Antiretroviral treatment m onitoring a canadian ca se example
Download
1 / 26

Antiretroviral Treatment M onitoring: A Canadian Ca se Example - PowerPoint PPT Presentation


  • 242 Views
  • Uploaded on

Antiretroviral Treatment M onitoring: A Canadian Ca se Example. Robert Hogg, PhD BC Centre for Excellence in HIV/AIDS Dept. of Health Care and Epidemiology University of British Columbia. British Columbia HIV/AIDS Drug Treatment Program.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Antiretroviral Treatment M onitoring: A Canadian Ca se Example' - jaden


An Image/Link below is provided (as is) to download presentation

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.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Antiretroviral treatment m onitoring a canadian ca se example l.jpg
Antiretroviral Treatment Monitoring: A Canadian Case Example

Robert Hogg, PhD

BC Centre for Excellence in HIV/AIDS

Dept. of Health Care and Epidemiology

University of British Columbia


British columbia hiv aids drug treatment program l.jpg
British ColumbiaHIV/AIDS Drug Treatment Program

  • In BC antiretrovirals have been centrally distributed free of charge to eligible HIV+ individuals since 1986

  • In October 1992, the HIV/AIDS Drug Treatment Program became the responsibility of the BC Centre for Excellence

  • Ever enrolled over 6,500 and 2,800 currently on therapy


Monitoring and evaluation l.jpg
Monitoring and Evaluation

  • Patient, Physician and geographical characteristics

  • Antiretroviral therapy dispensing information

  • Sociodemographic and adherence-related data

  • Clinical and laboratory data, including CD4 and plasma viral load

  • Morbidity and mortality data updated through linkages

  • Antiretroviral resistance

  • Adherence measures



Nevirapine use in british columbia jan 2002 to jan 2003 l.jpg
Nevirapine use in British Columbia NNRTIs (Aug 1998 to Jan 2003) (Jan 2002 to Jan 2003)


Percent frequency distribution of initial antiretroviral regimens in british columbia 1993 2001 l.jpg

Frequency Distribution (%) NNRTIs (Aug 1998 to Jan 2003)

N

614

317

398

764

456

397

291

284

963

Therapy Start Time (year)

Percent frequency distribution of initial antiretroviral regimens in British Columbia (1993-2001)


Progression to aids death l.jpg
Progression to AIDS/Death NNRTIs (Aug 1998 to Jan 2003)

No therapy

Mono-therapy

Dual-therapy

% of patients progressing

Triple therapy

Months

JAMA 1998 & CMAJ 1999


Deaths per 1 000 pts ever on therapy l.jpg

Updated from Hogg et al, Lancet, 1999 NNRTIs (Aug 1998 to Jan 2003)

Deaths per 1,000 pts ever on therapy

Number of Deaths

Year

By Quarters


Slide12 l.jpg

Drug Costs NNRTIs (Aug 1998 to Jan 2003)

Cost: 1992/93: $500,000 US

2003/3004: $30,000,000 US


Antiretroviral cohorts l.jpg
Antiretroviral cohorts NNRTIs (Aug 1998 to Jan 2003)


Haart observational medical evaluation and research homer study l.jpg
HAART Observational Medical NNRTIs (Aug 1998 to Jan 2003)Evaluation and Research (HOMER) Study

  • Population-based study of HIV+ men and women in the Drug Treatment Program

  • Aged 18 years and over

  • Antiretroviral naive

  • First prescribed triple therapy (2 NRTIs and either a PI or an NNRTI) between August 1, 1996 and September 30, 1999

HOMER


Slide15 l.jpg

When to start therapy in 2002 NNRTIs (Aug 1998 to Jan 2003)

Recommendations

> 30 K

5 to 30 K

< 5 K

Cells/mm3

Recommend

< 350

Symptomatic

Disease Type

Recommend

350 to 500

 200 cells/mm3

Based on CD4 decline, high viral load, patient interest, adherence potential, and risk of side effects

> 200 cells/mm3

> 500

IAS-USA, JAMA, July 2002


Combined cd4 hiv rna groups hogg et al jama 2001 l.jpg
Combined CD4 & HIV-RNA groups NNRTIs (Aug 1998 to Jan 2003)Hogg et al JAMA, 2001

Probablity of Survival (%)

Time from Start of ARVs (mths)


Slide17 l.jpg

CD4 groups stratified by adherence NNRTIs (Aug 1998 to Jan 2003)

> 75% Adherent

< 75% Adherent

Probability of Survival (%)

Probability of Survival (%)

Time Since Start of ARVs

Time Since Start of ARVs

Wood et al. AIDS, 2003


Slide18 l.jpg

Wood et al. NNRTIs (Aug 1998 to Jan 2003) AIDS, 2003


Slide19 l.jpg

NNRTI vs. PI: Time to Death NNRTIs (Aug 1998 to Jan 2003)

Log-rank

Probability of Survival (%)

p = 0.252

Initial Regimen

NNRTI

PI

Time from Start of ARVs (months)

Hogg et al., IAS, 2002


Time to switching therapy l.jpg
Time to Switching Therapy NNRTIs (Aug 1998 to Jan 2003)

log rank p<0.001

Probability of Adding/Switching ARV (%)

Time from Start of ARVs (months)


Time to first simultaneous resistance to antiretrovirals l.jpg
Time NNRTIs (Aug 1998 to Jan 2003) to First Simultaneous Resistance to Antiretrovirals

Probability of Detecting Resistance (%)

Time from Start of Antiretrovirals(months)

>=1C

1219

N=

873

743

621

488

N=

1219

>=2C

932

822

702

559

954

>=3C

N=

1219

861

752

602

4C

959

873

772

623

N=

1219

Harrigan et al., IAS, 2003


Time to first detection of resistance to each class of antiretrovirals l.jpg
Time to First Detection of Resistance to Each Class of Antiretrovirals

Probability of Detecting Resistance (%)

Time from Start of Antiretrovirals(months)

N=

1219

(Lamiv)

899

783

662

528

(NNRTI)

N=

712

1219

937

826

570

(NRTI)

730

N=

1219

935

839

580

(PI)

N=

1219

741

947

848

591

Harrigan et al., IAS, 2003


Slide23 l.jpg

Donald Rumsfeld AntiretroviralsClarifying US Policy on the war on terrorNewsweek, March 10, 2003

“There are known knows. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But these are also unknown unknowns. There are things we don’t know we don’t know.”


Human security l.jpg
Human security? Antiretrovirals


Slide25 l.jpg

Impact of Various ART Strategies in South Africa Antiretrovirals

50

49

48

47

46

1999

2000

2001

2002

2003

2004

2005

Based on E Wood and P Braitstein et al. Lancet 2000 June 17;vol 355:2095-2100

25% Antiretroviral Therapy Use

Life Expectancy at Birth

No Therapy

Year


Acknowledgements l.jpg
Acknowledgements Antiretrovirals

Michael O’Shaughnessy

Paula Braitstein

Richard Harrigan

Nada Gataric

Julio Montaner

Benita Yip

Keith Chan

Evan Wood

Michael Smith Foundation for Health Research

The Canadian Institutes of Health Research

BC Centre for Excellence in HIV/AIDS


ad