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Dr. Chris Vinnard's 2013 HIV Treatment Update
1. Christopher Vinnard, MD MPH MSCE
Assistant Professor of Medicine
Division of Infectious Diseases & HIV Medicine
Drexel University College of Medicine
5. Infant exposure to HIV was confirmed through review
of maternal HIV antibody and plasma viral load
testing
Infant infection was documented by plasma viral load
testing
ART (Combivir + Nevirapine) initiated in the infant at
30 hours of age
Persistence of HIV following treatment
discontinuation was assessed using plasma viral load,
proviral DNA, and HIV antibody testing
Ultrasensitive assays done at age 24 and 26 months
CROI 2013
6. Infant infection was confirmed by positive
HIV DNA and RNA testing on 2 separate
blood samples obtained on 2nd day of life
3 additional plasma viral load tests on day 7,
12, and 20 were positive, before reaching
undetectable levels at age 29 days
Plasma HIV RNA remained undetectable
between months 1 through 26, despite
discontinuation of ART at age 18 months
7. Ultrasensitive methods found a single copy of
HIV RNA in plasma at age 24 months
Replication-competent virus was not
detected following co-culture of 22 million
purified resting CD4+ T cells
Plasma viral load, PBMC DNA, and HIV-
specific antibodies remained undetectable
with standard clinical assays
18. Benefit to the patient
AIDS defining events
Cancers
All cause mortality
Benefit to the patient’s partner
ART was 96% effective in reducing transmission
between discordant couples
36. Risk Evaluation and Mitigation Strategy
Manage known or potential serious risks with
a drug or biological product
FDA sometimes determines that a REMS is
needed in order for the benefits to outweigh
the risks of an approved drug
REMS may include: Medication Guide,
Patient Package Insert, communication plan,
and other elements to assure safe use
37.
38. New treatments (and new drug-drug
interactions) for hepatitis C co-infection
39.
40. ~30% if HIV-infected individuals in the U.S.
are co-infected with hepatitis C
Chronic hepatitis C infection is a leading
cause of liver disease and mortality in HIV-
infected patients
HIV/hepatitis C co-infected patients are at
greater risk for liver disease and death,
compared with hepatitis C patients without
HIV infection
43. Telaprevir
NRTI backbone plus either raltegravir, efavirenz,
atazanavir/ritonavir, etravirine, or riplivirine
With efavirenz, increase dose of telaprevir
Boceprevir
NRTI backbone plus raltegravir
Wait...
New treatments on the horizon for 2014
44. New report of a cured patient
New research towards a “functional cure”
New guidelines for “when to start” therapy in
different patient populations
New one-pill-once-daily treatment regimen
New indication for antiretroviral therapy
Pre-exposure prophylaxis
New hepatitis C treatments, and new drug-
drug interactions with antiretroviral therapy