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Quand débuter les antirétroviraux? Recommandations internationales

Quand débuter les antirétroviraux? Recommandations internationales. Formation à l’usage des antirétroviraux Pr Willy Rozenbaum. Potential Benefits of Early Therapy. Earlier suppression of viral replication Preservation of immune function Prolongation of disease-free survival

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Quand débuter les antirétroviraux? Recommandations internationales

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  1. Quand débuter les antirétroviraux?Recommandations internationales Formation à l’usage des antirétroviraux Pr Willy Rozenbaum

  2. Potential Benefits of Early Therapy Earlier suppression of viral replication Preservation of immune function Prolongation of disease-free survival Lower risk of virologic failure? Lower risk of detrimental viral evolution Possible decrease in the risk of HIV transmission

  3. CD4+ Cell Count Response Based on Baseline CD4+ Cell Count Johns Hopkins HIV Clinical Cohort ATHENA National Cohort 1000 1000 800 800 600 600 Mean CD4+ Cell Count (cells/mm3) 400 400 BL CD4 BL CD4 > 350 201-350 > 500 200 200 201-350 51-200 351-500 < 200 < 50 0 0 0 1 2 3 4 5 0 48 96 144 192 240 288 336 Years on HAART Weeks From Starting HAART Keruly J, et at. CROI 2006. Abstract 529. Gras L, et al. CROI 2006. Abstract 530.

  4. HAART and Survival Based on Initial CD4+ Cell Count Modeled data from ART Cohort Collaborative 10,855 patients included 934 progressed to AIDS or died IDUs censored from model Cumulative Probability of AIDS/Death According to CD4+ Cell Count at Initiation of HAART 0.14 101-200 cells/mm3201-350 cells/mm3351-500 cells/mm3 0.12 0.10 0.08 Probability of AIDS or Death 0.06 0.04 0.02 0.00 3 4 5 1 2 0 Years Since Initiation of HAART D’Arminio Monforte A, et al. CROI 2006. Abstract 525.

  5. Time to Virologic Failure Stratified by Baseline CD4+ Cell Count 100 80 60 Patients Responding (%) Baseline CD4+ cell count (cells/mm3) 40 < 200 (n = 331)  200 to < 350 (n = 345) 20  350 to < 500 (n = 302)  500 (n = 236) 0 0 12 24 36 48 60 72 84 96 Time Since Start of Treatment (Weeks) Levy RS, et al. CROI 2001. Poster 325.

  6. Increasing Prevalence of X4- or R5/X4-Tropic Virus at Lower CD4+ Cell Counts CCR5 Patients with early-stage HIV disease tend to have pure R5-tropic virus CXCR4 With advanced disease, X4- or dual-tropic virus emerges Associated with more rapid clinical and immunologic progression Could CCR5 inhibition select for more virulent X4-tropic virus? 100 80 60 Prevalence of X4 or R5/X4 (%) 41.9% 40.0% 40 16.0% 16.0% 20 14.8% 0 > 300 248 201-300 104 101-200 81 51-100 31 < 50 50 CD4+ Cell Count (cells/mm3) n = Moyle G, et al. ICAAC 2004. Abstract 1135.

  7. Prise en charge médicale des personnes infectées par le VIH – Rapport 2006Traitement antirétroviral (1) • Quand débuter un traitement antirétroviral ? • L'instauration d'un traitement ARV doit toujours être préparée • Travail multidisciplinaire pour optimiser l’adhésion au traitementet aux soins

  8. DHHS Guidelines: When To Start 2008

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