Susan L. Koletar, MD
|
|
|
- Amie Burns
- 5 years ago
- Views:
Transcription
1 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 Recognition of Syndrome Opportunistic Infections Complications of Therapy Treatments Prevention Co-Morbidities 1980 s 1990 s 2000 s 2010 s Identifying Virus Focus on CD4 Early ARV Development (NRTIs) Measuring Viral Load Extensive ARV Development (PIs; NNRTIs) Focus on Viral Load Combination Therapies Once daily Fixed Dose Combinations 1
2 Typical Course of Untreated HIV Infection PCP, KS, MAC, CMV & others HIV through the Decades Recognition of Syndrome Opportunistic Infections Complications of Therapy Treatments Prevention Co-Morbidities 1980 s 1990 s 2000 s 2010 s Identifying Virus Focus on CD4 Early ARV Development (NRTIs) Measuring Viral Load Extensive ARV Development (PIs; NNRTIs) Focus on Viral Load Combination Therapies Once daily Fixed Dose Combinations 2
3 90% of new infections in males ages were attributable to male-to-male sexual contact 3
4 Contribution of AIDS & Non-AIDS Deaths to Loss in Life Expectancy by Transmission Risk Group Female Male Heterosex. Heterosex.MSM Years lost May M, et al. CROI 2013; Atlanta, GA. # CD4 <200 CD CD4 350 CD4 <200 CD CD4 350 CD4 <200 CD CD4 350 Non-AIDS deaths AIDS deaths 4
5 Cumulative Viral Load Predicts Mortality in ART-Treated Treated Patients Estimated cumulative VL (viremia copy-yrs) assessed in 33,563 pts 2.50 at 17 sites of ART Cohort Collaboration After adjusting for age, sex, risk group, BL and time-related VL, and cohort, viremia copy- yrs stratum predicted All-cause mortality AIDS-related mortality HR Hazard of All-Cause Mortality by Viremia Copy-Yrs Deciles (Controlling for Cross-sectional VL) Log 10 Viremia Copy-Yrs Mugavero M, et al. CROI Abstract 565. Reproduced with permission. Cumulative Viral Load Predicts Mortality in ART-Treated Treated Patients Mugavero M, et al. CROI Abstract 565. Reproduced with permission. 5
6 Normalization of CD4/CD8 Ratio and Non-AIDS Events 3,236 pts on ART with virologic suppression 7,305 PYFU 458 pts reached CD4/CD8 1 Median time to normalization: 10.1 yrs Younger pts, those starting ART in recent yrs, and those with higher CD4+ counts more likely to normalize Current CD4/CD8 ratio predicted incidence of clinical progression Remained predictive after adjusting for current CD4+ cell count Time Probability of CD4/CD8 Normalization (95% CI) 1 yr 4.4 ( ) 2 yrs 11.5 ( ) 5 yrs 29.4 ( ) Current CD4/CD8 Ratio Incidence of Clinical Progression* (95% CI) < ( ) ( ) > ( ) *serious non-aids related events (CV or cancer) or all-cause death Mussini C, et al. /Icona Study Group. CROI Abstract 753. Common Co-morbid Conditions in HIV-infected Persons Cardiovascular diseases Metabolic complications lipids/diabetes Bone disorders Renal Liver Malignancies 6
7 Projecting CVD Risk in HIV: Cumulative Risk by Age and Over a Lifetime Competing mortality due to HIV-related causes and other non-hiv causes within the HIVinfected population results in lower overall CVD lifetime risk for HIV-infected persons. Losina E, et al. 20 th CROI. Atlanta, Abstract 747. Projecting CVD Risk in HIV: Cumulative Risk by Age and Over a Lifetime Competing mortality due to HIV-related causes and other non-hiv causes within the HIVinfected population results in lower overall CVD lifetime risk for HIV-infected persons. Losina E, et al. 20 th CROI. Atlanta, Abstract
8 Incidence of MI in HIV+ vs HIV- Subjects in Kaiser Cohort Retrospective analysis of Kaiser cohort EMRs during for inpatient MI diagnosis HIV-/HIV+ pts matched 10:1 MI rates in HIV+ and HIV- converged over time 40% increased risk of MI in HIV+ pts overall, but difference no longer observed in most recent yrs Klein D, et al. CROI Abstract 737. Reproduced with permission. 0,000 PY MIs per Framingham Risk Score Components, HIV+ HIV- HIV+ HIV P Value Mean Framingham score, 10-yr risk of MI, % <.001 Male, % Mean age, yrs <.001 TC > 200 mg/dl, % <.001 HDL-C < 40 mg/dl, % <.001 Hx of hypertension, % <.001 Hx of smoking, % <.001 Incidence of MI in HIV+ vs HIV- Subjects in Kaiser Cohort Klein D, et al. CROI Abstract 737. Reproduced with permission. 8
9 Incidence of MI in HIV+ vs HIV- Subjects in Kaiser Cohort Framingham Risk Score Components, HIV+ HIV- P Value Mean Framingham score, 10-yr risk of MI, % <.001 Male, % Mean age, yrs <.001 TC > 200 mg/dl, % <.001 HDL-C < 40 mg/dl, % <.001 Hx of hypertension, % <.001 Hx of smoking, % <.001 Klein D, et al. CROI Abstract 737. Reproduced with permission. Excess Burden of Cancer Among HIV-Infected Infected Persons Estimated cancer rates in HIV - HIV/AIDS Cancer Match Study Expected cancer rates for general population p from SEER program (Surveillance, Epidemiology, and End Results) Excess = excess/total Deficit = deficit/expected Estimated Total & Excess Cancer among HIV-infected Persons in the U.S. (2010) Type of Cancer Expected # (Total Number) of Cancers Excess or Deficit (%) NHL (1645) KS (912) Lung (837) Anus (764) Prostate (574) % excess cancers in HIV-infected Liver (389) most occurred among males (51.5%) - largest excess among ages Colorectal (357) Hodgkin s lymphoma (317) Breast (177) Robbins et al. 12st CROI Boston 2014 #707 9
10 HIV and Cancer-Specific Mortality in the U.S. ( ) Retrospective analysis from 5 US Cancer registries (HIV/AIDS Cancer Match Study) - Cancer specific mortality by HIV status HIV-infected cancer patients experienced higher cancerspecific mortality Adjusted d Hazard Ratios for Cancer-Specific Mortality (HIV Infected vs Uninfected) HR (95% CI) Oral cavity/pharynx 1.50 ( ) Larynx 1.92 ( ) Pancreas 1.63 ( ) Colon and rectum 1.69 ( ) Lung 1.28 ( ) Melanoma 1.76 ( ) Breast 2.71 ( ) Prostate 1.83 ( ) Liver, anal, cervical cancers had suggested elevations Coghill et al 21 st CROI, Boston 2014 #99 HIV and the Older Patient In the U.S., approximately 30% of HIVinfected persons are 50 years of age Aging-related comorbidities may complicate management of HIV HIV may increase risk of comorbidities and may accelerate the aging process Limited it data on effects of ARVs in older persons (eg, adverse effects, drug-drug interactions) 10
11 HIV and the Older Patient: HIV Risk, Diagnosis, and Prevention Reduced mucosal and immunologic defenses and changes in risk behaviors may lead to increased risk of HIV acquisition and transmission HIV screening rates in older persons are low Older persons may have more advanced HIV at presentation and ART initiation Screen for HIV per CDC recommendations Sexual history, risk-reduction counseling, screening for STIs (as indicated) are important to general health care for HIV-infected and HIV-uninfected older persons Recommendations for HIV Testing HIV screening is recommended for patients in all health care settings Patient should be notified that testing will take place unless patient declines (opt out testing) Persons at high risk for HIV should be screened at least annually HIV screening should be included in the routine panel of prenatal screening forpregnant women Neither separate written consent nor prevention counseling should be required MMWR 2006;55(R14):
12 HIV/AIDS John Davis, MD, PhD Associate Dean for Medical Education Assistant Professor of Clinical Internal Medicine Department of Internal Medicine Division of Infectious Diseases The Ohio State University Wexner Medical Center Treatment 12
13 Clinical Category 2014 DHHS Guidelines: When to Start ART CD4 Cell Count (cells/mm 3 ) 2014 DHHS Guidelines Strength-Quality AIDS-defining i illness Any value Treat A-I <350 Treat Asymptomatic 350 to 500 Treat A-II >500 Treat B-III Transmission prev: Pregnancy Sexual (heterosexual, other) Any value Treat A-I (A-I, A-III) 27 May 2014 Goals of Treatment Decrease in morbidity/mortality Improvement in quality of life Virologic suppression VL<400 at 24wks VL<50 (ND) at 48wks Anything else = virologic failure Immunologic recovery (reconstitution) Increase in CD4+ number and/or percentage Anything else = immunologic failure Especially decline in CD4+ to <200 Surveillance for side effects 13
14 Current ARV Medications NRTI Abacavir (ABC) Didanosine (ddi) Emtricitabine (FTC) Lamivudine (3TC) Stavudine (d4t) Tenofovir (TDF) Zidovudine (AZT, ZDV) NNRTI Delavirdine (DLV) Efavirenz (EFV) Etravirine (ETR) Nevirapine (NVP) Rilpivirine (RPV) Protease Inhibitor (PI) Atazanavir (ATV) Darunavir (DRV) Fosamprenavir (FPV) Indinavir (IDV) Lopinavir (LPV) Nelfinavir (NFV) Ritonavir (RTV) Saquinavir (SQV) Tipranavir (TPV) * EVG currently available only in coformulation with cobicistat (COBI)/ TDF/FTC May 2014 Current ARV Medications Integrase Inhibitor (II) Dolutegravir (DTG) Elvitegravir* (EVG) Raltegravir (RAL) Fusion Inhibitor Enfuvirtide (ENF, T-20) CCR5 Antagonist Maraviroc (MVC) * EVG currently available only in coformulation with cobicistat (COBI)/ TDF/FTC May
15 2014 DHHS Guidelines: Regimens for Treatment-Naïve Patients Recommended For patients with VL<100,000 Alternative Regimens Notes EFV ATV/r, DRV/r (QD) + TDF/FTC DTG, RAL, EVG/cobi DTG + ABC/3TC (1) [Recommendations for pregnant women differ; see (a)] EFV + ABC/3TC (1) RPV + TDF/FTC (for patients with CD4 > 200) ATV/r + ABC/3TC (1) DRV/r + ABC/3TC (1) LPV/r + (ABC/3TC or TDF/FTC) (1) RAL + ABC/3TC (1) 1 only in patients who are HLA-B*5701 negative 2 3TC and FTC may be used interchangeably throughout (a) May 2014 Advances Comparative effectiveness (1) ATV/r vs DRV/r vs RAL (with TDF/FTC) RAL superior, mostly d/t tolerability New agents (2) Long-acting, g, injectable agents Phase IIb, equivalent to TDF/FTC/EFV 1. Landovitz R, et al. CROI Abstract Margolis D, et al. CROI Abstract 91LB. 15
16 Prevention HIV Prevention Study ART for prevention; HPTN 052, Africa, Asia, Americas PrEP for discordant couples; Partners PrEP, Uganda, Kenya PrEP for heterosexual men and women; TDF2, Botswana Medical male circumcision; Orange Farm, Rakai, Kisumu PrEP for MSMs; iprex, Americas, Thailand, South Africa Sexually transmitted diseases treatment; Mwanza, Tanzania Microbicide; CAPRISA 004, South Africa HIV vaccine; RV144, Thailand Efficacy (%) Effect Size, % (95% CI) (73-99) 73 (49-85) 63 (21-84) 54 (38-66) 44 (15-63) 42 (21-58) 39 (6-60) 31 (1-51) Abdool Karim SS, et al. Lancet
17 CDC PrEP Recommendations Cure Research 17
18 Promising Studies Adults cured of HIV Patient with AML, s/p BMT Remains ND off ART (1) Others s/p BMT relapse of HIV (2) Infants cured of HIV One in Mississippi, ND off ART (3) One new infant, ND on ART (4) 1. N Engl J Med. 2009;360: CROI Abstract 144LB 3. CROI Abstract 48LB. 4. CROI Abstract 75LB Promising Studies Failure of PrEP Possibility of reduced seeding of reservoir (1) Gene editing Removal of co-receptor from CD4 cells by use of a Zn-finger endonuclease (2) 1. CROI Abstract 397LB. 2. N Engl J Med. 2014; 370(10):
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
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:
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 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
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
Pediatric HIV Infection and the Medical Management of Pregnant Women infected with HIV. Ernesto Parra, M.D., M.P.H.
Pediatric HIV Infection and the Medical Management of Pregnant Women infected with HIV Ernesto Parra, M.D., M.P.H. Adjunct Associate Professor UTHSCSA Department of Pediatrics and Family and Community
Pharmacological considerations on the use of ARVs in pregnancy
Pharmacological considerations on the use of ARVs in pregnancy 11 th Residential Course on Clinical Pharmacology of Antiretrovirals Torino, 20-22 January 2016 Prof. David Burger, PharmD, PhD david.burger@radboudumc.nl
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
Dr Valérie Martinez-Pourcher
Educa&ng Nurses About An&retrovirals and HIV Preven&on - State of the Science, Uptake Challenges, and Barriers Dr Valérie Martinez-Pourcher Pitié-Salpêtrière Hospital Paris We need to control HIV replication
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
/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
Continuing Education for Pharmacy Technicians
Continuing Education for Pharmacy Technicians HIV/AIDS TREATMENT Michael Denaburg, Pharm.D. Birmingham, AL Objectives: 1. Identify drugs and drug classes currently used in the management of HIV infected
HIV Overview. Mary Marovich, MD, DTMH Division of Retrovirology Walter Reed Army Ins?tute of Research US Military HIV Research Program
HIV Overview Mary Marovich, MD, DTMH Division of Retrovirology Walter Reed Army Ins?tute of Research US Military HIV Research Program www.hivresearch.org 1 Outline HIV Virology, Transmission, and Pathogenesis
Update on Antiretroviral Treatment for HIV Infection 2008
Update on Antiretroviral Treatment for HIV Infection 2008 Janet Gilmour MD FRCP(C) Clinical Associate Professor of Medicine University of Calgary November 2008 Disclosure and Acknowledgements Disclosure:
HIV 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
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
HIV Treatment: New and Veteran Drugs Classes
HIV Treatment: New and Veteran Drugs Classes Jonathan M Schapiro, MD National Hemophilia Center Stanford University School of Medicine Rome, March 2013 Overview Many excellent antiretroviral agents are
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
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
HIV: 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
HIV Treatment Update. Awewura Kwara, MD, MPH&TM Associate Professor of Medicine and Infectious Diseases Brown University
HIV Treatment Update Awewura Kwara, MD, MPH&TM Associate Professor of Medicine and Infectious Diseases Brown University Outline Rationale for highly active antiretroviral therapy (HAART) When to start
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
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
HIV Treatment: State of the Art 2013
HIV Treatment: State of the Art 2013 Daniel R. Kuritzkes, MD Chief, Division of Infectious Diseases Brigham and Women s Hospital Professor of Medicine Harvard Medical School Success of current ART Substantial
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
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
SELECTING THE BEST ART FOR EACH PATIENT
SELECTING THE BEST ART FOR EACH PATIENT Corklin R Steinhart, MD, PhD Head, Global Medical Directors ViiV Healthcare CNVX/HIVP/0025/16 5th Asian Conference on Hepatitis & AIDS 第五届亚洲肝炎与艾滋病学术会议 28-29 May
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
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
Pediatric HIV Update NORTHWEST AIDS EDUCATION AND TRAINING CENTER
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Pediatric HIV Update Christian B. Ramers, MD, MPH Assistant Medical Director, Family Health Centers of San Diego HIV/HCV Distance Education Specialist - NWAETC,
HIV - 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
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
Disclosures. Update on HIV Drug Therapy: A Case based Discussion. Case # 1: Dr. Grant has received grant support from BMS, Gilead, Janssen, and Viiv
Disclosures Update on HIV Drug Therapy: A Case based Discussion Dr. Grant has received grant support from BMS, Gilead, Janssen, and Viiv Philip Grant Assistant Professor Division of Infectious Diseases
ART 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
Selected Issues in HIV Clinical Trials
Selected Issues in HIV Clinical Trials Judith S. Currier, M.D., MSc Professor of Medicine Division of Infectious Diseases University of California, Los Angeles Issues Evolving Global and Domestic Epidemic
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,
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)
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
Selected Issues in HIV Clinical Trials
Selected Issues in HIV Clinical Trials Judith S. Currier, M.D., MSc Professor of Medicine Division of Infectious Diseases University of California, Los Angeles Issues Evolving Global and Domestic Epidemic
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
Antiretroviral 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,
Starting and Switching ART: 2016
Starting and Switching ART: 2016 Luke Jerram Rajesh T. Gandhi, M.D. Massachusetts General Hospital Harvard Medical School Disclosures: grant support from EBSCO, Gilead, Merck, Viiv Thanks to Henry Sunpath,
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
HIV Update Objectives. Epidemiology. Epidemiology, Transmission and Natural History. Transmission Risk by Exposure. Transmission 9/29/2014
Objectives HIV Update 2014 Jay Sizemore, MD, MPH Medical Director Chattanooga CARES Assistant Professor UTCOM Chattanooga 2October 2014 Review HIV epidemiology and screening/testing guidelines Discuss
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
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
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
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
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
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,
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
I S H P S p r i n g C o n f e r e n c e Megan Koyle, PharmD Elaine Nguyen, PharmD, MPH, BCPS
I S H P S p r i n g C o n f e r e n c e 2 0 1 5 Megan Koyle, PharmD Elaine Nguyen, PharmD, MPH, BCPS Objectives Increase foundational knowledge of HIV/AIDS through greater awareness of epidemiology, pathophysiology,
Didactic Series. Update: 2012 HIV Treatment Guidelines. Daniel Lee, MD August 30, 2012
Didactic Series Update: 2012 HIV Treatment Guidelines Daniel Lee, MD August 30, 2012 ACCREDITATION STATEMENT: University of California, San Diego School of Medicine is accredited by the Accreditation Council
Update 2013 HIV Treatment & Prevention
Update 2013 HIV Treatment & Prevention Kiat Ruxrungtham Professor of Medicine, Chulalongkorn University; and HIV-NAT, Thai Red Cross AIDS Research Center Time from HIV seroconversion to death N= 3823 from
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.
Single 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
Somnuek 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
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
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
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
ARVs 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
Optimizing 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)
What'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
Actualización y Futuro en VIH
Actualización y Futuro en VIH Dr. Santiago Moreno Servicio de Enfermedades Infecciosas Hospital U. Ramón y Cajal. Universidad de Alcalá. IRYCIS. Madrid Agenda Control of the HIV-epidemic Coinfections Antiretroviral
HIV 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
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
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,
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
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,
Didactic Series. CROI 2014 Update. March 27, 2014
Didactic Series CROI 2014 Update Christian Ramers, MD, MPH Family Health Centers of San Diego Ciaccio Memorial Clinic Jacqueline Peterson Tulsky, MD UCSF Positive Health Program at SFGH Medical Director,
Antiretroviral 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 &
What s New. In The 2016 Perinatal HIV Treatment Guidelines? Provided by CDC s Elimination of Perinatal HIV Transmission Stakeholders Group
What s New In The 2016 Perinatal HIV Treatment Guidelines? Provided by CDC s Elimination of Perinatal HIV Transmission Stakeholders Group Guidelines for our Online Meeting Room You will be listening to
Antiretroviral Therapy: Panel Discussion
disclosures Antiretroviral Therapy: Panel Discussion Medical Management of HIV December 9, 217 Panelists: Harry Lampiris, MD; Annie Luetkemeyer, MD; Carina Marquez, MD Moderator: Oliver Bacon, MD none
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
NON-OCCUPATIONAL POST EXPOSURE PROPHYLAXIS IN HIV PREVENTION. Jason E. Vercher, PA-C, AAHIVM
NON-OCCUPATIONAL POST EXPOSURE PROPHYLAXIS IN HIV PREVENTION Jason E. Vercher, PA-C, AAHIVM Disclosures No disclosures to report Learning Objectives q Identify Individuals who would benefit from non-occupational
Cases 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,
The Global HIV Epidemic. Jerome Larkin, MD
The Global HIV Epidemic Jerome Larkin, MD Outline Global Epidemiology Natural History of HIV Antiretroviral Therapy Malaria Tuberculosis Prevention of Mother to Child Transmission Post-Exposure Prophylaxis
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
Gaps between Policy and Practice in Managing HIV disease in Asia Pacific
Gaps between Policy and Practice in Managing HIV disease in Asia Pacific Dr. N. Kumarasamy Chief Medical Officer YRGCARE Medical Centre Voluntary Health Services Chief-Chennai Antiviral Research and Treatment
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
POST-EXPOSURE PROPHYLAXIS, PRE-EXPOSURE PROPHYLAXIS, & TREATMENT OF HIV
POST-EXPOSURE PROPHYLAXIS, PRE-EXPOSURE PROPHYLAXIS, & TREATMENT OF HIV DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none
Pediatric Antiretroviral Resistance Challenges
Pediatric Antiretroviral Resistance Challenges Thanyawee Puthanakit, MD The HIVNAT, Thai Red Cross AIDS research Center The Research Institute for Health Science, Chiang Mai University Outline The burden
Advances in HIV Treatment: When to Start Treatment Which Antivirals to Use
Advances in HIV Treatment: When to Start Treatment Which Antivirals to Use Calvin Cohen MD Harvard Vanguard Medical Associates CRI New England Vice Chair, Science Steering Cmte, INSIGHT Boston MA Learning
Distribution and Effectiveness of Antiretrovirals in the Central Nervous System
Distribution and Effectiveness of Antiretrovirals in the Central Nervous System Scott Letendre, MD Associate Professor of Medicine HIV Neurobehavioral Research Center and Antiviral Research Center University
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
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
Antiretroviral Therapy
Antiretroviral Therapy Scott M. Hammer, M.D. 1986 1990 ZDV monorx 1990 1995 Alternative NRTI monorx Combination NRTI Rx Introduction of NNRTI s Antiretroviral resistance Pathogenetic concepts Evolution
The Eras of the HIV Epidemic
The Eras of the HIV Epidemic 1930-1980 1981-1986 1987-1995 1996-2005 2006-2011 2012+ 3 rd Gen. HAART 3 rd Generation Future HAART: 2012 + THE FUTURE OF ANTIRETROVIRAL THERAPY New drugs INSTI: Elvitegravir,
HIV 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
Second-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
Report Back from CROI 2010
Report Back from CROI 2010 Conference on Retroviruses and Opportunistic Infections Edwin Charlebois, MPH PhD Associate Professor of Medicine Department of Medicine University of California, San Francisco
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
Antiretroviral Therapy During Pregnancy and Delivery: 2015 Update
Frontier AIDS Education and Training Center Antiretroviral Therapy During Pregnancy and Delivery: 2015 Update Brian R. Wood, MD Assistant Professor of Medicine, University of Washington Medical Director,
FOCUS ON HIV. By Christine Elliott, BScPhm, RPh
Therapeutic Options FOCUS ON HIV By Christine Elliott, BScPhm, RPh BACKGROUND The human immunodeficiency virus type 1 (HIV-1) was first discovered in 1982. 1 A global pandemic followed, with an estimated
L 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
When to Start HIV Treatment? Which Treatments to Start?
When to Start HIV Treatment? Which Treatments to Start? Calvin Cohen MD Harvard Medical School Harvard Vanguard Medical Associates CRI New England Vice Chair, Science Steering Cmte, INSIGHT Boston USA
HIV 101. Applications of Antiretroviral Therapy
HIV 101. Applications of Antiretroviral Therapy Michael S. Saag, MD Professor of Medicine Associate Dean for Global Health Jim Straley Chair in AIDS Research University of Alabama at Birmingham Birmingham,
2016 Perinatal Treatment Guidelines Update
Mountain West AIDS Education and Training Center 2016 Perinatal Treatment Guidelines Update Shireesha Dhanireddy, MD Associate Professor of Medicine, University of Washington 2 November 2016 This presentation
ART: The New, The Old and The Ugly
ART: The New, The Old and The Ugly Our Current ARVS The Nucleoside/ Nucleotide Reverse Transcriptase Inhibitors (NRTIs/ NtRTIs) Abacavir Emtricitabine Lamivudine Stavudine Tenofovir Zidovudine The Non-Nucleoside
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