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PrEP and My Patients: Guidance for LGBT Community–Based Primary Care Providers on Novel Strategies to Reduce Risk of HIV Acquisition
 

PrEP and My Patients: Guidance for LGBT Community–Based Primary Care Providers on Novel Strategies to Reduce Risk of HIV Acquisition

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Expert faculty Jared Baeten, MD, PhD; Susan Buchbinder, MD; Connie L. Celum, MD, MPH; and Albert Liu, MD, MPH review emerging data on pre-exposure prophylaxis and antiretroviral therapy as prevention ...

Expert faculty Jared Baeten, MD, PhD; Susan Buchbinder, MD; Connie L. Celum, MD, MPH; and Albert Liu, MD, MPH review emerging data on pre-exposure prophylaxis and antiretroviral therapy as prevention and discuss implications for community providers.

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    PrEP and My Patients: Guidance for LGBT Community–Based Primary Care Providers on Novel Strategies to Reduce Risk of HIV Acquisition PrEP and My Patients: Guidance for LGBT Community–Based Primary Care Providers on Novel Strategies to Reduce Risk of HIV Acquisition Presentation Transcript

    • PrEP and My Patients: Guidance for LGBT Community–Based Primary Care Providers on Novel Strategies to Reduce Risk of HIV AcquisitionThis program is supported by an educational grant fromOriginally posted 5/21/2012 at clinicaloptions.com/ss/PrEPGuidance
    • PrEP and My Patientsclinicaloptions.com/hiv About These Slides  Our thanks to the presenters who gave permission to include their original data  Users are encouraged to use these slides in their own noncommercial presentations, but we ask that content and attribution not be changed. Users are asked to honor this intent  This abbreviated slideset was posted to SlideShare to publicize the availability of the full slideset. These slides may not be published or posted online without permission from CCO (email permissions@clinicaloptions.com)DisclaimerThe materials published on the Clinical Care Options Web site reflect the views of the authors of theCCO material, not those of Clinical Care Options, LLC, the CME providers, or the companies providingeducational grants. The materials may discuss uses and dosages for therapeutic products that have notbeen approved by the United States Food and Drug Administration. A qualified healthcare professionalshould be consulted before using any therapeutic product discussed. Readers should verify all informationand data before treating patients or using any therapies described in these materials.
    • PrEP and My Patientsclinicaloptions.com/hiv Faculty Who Contributed to This Program Susan Buchbinder, MD Jared M. Baeten, MD, PhD Associate Clinical Professor Associate Professor Departments of Medicine, Department of Global Health Epidemiology, and and Medicine Biostatistics University of Washington University of California, Seattle, Washington San Francisco Director, HIV Research Section San Francisco Department of Public Health San Francisco, California
    • PrEP and My Patientsclinicaloptions.com/hiv Faculty Who Contributed to This Program (cont’d) Connie Celum, MD, MPH Albert Liu, MD, MPH Professor, Department of Assistant Clinical Professor Global Health and Medicine Department of Medicine University of Washington University of California, Seattle, Washington San Francisco Director, HIV Prevention Intervention Studies HIV Research Section San Francisco Department of Public Health San Francisco, California
    • PrEP and My Patientsclinicaloptions.com/hiv Disclosures Jared M. Baeten, MD, PhD, has no significant financial relationships to disclose. Susan Buchbinder, MD, has no significant financial relationships to disclose. Connie L. Celum, MD, MPH , has no significant financial relationships to disclose. Albert L. Liu, MD, MPH, has no significant financial relationships to disclose.
    • Antiretroviral Therapy forPreventing HIV Acquisition:Available Data and Ongoing Trials
    • PrEP Background
    • PrEP and My Patientsclinicaloptions.com/hiv Using Antiretroviral Medications for HIV-1 Prevention PrEP PEP ART Time of Prior to exposure After infection transmission Advantages Advantages Advantages  Demonstrated efficacy Shorter course than PrEP Clinical benefits and reduced infectiousness Challenges Challenges Challenges  Adherence Limited data Scale up; resources  Delivery Recognition of risk Long-term adherence  Cost-effectiveness Initiation < 48 hrs Long term toxicity  Resistance  Adherence Resistance Public health impact
    • PrEP and My Patientsclinicaloptions.com/hiv Tenofovir for PrEP  Completed clinical trials of PrEP have tested tenofovir – Oral TDF, oral TDF/FTC, vaginal gel  Potent: rapid antiretroviral activity  Safe: Substantial treatment safety experience  Easy: Once-daily dosing, few drug-drug interactions  Evidence that concept should work – Animal models and postnatal prophylaxis of breastfeeding infants showed high levels of protection
    • Breakthroughs in PrEP
    • PrEP and My Patientsclinicaloptions.com/hiv iPrEx: Eligibility  Male sex at birth (N = 2499)  18 yrs of age or older  HIV-seronegative status  Evidence of risk for acquisition of HIV infectionGrant RM, et al. N Engl J Med. 2010;363:2587-2599.
    • PrEP and My Patientsclinicaloptions.com/hiv iPrEX Study Sites Sites 11 Participants 2499San Francisco 9% Boston Chiang Mai 5% Iquitos 12% Guayaquil Sao Paulo Lima 15% 56% Rio de Janeiro Cape Town 4%Grant R, et al. CROI 2011. Abstract 92.
    • PrEP and My Patientsclinicaloptions.com/hiv iPrEx: Baseline Demographics Characteristic, % Overall (N = 2499) Age  Younger than 25 yrs 50  25-39 yrs 40  40 yrs or older 10 Race  White 17 Black 9  Asian 5  Mixed/other 69  Latino 72 Completed some college 43Grant RM, et al. N Engl J Med. 2010;363:2587-2599.
    • PrEP and My Patientsclinicaloptions.com/hiv iPrEx: Efficacy  Efficacy through study end (mITT): 42% (95% CI: 18% to 60%) 0.12 Placebo FTC/TDF Cumulative Probability 0.10 of HIV Infection 0.08 0.06 P = .002 0.04 0.02 0 0 12 24 36 48 60 72 84 96 108 120 132 144 Wks Since Randomization Pts at Risk, n Placebo 1248 1198 1157 1119 1030 932 786 638 528 433 344 239 106 FTC/TDF 1251 1190 1149 1109 1034 939 808 651 523 419 345 253 116Grant R, et al. CROI 2011. Abstract 92.
    • Challenges of PrEP
    • For the rest of this presentation download the full PowerPoint slideset for self-study or use in your own educational presentations at: clinicaloptions.com/ss/PrEPGuidanceMore ways to connect with CCO: