ partner. Diagnosed 10 years ago and is taking ART Started standard regimen of Truvada Kaletra What do you want to know?
72 Case 2 (2) CD4? Viral load? Previous regimen? Resistance profile? Adherence?
73 Case 2 (3) CD4 920 Viral load What is his risk of acquiring HIV? < 50 copies/ml Previous regimen Atripla Should he continue PEP? Resistance profile Adherence Wild type Excellent
74 Viral load < 50 Viral load does not = non infectious? Usually plasma VL proportional to genital tract VL Impact of STIs? Impact of non/poor adherence? Overall risk VERY SMALL
75 Viral load < 50? Exposure Source HIV+ Source Prevalence high (>10%) Source Prevalence low Receptive anal sex R 3 /1000? R 3 /10000? C Insertive anal sex R 1/10000? C Receptive vaginal sex Insertive vaginal sex Fellatio with ejaculation R R C 1/10000? 1/10000? C C C Fellatio without ejaculation Splash semen into eye C Cunnilingus
76 Viral load < 50 Viral load does not = non infectious Usually plasma VL proportional to genital tract VL Impact of STIs? Impact of non/poor adherence? Overall risk VERY SMALL
77 Case 3 29 year old female nurse is referred to your clinic following a needle stick injury from a man on HDU with severe pneumonia, recently moved from S. Africa. What do you want to do next?
78 Case 3 (2) Test source with his consent Sexual, PMH, DH of nurse Test nurse with consent Risk of pregnancy positive high risk partner negative 6/52 pregnant Would you give PEP? If so what?
79 Pregnancy Pregnancy not a contraindication to taking PEP Risk vs benefit analysis Combivir & kaletra
80 Case 4 (1) 43 year old MSM presents to your clinic following UPRAI with several men at least one is known to be HIV + 24 hours ago On further questioning he has taken PEP four times this year Should you offer him PEP?
81 Impact of PEPSE upon sexual behaviour? Individual
82 Impact of PEPSE upon sexual behaviour? Negative impact: people who use seat-belts drive faster 1 Or? Positive impact: access to sexual health care and wake-up call 2
83 Summary of impact of PEPSE upon sexual behaviour (NONOPEP study)? High risk group Majority of people report reduction or no change in risk taking behaviour compared to baseline in short to medium term - number of partners in 3/12 - number of additional HIV exposures
84 Impact of PEPSE upon sexual behaviour?? Population
85 Multiple requests for PEP among MSM following sexual exposure to HIV 1/98 to 12/06 Mortimer Market Centre 30/794 (3.8%) Brighton 7/118 (5.9%) St Thomas 10/609 (1.6%)
86 Case 4 (2) Very high risk of acquiring HIV Case by case analysis of risk vs benefit Involve health advisor & psychology teams
87 Case 4 (3) He reports that he has been taking PEPSE from St elsewhere for two weeks and has another 14 days left What do you do?
88 Future research and surveillance Occupational exposures Voluntary reporting system to HPA Non-occupational exposures No surveillance system PEP BASHH HIV SIG- KC60 codes Web based enhanced surveillance RCT Maraviroc vs Kaletra + Truvada
89 Conclusions Risk HIV acquisition is small/risk assessment key Awareness & easily accessible PEP/PEPSE may reduce delays in initiation Guidelines and POCT ensure appropriate use of PEP/PEPSE Which PEP regimen? Poor tolerability & follow up rates Majority individuals taking PEPSE report reduction risk taking behaviour short/medium term Future surveillance/studies
90 Acknowledgments MRC grant NONOPEP study Co-investigators NONOPEP study Fortune Ncube HPA Sarah Tomkins HPA
PEP and PREP. Dr David Hawkins Chelsea and Westminster Hospital
PEP and PREP Dr David Hawkins Chelsea and Westminster Hospital Opportunities for biomedical interventions YEARS HOURS 72 HOURS YEARS Prior to exposure Exposure (pre-coital/ coital) Exposure (pre-coital/
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 informationBlood-Borne Pathogens and Post-Exposure Prophylaxis
Blood-Borne Pathogens and Post-Exposure Prophylaxis Christopher Behrens MD Northwest Association of Occupational and Environmental Medicine October 2017 with thanks to Shireesha Dhanireddy MD Disclosures
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 informationART FOR HIV PREVENTION: PANACEA OR PANDORA S BOX? KENNETH H. MAYER, M.D.
ART FOR HIV PREVENTION: PANACEA OR PANDORA S BOX? KENNETH H. MAYER, M.D. HIV TRANSMISSION SIGNIFICANT, LOW PROBABILITY EVENT (
More informationHIV Occupational Transmission and Exposure. Marsh Gelbart 2010
HIV Occupational Transmission and Exposure Marsh Gelbart 2010 Rationale for Post Exposure Prophylaxis (PEP) It was estimated that the risk for HIV transmission after percutaneous exposures involving larger
More informationHIV TRANSMISSION AND PREVENTION KENNETH H. MAYER, M.D. BROWN UNIVERSITY/MIRIAM HOSPITAL FENWAY COMMUNITY HEALTH 5/31/07
HIV TRANSMISSION AND PREVENTION KENNETH H. MAYER, M.D. BROWN UNIVERSITY/MIRIAM HOSPITAL FENWAY COMMUNITY HEALTH 5/31/07 Estimates of Per-Contact Risk of HIV Infection HIV TRANSMISSION SIGNIFICANT, LOW
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 informationPost-Sexual Exposure Prophylaxis (npep)
Projeto Praça Onze Universidade Federal do Rio de Janeiro Post-Sexual Exposure Prophylaxis (npep) Mauro Schechter Principal Investigator, Projeto Praça Onze Professor of Infectious Diseases Universidade
More informationWhat does the HIV Pharmacy Team need to know about PEP
What does the HIV Pharmacy Team need to know about PEP Rosy Weston Senior Lead Pharmacist Sexual Health and HIV St. Mary s Hospital Imperial College Healthcare NHS Trust London November 2008 Objectives
More informationFertility Desires/Management of Serodiscordant HIV + Couples
Fertility Desires/Management of Serodiscordant HIV + Couples William R. Short, MD, MPH Assistant Professor of Medicine Division Of Infectious Diseases Jefferson Medical College of Thomas Jefferson University
More informationMANAGEMENT OF SEXUAL EXPOSURE TO HIV: PEPSE
Sandyford Protocols MANAGEMENT OF SEXUAL EXPOSURE TO HIV: PEPSE www.hiv-druginteractions.org If you require information on occupational exposure to blood borne viruses, including HIV, please refer to the
More informationFAMILY HIV CENTER NJ CARES SANE
HIV, Hepatitis B & C Postexposure Prophylaxis for Sexual Assault Victims Update for Case Managers Susan Burrows-Clark, RN, MSN, CNS, C. 10/17/11 Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug
More informationOccupational and Non- Occupational HIV Post-exposure Prophylaxis
Occupational and Non- Occupational HIV Post-exposure Prophylaxis Amy V. Kindrick, MD, MPH National Clinicians Post-Exposure Prophylaxis Hotline (PEPline) University of California, San Francisco San Francisco
More informationNon-occupational HIV Post Exposure Prophylaxis (npep)
Mountain West AIDS Education and Training Center Non-occupational HIV Post Exposure Prophylaxis (npep) Robert Harrington, M.D. This presentation is intended for educational use only, and does not in any
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 informationHIV 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
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 informationPost Exposure Prophylaxis for HIV following Sexual Exposure (PEPSE) Assessment Proforma PART A: FOR COMPLETION AT INITIAL PRESENTATION
Addressograph or Name D.O.B Address Clinic no DOB Post Exposure Prophylaxis for HIV following Sexual Exposure (PEPSE) Assessment Proforma PART A: FOR COMPLETION AT INITIAL PRESENTATION The use of PEP following
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 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 information/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
More informationMaraviroc Pharmacokinetics in Blood Plasma, Genital Tract Fluid and Tissue in Healthy Female Volunteers
Maraviroc Pharmacokinetics in Blood Plasma, Genital Tract Fluid and Tissue in Healthy Female Volunteers Julie B. Dumond, Kristine B. Patterson, Allison Pecha, Rebecca E. Werner, Emma Andrews,* Bharat Damle,*
More informationBiomedical Prevention in HIV
Biomedical Prevention in HIV CHART - CCAS-CDC 3 RD Joint Meeting Montego Bay, Jamaica August 21-26,2011 Presented by Tina Hylton-Kong, ERTU-CHART Some Slides from Impact of ART on HIV Transmission Wafaa
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 informationHIV 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
More informationMalaysian Consensus Guidelines on Antiretroviral Therapy Cheng Joo Thye Hospital Raja Permaisuri Bainun Ipoh
Malaysian Consensus Guidelines on Antiretroviral Therapy 2017 Cheng Joo Thye Hospital Raja Permaisuri Bainun Ipoh Acknowledgement Table of contents Evolution of when to initiate therapy ART improves survival
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 informationSEXUAL TRANSMISSION. SEXUAL TRANSMISSION under ART: Biological Considerations
SEXUAL TRANSMISSION under ART: Biological Considerations Dr Steve Taylor, MB ChB, FRCP, PhD Consultant Physician, HIV/GU Medicine, Lead Consultant HIV Services, Directorate of Sexual Medicine and HIV Birmingham
More informationHIV: Pregnancy in Serodiscordant Couple. Dr Chow TS ID Clinic HPP
HIV: Pregnancy in Serodiscordant Couple Dr Chow TS ID Clinic HPP Sexual Reproductive Health and Rights The recognition of the sexual and reproductive health and rights (SRHR) of all individuals and couples
More informationU=U NHIVNA HIV, Fertility and Contraception in the era of
HIV, Fertility and Contraception in the era of U=U NHIVNA 2018 Yvonne Gilleece Consultant in HIV and Sexual Health Brighton &Sussex University Hospitals NHS Trust Honorary Senior Lecturer Brighton & Sussex
More informationHIV. The Role of Pre-Exposure Prophylaxis (PrEP) for the Prevention of HIV. Brief History of HIV AIDS. Global HIV Infection.
The Role of Pre-Exposure Prophylaxis (PrEP) for the Prevention of HIV HIV Sarah Kemink, PharmD, AAHIVP WMSHP Spring Seminar 5/05/2015 AIDS CD4 less than 200 +/- AIDS-defining illness Most common: Candidiasis
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 informationDisclosure. Learning Objectives. Epidemiology. Transmission. Risk of Transmission PRE-EXPOSURE PROPHYLAXIS (PREP) FOR HIV PREVENTION 50,000.
Disclosure PRE-EXPOSURE PROPHYLAXIS (PREP) FOR HIV PREVENTION I have no financial interest in and/or affiliation with any external organizations in relation to this CE program. DaleMarie Vaughan, PharmD
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 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 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 informationDrug development in relation to PrEP and the PROUD study
Drug development in relation to PrEP and the PROUD study David Dolling Medical Statistician MRC Clinical Trials Unit 18 th October 2012 What is PrEP? - Pre-exposure Prophylaxis A strategy that uses antiretrovirals
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 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 informationPEP and PrEP. Yvonne Gilleece Consultant in HIV Brighton & Sussex University Hospitals NHS Trust
PEP and PrEP Yvonne Gilleece Consultant in HIV Brighton & Sussex University Hospitals NHS Trust UNAIDS 90-90-90: HIV Treatment Targets for 2020 with Global Estimates (2014) 100% 80% 60% Target 1: 90% of
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 informationSA HIV Clinicians Society Adult ART guidelines
SA HIV Clinicians Society Adult ART guidelines In draft format Graeme Meintjes (on behalf of the guidelines committee) Selected topics When to start ART First-line Second-line Third-line Patients with
More informationAn 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
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 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 informationNational guidelines for post-exposure prophylaxis after non-occupational exposure to HIV
National guidelines for post-exposure prophylaxis after non-occupational exposure to HIV These guidelines outline the management of individuals who have been exposed (or suspect they have been exposed)
More informationThe Science behind Preexposure Prophylaxis (PrEP) Yunus Moosa Department of Infectious Diseases UKZN
The Science behind Preexposure Prophylaxis (PrEP) Yunus Moosa Department of Infectious Diseases UKZN 1 Ongoing HIV transmission despite expanding access to ART SA 18 16 14 12 10 8 6 4 2 0 Treatment exposure
More informationModule 1: HIV epidemiology, transmission and prevention
Session 2 Module goals Module 1 Participants will be able to: -offer an insight into the epidemiological situation in the country and worldwide -present the HIV transmission modes and the broad approaches
More informationPrEP: Pre Exposure Prophylaxis
PrEP: Pre Exposure Prophylaxis Lyn Stevens, NP, MS, ACRN Deputy Director Office of the Medical Director NYS Department of Health, AIDS Institute Faculty Disclosure Lyn Stevens No relationships to disclose
More informationDownloaded from:
Cresswell, F; Waters, L; Briggs, E; Fox, J; Harbottle, J; Hawkins, D; Murchie, M; Radcliffe, K; Rafferty, P; Rodger, A; Fisher, M (2016) UK guideline for the use of HIV Post-Exposure Prophylaxis Following
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 informationPost-Exposure Prophylaxis Review for International Visitors
Post-Exposure Prophylaxis Review for International Visitors Case Presentation 27 yo nurse presents to Urgent Care for a needlestick 2 days ago from a diabetic lancet. Source patient (SP): 35 yo male known
More informationAdvances in HIV science and treatment. Report on the global AIDS epidemic,
HIV biomolecular advances and treatment updates David A Cooper National Centre in HIV Epidemiology and Clinical Research The University of New South Wales Sydney, Australia UNAIDS: global l HIV infections
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 informationPEP and PrEP: AWAAC 2014
Acknowledgements: HIVCS PEP guidelines group, Helen Rees, Slim Abdool Karim, Quarraisha Abdool Karim, Clinical Care Options, Edwina Wright, Jared Baeton, AETC PEP and PrEP: AWAAC 2014 Francois Venter Wits
More informationHIV, HBV, AND HCV POSTEXPOSURE MANAGEMENT FOR HEALTHCARE WORKERS. Weerawat Manosuthi Bamrasnaradura Infectious Diseases Institute
HIV, HBV, AND HCV POSTEXPOSURE MANAGEMENT FOR HEALTHCARE WORKERS Weerawat Manosuthi Bamrasnaradura Infectious Diseases Institute Outline Case scenario of HIV postexposure prophylaxis Risks of and how to
More informationI. 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
More informationLITERATURE REVIEW for the National guidelines for postexposure
LITERATURE REVIEW for the National guidelines for postexposure prophylaxis after non-occupational and occupational exposure to HIV LITERATURE REVIEW for the National Guidelines for Post-Exposure Prophylaxis
More informationHIV Pre-Exposure Prophylaxis (HIV PrEP) in Scotland. An update for registered practitioners September 2017
HIV Pre-Exposure Prophylaxis (HIV PrEP) in Scotland An update for registered practitioners September 2017 Key Messages HIV is a major public health challenge for Scotland with an annual average of 359
More informationPOST-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
More informationTHE SOUTH AFRICAN ANTIRETROVIRAL TREATMENT GUIDELINES 2010
THE SOUTH AFRICAN ANTIRETROVIRAL TREATMENT GUIDELINES 2010 The South African Antiretroviral Treatment Guidelines 2010 Goals of the programme Achieve best health outcomes in the most cost-efficient manner
More informationStudy finds PEP not 100% effective in preventing HIV infection
From TreatmentUpdate 152 Study finds PEP not 100% effective in preventing HIV infection Some doctors and nurses who care for PHAs may sustain needle-stick injuries. This raises the possibility that they
More informationPROTOCOL FOR THE MANAGAMENT OF SEXUAL EXPOSUE TO HIV, HBV AND HCV: POST EXPOSURE PROPHYLAXIS FOR HIV (PEPSE) AND HEPATITIS B
PROTOCOL FOR THE MANAGAMENT OF SEXUAL EXPOSUE TO HIV, HBV AND HCV: POST EXPOSURE PROPHYLAXIS FOR HIV (PEPSE) AND HEPATITIS B Printed copies must not be considered the definitive version DOCUMENT CONTROL
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 informationResistance Workshop. 3rd European HIV Drug
3rd European HIV Drug Resistance Workshop March 30-April 1 st, 2005 Christine Hughes, PharmD Clinical Associate Professor Faculty of Pharmacy & Pharmaceutical Sciences University of Alberta Tenofovir resistance
More informationMoving beyond condoms to prevent HIV transmission. Are you Prepared for HIV PrEP?
Moving beyond condoms to prevent HIV transmission Are you Prepared for HIV PrEP? The Issues New HIV infections in the US continue Vast majority of infections are sexually acquired Condoms work but are
More informationHIV 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
More informationOne of your office personnel
Doug Campos-Outcalt, MD, MPA Department of Family and Community Medicine, University of Arizona College of Medicine, Phoenix HIV postexposure prophylaxis: Who should get it? CORRESPONDENCE Doug Campos-Outcalt,
More informationSomnuek Sungkanuparph, M.D.
HIV Drug Resistance Somnuek Sungkanuparph, M.D. Associate Professor Division of Infectious Diseases Department of Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University Adjunct Professor
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 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 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 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 informationHistoric Perspective on HIV and TB Research in Pregnant Women
Historic Perspective on HIV and TB Research in Pregnant Women Lynne M. Mofenson, M.D. Senior HIV Technical Advisor Elizabeth Glaser Pediatric AIDS Foundation High Burden of TB/HIV in Women - 2016 TB HIV
More informationInfertility Treatment and HIV
Infertility Treatment and HIV Infertility Treatment by IVF Or Intra-cytoplasmic Sperm Injections (ICSC) In Chronic HIV-1 Sero- discordant Couples (Poster 670) Retrospective study of outcome of IVF or ICSC
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 informationPre-Exposure Prophylaxis (PrEP) A Biomedical Intervention Prevention with Negatives Antiretroviral Prevention
Pre-Exposure Prophylaxis (PrEP) A Biomedical Intervention Prevention with Negatives Antiretroviral Prevention New and Emerging Biomedical HIV Prevention Interventions Vaccines Vaginal microbicides Pre-exposure
More informationTunisian recommendations on ART : process and results
Second Arab Congress of Clinical Microbiology and Infectious Diseases May 24-26, 2012. Tunisian recommendations on ART : process and results M. BEN MAMOU UNAIDS Email: BenmamouM@unaids.org M. CHAKROUN
More informationARVs on an Empty Stomach: Food Interaction Studies in a resource Limited Setting
ARVs on an Empty Stomach: Food Interaction Studies in a resource Limited Setting Dr. Andrew D Kambugu, FRCP (UK) Infectious Diseases Institute, Makerere University Outline of Discussion Key Definitions
More informationSwitching 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 informationEQuIP 5 - This version June 2011 Revision Due June 2014
Preamble Rockingham Peel Group Non-Occupational Post-Exposure Prophylaxis (NPEP) To Prevent HIV in Western Australia Protocol The purpose of this protocol is to clarify the appropriate use and methods
More informationPrEP efficacy the evidence
PrEP efficacy the evidence Dr Michael Brady Consultant, HIV and Sexual Health King s College Hospital, London Medical Director Terrence Higgins Trust PrEP Pre-exposure prophylaxis Tenofovir and emtricitabine
More informationHIV Reproductive Health: Conception Options in the Era of PrEP
HIV Reproductive Health: Conception Options in the Era of PrEP Meg Sullivan, MD Director, HIV Clinical Programs, Section of Infectious Diseases Boston Medical Center Boston University School of Medicine
More informationHIV 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
More informationSupplementary information
Supplementary information Dose-response Curve Slope Sets Class-Specific Limits on Inhibitory Potential of Anti-HIV Drugs Lin Shen 1,2, Susan Peterson 1, Ahmad R. Sedaghat 1, Moira A. McMahon 1,2, Marc
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 informationHIV 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
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 informationTo provide the guidelines for the management of healthcare workers who have had an occupational exposure to blood and/or body fluids.
TITLE/DESCRIPTION: MANAGEMENT OF OCCUPATIONAL EXPOSURE TO HBV, HCV, and HIV INDEX NUMBER: EFFECTIVE DATE: APPLIES TO: ISSUING AUTHORITY: 01/01/2009 01/01/2013 All GCC Countries GULF COOPERATION COUNCIL
More informationVitamin D Deficiency in HIV: A Shadow on Long-Term Management?
AIDS Rev. 2014;16:59-74 (Supplementary Data) Vitamin D Deficiency in HIV: A Shadow on Long-Term Management? Chloe Orkin, et al.: Vitamin D deficiency in HIV (Supplementary Data) Chloe Orkin 1, David A.
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 informationprevention of hiv transmission
the safer motherhood Knowledge Transfer Program Editor-in-Chief: Professor Sir Sabaratnam Arulkumaran prevention of hiv transmission Guidelines THE GLOBAL LIBRARY OF WOMEN S MEDICINE www.glowm.com 1 HIV
More informationOverview 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
More informationStructured 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
More informationSouth African Guidelines for the Safe Use of. Dr. Oscar Radebe
South African Guidelines for the Safe Use of PrEP in MSM Dr. Oscar Radebe Background Globally MSM(men who have sex with men) have been disproportionately at high risk of HIV transmission. Biological &
More informationOverview 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
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 informationMEDICAL 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
More informationAntiretroviral Drugs for HIV Seronegative People: It works in trials, what about the real world?
Antiretroviral Drugs for HIV Seronegative People: It works in trials, what about the real world? Lut Van Damme 11 Oct 2012 1 Disclaimer Gilead donated the study product for the FEM-PrEP trial I participated
More information