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HIV 201 Laura N Armas-Kolostroubis MD Clinical Director Texas/Oklahoma AIDS Education and Training Center
Christine, 2008 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Christine 2008 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Christine 2009 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Christine, 2008 HBV HBsAg HBsAb HBc Ab  HBeAg HBeAb IgG IgM Incubating + - - - +/- - Acute Infection + - +/- + + - Chronic Carrier + - + - - + Chronic Infection + - + - + - Resolved Infection - + + - - + Immune - + - - - -
Christine, 2008 HBV HBsAg HBsAb HBc Ab  HBeAg HBeAb IgG IgM Incubating + - - - +/- - Acute Infection + - +/- + + - Chronic Carrier + - + - - + Chronic Infection + - + - + - Resolved Infection - + + - - + Immune - + - - - -
Hepatitis B Vaccination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hepatitis B Vaccination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CROI 2010: Launay O #623; de Vries-Sluijs T #624
Christine 2008 ,[object Object],[object Object],[object Object],[object Object],[object Object]
http://www.aidsinfo.nih.gov/Guidelines/GuidelineDetail.aspx?GuidelineID=7
Indications for Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ARV Initiation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
Christine 2008 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Christine 2010 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Christine 2010 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Mark  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
A few months ago noticed the following lesion, but did not seek medical attention
Mark ,[object Object],[object Object],[object Object],[object Object],[object Object]
High Prevalence of Asymptomatic STI’s  in  HIV-Positive MSM, Visiting HIV Outpatient Clinics i ,[object Object],[object Object],[object Object],[object Object],[object Object],Heiligenberg M; Netherlands;  Poster 1022; CROI 2010 STD LOCATION TEST C. tracomatis Oral swabs, anal self swabs, urine PCR N. gonorrhea Oral swabs, anal self swabs, urine PCR HBV serum ABs HCV serum ABs T. pallidum serum RPR
Syphilis and HIV  1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Prevention and Management of STDs in People Living with HIV/AIDS; The Eastern Quadrant STD/HIV/AIDS Prevention Centers, 2002
Mark ,[object Object],[object Object],[object Object],[object Object],[object Object]
Juan  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Juan ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Juan ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Juan ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ATP III NCEP Guidelines
Juan ,[object Object],[object Object]
 
 
 
Risk factors of MI in HIV infected patients Costagliola, IAS 2009 Controls  N=1151 Cases  N=278 OR [95% CI ] CV risk factors 0 173 5 1 1 or 2 710 166 16.8 (5.9 – 48.4) 3 or more 268 107 49.4 (16.4 – 149,0) Plasma HIV-1 RNA <= 50 copies/ml 573 121 1 > 50 copies/ml 578 157 1.6 (1,1 – 2,1) CD4 / CD8 ratio >= 1 135 19 1 < 1 1016 259 1.8 (1,0 – 3,0)
Rates of MIs ,[object Object],[object Object]
Juan ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Juan ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Juan ,[object Object],[object Object],[object Object],[object Object],[object Object]
Lessons ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fred ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fred ,[object Object],[object Object],[object Object],[object Object]
 
 
Tools ,[object Object],[object Object],[object Object],http://www.iasusa.org/resistance_mutations/
Three Pathways to  NRTI Cross-Resistance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Two Groups of NRTIs ,[object Object],[object Object],[object Object],[object Object]
Fred ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fred ,[object Object],[object Object],[object Object],[object Object],[object Object]
HIV Variability  ,[object Object],[object Object],[object Object],Viral Genetic Sequence Diversity Desrosiers Abstract 91, CROI 2008
HIV REVERSE TRANSCRIPTASE  CANNOT PROOF READ C HIV RNA T U  T  T  A G  A  A  G  G  A  G  C  C  T  C  HIV DNA
Fred ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RELATIONSHIP BETWEEN ADHERENCE AND VIRAL LOAD P <0.01 % of PI Doses Taken
EFFECTS OF SPONTANEOUS MUTATIONS ON VIRAL SWARMS Wild Type HIV Dead End HIV Resistant HIV
EFFECT OF SELECTIVE PRESSURE OF INSUFFICIENT  ART   Wild Type HIV Resistant HIV Dead End HIV
WHAT IS RESISTANCE? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Genotypic Testing Plasma Amplified HIV DNA HIV RNA RT/PCR ,[object Object],[object Object],[object Object],[object Object],[object Object],AAAAAAAAA AAAAAAAAA AAAAAAAAA AAAAAAAAA AAAAAAAAA AAAAAAAAA AAAAAAAAA AAAAA AAAAA AAAAA
Fred ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fred ,[object Object],[object Object],[object Object],[object Object]
Adherence Access to care Access to medication Life situation Disease stage Challenges to Successful ART: Considerations When Initiating Therapy Replication rate (Viral load) Mutation rate (Resistance) Latent HIV reservoirs Potency Pharmacokinetics (dosage schedule)  Tolerability Toxicity Convenience Resistance Clinician experience Communication skills Virus Drug  Clinician Patient
Declining Incidence of Initial ART Failure During 1st Year of Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lampe F, et al. CROI 2005. Abstract 593. Patients With Virologic Failure by  Year of Starting ART 25 30 31 34 39 42 40 0 10 20 30 40 50 1996 1997 1998 1999 2000 2001 2002 Patients (%)
Fred ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Fred ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DUET-1 & -2:  Predictors of ETR Response ,[object Object],[object Object],[object Object],[object Object],[object Object],Vingerhoets Resistance Workshop 2008 #24 HIV-1 RNA < 50 copies/mL at Wk 24 (%) Weighted Score Category 0-2.0 2.5-3.5 > 3.5 0 10 20 30 40 50 60 70 80 100 74% 52% 38%
Etravirine Score Response Rate 0-2 74% 2.5-3.5 52% 4 or greater 38%

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C6 HIV 201 Armas

  • 1. HIV 201 Laura N Armas-Kolostroubis MD Clinical Director Texas/Oklahoma AIDS Education and Training Center
  • 2.
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  • 5. Christine, 2008 HBV HBsAg HBsAb HBc Ab HBeAg HBeAb IgG IgM Incubating + - - - +/- - Acute Infection + - +/- + + - Chronic Carrier + - + - - + Chronic Infection + - + - + - Resolved Infection - + + - - + Immune - + - - - -
  • 6. Christine, 2008 HBV HBsAg HBsAb HBc Ab HBeAg HBeAb IgG IgM Incubating + - - - +/- - Acute Infection + - +/- + + - Chronic Carrier + - + - - + Chronic Infection + - + - + - Resolved Infection - + + - - + Immune - + - - - -
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  • 19. A few months ago noticed the following lesion, but did not seek medical attention
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  • 31.  
  • 32. Risk factors of MI in HIV infected patients Costagliola, IAS 2009 Controls N=1151 Cases N=278 OR [95% CI ] CV risk factors 0 173 5 1 1 or 2 710 166 16.8 (5.9 – 48.4) 3 or more 268 107 49.4 (16.4 – 149,0) Plasma HIV-1 RNA <= 50 copies/ml 573 121 1 > 50 copies/ml 578 157 1.6 (1,1 – 2,1) CD4 / CD8 ratio >= 1 135 19 1 < 1 1016 259 1.8 (1,0 – 3,0)
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  • 48. HIV REVERSE TRANSCRIPTASE CANNOT PROOF READ C HIV RNA T U T T A G A A G G A G C C T C HIV DNA
  • 49.
  • 50. RELATIONSHIP BETWEEN ADHERENCE AND VIRAL LOAD P <0.01 % of PI Doses Taken
  • 51. EFFECTS OF SPONTANEOUS MUTATIONS ON VIRAL SWARMS Wild Type HIV Dead End HIV Resistant HIV
  • 52. EFFECT OF SELECTIVE PRESSURE OF INSUFFICIENT ART Wild Type HIV Resistant HIV Dead End HIV
  • 53.
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  • 57. Adherence Access to care Access to medication Life situation Disease stage Challenges to Successful ART: Considerations When Initiating Therapy Replication rate (Viral load) Mutation rate (Resistance) Latent HIV reservoirs Potency Pharmacokinetics (dosage schedule) Tolerability Toxicity Convenience Resistance Clinician experience Communication skills Virus Drug Clinician Patient
  • 58.
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  • 62.
  • 63. Etravirine Score Response Rate 0-2 74% 2.5-3.5 52% 4 or greater 38%

Hinweis der Redaktion

  1. Answer is b, a elite controller
  2. Second study provides additional information on possible utility of using double dose HBV vaccination in non-responders (also recommended by hepatologist speaker at RWCA clinical update conference 2009) First study – accelerated vaccine schedule proposed as option for thiose who are less likely to finish traditional dosing schedule
  3. Answer is a
  4. Answer is e
  5. Correct answer is c
  6. Since the introduction of HAART, an increase in STIs has been observed in MSMs who are aware of their HIV + status. Many of these STI may be asymptomatic. The question is whether regular STI screening should be considered for all HIV-infected MSM.
  7. Correct answer is b
  8. Correct answer is e
  9. Correct answer is b
  10. Correct answer is c
  11. Correct answer is c
  12. Answer is e (all of the above)
  13. Answer is e (all of the above)
  14. Slide #5: Challenges to Successful ART: Considerations When Initiating Therapy This Venn diagram illustrates the four interrelated components that play a role in determining successful outcomes with antiretroviral therapy and therefore should be addressed when initiating treatment.   Designing a general strategy for interventions specific to each of these components right from the beginning of treatment is a key factor in the overall success of anti-HIV therapy.
  15. Correct answer is e
  16. Collect the answers but no correct answer
  17. A cumulative score of 0 to 2 is associated with a 74% response rate, whereas cumulative scores of 2.5 to 3.5 and 4.0 or greater are associated with response rates of 52% and 38%, respectively. 38 Presence of the K103N mutation at baseline is not associated with a reduced virological response. 39