1 / 21

Prevention and Care Dr S Charalambous kaizernetwork aids2006 WHO guidelines

Prevention and Care Dr S Charalambous www.kaizernetwork.org www.aids2006.org WHO guidelines. Toronto : new information. Kericho, Kenya : tea plantation workers - 2800 volunteers* Circumcised 0.79/100py Uncircumcised 2.84/100py HRR 0.31 (95%CI 0.15 – 0.64)

mahon
Download Presentation

Prevention and Care Dr S Charalambous kaizernetwork aids2006 WHO guidelines

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Prevention and Care Dr S Charalambous www.kaizernetwork.org www.aids2006.org WHO guidelines

  2. Toronto : new information • Kericho, Kenya : tea plantation workers - 2800 volunteers* • Circumcised 0.79/100py • Uncircumcised 2.84/100py • HRR 0.31 (95%CI 0.15 – 0.64) • (Models : Demographic factors – less significant, Behavioural factors – still significant) • Modelling study of HIV prevalence in Soweto* in 20 years (61% protective effect) • 318 000 HIV infxns – HIV prev 16% - 23% • Current rates of circ : 17% • 10% per year –32000 fewer infections: 17% to 14% HIV prevalence • 20% per year –53000 fewer infections: 17% to 13% HIV prevalence • 30% risk behaviour – 18 000 fewer infections: 17% to 15% HIV prev *TUAC0201 ** TUAC0203

  3. Toronto : new information Cost-effectiveness of male circumcision, J Khan* • Orange Farm study data: Total cost: $ 56 • Assumptions: • No effect on women • 25% increased risk compensation • Life time cost of treatment $ 8000 • Cost of HIV infection averted $181 ($91 – 668 HIV Prev) Savings: $2,4 million • Cost of circumcision must inc 45x for no cost difference Kenya : assessment of behavioural disinhibition** following male circumcision • 648 men : 324 circumcised vs 324 uncircumcised • Baseline : Risky acts 33.6% circum vs 25.6% uncirc 0.025 • No increase in sex acts or unprotected sex acts *TUAC0203 **TUAC0205

  4. STATE-OF-THE-ART • Treatment naïve patients: New IAS guidelines • Treatment experienced patients: achieving undetectable viral load • Role of HAART in HIV prevention

  5. Antiretroviral regimens recommended for first-line therapy (new IAS-USA guidelines) *In selected patients #No longer recommended for initial therapy except when use of NNRTIs or PIs is precluded Adapted from Hammer et al. JAMA 2006; 296:827-43 *In selected patients #No longer recommended for initial therapy except when use of NNRTIs or PIs is precluded Adapted from Hammer et al. JAMA 2006; 296:827-43

  6. Staccato: Highest response of 24-week analyses (HIV RNA < 50 copies/mL; ITT) 38% ATV + d4T + 3TC BMS-008*† 55% FPV/r + ABC + 3TC GSK - SOLO 57% LPV/r (od) + FTC + TDF Abbott 418 65% LPV/r + d4T + 3TC Abbott M98-863* 65% NVP (bid) + d4T + 3TC 2NN* 68% FPV/r + ABC + 3TC KLEAN* 72% LPV/r + ABC + 3TC KLEAN* 74% EFV + ddI + d4T Gilead FTC-301 78% EFV + TDF + 3TC Gilead 903 81% EFV + ddI + FTC Gilead FTC-301 89% SQV/r** + 2 NRTIs Staccato 0 20 40 60 80 100 Subjects with HIV RNA < 50 copies/mL (%) † ATV 400 mg results used; *HIV RNA at 24 weeks estimated from graph; **Investigational Invirase/r 1600/100 mg qd dosage. The approved dosing regimen is Invirase/r 1000/100 mg bid 1. Murphy et al. AIDS 2003; 17:2603–14 2. Gathe et al.AIDS 2004; 18:1529–37 3. Podzamczer et al. 9th EACS 2003. Abstract F1/3 4. Walmsley et al. N Engl J M,ed 2002; 346:2039–46 5. van Leth et al.Lancet. 2004; 363:1253–63 6. Saag et al.JAMA 2004; 292:180–9 7. Staszewski et al. 10th CROI 2003. Poster 564b 8. Eron J, et al. Lancet 2006; 368: 476–82 9. Ananworanich et al.Antivir Ther 10: 761-7

  7. Tenofovir • 903 Trial: 96 week results: safety and tolerability of tenofovir, • Uganda: reduction in side effects due to tenofovir • Subtype C isolates may develop the K65R mutation more rapidly than Subtype B isolates • Uganda & Zimbabwe: 1.3% patients developed severe GFR reduction, found to have similar rates of glomerular filtration reduction as other regimens

  8. Treatment-experienced patients • Undetectable viremia is now a realistic goal of therapy for treatment-experienced patients • Before adding a new agent, ARVs should be selected to provide the maximum activity • Baseline characteristics are important prognostic factors predictive of a treatment response • Resistance testing may overestimate the number of active drugs • Drugs from a new mechanistic class (e.g. ENF) should retain their full activity in treatment-experienced patients

  9. Summary of TORO, RESIST and POWER trials POWER 1 & 2 TORO 1 & 2 RESIST 1 & 2 64% 60% 54% 46% Patients (%) Patients (%) Patients (%) 30% 30% < 50 copies/mL Week 24 < 400 copies/mLWeek 24 < 400 copies/mL Week 24 LPV/r TPV/r DRV/r LPV/r + ENF TPV/r + ENF DRV/r + ENF Haubrich et al. IDSA 2005; Abstract 785; Hill and Moyle. BHIVA 2006; Abstract P1.

  10. HAART and HIV Prevention • PMTCT works by reducing viral load to reduce transmission • Uganda, Quinn et al – reduction of transmission in serodiscordant couples – no transmission if VL<1500 • Taiwan, reduction in HIV transmission 53% after introduction of HAART • Call for cost-effectiveness of use of HAART as prevention : immediate treatment of 100% HIV population • Cost $7 billion/year – total cost $42 billion • HIV infected people 38 million to <1 million

  11. “History will judge us not by our scientific advances, but what we do with our scientific advances” A Fauci

More Related