Advances In HIV Treatment: HAART And Its Complications . Amy V. Kindrick, M.D., M.P.H. National HIV/AIDS Clinicians’ Consultation Center April 26, 2003. Overview. New concepts and strategies in HIV antiretroviral therapy Long-term toxicities of ARV therapy
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
Amy V. Kindrick, M.D., M.P.H.
National HIV/AIDS Clinicians’ Consultation Center
April 26, 2003
“Drugs don’t work if people don’t take them.”
C. Everett Koop
Chesney M. Adherence to antiretroviral therapy. 12th World AIDS Conference, 1998; Geneva. Lecture 281
N = 504 pts on HAART
% Achieving <500 copies/mL
Adherence, by prescription refill
Montessori, V, et al. XII International Conference on AIDS, Durban, South Africa, 2000. Abstract MoPpD1056.
MEMScaps, Aardex Corp.
Patients with HIV RNA<400 copies/mL, %
PI adherence, % (electronic bottle caps)
Paterson, et al. 6th Conference on Retroviruses and Opportunistic Infections; 1999; Chicago, IL. Abstract 92.
O 0–49%Adherence and AIDS-Free Survival
10% adherence difference = 21% reduction in risk of AIDS
P = .0012
Months from entry
Bangsberg D, et al. AIDS. 2001:15:1181
Area of Potential HIV Replication
V. Simon, MD
Not Generally Recommended
Varying symptoms, including
Malaise a/o fatigue
Nausea a/o vomiting
Abnormal laboratory values
Elevated serum lactate
Low serum bicarbonate
Elevated amylase/lipaseLactic Acidosis: Clinical Presentation
Two plasma HIV RNA levels
CD4+ T cell count
Remaining treatment options
Drug failure or drug toxicity?
Pharmacology & drug interactions
Patient preferenceChanging Therapy:Considerations
Deeks, et al. NEJM 2/15/01
Loss of viral suppression
Development of resistance
Repopulation of reservoirs
Acute antiretroviral syndrome
CD4 cell decline
Loss of immune responses
Reduced drug exposure
Increased access to drugs
Enhanced immune function
Long-term viral control off ARVsTreatment Interruptions: Real Risks And Theoretical Benefits
Lisziewicz J et al. NEJM 1999; 340: 1683-1684.
May prevent immune system damage
May allow control of viremia without ARVs
No obvious end point
Risk of cumulative ARV toxicity
Risk of suboptimal adherence leading to emergence of resistanceARV Therapy for Primary Infection