This document discusses HIV drug resistance monitoring in Indonesia. It provides background on the HIV epidemic in Indonesia, noting the first reported case in 1980 and rapid increase between 1990-2010. It describes the scale up of antiretroviral therapy (ART) starting in 2004-2005. It also discusses the establishment of the National Working Group on HIV Drug Resistance in 2005 and their key activities of monitoring early warning indicators and conducting HIV drug resistance surveys. Results of various drug resistance monitoring activities from 2004-2014 are presented, finding levels of transmitted drug resistance below 5%. Future plans for 2016-2019 include expanding early warning indicator monitoring, conducting additional drug resistance monitoring and surveys, and achieving WHO accreditation for the national HIV drug resistance genotyping
Richard Garfein, PhD, MPH
Professor
Herbert Wertheim School of Public Health and Human Longevity Science
Adjunct Professor
Division of Infectious Disease and Global Public Health
Department of Medicine
University of California, San Diego
Gabriel Wagner, MD
Associate Clinical Professor
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Elliot Welford, MD
Infectious Diseases Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Laura Bamford, MD, MSCE
Associate Professor of Medicine
Medical Director, Owen Clinic
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
Jocelyn Keehner, MD
Infectious Disease Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This presentation summarizes research on cryptococcal antigen screening and treatment in resource-limited settings. It finds that screening individuals with CD4 counts <100 cells/uL and <200 cells/uL can reduce mortality, and point-of-care tests now enable screening in primary care clinics. Studies of simplified treatment regimens show promise, such as using high-dose liposomal amphotericin B for only 1-2 weeks. Field work in Mozambique demonstrated a 7.3% prevalence of cryptococcal antigenemia through screening at two clinics, and identified opportunities to improve care through expanded screening and ambulatory treatment models.
This document summarizes key information from an HIV & Global Health Rounds presentation on updates from the 2020 Conference on Retroviruses and Opportunistic Infections (CROI 2020). The presentation covered the global HIV epidemic, contraception and prevention, treatment as prevention, pre-exposure prophylaxis (PrEP), and HIV vaccines. Highlights included findings from the ECHO contraceptive study showing no increased HIV risk from various contraceptives, modest reductions in HIV incidence from universal test and treat trials, long-term efficacy and safety data from the DISCOVER PrEP trial, and the failure of the HVTN 702 vaccine trial to show efficacy.
This document provides an overview and summary of recent data on antiretroviral therapy (ART) for HIV. Key findings include:
- A study in Thailand found that daily oral tenofovir reduced HIV infection risk among injection drug users by 48.9%, leading to new guidelines recommending PrEP for high-risk drug users.
- US demonstration projects found high adherence to PrEP among at-risk populations, with tenofovir levels indicating protection.
- Multiple studies found dolutegravir to be superior to other regimens in suppressing HIV and had fewer side effects, establishing it as a preferred integrase inhibitor.
- No transmissions occurred in a large study of serod
Richard Garfein, PhD, MPH
Professor
Herbert Wertheim School of Public Health and Human Longevity Science
Adjunct Professor
Division of Infectious Disease and Global Public Health
Department of Medicine
University of California, San Diego
Gabriel Wagner, MD
Associate Clinical Professor
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Elliot Welford, MD
Infectious Diseases Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Laura Bamford, MD, MSCE
Associate Professor of Medicine
Medical Director, Owen Clinic
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
Jocelyn Keehner, MD
Infectious Disease Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This presentation summarizes research on cryptococcal antigen screening and treatment in resource-limited settings. It finds that screening individuals with CD4 counts <100 cells/uL and <200 cells/uL can reduce mortality, and point-of-care tests now enable screening in primary care clinics. Studies of simplified treatment regimens show promise, such as using high-dose liposomal amphotericin B for only 1-2 weeks. Field work in Mozambique demonstrated a 7.3% prevalence of cryptococcal antigenemia through screening at two clinics, and identified opportunities to improve care through expanded screening and ambulatory treatment models.
This document summarizes key information from an HIV & Global Health Rounds presentation on updates from the 2020 Conference on Retroviruses and Opportunistic Infections (CROI 2020). The presentation covered the global HIV epidemic, contraception and prevention, treatment as prevention, pre-exposure prophylaxis (PrEP), and HIV vaccines. Highlights included findings from the ECHO contraceptive study showing no increased HIV risk from various contraceptives, modest reductions in HIV incidence from universal test and treat trials, long-term efficacy and safety data from the DISCOVER PrEP trial, and the failure of the HVTN 702 vaccine trial to show efficacy.
This document provides an overview and summary of recent data on antiretroviral therapy (ART) for HIV. Key findings include:
- A study in Thailand found that daily oral tenofovir reduced HIV infection risk among injection drug users by 48.9%, leading to new guidelines recommending PrEP for high-risk drug users.
- US demonstration projects found high adherence to PrEP among at-risk populations, with tenofovir levels indicating protection.
- Multiple studies found dolutegravir to be superior to other regimens in suppressing HIV and had fewer side effects, establishing it as a preferred integrase inhibitor.
- No transmissions occurred in a large study of serod
Stephen Rawlings, MD, PhD
Clinical Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Daniel Lee, MD
Clinical Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This document summarizes a presentation on new and investigational antiretrovirals given at the UC San Diego HIV & Global Health Rounds. The presentation reviewed fostemsavir, cabotegravir/rilpivirine, leronlimab, islatravir, and lenacapavir. For each drug, the presenter discussed indications, dosing, efficacy and safety data from clinical trials, resistance profiles, and potential advantages and limitations. The goal of the HIV & Global Health Rounds is to provide clinicians and researchers with the most up-to-date information on HIV, hepatitis, tuberculosis, and other infectious diseases.
Maile Young Karris, MD
Associate Professor
Co-Director San Diego Center for AIDS Research Clinical Investigations Core
Divisions of Infectious Diseases & Global Public Health and Geriatrics & Gerontology
Department of Medicine
University of California San Diego
The document discusses the case of Timothy Ray Brown, known as the "Berlin Patient", who is considered the first person cured of HIV/AIDS. Brown was diagnosed with HIV in 1995 and later developed leukemia. In 2007, he received a stem cell transplant from a donor with a CCR5 mutation that provides resistance to HIV. Despite complications, the treatment eliminated both his cancer and HIV infection. Nearly eight years later, Brown remained free of detectable HIV. The document also mentions a second patient in London who received similar treatment and may have been cured of HIV, providing further evidence that stem cell transplantation can cure HIV infection in some cases.
PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"StopTb Italia
This document discusses the challenges of diagnosing HIV, AIDS, and co-infections. It notes that distinguishing between HIV infection, AIDS, and co-infections can be difficult. Point-of-care rapid tests have helped increase HIV testing, though they cannot identify acute HIV infections. The document emphasizes the importance of confirming positive rapid HIV tests with supplemental tests due to the potential for false positives in low prevalence populations.
The latest recommendations by WHO on HIV treatment--New GuidelinesSyriacus Buguzi
This document provides consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. It includes recommendations for a public health approach across the continuum of HIV care, from diagnosis to treatment to monitoring. The guidelines were developed by the World Health Organization and draw on the most recent evidence from multiple sources. They are intended to guide national HIV programs in providing optimal HIV treatment, care, and prevention.
This document provides guidelines for treating and preventing HIV infection in Kenya in 2016. It summarizes recommendations for HIV testing and linkage to care, initial evaluation and follow up of people living with HIV, the standard package of care including antiretroviral therapy and prevention services, adherence preparation and monitoring, antiretroviral therapy for infants/children/adults, prevention of mother-to-child transmission, and the use of antiretrovirals for pre-exposure prophylaxis. The guidelines are intended to help healthcare workers in Kenya provide comprehensive HIV prevention and treatment services in line with best practices.
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
Testing for Acute HIV and Early Initiation of ARTHopkinsCFAR
This document summarizes evidence from several studies on testing for acute HIV infection and initiating antiretroviral therapy (ART) on the same day as diagnosis. It discusses the optimal window for initiating ART after infection to restore immune function based on a study showing greater probability of achieving CD4 counts over 900 if starting ART within 4 months of infection. It also summarizes results from randomized controlled trials and observational studies demonstrating that rapid/same-day ART initiation improves linkage to care, ART initiation rates, and viral suppression compared to standard of care with initiation delayed by weeks or months.
Kathleen Brady from the Philadelphia Department of Public Health presented her annual updated on the HIV Epidemic in Philadelphia at a February 2015 combined meeting of the Philadelphia Ryan White Part A Planning Council and the HIV Prevention Planning Group.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Jens Lundgren, CHIP
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
This study investigated the seroprevalence of hepatitis B virus (HBV) infection in outpatients at a district hospital in Mardan, Pakistan. The study found that 34.8% of the 270 patients tested positive for HBV DNA using real-time PCR. Males had a slightly higher prevalence of HBV (34.5%) than females (35.1%). The highest prevalence was found in patients aged 21-40 years old (38.9%). When analyzing viral load levels, 50% of positive patients had a low viral load, 33% had an intermediate load, and 17% had a high viral load. Females were more likely to have a high viral load compared to males. The study provides
- The study assessed the knowledge and practices of nurses regarding post-exposure prophylaxis (PEP) of HIV at BPKIHS hospital in Nepal.
- It found that while most nurses had satisfactory knowledge of PEP, their practices regarding seeking care after exposure were less than ideal. Only around 15% sought healthcare after an exposure.
- The study concluded that while knowledge of PEP was high, practices needed improvement. It recommended further training and education to promote safer work practices among nurses.
Kathleen Brady - HIV in Philadelphia (Annual Epidemiological Presentation)Office of HIV Planning
On April 27, 2016, Kathleen Brady of the Philadelphia AIDS Activities Coordinating Office (AACO) presented her annual review of the HIV Epidemic in Philadelphia and the surrounding areas.
The UC San Diego AntiViral Research Center sponsors weekly presentations on infectious diseases research and clinical practices. A presentation on whether widespread HIV treatment can end transmission discussed recent trends showing HIV declining among adolescents and young adults in the US. The presentation reviewed research showing that early HIV treatment dramatically reduces heterosexual transmission but some transmission may still occur through anal sex among men who have sex with men on antiretroviral therapy. Future interventions could focus on optimizing HIV treatment, comparing antiretroviral regimens, and suppressing coinfections like CMV to further reduce HIV transmission.
This document summarizes a presentation on hepatitis C virus (HCV) epidemiology and screening recommendations. It discusses global and local HCV prevalence, the health impacts and economic costs of HCV infection, and the potential for HCV elimination with new direct-acting antiviral treatments. It also reviews evolving HCV screening guidelines and epidemiologic trends in the US, including increasing infections associated with opioid epidemics. Risk factors for HCV transmission are identified based on a study of HCV-positive blood donors.
Jill Blumenthal, MD
Assistant Professor of Medicine
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
El documento explica brevemente el concepto de streaming como la capacidad de escuchar música o ver videos en línea sin necesidad de descargarlos, transmitiéndolos secuencialmente a través de la red. Además, menciona algunos ejemplos populares de servicios de streaming como Spotify, YouTube y Last.fm.
Stephen Rawlings, MD, PhD
Clinical Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Daniel Lee, MD
Clinical Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This document summarizes a presentation on new and investigational antiretrovirals given at the UC San Diego HIV & Global Health Rounds. The presentation reviewed fostemsavir, cabotegravir/rilpivirine, leronlimab, islatravir, and lenacapavir. For each drug, the presenter discussed indications, dosing, efficacy and safety data from clinical trials, resistance profiles, and potential advantages and limitations. The goal of the HIV & Global Health Rounds is to provide clinicians and researchers with the most up-to-date information on HIV, hepatitis, tuberculosis, and other infectious diseases.
Maile Young Karris, MD
Associate Professor
Co-Director San Diego Center for AIDS Research Clinical Investigations Core
Divisions of Infectious Diseases & Global Public Health and Geriatrics & Gerontology
Department of Medicine
University of California San Diego
The document discusses the case of Timothy Ray Brown, known as the "Berlin Patient", who is considered the first person cured of HIV/AIDS. Brown was diagnosed with HIV in 1995 and later developed leukemia. In 2007, he received a stem cell transplant from a donor with a CCR5 mutation that provides resistance to HIV. Despite complications, the treatment eliminated both his cancer and HIV infection. Nearly eight years later, Brown remained free of detectable HIV. The document also mentions a second patient in London who received similar treatment and may have been cured of HIV, providing further evidence that stem cell transplantation can cure HIV infection in some cases.
PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"StopTb Italia
This document discusses the challenges of diagnosing HIV, AIDS, and co-infections. It notes that distinguishing between HIV infection, AIDS, and co-infections can be difficult. Point-of-care rapid tests have helped increase HIV testing, though they cannot identify acute HIV infections. The document emphasizes the importance of confirming positive rapid HIV tests with supplemental tests due to the potential for false positives in low prevalence populations.
The latest recommendations by WHO on HIV treatment--New GuidelinesSyriacus Buguzi
This document provides consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. It includes recommendations for a public health approach across the continuum of HIV care, from diagnosis to treatment to monitoring. The guidelines were developed by the World Health Organization and draw on the most recent evidence from multiple sources. They are intended to guide national HIV programs in providing optimal HIV treatment, care, and prevention.
This document provides guidelines for treating and preventing HIV infection in Kenya in 2016. It summarizes recommendations for HIV testing and linkage to care, initial evaluation and follow up of people living with HIV, the standard package of care including antiretroviral therapy and prevention services, adherence preparation and monitoring, antiretroviral therapy for infants/children/adults, prevention of mother-to-child transmission, and the use of antiretrovirals for pre-exposure prophylaxis. The guidelines are intended to help healthcare workers in Kenya provide comprehensive HIV prevention and treatment services in line with best practices.
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
Testing for Acute HIV and Early Initiation of ARTHopkinsCFAR
This document summarizes evidence from several studies on testing for acute HIV infection and initiating antiretroviral therapy (ART) on the same day as diagnosis. It discusses the optimal window for initiating ART after infection to restore immune function based on a study showing greater probability of achieving CD4 counts over 900 if starting ART within 4 months of infection. It also summarizes results from randomized controlled trials and observational studies demonstrating that rapid/same-day ART initiation improves linkage to care, ART initiation rates, and viral suppression compared to standard of care with initiation delayed by weeks or months.
Kathleen Brady from the Philadelphia Department of Public Health presented her annual updated on the HIV Epidemic in Philadelphia at a February 2015 combined meeting of the Philadelphia Ryan White Part A Planning Council and the HIV Prevention Planning Group.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Jens Lundgren, CHIP
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
This study investigated the seroprevalence of hepatitis B virus (HBV) infection in outpatients at a district hospital in Mardan, Pakistan. The study found that 34.8% of the 270 patients tested positive for HBV DNA using real-time PCR. Males had a slightly higher prevalence of HBV (34.5%) than females (35.1%). The highest prevalence was found in patients aged 21-40 years old (38.9%). When analyzing viral load levels, 50% of positive patients had a low viral load, 33% had an intermediate load, and 17% had a high viral load. Females were more likely to have a high viral load compared to males. The study provides
- The study assessed the knowledge and practices of nurses regarding post-exposure prophylaxis (PEP) of HIV at BPKIHS hospital in Nepal.
- It found that while most nurses had satisfactory knowledge of PEP, their practices regarding seeking care after exposure were less than ideal. Only around 15% sought healthcare after an exposure.
- The study concluded that while knowledge of PEP was high, practices needed improvement. It recommended further training and education to promote safer work practices among nurses.
Kathleen Brady - HIV in Philadelphia (Annual Epidemiological Presentation)Office of HIV Planning
On April 27, 2016, Kathleen Brady of the Philadelphia AIDS Activities Coordinating Office (AACO) presented her annual review of the HIV Epidemic in Philadelphia and the surrounding areas.
The UC San Diego AntiViral Research Center sponsors weekly presentations on infectious diseases research and clinical practices. A presentation on whether widespread HIV treatment can end transmission discussed recent trends showing HIV declining among adolescents and young adults in the US. The presentation reviewed research showing that early HIV treatment dramatically reduces heterosexual transmission but some transmission may still occur through anal sex among men who have sex with men on antiretroviral therapy. Future interventions could focus on optimizing HIV treatment, comparing antiretroviral regimens, and suppressing coinfections like CMV to further reduce HIV transmission.
This document summarizes a presentation on hepatitis C virus (HCV) epidemiology and screening recommendations. It discusses global and local HCV prevalence, the health impacts and economic costs of HCV infection, and the potential for HCV elimination with new direct-acting antiviral treatments. It also reviews evolving HCV screening guidelines and epidemiologic trends in the US, including increasing infections associated with opioid epidemics. Risk factors for HCV transmission are identified based on a study of HCV-positive blood donors.
Jill Blumenthal, MD
Assistant Professor of Medicine
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
El documento explica brevemente el concepto de streaming como la capacidad de escuchar música o ver videos en línea sin necesidad de descargarlos, transmitiéndolos secuencialmente a través de la red. Además, menciona algunos ejemplos populares de servicios de streaming como Spotify, YouTube y Last.fm.
This document promotes Gail Boring's writing coaching services and provides testimonials from educators who have worked with her. The testimonials praise Gail's expertise in helping schools improve writing scores on state assessments and develop strong writing programs. One principal notes that after working with Gail, their 4th grade students scored 100% on the state writing test as 7th graders, compared to the state average of 47%. Teachers also appreciate Gail's help in becoming better writing instructors and her ability to inspire students.
This document discusses privacy and security topics such as tracking cookies, private browsing, permissions management, and HTTPS. It explains how tools like Lightbeam and the Permissions Manager in Firefox can help with transparency and control over privacy. Private browsing is described as allowing browsing without saving history or other records. The importance of security and privacy online is stressed.
This short document discusses Google's relationship with third party brand hotels. It was written by Etienne Thomas and encourages sharing the presentation on Google's work with hotels through two website links. The document does not provide much other context or details about Google's third party relationships.
This document contains a detailed menu listing for vegetarian food options for an event. It includes categories for beverages, welcome sweets and snacks, salads, soups, sweets, starters/appetizers, breads, rice dishes, curries, pickles, desserts, fruits and more. Over 100 individual food items are listed under each category, providing guests with a wide variety of Indian and international veg meal and snack options.
- The document describes case studies of how various companies from different industries implemented ILANTUS EXPRESS password management and single sign-on products to reduce helpdesk calls and improve productivity.
- A leading infrastructure finance company in India saw a 20% reduction in password reset calls, freeing up approximately 300 calls per month after implementing ILANTUS Password Express.
- A large cement sheet manufacturer in India deployed ILANTUS Password Express for 500 users, allowing self-service password resets.
- A global BPO company with 20,000 users saw an 80% reduction in password reset calls within 1 month of implementing ILANTUS Password Express.
Sistem pencernaan makanan pada manusia dan hewan mamalia terdiri dari mulut, esofagus, lambung, usus halus, usus besar, hati, dan pankreas. Makanan dicerna dengan enzim pencernaan untuk menyerap nutrisi dan energi, sementara sisa makanan dikeluarkan sebagai feses. Gangguan pencernaan seperti ulkus, konstipasi, dan diare dapat terjadi akibat infeksi atau kekurangan zat gizi.
This document discusses various C++ basics including:
- Structured programming has advantages for building internal object structures and manipulating objects.
- Interpreters directly execute programs without compiling, used when programs are frequently updated. Compilers produce faster compiled versions.
- Escape sequences like \n control printers and are not printed.
- Namespaces like std avoid naming collisions between standard and custom libraries.
- Object-oriented programming has advantages like reduced errors from data encapsulation and isolation.
- The math.h library contains mathematical functions like pow, sqrt, cos.
- Function prototypes declare functions before use for type checking.
- Blocks declared with braces have their own scope and hiding rules.
- time(0
Evaluation of Anti-Retroviral Combination Therapy In Patients With HIV/Aids I...iosrphr_editor
This study evaluated the effectiveness of different combination antiretroviral therapy (ART) regimens in 100 HIV-positive patients who were injecting drug users in Indonesia. The study found that all ART combinations led to increases in CD4 count and body weight over 6-12 months. The most common side effect was nausea. Adherence to therapy was high, at 94%. While increases in CD4 count did not significantly differ between regimens, the combination of lamivudine, zidovudine and efavirenz had the highest treatment costs. The study concluded that combination ART is effective at improving immune function and health in HIV-positive injecting drug users.
current hiv situation in india and national aids control programme an overviewikramdr01
The document provides information about an orientation programme for doctors on the National AIDS Control Programme (NACO) in India. It will take place on December 26-27, 2013 at the Government Thiruvarur Medical College and Hospital in Thiruvarur, India. The programme will provide an overview of the current HIV situation in India, NACO's objectives and approaches, national guidelines for detecting HIV, and NACO's comprehensive HIV care and antiretroviral therapy (ART) services.
The document provides information on HIV/AIDS, including:
1. HIV was first identified in 1981 and there have been two major strains identified, HIV-1 and HIV-2.
2. HIV is transmitted through bodily fluids and can be transmitted sexually or through contact with infected blood.
3. There are three phases of HIV infection eventually resulting in AIDS if not treated. Antiretroviral treatment can suppress the virus and prevent AIDS.
India has seen a 57% reduction in its HIV count between 2001-2011, while Bangladesh and Sri Lanka saw increases of 25%. As of 2011, an estimated 2.1 million people in India were living with HIV. India's epidemic is heterogeneous and concentrated in certain states and sub-populations. Successful prevention efforts have led international figures to praise India's HIV/AIDS prevention model. However, more work remains as even a small increase in prevalence could mean over half a million new infections. The continuum of HIV care involves testing and counseling, treatment of opportunistic infections, anti-retroviral therapy initiation and monitoring, management of co-infections, and adherence support. WHO guidelines recommend treatment for all HIV-positive individuals
This document provides information on managing patients with AIDS. It discusses the introduction and global impact of HIV/AIDS. It then covers basic facts about HIV and AIDS, including causative agents, transmission, clinical staging, opportunistic infections, cancers, and complications. The remainder of the document outlines diagnosis, treatment, nursing management including common nursing diagnoses, and prevention of HIV/AIDS. It aims to inform on all aspects of caring for patients living with HIV/AIDS.
The document discusses anti-retroviral drug resistance in HIV. It notes that drug resistance is a major reason why HIV drugs stop being effective over time. It outlines steps India is taking to monitor and prevent drug resistance, including establishing a national committee on HIV drug resistance to develop surveillance strategies. Pilot sites for initial threshold surveys and drug resistance monitoring are proposed to provide initial data on transmission levels and resistance in patients on antiretroviral therapy.
An estimated 40-90% of patients acutely infected with HIV will experience flu-like symptoms, though acute HIV infection is often not recognized. Diagnosis involves testing for HIV antibodies and viral load, with differential diagnosis including infectious mononucleosis, influenza, and others. While treatment trials are limited, initiating antiretroviral therapy early in acute infection may theoretically decrease disease severity and progression by suppressing viral replication and mutation.
Современное лечение ВИЧ: новые парадигмы в АРТ / Contemporary Management of H...hivlifeinfo
Набор слайдов c рассмотрением важных вопросов об АРТ первого ряда, арв-препаратами пролонгированного действия и схемами АРТ с двумя препаратами, акцент в публикации на роль новых стратегий.
Can we end the HIV/AIDS epidemic? Josip begovacPinHealth
1) In 2013, 136,235 new HIV infections were diagnosed in Europe, with 79,728 infections in Russia alone.
2) The concept of "ending AIDS" refers to bringing the HIV epidemic under control through strategies like widespread antiretroviral treatment and prevention of onward transmission.
3) Studies have shown pre-exposure prophylaxis (PrEP) using antiretroviral drugs can reduce the risk of HIV transmission by over 80% when used consistently before and after exposure to the virus.
Trevor Hawkins, M.D., M.P.H. of the Univeristy of New Mexico and Southwest CARE Center, presents "Top Ten HIV Clinical Controversies 2014" at AIDS Clinical Rounds
Современное лечение ВИЧ: лечение многократно леченных пациентов с резистентно...hivlifeinfo
This document discusses management of HIV in heavily treatment-experienced patients with multiclass resistance and limited treatment options. It provides an overview of the problem, including that some older patients were treated early in the HIV epidemic with less potent regimens, resulting in resistance. Younger patients may have congenital HIV and been treated long-term. Assessment of virologic failure and resistance testing are important to select an effective new regimen. Current options for active drugs in these patients include maraviroc, ibalizumab, fostemsavir, and enfuvirtide, which have novel mechanisms of action. Adherence assessment is also critical to determine if the current regimen may still be effective if taken as prescribed.
Dr. Kathleen Brady (AACO)'s annual epidemiological update. This presentation was given to the Philadelphia EMA Ryan White Planning Council on Thursday, February 20, 2014.
This document discusses HIV/AIDS, including transmission, testing, treatment, and comprehensive care approaches. It provides details on:
- How HIV enters the body, common routes of transmission, and viral load in different body fluids.
- The stages of HIV infection and testing methods, including the window period and antibody response.
- Treatment options like HAART and the importance of early diagnosis and treatment.
- Components of comprehensive care including medical, psychological, and socioeconomic support, with an emphasis on prevention and respect for human rights.
The document summarizes a randomized trial comparing a public health approach to a standard clinical approach for delivering antiretroviral therapy in Cameroon. The trial aims to compare the increase in CD4 cell count and other outcomes between the two approaches. It describes the standard clinical approach as relying on biological exams and physicians, while the public health approach uses simplified criteria and involves other personnel like nurses. The trial design involves randomizing patients across 9 rural hospitals to receive antiretrovirals through either approach and following outcomes over 24 months. Baseline characteristics of the 459 enrolled patients are provided. Survival and treatment change outcomes over time are shown graphically. The discussion covers feasibility challenges and capacity building efforts, as well as relevance for
This document provides an overview of paediatric HIV/AIDS and challenges of management in Nigeria. It discusses the epidemiology of HIV globally and in Nigeria, where the disease burden is highest. It covers pathogenesis, transmission, clinical manifestations, diagnosis, treatment including antiretroviral therapy, and challenges in management. In Nigeria, paediatric HIV care began in 2004 and the strategic plan aims to scale up access to care, treatment and support for infected and exposed children. Management of paediatric HIV presents many challenges.
1) The patient presented with symptoms consistent with primary HIV infection including fever, rash, oral ulcers and lymphadenopathy. Testing confirmed HIV infection during the acute phase.
2) Treating primary HIV infection may lower viral setpoint and preserve immune function, reducing disease progression rates. However, the benefits are not proven and treatment can cause toxicities or resistance.
3) The patient was referred to a study evaluating immediate treatment versus deferred treatment during acute infection to help address unresolved issues around managing primary HIV.
The document discusses guidelines for initiating antiretroviral therapy (ART) in children with HIV. It recommends that all children under 12 months with confirmed HIV infection should start ART regardless of clinical stage or CD4 count. For children over 12 months, ART should be initiated for those with WHO Stage 3 or 4 disease or Stage 1 or 2 disease when the CD4 count is below the threshold for that age. The document also provides criteria for presumptively diagnosing severe HIV disease and starting ART in infants under 18 months when virologic testing is unavailable.
Socio-demographic Characteristics of Clients Visiting Integrated Counseling and Testing Centre (ICTC) at SMS Medical College, Jaipur (Rajasthan) India-Human immunodeficiency virus (HIV) infection is a global pandemic and India counts for 10% of the global HIV burden and 65% of that in the South and South-East Asia. This study of clients of ICTC was carried out to know the association of HIV positivity with socio-demographic variables. Total 2412 clients have visited at ICTC of SMS Medical College, Jaipur, either voluntarily or referred by various department of this institute in ICTC in 1st quarter of 2009. They Overall HIV positivity was found 12.35% with a significant difference in voluntary and referred clients i.e. 83.59% v/s 8.36%. It was also found that HIV positivity is more in reproductive age group than extremes of ages, more in females than males, more in person who were married but presently single because of separation of spouse, divorce form spouse or death of spouse than the unmarried or married living with their spouses.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. I. LATAR BELAKANG (1)
Indonesia adalah negara kepulauan yang luas dengan jumlah
penduduk 237 juta jiwa
Kasus HIV pertama di temukan pada tahun 1980 di bali
Peningkatan cepat terjadi tahun 1990-2010
Pada tahun 2010
3. I. LATAR BELAKANG (2)
• Penularan utama HIV:
sexual dan jarum suntik
(IDUs)
•ART scale up, dimulai
tahun 2004-2005,
•ART center: 182 sites di
123 districts dari 440 and
32 provinsi dari 33
• Kemenkes RI Inisiasi
National Working Group on
HIV-DR tahun 2005
•Kegiatan utama
Monitoring ARV
drug resistances:
• Early Warning
Indicators (EWI)
monitoring
• HIV-DR Surveys
• HIV-DR
Surveillans
4. I. LATAR BELAKANG (3)
Tingkat resistensi HIV DR <5% adalah rendah
dibandingkan di Eropa (10% - 20% ) dan USA (17% ).
10% dari pasien dengan viral loads>1000 c/ml, 2/3nya
menunjukkan resistensi terhadap salah satu jenis ARV
di negara berkembang.
Dari tahun 2006-2010 telah dilakukan 102 surveys EWI
di 52 negara dan menujukkan adanya adherence, drug
stock-out, and lost to follow-up yang problematik dan
membutuhkan perhatian serta monitoring yang terus
menerus.
5. ELEMEN HIV DR DI INDONESIA DAN
PERKEMBANGANNYA (SEBELUM 2013)
Working
Group
HIV DR TS
EWIs
HIV DR
Monitoring
HIV DR
laboratory
6. 1. EWIS INDICATORS (SEBELUM 2013)
indicators used in indonesia:
1. Prescribing practices (target:100%)
2. % lost to follow-up (target: ≤ 20%)
3. Patient retention on first-line ART (≥
70%)
4. On-time ARV Drug pick up (>90%)
5. ART appointment-keeping (>80%)
6. Drug Supply Continuity (target:
>80%)
7. Patient Adherence to ART
8. Viral Load
8. WHO HIV Drug Resistance Surveillance
andSeSesudah 2012 Monitoring Strategy
2012
Monitoring of
HIVDR Early
Warning
Indicators
Surveillance of
Transmitted HIVDR in
Recently Infected
Populations
Surveillance of pre-
treatment HIVDR
in Populations
Initiating ART
Surveillance of
Acquired HIVDR in
Populations Receiving
First-Line ART
Surveillance of
HIVDR in Children
<18 months of Age
9. 3 CATEGORIES OF HIVDR RELEVANT TO
PUBLIC HEALTH
Acquired HIVDR (ADR): occurs when mutations are selected for
by ARV drugs in populations receiving ART
• Suboptimal drug combinations or adherence, treatment
interruptions
Transmitted HIVDR (TDR): occurs when previously uninfected
populations are infected with drug-resistant virus (appropriately
measured in recently infected populations)
Pre-Treatment HIVDR (PDR): detected in individuals starting ART
in which HIVDR can be either transmitted or acquired (previous
ARVs: treatment, PMTCT, PrEP/PEP etc.)
10. WHO HIVDR SURVEILLANCE IN A NUTSHELL:
POPULATIONS AND PUBLIC HEALTH RELEVANCE
Population
Public Health
Relevance
Programatic
assessment
(ART clinic
level)
1. Early Warning
Indicators
Adults and children on
ART
Identifies clinic level
weaknesses allowing
corrective action
(National
Level)
2. Pre-treatment
HIVDR (PDR)
Adults initiating 1st-
line ART
1st-line, Prep, PEP,
regimen selection
3. Acquired HIVDR
(ADR)
Adults on ART for
12(±3) and ≥48 months
2nd-line (and beyond)
regimen selection
4. HIVDR in infants
<18 months
Infants <18 months,
ART naive & recently
diagnosed with HIV
1st-line paediatric
regimen selection
5. Transmitted HIVDR
(TDR)
ARV-naïve recently
infected adults
Monitor level of transmission
of HIVDR;
Inform on programme
quality (indirect indicator)
and future first-line
HIVDR
Survey
11. 2012 REVISED EWI INDICATOR PACKAGE
Early Warning Indicator Target
1. On-time pill pick-up Red: <80%
Amber: 80–90%
Green: >90%
2. Retention in care * Red: <75% retained after 12 months of ART
Amber: 75–85% retained after 12 months of ART
Green: >85% retained after 12 months of ART
3. Pharmacy stock-outs Red: <100% of a 12-month period with no stock-outs
Green: 100% of a 12-month period with no stock-outs
4. Dispensing practices Red: >0% dispensing of mono- or dual therapy
Green: 0% dispensing of mono- or dual therapy
5. Viral load suppression
at 12 months #dfg
Red: <70% viral load suppression after 12 months of ART
Amber: 70–85% viral load suppression after 12 months of ART
Green: >85% viral load suppression after 12 months of ART
* Retention in care definition equal to UNGASS #24 and PEPFAR #T1.3.D; #Targets for virological
suppression in children <2 years old; Red <60%; Amber 60–70%; Green >70%
13. 1. EWIS INDICATORS
Lokasi: Pilot di 5 ART sites di DKI Jakarta
Sudah dilatih 17 ART Sites di 6 Provinsi di Indonesia
Tahun 2013-201 dilatih 22 provinsi dengan cara pelatihan TOT
15. 2. HIV-DR TRESHOLD SURVEY
RESULTS 2007 AT JAKARTA AND 2013 AT
BALI
Prevalensi ARV Resistansi< 5 % (2
atau kurang (+) diantara 47 sampel)
di Jakarta 2007
Prevalensi ARV resistensi <5% di
Bali 2013
16. 3. HIV-DR MONITORING SURVEY
Data Collection : 23 Sept 2008 to 31 July
2009 (Cohort 12 months): Eligible sample: 165
persons
Retention rate: 78%
Kepatuhan minum obat: 60-70%
Monitoring Survey at RSHS Bandung and RS Dr.
Soetomo sdg dalam analysis
17. 4. HIV DR NATIONAL LABORATORY
Microbiology Department of UI as national lab
for HIV-DR
BSL2 and BSL3 available
Sequencer was available (Funded by Global
Fund) in Oct 2009
HIVDR Genotyping Assay: Virosec and
inhouse genotyping
Planned to be WHO accredited next year
2016...
19. 1. EWIS
• Tahun 2015-2018 dilatih 34 provinsi
dengan cara pelatihan TOT dan provinsi
melatih kabupaten (refreshing)
• Supervisi dan peran provinsi dalam
EWIs monitoring ditingkatkan
20. 2. HIV DR MONITORING DAN SURVEY
• PDR tahun 2016 seluruh Indonesia
• ADR tahun 2017 seluruh Indonesia
21. 3. HIV DR GENOTYPING LABORATORY
Departemen Mikrobiologi sbg laboratorium
yang terakreditasi WHO sebagai national
HIVDR reference laboratory 2016
in 2012, dan Pengembangan laboratory
for genotyping dalam rangka mencakup
pelayanan wilayah timur Indonesia
setelah akreditasi WHO
22.
23. HIV IN INDONESIA
UNAIDS (2009):
HIV/AIDS in Indonesia is one of Asia’s fastest growing
epidemics
Sharp increase in the number of People Living with
HIV/AIDS (PLHA) :
7,195 (2006) 76,879 (2011)
24. HIV Prevalence in 15-49 years of age (%)
Number of People Living with HIV/AIDS
25. PERBANDINGAN JUMLAH ORANG DENGAN HIV-
AIDS DENGAN TOTAL PENGELUARAN UNTUK
INFEKSI HIV-AIDS
0
2
4
6
8
10
12
2006 2010 2011
PLH
Cost
Linear (PLH)
Linear (Cost)
27. “State of the Art”
Management of HIV infection
• Decrease in “Viral Load”
• Increase in the number of CD4+ T-
Cells
28. VIRAL LOAD AND HIV INFECTION
CONTROL AND PREVENTION
INCREASE IN VIRAL LOAD IN HIV INFECTED
INDIVIDUALS INCREASED RATE OF
TRANSMISSION
ADMINISTRATION OF HAART DECREASE OF
VIRAL LOAD
29. ANTIRETROVIRAL THERAPY
Decrease the replication of “wild type” virus that is
more sensitive to therapy
Strain that is less sensitive to antiretroviral
treatment will continue to develop
Under selection pressure of antiretroviral treatment
resistant virus will replicate become dominant
strain in infected person reduced efficacy of
antiretroviral treatment
30. ANTIRETROVIRAL RESISTANCE
High mutation rates of HIV:
Emergence of Antiretroviral Resistance
Primary transmission of antiretroviral drug resistant
virus Occurence of Anti HIV resistance prior to
initiation of therapy
31. SELECTIVE PRESSURES OF THERAPY
Selection of resistant
quasispecies
Incomplete suppression
• Inadequate potency
• Inadequate drug levels
• Inadequate adherence
• Pre-existing resistance
Viralload
Time
Drug-susceptible quasispecies
Drug-resistant quasispecies
Treatment begins
http://clinicaloptions.com
32. Antiretroviral resistance testing
• Phenotypic
• Based on viral ability to replicate in cell culture in the presence of
antireretroviral drug
• Easy to understand
• Time consuming, expensive, complicated, less sensitive, only
available in very few laboratories
• Genotypic Assay
• More available, more widely used, rapid, predictive,
semiquantitative, less complicated
• The result is not easy to interprete, the detection capacity is
limited, expensive, requires special expertise
• Have been performed under routine Quality Assurance Program
(Treat Asia Quality Assurance Scheme) at the Department of
Microbiology, Faculty of Medicine, University of Indonesia/
IHVCB-UI
33. Distribution of drug resistance mutations
within the HIV 1 protease and RT genes
34. ANTIRETROVIRAL RESISTANCE TEST
Patient population that are under treatment by
physician with access to resistance data
(particularly genotypic) have a better response
compared with control population treated by
physician without resistance data.
Anti HIV Resistance test is recommended in
anti-HIV treatment : EXPENSIVE!!
35. HIV's high mutation rate and the need for lifelong
treatment The emergence of HIVDR is
inevitable
In countries with years of ART experience,
a high percentage of treated individuals have resistant HIV,
and
transmitted resistance to some drugs and drug classes is
reported in 5%-20% of newly infected drug naïve persons
36. Study n Definition Year Prevalence
CATCH1 596 Clinical 1996-2002 10%
CDC2 182 STARHS* 1997-2001 12%
San Francisco3 180 < 1 year 2000-2002 26%
North Carolina4 30 < 30 days 1998-2003 13%
Canada†5 144 STARHS* 1997-2001 10%
Montreal6 170 < 1 year 1996-2003 12%
France7 296 < 6 months 2001-2002 11%
UK8 157 < 18 months 1996-2003 17%
Madrid9 74 < 1 year 1997-2002 19%
Switzerland10 453 < 1 year 1996-2002 11%
1, Resistance Workshop 2003, Abstract 117, 2, Ibid, Abstract 119, 3, Ibid, Abstract 120, 4, CROI, 2004,
Abstract 682, 5, Resistance Workshop 2003, Abstract 121, 6, Ibid, Abstract 122, 7, Ibid, Abstract 123,
8, Ibid, Abstract 124, 9, Ibid, Abstract 130, 10, CROI, 2004, Abstract 680,
* STARHS : Serologic Testing Algorithm for Recent HIV Seroconversions; † surveillance data
PREVALENCE OF HIVDR IN PERSONS WITH ACUTE
PRIMARY INFECTION
40. HIV-DR TRESHOLD SURVEY IN INDONESIA
Period of Survey : Oct 2006 – Aug 2007
Sample: 47 samples
Criteria (inclusion & exclusion) :
IDU, HIV (+), age < 21, Asymptomatic, Not
under Antiretroviral Therapy
ARV Resistance Prevalence (Primary
Transmission):
< 5 % (2 or less resistance out of 47 samples)
(WHO protocol, binomial sequential sampling
technique)
41. HIV-DR MONITORING SURVEY IN INDONESIA
Location : Piloting in Prof.Sulianti Saroso Hospital in
Jakarta
Survey Design : Cohort
Criteria inclusion: PLHA, > 15 years old, initiated an
adult first-line ART regimen at the site
Data Collection done among 110 cohort
42. HIV-DR MONITORING SURVEY IN INDONESIA
Data Collection : 23 Sept 2008 to 31 July 2009
(Cohort 12 months)
Number sample included into study (voluntary)
(Baseline): 110 persons
Number of sample tested for viral load at baseline
(pretreatment): 110 persons
Number of sample tested for viral load at endline (post-
treatment): 68 persons
43. VIRAL LOAD VALUE AND GENOTYPING OF
POST TREATMENT SAMPLES (N = 68)
35 undetectable Viral Load
33 Detectable Viral Load
23 samples could not be amplified for Genotyping:
Genotyping sensitivity : viral load of > 1000 copies/mL
18 samples: 100 – 1000 copies/mL
4 samples : > 1000 and < 10000 copies/mL
1 sample : > 10000 copies/mL
10 samples could be amplified for Genotyping:
2 samples with VL < 500 copies/mL
3 samples with VL >1000 and <10000 copies/mL
1 samples with VL > 10000 and < 100000 copies/mL
4 samples with VL > 100000 and < 1000000 copies/mL
44. HIV DRUG RESISTANCE IN PRE-TREATMENT
SAMPLES, N=110 (INITIAL RESULT OF HIV-DR
MONITORING SURVEY IN INDONESIA)
Resistance to Protease Inhibitors (PI): 1.8% (2/110)
V11IV, L33F
1 patient
Low-level resistance to fosamprenavir/r (FPV/r)
Potential low-level resistance to tipranavir/r (TPV/r)
L33F :
1 patient
Potential low-level resistance to fosamprenavir/r (FPV/r)
Potential low-level resistance to tipranavir/r (TPV/r)
45. HIV DRUG RESISTANCE IN POST TREATMENT
SAMPLES, N= 68 (INITIAL RESULT OF HIV-DR
MONITORING SURVEY IN INDONESIA)
Only 10 samples could be tested for HIVDR genotyping
out of 68 endline samples (low to undetectable viral
load in samples that could not be tested)
Resistance to Protease Inhibitors (PI):
L33F
1 patient (was found with low level resistance to FPV/r in pre treatment
specimen)
Potential low-level resistance to fosamprenavir/r (FPV/r)
Potential low-level resistance to tipranavir/r (TPV/r)
46. PROTEASE INHIBITOR RESISTANCE IN PRE AND POST
TREATMENT SAMPLES
0
0.5
1
1.5
2
2.5
Pre-treatment Post-treatment
L33F (LLR FPV/r, PLLR TPV/r)
L33F (LLR FPV/r, PLLR
TPV/r)
(initial result of HIV-DR Monitoring Survey in Indonesia)
48. HIV DRUG RESISTANCE IN POST-TREATMENT
SAMPLES, N=110 (INITIAL RESULT OF HIV-DR
MONITORING SURVEY IN INDONESIA)
Resistance to Nucleot(s)ide Reverse Transcriptase Inhibitors
(NRTIs):
Potential low level resistance (PLR) , Low Level Resistance (LR) ,
Intermediate Resistance (IR), High Level Resistance (HR)
Lamivudine (3TC) : 1 IR, 6 HR
Zidovudine (AZT): 1 HR
Stavudine (D4T) : 2 LR, 2 IR
Didanosine (DDI) : 1 PLR, 3 IR
Tenofovir (TDF) : 1 LR, 1 IR
49. NRTI Resistance in Pre and Post treatment
samples
Potential low level resistance (PLR), Low Level Resistance (LLR) , Intermediate Resistance (IR), High Level Resistance (HR):
50. HIV DRUG RESISTANCE IN PRE-TREATMENT
SAMPLES, N=110 (INITIAL RESULT OF HIV-DR
MONITORING SURVEY IN INDONESIA)
Resistance to Non-Nucleot(s)ide Reverse Transcriptase
Inhibitors (nNRTIs): 3.6% (4/110)
Potential low level resistance (PLR) , Low Level Resistance
(LLR), Intermediate Resistance(I R), High Level Resistance (HR):
Efavirenz (EFV): 4/110 (1PLR, 1 LR, 1IR, 1 HR)
Nevirapine (NVP) : 4/110 (1 PLR, 1LR, 2 HR)
51. HIV DRUG RESISTANCE IN POST-TREATMENT
SAMPLES, N=110 (INITIAL RESULT OF HIV-DR
MONITORING SURVEY IN INDONESIA)
Resistance to Non-Nucleot(s)ide Reverse Transcriptase
Inhibitors (nNRTIs):
Potential low level resistance (PLR) , Low Level Resistance
(LLR), Intermediate Resistance(I R), High Level Resistance (HR):
Efavirenz (EFV): 1 LR, 1 IR, 5 HR
Nevirapine (NVP) : 7 HR
52. NNRTI RESISTANCE IN PRE AND POST
TREATMENT SAMPLES
Potential low level resistance (PLR), Low Level Resistance (LLR) , Intermediate Resistance (IR), High Level Resistance (HR):
53. SUMMARY AND CONCLUSION
The prevalence of antiretroviral resistance was low in antiretroviral naive patients
possibly indicating the low coverage of ART in People Living with HIV/AIDS
Resistance NRTIs and nNRTIs drugs was found in respectively 9.7% and 3.6% of
pre-treatment cohort in HIVDR monitoring survey (23 Sept 2008 to 31 July
2009) at Sulianti Saroso Hospital, Jakarta)
No resistance against the Protease inhibitors used in the HAART regimen in
Indonesia (lopinavir+ritonavir) was observed
High Level Resistance resistance against Efavirenz and Nevirapine was observed
in pre treatment samples
Increased resistance to antiretroviral drugs occurs after treatment
Unique features in the development of antiretroviral resistance may be observed
in Indonesia, due to HIV-1 evolution and host genetics specific to the country
More economical HIV drug resistance test should be developed for increased
identification of HIV drug resistance in people with HIV/AIDS under
antiretroviral therapy