Dr. Chris Vinnard's 2013 HIV Treatment Update

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Dr. Chris Vinnard provided this update on HIV/AIDS care and treatment at the March 14, 2013 Philadelphia EMA Ryan White Planning Council meeting.

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Dr. Chris Vinnard's 2013 HIV Treatment Update

  1. 1. Christopher Vinnard, MD MPH MSCEAssistant Professor of MedicineDivision of Infectious Diseases & HIV MedicineDrexel University College of Medicine
  2. 2. A new report of a cure...
  3. 3.  Infant exposure to HIV was confirmed through review of maternal HIV antibody and plasma viral load testing Infant infection was documented by plasma viral load testing ART (Combivir + Nevirapine) initiated in the infant at 30 hours of age Persistence of HIV following treatment discontinuation was assessed using plasma viral load, proviral DNA, and HIV antibody testing Ultrasensitive assays done at age 24 and 26 months CROI 2013
  4. 4.  Infant infection was confirmed by positive HIV DNA and RNA testing on 2 separate blood samples obtained on 2nd day of life 3 additional plasma viral load tests on day 7, 12, and 20 were positive, before reaching undetectable levels at age 29 days Plasma HIV RNA remained undetectable between months 1 through 26, despite discontinuation of ART at age 18 months
  5. 5.  Ultrasensitive methods found a single copy of HIV RNA in plasma at age 24 months Replication-competent virus was not detected following co-culture of 22 million purified resting CD4+ T cells Plasma viral load, PBMC DNA, and HIV- specific antibodies remained undetectable with standard clinical assays
  6. 6. What about the first patient curedof HIV infection?
  7. 7. New approaches to treatment: Targeting the CCR5 Receptor
  8. 8. “When to start treatment?” New recommendations
  9. 9.  Benefit to the patient  AIDS defining events  Cancers  All cause mortality Benefit to the patient’s partner  ART was 96% effective in reducing transmission between discordant couples
  10. 10. A new one-pill-once-daily regimen
  11. 11. A new indication for antiretroviral therapy
  12. 12. http://www.cdc.gov/hiv/prep/
  13. 13.  Risk Evaluation and Mitigation Strategy Manage known or potential serious risks with a drug or biological product FDA sometimes determines that a REMS is needed in order for the benefits to outweigh the risks of an approved drug REMS may include: Medication Guide, Patient Package Insert, communication plan, and other elements to assure safe use
  14. 14. New treatments (and new drug-druginteractions) for hepatitis C co-infection
  15. 15.  ~30% if HIV-infected individuals in the U.S. are co-infected with hepatitis C Chronic hepatitis C infection is a leading cause of liver disease and mortality in HIV- infected patients HIV/hepatitis C co-infected patients are at greater risk for liver disease and death, compared with hepatitis C patients without HIV infection
  16. 16. Telaprevir + PegIFN/Ribavirin Boceprevir + PegIFN/RibavirinPegIFN/Ribavirin PegIFN/Ribavirin
  17. 17.  Telaprevir  NRTI backbone plus either raltegravir, efavirenz, atazanavir/ritonavir, etravirine, or riplivirine  With efavirenz, increase dose of telaprevir Boceprevir  NRTI backbone plus raltegravir Wait...  New treatments on the horizon for 2014
  18. 18.  New report of a cured patient New research towards a “functional cure” New guidelines for “when to start” therapy in different patient populations New one-pill-once-daily treatment regimen New indication for antiretroviral therapy  Pre-exposure prophylaxis New hepatitis C treatments, and new drug- drug interactions with antiretroviral therapy
  19. 19. Thank you!

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