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The African Eye Trust HIV Treatment Information Event By Badru Male&Elijah Amooti

The African Eye Trust HIV Treatment Information Event By Badru Male&Elijah Amooti. Background. HIV discovered within Gay communities in San Francisco, USA in 1982 as HTLV1. 1984 rediscovered in heterosexuals in Central Africa In France, a scientist discovered that HIV causes AIDS.

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The African Eye Trust HIV Treatment Information Event By Badru Male&Elijah Amooti

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  1. The African Eye Trust HIV Treatment Information EventBy BadruMale&ElijahAmooti Understanding HIV Treatment and adherence.

  2. Background • HIV discovered within Gay communities in San Francisco, USA in 1982 as HTLV1. • 1984 rediscovered in heterosexuals in Central Africa • In France, a scientist discovered that HIV causes AIDS. • 1988 – Use of septrin to cure PCP and HIV encephalopathy/Toxoplasmosis • AZT Monotherapy Understanding HIV Treatment and adherence.

  3. The UK HIV deaths Trend • 2006 - 5,505 new diagnoses of HIV (about 50% acquired in Africa) • 84,730 Cumulative since 1982 (33% do not know they are HIV positive) • 40% People of African ethnicity (about 24,000) Understanding HIV Treatment and adherence.

  4. The UK HIV deaths Trend • 1995 - 1800 deaths • 2000 - 500 deaths • 2006 - 419 deaths (down by 15%) • 22,745 Cumulative deaths Understanding HIV Treatment and adherence.

  5. HIV and AIDS diagnoses and deaths in HIV infected individuals, UK reports to end December 2006 Numbers, particularly for recent years, will rise as further reports are received. Understanding HIV Treatment and adherence.

  6. History of HIV Anti-Retroviral Therapy (ART) • Nucleoside analogues • 1988, A drug called Zidovudine (AZT) used to treat HIV infection. • 1989, Videx (DdI) • 1990, Hivid (DdI) • Non-nucleoside analogues (1989) (Nevirapine/ viramune) Understanding HIV Treatment and adherence.

  7. History of HIV Anti-Retroviral Therapy (ART) • 1995 Protease inhibitors (PI) • Combination Therapy – Vancouver (1998) • 1999 – Tenofovir (Nucleotide analogue) • 2001- Entry inhibitor – T/20 (Fuzeon) • 2005 - Entry CCR5 receptors Understanding HIV Treatment and adherence.

  8. Anti-Retro-Viral classes of drugs • Nucleoside analogues (NUKES) • Non-Nucleoside analogues (NON-NUKES) • Protease Inhibitors (PIs) • Entry/Fusion Inhibitors (FIs) • CCR5 blockers • Nucleotide analogues (Nukets) • Intergrase inhibitors Understanding HIV Treatment and adherence.

  9. Understanding HIV Treatment and adherence.

  10. Viral Enzymes • Reverse Transcriptase • Intergrase • Protease Understanding HIV Treatment and adherence.

  11. HIV Manifestation Understanding HIV Treatment and adherence.

  12. Reverse transcriptase Understanding HIV Treatment and adherence.

  13. Geneticvariability/mutation Gene for envelope changes Gene for envelope changes Body makes antibodies Body makes new antibodies Antibodies cannot recognise virus New antibodies cannot recognise virus Understanding HIV Treatment and adherence.

  14. How HIV infects T4 cells VIRUS CD4 receptor molecule T4 CELL CYTOPLASM Enters host cell, loses envelope RT enzyme NUCLEUS Viral RNA T4 cell genome RNA copies of viral RNA (messenger RNA) DNA New viruses bud out of T4 cell Viral DNA viral genome integrates with T4 cell genome

  15. GROUP EXERCISE • Assume that you are one of the viral enzymes • Pick a card of a drug that you consider your enemy • Place it in the right place • Pick a friend from the other groups who will help you fight the virus and explain Understanding HIV Treatment and adherence.

  16. HIV Treatment issues • Starting treatment • Adherence • Side effects/Toxicity • Drug Concentration (IQ) • Drug Resistance • Changing treatment • Drug interactions Understanding HIV Treatment and adherence.

  17. STARTING HIV TREATMENT • Why start HIV treatment • When to start HIV treatment • What to start with Understanding HIV Treatment and adherence.

  18. Viral load & CD4 after HIV-1 Infection[without treatment] Death Seroconversion Infection Asymptomatic Symptomatic AIDS 2 million 1000 CD4+ Cells/mm3 viral load copies/mL 500 200 0 0 Up to 12 years 4-8 wks 2-12 mo 2-3 years Time Understanding HIV Treatment and adherence.

  19. ADHERENCE to ARVs • The meaning – (KMS=A) • What is non-adherence • Factors affecting adherence • Support needed for adherence • Outcomes of adherence Understanding HIV Treatment and adherence.

  20. What is adherence? • Knowledge • How drugs work • Why they work • Why they may not work and consequences • Memory • Biopsychosocial issues • Satisfaction • Benefits, lifestyle, Side/effects/QOL Understanding HIV Treatment and adherence.

  21. After HIV treatment (ARVs): effect on CD4 and viral load Start treatment Viral load <50 copies/mL 2 million 1000 CD4+ cells/mm3 viral load (RNA) copies/mL 500 200 < 50 copies/mL 0 0 + 1-40+ years !! 1-12 yrs +1-6 mo Time Chronic Infection Understanding HIV Treatment and adherence.

  22. Drug levels and resistance.1 Taking drugs at the exact time makes sure that you keep above a minimum level Increased risk of side effects Drug concentration MEC (Minimum Effective Concentration) Increased risk of resistance 0 dose dose dose dose Understanding HIV Treatment and adherence.

  23. Side Effects/Toxicity • Why it is better to know before starting. • What are “side effects” • Short term • Long Term • How to manage side effects • The balance of benefits Understanding HIV Treatment and adherence.

  24. Managing side effects • Complimentary therapies • Taichi • Acupuncture • Reflexology • Shiatsu • Yoga • New fill for lipodystrophy • Exercising for high LDL Understanding HIV Treatment and adherence.

  25. Changing treatment combination • Why should some one change treatment • What should someone change to • When should someone change treatment • Why are consultants usually against change Understanding HIV Treatment and adherence.

  26. Drug interactions • ARVs / ARVs • ARVs / Anelgesics • ARVs /Antibacterials • ARVs / Anticonvulsants • ARVs Antivirals • ARVs / Neoplastics • ARVs / Antiprotozoals Understanding HIV Treatment and adherence.

  27. Drug interactions • ARvs / Sedatives • ARVs / Gastrointestinal agents • ARVs / Illicit recreational • ARVs / Immunosuppressants • ARVs / Steroids • ARVs / Herbals • ARvs / Beta blockers • ARVs / Antipsychotics Understanding HIV Treatment and adherence.

  28. New Drugs • PI – TMC114 (Darunavir, PREZISTA) • 600mg/boosted with 100mg Rit. BD • NNRTI – TMC125 • CCR5 Inhibitors (in pipeline) • Aplaviroc • Vincriviroc • Maraviroc • CXCR4 Inhibitors (in pipeline) • Integrase Inhibitors Understanding HIV Treatment and adherence.

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