Edward Lalo Cachay, M.D., M.A.S., of UC San Diego Owen Clinic, presents "A Decade of Treating HCV in Patients with Ongoing Barriers to Care" at AIDS Clinical Rounds
David L. Wyles, M.D., of UCSD, presents "On again, off again... on again? Resistance testing for the management of HCV infection" at AIDS Clinical Rounds
Jill Blumenthal, M.D., of UC San Diego, presents "ADDIS-VP: Screening of TB, HIV and Syphilis in an Ethiopian Prison Addis Ababa" at AIDS Clinical Rounds
The UC San Diego AntiViral Research Center sponsors weekly presentations providing the most current research, clinical practices, and trends in HIV, HBV, HCV, TB and other infectious diseases. The slides from an upcoming AIDS Clinical Rounds presentation are intended for educational purposes of the audience and may not be used without the presenter's permission.
Richard Haubrich, M.D., and David Wyles, M.D. of UC San Diego Antiviral Research Center, presents "Update from the American Association for the Study of Liver Diseases Meeting" at AIDS Clinical Rounds
The UC San Diego AntiViral Research Center sponsors weekly presentations on infectious diseases like HIV, HBV, HCV and TB. The goal is to provide current research, clinical practices and trends. This presentation is from their AIDS Clinical Rounds series and the slides are intended for educational purposes of the audience and may not be used without permission. The presentation is about risk and trauma in the lives of women living with HIV, including their experiences with diagnosis, relationships, and cultural invisibility within the HIV epidemic.
Edward Lalo Cachay, M.D., M.A.S., of UC San Diego Owen Clinic, presents "A Decade of Treating HCV in Patients with Ongoing Barriers to Care" at AIDS Clinical Rounds
David L. Wyles, M.D., of UCSD, presents "On again, off again... on again? Resistance testing for the management of HCV infection" at AIDS Clinical Rounds
Jill Blumenthal, M.D., of UC San Diego, presents "ADDIS-VP: Screening of TB, HIV and Syphilis in an Ethiopian Prison Addis Ababa" at AIDS Clinical Rounds
The UC San Diego AntiViral Research Center sponsors weekly presentations providing the most current research, clinical practices, and trends in HIV, HBV, HCV, TB and other infectious diseases. The slides from an upcoming AIDS Clinical Rounds presentation are intended for educational purposes of the audience and may not be used without the presenter's permission.
Richard Haubrich, M.D., and David Wyles, M.D. of UC San Diego Antiviral Research Center, presents "Update from the American Association for the Study of Liver Diseases Meeting" at AIDS Clinical Rounds
The UC San Diego AntiViral Research Center sponsors weekly presentations on infectious diseases like HIV, HBV, HCV and TB. The goal is to provide current research, clinical practices and trends. This presentation is from their AIDS Clinical Rounds series and the slides are intended for educational purposes of the audience and may not be used without permission. The presentation is about risk and trauma in the lives of women living with HIV, including their experiences with diagnosis, relationships, and cultural invisibility within the HIV epidemic.
The document summarizes a presentation on neurocognitive complications of HIV disease. The presentation was given at the UC San Diego AntiViral Research Center, which sponsors weekly presentations on infectious diseases research. The goal is to provide current research, clinical practices, and trends in diseases like HIV, HBV, HCV, and TB. The slides from this particular presentation on neurocognitive complications of HIV are intended for educational purposes of the audience and may not be used for other purposes without permission.
- The document summarizes potential harms of HIV self-testing, including false negatives during the window period, delays in diagnosis and linkage to care, and decreased condom use during point-of-sex testing.
- A transmission model found that replacing clinic tests with self-tests could increase HIV prevalence up to 31.4%, depending on reductions in linkage to care.
- Additional studies are needed to fully assess harms and benefits of self-testing in real-world settings and determine how to mitigate identified risks.
High SVR rates in HCV/HIV-1 co-infected patients regardless of baseline chara...Илья Антипин
Wyles D и др. «High SVR rates in HCV/HIV-1 co-infected patients regardless of baseline characteristics» 8th IAS Conference on HIV Pathogenesis, Treatment, and Prevention, Vancouver, 2015. TUAB0203.
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 a study that tested over 2,000 patients for hepatitis C virus (HCV) at a primary care clinic in Washington D.C. between 2012-2015. The study found a HCV prevalence of 7.5%, higher than national rates. Non-Hispanic black males had the highest prevalence at 12.8%. While linkage to care for HCV-positive patients was strong, overall testing uptake remained low at 24% despite efforts to encourage more screening. Barriers to increased screening need to be addressed to improve identification of undiagnosed cases.
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
The presentation discusses a case of a 60-year-old HIV-positive man with a painful enlarging scrotal lesion. He has a history of recurrent genital HSV infections that developed into resistant hypertrophic lesions. The presentation reviews the patient's medical history and treatments tried, discusses hypertrophic HSV in HIV patients more broadly, and concludes that topical imiquimod may be an effective treatment for resistant cases.
Using HIV Surveillance Data to Evaluate Outcomes of Site Randomized Intervent...CDC NPIN
The document describes the design of the HPTN 065 study which tested the efficacy of financial incentives to improve linkage to care and viral suppression outcomes across HIV testing and care sites in the Bronx, New York and Washington D.C. using aggregate HIV surveillance data from local health departments. The study involved randomizing sites to either receive financial incentives or standard of care and then measuring aggregate linkage to care and viral suppression outcomes using surveillance data to compare the two study arms.
The views expressed in the presentations are that of the author and do not necessarily reflect the views of the Government of Canada. Presentations are shared in the original format received from the presenter.
Presentations given at the Conference to Develop a Federal Framework on Lyme Disease are the property of the author, unless otherwise cited. If you reference the author's work, you must give the author credit by naming the author and their work as well as the place and date it was presented.
For more information, contact the Lyme Disease Conference Secretariat at maladie_lyme_disease@phac-aspc.gc.ca
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
This editorial commentary discusses a study that assessed the impact of provider expertise on quality of HIV care. The study found that patients treated by providers with low HIV patient volumes (<20 patients) had poorer outcomes compared to patients treated by more experienced providers. While HIV treatment has improved, making the disease potentially manageable by generalists, this study suggests that HIV infection should still be considered a disease best managed or co-managed by experts, due to the importance of maintaining high quality care.
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 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.
The document discusses HIV epidemiology in Saskatchewan, highlighting that the province has seen a rapid increase in new HIV cases and now has the highest rates in Canada. It summarizes Saskatchewan's 2010-2013 HIV Strategy, which aims to reduce new infections and improve quality of life for those living with HIV through improved surveillance, clinical management, prevention, and harm reduction programs. The strategy goals include earlier detection of cases, decreasing new infections and sexually transmitted infections, and increasing access to testing, care, and prevention services.
Presentation by Daniel Raymond, the Harm Reduction Coalition's Policy Director, to the Institute of Medicine's Committee on Prevention and Control of Viral Hepatitis Infections on March 3, 2009.
Public Health HIV/STD Control in the US in the Era of TASP: 90-90-90 and Beyond
Matthew Golden, MD, MPH
February 2nd, 2018
UCSD HIV & Global Health Rounds
Global Medical Cures™ | HIV TESTING IN USA
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
The views expressed in the presentations are that of the author and do not necessarily reflect the views of the Government of Canada. Presentations are shared in the original format received from the presenter.
Presentations given at the Conference to Develop a Federal Framework on Lyme Disease are the property of the author, unless otherwise cited. If you reference the author's work, you must give the author credit by naming the author and their work as well as the place and date it was presented.
For more information, contact the Lyme Disease Conference Secretariat at maladie_lyme_disease@phac-aspc.gc.ca
Global Health Intervention Review: Making Global Health Data Accessible to Po...tombesam
The Global Health Intervention Review (GHIR) aims to make global health data accessible to policymakers by distilling evidence from systematic reviews into concise summaries of key intervention effects for various health conditions, including relative risk reductions, strength of evidence, and limitations; phase 1 focused on summarizing intervention efficacy for 10 health conditions like diarrhea, HIV, and malaria; phase 2 will explore effectiveness, burden reduction, and cost-effectiveness to better inform policy and funding decisions.
Edward Cachay, MD, MAS
Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Pharmacy Essentials for HIV Screening and Management.2019hivlifeinfo
Pharmacy Essentials for HIV Screening and Management
This downloadable slideset provides an in-depth review of key pharmacy strategies for expanding and supporting safe and effective HIV screening and treatment services to patients at risk of or living with HIV infection.
Jennifer Cocohoba Headshot
Jennifer Cocohoba, PharmD
Format: Microsoft PowerPoint (.ppt)
File Size: 1.93 MB
Released: January 31, 2019
The document summarizes a presentation on neurocognitive complications of HIV disease. The presentation was given at the UC San Diego AntiViral Research Center, which sponsors weekly presentations on infectious diseases research. The goal is to provide current research, clinical practices, and trends in diseases like HIV, HBV, HCV, and TB. The slides from this particular presentation on neurocognitive complications of HIV are intended for educational purposes of the audience and may not be used for other purposes without permission.
- The document summarizes potential harms of HIV self-testing, including false negatives during the window period, delays in diagnosis and linkage to care, and decreased condom use during point-of-sex testing.
- A transmission model found that replacing clinic tests with self-tests could increase HIV prevalence up to 31.4%, depending on reductions in linkage to care.
- Additional studies are needed to fully assess harms and benefits of self-testing in real-world settings and determine how to mitigate identified risks.
High SVR rates in HCV/HIV-1 co-infected patients regardless of baseline chara...Илья Антипин
Wyles D и др. «High SVR rates in HCV/HIV-1 co-infected patients regardless of baseline characteristics» 8th IAS Conference on HIV Pathogenesis, Treatment, and Prevention, Vancouver, 2015. TUAB0203.
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 a study that tested over 2,000 patients for hepatitis C virus (HCV) at a primary care clinic in Washington D.C. between 2012-2015. The study found a HCV prevalence of 7.5%, higher than national rates. Non-Hispanic black males had the highest prevalence at 12.8%. While linkage to care for HCV-positive patients was strong, overall testing uptake remained low at 24% despite efforts to encourage more screening. Barriers to increased screening need to be addressed to improve identification of undiagnosed cases.
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
The presentation discusses a case of a 60-year-old HIV-positive man with a painful enlarging scrotal lesion. He has a history of recurrent genital HSV infections that developed into resistant hypertrophic lesions. The presentation reviews the patient's medical history and treatments tried, discusses hypertrophic HSV in HIV patients more broadly, and concludes that topical imiquimod may be an effective treatment for resistant cases.
Using HIV Surveillance Data to Evaluate Outcomes of Site Randomized Intervent...CDC NPIN
The document describes the design of the HPTN 065 study which tested the efficacy of financial incentives to improve linkage to care and viral suppression outcomes across HIV testing and care sites in the Bronx, New York and Washington D.C. using aggregate HIV surveillance data from local health departments. The study involved randomizing sites to either receive financial incentives or standard of care and then measuring aggregate linkage to care and viral suppression outcomes using surveillance data to compare the two study arms.
The views expressed in the presentations are that of the author and do not necessarily reflect the views of the Government of Canada. Presentations are shared in the original format received from the presenter.
Presentations given at the Conference to Develop a Federal Framework on Lyme Disease are the property of the author, unless otherwise cited. If you reference the author's work, you must give the author credit by naming the author and their work as well as the place and date it was presented.
For more information, contact the Lyme Disease Conference Secretariat at maladie_lyme_disease@phac-aspc.gc.ca
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
This editorial commentary discusses a study that assessed the impact of provider expertise on quality of HIV care. The study found that patients treated by providers with low HIV patient volumes (<20 patients) had poorer outcomes compared to patients treated by more experienced providers. While HIV treatment has improved, making the disease potentially manageable by generalists, this study suggests that HIV infection should still be considered a disease best managed or co-managed by experts, due to the importance of maintaining high quality care.
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 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.
The document discusses HIV epidemiology in Saskatchewan, highlighting that the province has seen a rapid increase in new HIV cases and now has the highest rates in Canada. It summarizes Saskatchewan's 2010-2013 HIV Strategy, which aims to reduce new infections and improve quality of life for those living with HIV through improved surveillance, clinical management, prevention, and harm reduction programs. The strategy goals include earlier detection of cases, decreasing new infections and sexually transmitted infections, and increasing access to testing, care, and prevention services.
Presentation by Daniel Raymond, the Harm Reduction Coalition's Policy Director, to the Institute of Medicine's Committee on Prevention and Control of Viral Hepatitis Infections on March 3, 2009.
Public Health HIV/STD Control in the US in the Era of TASP: 90-90-90 and Beyond
Matthew Golden, MD, MPH
February 2nd, 2018
UCSD HIV & Global Health Rounds
Global Medical Cures™ | HIV TESTING IN USA
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
The views expressed in the presentations are that of the author and do not necessarily reflect the views of the Government of Canada. Presentations are shared in the original format received from the presenter.
Presentations given at the Conference to Develop a Federal Framework on Lyme Disease are the property of the author, unless otherwise cited. If you reference the author's work, you must give the author credit by naming the author and their work as well as the place and date it was presented.
For more information, contact the Lyme Disease Conference Secretariat at maladie_lyme_disease@phac-aspc.gc.ca
Global Health Intervention Review: Making Global Health Data Accessible to Po...tombesam
The Global Health Intervention Review (GHIR) aims to make global health data accessible to policymakers by distilling evidence from systematic reviews into concise summaries of key intervention effects for various health conditions, including relative risk reductions, strength of evidence, and limitations; phase 1 focused on summarizing intervention efficacy for 10 health conditions like diarrhea, HIV, and malaria; phase 2 will explore effectiveness, burden reduction, and cost-effectiveness to better inform policy and funding decisions.
Edward Cachay, MD, MAS
Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Pharmacy Essentials for HIV Screening and Management.2019hivlifeinfo
Pharmacy Essentials for HIV Screening and Management
This downloadable slideset provides an in-depth review of key pharmacy strategies for expanding and supporting safe and effective HIV screening and treatment services to patients at risk of or living with HIV infection.
Jennifer Cocohoba Headshot
Jennifer Cocohoba, PharmD
Format: Microsoft PowerPoint (.ppt)
File Size: 1.93 MB
Released: January 31, 2019
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
This document summarizes Julio Montaner's presentation on expanding access to HAART (Highly Active Antiretroviral Therapy) to curb the spread of HIV/AIDS. The presentation discusses evidence that HAART can reduce HIV transmission through several mechanisms, including lowering viral loads at the individual and population levels. It also outlines a proposal to evaluate the impact of expanding HAART access according to 2008 guidelines on HIV incidence among injection drug users in British Columbia. The proposal aims to characterize changes in HIV incidence resulting from increased HAART use while addressing various challenges to expanding treatment for prevention purposes.
This document summarizes key issues discussed at a consensus conference on product safety in 2018. It covers:
1) Selection and screening processes in the aftermath of relaxing donor deferral policies for men who have sex with men.
2) Emerging viruses like Zika and transmissible spongiform encephalopathies like variant Creutzfeldt-Jakob disease.
3) Studies showing blood infectivity in variant Creutzfeldt-Jakob disease but not sporadic Creutzfeldt-Jakob disease patients.
The 18th International AIDS Conference (AIDS 2010)Abhishek Shah
The document summarizes key findings from the 18th International AIDS Conference held in Vienna, Austria in July 2010. Some of the main topics discussed include:
- The Vienna Declaration calling for decriminalization of drug use and scaling up HIV prevention and treatment services.
- Studies showing reduced HIV risk with male circumcision and use of tenofovir gel.
- Ongoing PrEP trials evaluating daily oral tenofovir for HIV prevention.
- Modeling suggesting universal HIV testing and treatment could reduce new infections and deaths in South Africa over 40 years.
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.
In this downloadable slideset, Joel E. Gallant, MD, MPH, reviews the evidence behind the latest antiretroviral guidelines and offers a glimpse at upcoming agents currently under investigation.
Format: Microsoft PowerPoint (.ppt)
File size: 3.00 MB
Date posted: 6/15/2015
In this downloadable slideset, Joel E. Gallant, MD, MPH, reviews the evidence behind the latest antiretroviral guidelines and offers a glimpse at upcoming agents currently under investigation.
Format: Microsoft PowerPoint (.ppt)
File size: 3.00 MB
Date posted: 6/15/2015
Update on HIV Prevention Issues Presented at 2016 CROI
Helen King MD
Jill Blumenthal MD
Susannah Graves MD
May 13, 2016
UCSD HIV & Global Health Rounds
Christian B. Ramers, M.D., M.P.H., of Family Health Centers of San Diego, presents "The HCV Treatment Revolution: A View from the Community Health Center" for AIDS Clinical Rounds at UC San Diego
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Valerie Delpech, Public Health Engand
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.
Clinical Impact of New Data From AIDS 2018hivlifeinfo
Clinical Impact of New Data From AIDS 2018
July 23-27, 2018; Amsterdam, The Netherlands
Expert faculty members summarize key studies from this important annual conference.
The document summarizes a presentation about HIV/HCV co-infection given by Dr. Susanna Naggie. It discusses the case of a 34-year-old man with HIV/HCV co-infection and cirrhosis. It reviews the accelerated progression of liver disease seen in HIV/HCV patients and potential mechanisms including the role of hedgehog signaling and immune activation. Treatment options for co-infected patients have advanced significantly in recent years with highly effective all-oral regimens that achieve cure rates over 90% with minimal side effects.
Clinical Impact of New Data From AIDS 2020hivlifeinfo
current ART in principal populations, including older patients and women who become pregnant; metabolic outcomes during ART; HIV and COVID-19; investigational ART strategies; and HIV prevention.
Hepatitis C elimination in HIV-infected men who have sex with men: reality and challenges
Edward Cachay MD, MAS
February 23rd, 2018
UCSD HIV & Global Health Rounds
This document summarizes the results of a program implemented across the MedStar Health network to improve hepatitis C virus (HCV) testing and linkage to care. Key results include:
- Of over 50,000 patients in the birth cohort (born 1945-1965) tested for HCV antibodies, 1% (64 patients) tested positive.
- Testing was higher in women overall, but men were more likely to test HCV antibody positive.
- The next steps of the program are to improve linkage to care for those testing positive and identify barriers to broader HCV testing.
This document summarizes the results of a program implemented across the MedStar Health network to improve hepatitis C virus (HCV) testing and linkage to care. Key results include:
- Of over 50,000 patients in the birth cohort (born 1945-1965) tested for HCV antibodies, 1% (64 patients) tested positive.
- Testing was higher in women overall, but men were more likely to test HCV antibody positive.
- The next steps of the program are to improve linkage to care for those testing positive and identify barriers to testing and care.
Update from the 23rd Conference on Retroviruses and Opportunistic Infections (CROI), Boston, MA 22-25 Feb 2016
Charles Hicks, M.D.
April 1, 2016
UCSD HIV & Global Health Rounds
Similar to 8th IAS Conference - Update from Vancouver (20)
Katherine Promer Flores, MD (she/her)
Staff Physician
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California San Diego
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
Gabriel Wagner, MD
Associate Clinical Professor
Division of Infectious Diseases & 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
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
Este documento fornece informações sobre uma sessão de treinamento virtual sobre HIV/AIDS para militares internacionais. A agenda inclui atualizações sobre a vacina COVID-19 e sua implementação na Nigéria, com discussões sobre implicações para pessoas vivendo com HIV. A sessão é conduzida pelo programa MIHTP-ECHO com o objetivo de melhorar o atendimento e prevenção de HIV em militares em todo o mundo.
This document provides information about a MIHTP-ECHO training session on COVID-19 vaccines. It includes the agenda, presenters, and an overview of MIHTP and the ECHO model. The presentation by Dr. Allen McCutchan will discuss COVID epidemiology, vaccine mechanisms of action, effectiveness, safety, and duration of protection. It will also cover implications for people living with HIV and emerging variants. A presentation by Captain UO Adekanye will provide an update on Nigeria's COVID vaccine rollout and implications for people living with HIV. The session aims to inform participants and facilitate discussion on these topics.
Davey Smith, MD, MAS
Professor of Medicine
Chief, Division of Infectious Diseases and Global Public Health
Co-Director, San Diego Center for AIDS Research (CFAR)
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
Darcy Wooten, MD
Assistant Professor of Medicine
Associate Program Director, Infectious Diseases Fellowship
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.
Winston Tilghman, MD
Medical Director, STD Controller
HIV, STD & Hepatitis Branch of Public Health Services
County of San Diego Health & Human Services Agency
Scott Letendre, MD
Professor in Residence
Division of Infectious Diseases & Global Public Health
Departments of Medicine and Psychiatry
University of California, San Diego
Susan Little, MD
Professor of Medicine
Co-Director, AntiViral Research Center
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Mackenzie Cottrell, PharmD
Assistant Professor
Co-Director of the UNC CFAR Clinical Pharmacology and Analytical Chemistry Core
Division of Pharmacotherapy and Experimental Therapeutics
University of North Carolina at Chapel Hill
The document summarizes an HIV & Global Health Rounds presentation on using mHealth to address the HIV continuum among sexual and gender minorities. It provides background on the presenter and collaborators. It then discusses how mHealth can enhance HIV research among sexual and gender minorities by providing tailored interventions, addressing co-occurring health issues, and reducing costs. Examples are given of mHealth interventions that have addressed these areas. The document advocates for matching intervention intensity to individual needs and integrating evidence-based interventions to impact multiple outcomes.
Maile Karris, MD
Research Director, Owen Clinic
Associate Director, San Diego Center for AIDS Research Clinical Investigations Core
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
More from UC San Diego AntiViral Research Center (20)
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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.
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.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8th IAS Conference - Update from Vancouver
1. The UC San Diego AntiViral Research Center sponsors weekly
presentations by infectious disease clinicians, physicians and
researchers. The goal of these presentations is to provide the most
current research, clinical practices and trends in HIV, HBV, HCV, TB
and other infectious diseases of global significance.
The slides from the AIDS Clinical Rounds presentation that you are
about to view are intended for the educational purposes of our
audience. They may not be used for other purposes without the
presenter’s express permission.
AIDS CLINICAL ROUNDS
2. 8th IAS Conference on HIV Pathogenesis,
Treatment, and Prevention, July 19-22, 2015
Vancouver, British Columbia
3. Speaker and Disclosure Information
Charles Hicks, MD
Professor of Clinical Medicine
Director, Owen Clinic
University of California, San Diego
San Diego, California
Disclosures:
Scientific Advisory Board: Bristol-Myers Squibb, Gilead Sciences,
Janssen Virology, Merck, and ViiV
Royalties: UpToDate, Inc.
Authorship/Editorial Board: Journal Watch-ID, Massachusetts
Medical Society
5. HPTN 052:
Updated Analysis on Interim Results
Cohen M, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOAC0101LB.
April 2005-May 2011
Person-
years
F/U
All Partner
Infections #
(Rate)
Linked
Partner
Infections #
(Rate)
Total 3482 46 (1.32) 37 (1.06)
Early Arm 1751 4 (0.23) 1 (0.06)
Delayed Arm 1731 42 (2.43) 36 (2.08)
Rate Ratio 0.09 0.03
Risk Reduction 91% 97%
Rate = # of events / 100 PY
Risk reduction = 1 – rate ratio
Linked = index-to-partner transmission likely
6. HPTN 052:
Updated Analysis on Interim Results
April 2005-May 2011 May 2011-May 2015
Person-
years
F/U
All Partner
Infections #
(Rate)
Linked
Partner
Infections #
(Rate)
Person-
years
F/U
All Partner
Infections #
(Rate)
Linked
Partner
Infections #
(Rate)
Total 3482 46 (1.32) 37 (1.06) 5012 32 (0.64) 9 (0.18)
Early Arm 1751 4 (0.23) 1 (0.06) 2563 15 (0.59) 2 (0.08)
Delayed Arm 1731 42 (2.43) 36 (2.08) 2449 17 (0.69) 7 (0.29)
Rate Ratio 0.09 0.03 0.86 0.28
Risk Reduction 91% 97% 14% 72%
Cohen M, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOAC0101LB.
Rate = # of events / 100 PY
Risk reduction = 1 – rate ratio
Linked = index-to-partner transmission likely
7. HPTN 052:
Updated Analysis on Interim Results
April 2005-May 2011 May 2011-May 2015
Person-
years
F/U
All Partner
Infections #
(Rate)
Linked
Partner
Infections #
(Rate)
Person-
years
F/U
All Partner
Infections #
(Rate)
Linked
Partner
Infections #
(Rate)
Total 3482 46 (1.32) 37 (1.06) 5012 32 (0.64) 9 (0.18)
Early Arm 1751 4 (0.23) 1 (0.06) 2563 15 (0.59) 2 (0.08)
Delayed Arm 1731 42 (2.43) 36 (2.08) 2449 17 (0.69) 7 (0.29)
Rate Ratio 0.09 0.03 0.86 0.28
Risk Reduction 91% 97% 14% 72%
Cohen M, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOAC0101LB.
8 transmissions on treatment:
4 prior to or at start of ART; 4 during VL failure
Overall risk reduction – 93%
8. UNAIDS 90-90-90:
2020 HIV Treatment Targets
! 90% of HIV+ people
diagnosed
! 90% of those
diagnosed on ART
! 90% of those on ART
with Undetectable
HIV RNA
100%
90%
81%
73%
0%
20%
40%
60%
80%
100%
HIV Positive People Diagnosed On ART Viral Suppression
35.0
million
31.5
million
28.4
million
25.6
million
Levi J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOAD0102.
Ref: The Joint United Nations Program on HIV/AIDS.
90-90-90 An ambitious treatment target to help end the AIDS epidemic. 2014; JC2684
9. UNAIDS 90-90-90:
Percent of HIV+ Population Aware of Diagnosis
87% 86%
86% 85% 84%
81% 80%
76%
73%
71%
52%
49%
45%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Estonia Australia USA Denmark Switzerland France Brazil United
Kingdom
Netherlands British
Columbia
(Ca)
Georgia Russia Sub
Saharan
Africa
UNAIDS 90-90-90 Target of 90% Diagnosed
Global Average
(Estimate 2013) – 48%
Levi J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOAD0102.
11. UNAIDS 90-90-90:
Percent of HIV Population w/ Viral Suppression
68%
62% 61%
59% 58%
52%
40%
35%
30% 29%
20% 19%
9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Switzerland Australia United
Kingdom
Denmark Netherlands France Brazil British
Columbia
(Ca)
USA Sub
Saharan
Africa
Georgia Estonia Russia
UNAIDS 90-90-90 Target of 73% Viral Suppression
Levi J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOAD0102.
13. IPERGAY pK Sub-study:
Concentrations of TDF in Rectal Tissue
Concentrations of TFV and FTC After TDF 600 mg and FTC 400 mg – One Double Dose
Molina JM, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0102.
In explant cultures – 10/10 biopsies with productive infection vs 6/10 post-dose
0
5
10
15
20
0.0 0.5 1.0 2.0 4.0 8.0 24.0 30.0
Time (hours)
FTC
TFV
Concentration
(ng/mg)
Control
14. HPTN 067:
Daily vs Intermittent PrEP Trial Design
Primary Outcome: Sex Coverage with Drug:
≥1 dose within 4 days of sex and ≥1 dose within 24 hours after sex
Grant R, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0103.
Final
study
Visit
Week 34
4
weeks
off
drug
24 Weeks
Self-administered
dosing
6 Weeks
DOT
period
Women
(incl.TGW)
& MSM
Daily - One tablet/day
Time driven – 1 tablet /2x week with a post sex boost
Event driven -1 tablet pre-sex and 1 tablet post-sex
No more than 2 tablets daily or 7 tablets/week
FTC/TDF
Randomized
D
E
T
Sex Coverage
Subjects:
Women in Cape Town
MSM, TGW in Harlem
and Bangkok
15. HPTN 067:
Primary Outcome
0
10
20
30
40
50
60
70
80
90
Cape Town Harlem Thailand
Daily
Time Driven
Event Driven
PercentCompleteCoverage
WSM MSM
! 10 Outcome: Percent Complete Coverage by PrEP Strategy
! Post Sex Dose Most Frequently Missed
Grant R, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0103; Holtz T, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0104;
Mannheimer S, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0104.
16. Percent with TFV-DP >9.1 fmol/M PBMC*
HPTN 067:
Waning Adherence Over Time in Cape Town
Time Period Daily
Event
Driven
Time
Driven
Week 10
(with sex in the past 7 days)
81%
(33/41)
52%
(12/23)
54%
(20/37)
Week 30
(with sex in the past 7 days)
66%
(19/29)
46%
(11/24)
32%
(10/31)
Grant R, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0103.
*Indicative of > two doses per week
Seroconversions:
- 2 during pre-study pK eval (8.9/100 PYs)
- 5 in study: 1 in daily, 2 in Time-d, 2 in Event-d (5.4/100 PYs)
- All seroconversions w/ no detectable TDF pK
17. 47%
11%
21%
21%
1%
Black Hispanic/Latino
White Other/Mixed
Asian/PI
ATN 110:
PrEP Demonstration Project in Young MSM in US
Age (range 18-22) 20.18 (SD 1.34)
Sexual identity
Gay – 77.8%
Bisexual – 13.7%
Highest grade
completed
High school – 33.8%
Some college – 45.5%
Not currently working 30.1%
Kicked out of home 17.2%
Been paid for sex 28.6%
Exchange sex for
shelter
9%
CRAI* w/ last partner 58%
Positive STI test
Rect. Gonorrhea – 8%
Rect. Chlamydia – 18%
Syphilis – 6.5%
Decided to take PrEP 98%
Hosek S, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUAC0204LB.
* CRAI = condomless receptive anal intercourse
Baseline Characteristics
19. US PrEP Demonstration Project:
Adherence to PrEP by TDF Levels in Dried Blood Spots
Open Label PrEP among MSM and transgender women in San
Francisco (n=300), Miami (n=157), and Washington DC (n=100)
Hosek S, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUAC0204LB.
0%
20%
40%
60%
80%
100%
4 12 24 36 48
Engagement(Percentage)
Visit Week
No Visit BLQ <2 doses 2-3 doses 4-7 doses
20. US PrEP Demonstration Project:
Predictors of Protective Levels of TFV
Characteristic % PL* AOR (95% CI) P value
Site
San Francisco
Miami
DC
90
65
88
Ref
0.32 (0.17-0.60)
1.08 (0.54-2.19)
<0.001
0.82
Race/Ethnicity
White
Latino
Black
Asian
Other
91
77
57
84
82
Ref
0.81 (0.41-1.61)
0.28 (0.12-0.64)
0.72 (0.17-3.03)
0.42 (0.13-1.38)
0.55
0.003
0.65
0.15
Living situation
Rent or own housing
Other
87
70
2.02 (1.14-3.55)
Reference
0.02
# Condomless Anal Sex Partners, Past 3 mo
0-1
≥2
75
89
Reference
1.82 (1.14-2.89) 0.01
Liu A, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUAC0202.
*PL = Protective DBS levels (TFV-DP in DBS consistent with ≥4 doses/week)
OR for protective levels did not differ by age, education, alcohol, or drug use
21. US PrEP Demonstration Project:
STI Rate Over Time
0
2
4
6
8
10
12
14
16
18
Screening 12 24 36 48
STIPositivityRateatEachVisit(%)
Visit interval
Rectal STI (GC/CT) Urethral STI (GC/CT)
Pharyngeal STI (GC/CT) Primary, secondary, or early latent syphilis
Liu A, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUAC0202.
23. Vancouver 2015
Review from the 8th IAS Conference on HIV
pathogenesis, treatment, and prevention
Studies in Treatment-Naïve Patients
19-22 July 2015
Vancouver, British Columbia
28. START Study:
Baseline Characteristics
Characteristics
Immediate-Initiation
Group
(N=2326)
Deferred-Initiation
Group
(N=2359)
All Patients
(N=4685)
Median Age (IRQ)-yr 36 (29-44) 36 (29-44) 36 (29-44)
Female Sex – no. (%) 624 (26.8) 633 (26.8) 1,257 (26.8)
Mode of Infection with HIV – no. (%)
Sexual Contact
Men Having Sex with Men 1,300 (55.9) 1,286 (54.5) 2,586 (55.2)
With Person of Opposite Sex 873 (37.5) 917 (38.9) 1,790 (38.2)
Injection-drug Use 37 (1.6) 27 (1.1) 37 (1.6)
Blood Products, Other, or Unknown 116 (5.0) 129 (5.5) 116 (5.0)
Median Time Since HIV Diagnosis (IQR) – yr 1.0 (0.4-3.0) 1.1 (0.4-3.1) 1.0 (0.4-3.0)
Median CD4+ count (IQR) – cells/mm 651 (585-765) 651 (582-764) 651 (585-765)
Median HIV RNA (IQR) – copies/ml
13,000
(3133-43,808)
12,550
(2963-42,567)
13,000
(3133-43,808)
Median CHD Risk at 10yr (IQR) - % 1.9 (0.5-5.0) 1.9 (0.5-5.3) 1.9 (0.5-5.0)
Lundgren J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0301.
No significant differences between groups
29. 0
10
20
30
40
50
60
70
80
90
100
0 12 24 36 48 60
PercentageofParticipants
Months
START Study:
Proportion on ART
% of Follow-up
on ART
Immediate 94
Deferred 28
Lundgren J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0301.
Deferred Arm:
Median time to ART
3 years (IQR 1.6-4.8)
(projected 4 years)
Immediate ART, % with HIV RNA ≤ 200 c/mL
Deferred ART, % using ART
Deferred ART, % with HIV RNA ≤ 200 c/mL
Immediate ART, % using ART
30. START Study:
Initial ART Combinations
Lundgren J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0301.
Deferred
TDF/FTC/EFV
TDF/FTC/ATV/r
ZDV/3TC/EFV
TDF/FTC/DRV/r
TDF/FTC/RPV
TDF/FTC/RAL
Other
Immediate
N=2287 (98%) N=1134 (48%)
EFV: 73% vs 51%
TDF: 89% in both groups
32. START Study:
CD4 Cell Counts
Lundgren J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0301.
450
500
550
600
650
700
750
800
850
900
950
1000
12 24 36 48 60
MeanCD4+Count(cells/mm3)
Months
B CD4+ Count
Immediate Initiation
Deferred Initiation
CD4 at the start of ART
in deferred.
Median 408
Estimated difference
194 cells
33. START Study:
Primary Endpoint
Immediate ART Deferred ART
No. with Event (%) 42 (1.8%) 96 (4.1%)
Rate/100PY 0.60 1.38
HR (Imm/Def) 0.43 (95% CI: 0.30 to 0.62, p<0.001)
Lundgren J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0301.
0
2
4
6
8
10
0 6 12 18 24 30 36 42 48 54 60
CumulativePercentwithanEvent
Months
Immediate ART
Deferred ART
5.3
2.5
34. 0
2
4
6
8
10
0 6 12 18 24 30 36 42 48 54 60
CumulativePercentwithanEvent
Months
Immediate ART
Deferred ART
START Study:
Serious AIDS Events
Immediate ART Deferred ART
No. with Event (%) 14 50
Rate/100PY 0.20 0.72
HR (Imm/Def) 0.28 (95% CI: 0.15 to 0.50, p<0.001)
Lundgren J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0301.
35. START Study:
Serious NON-AIDS Events
Immediate ART Deferred ART
No. with Event (%) 29 47
Rate/100PY 0.42 0.67
HR (Imm/Def) 0.61 (95% CI: 0.38 to 0.97, p=0.04)
Lundgren J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0301.
0
2
4
6
8
10
0 6 12 18 24 30 36 42 48 54 60
CumulativePercentwithanEvent
Months
Immediate ART
Deferred ART
36. START Study:
Primary and Secondary Endpoints
End Point
Immediate-
Initiation
Group
(N=2326)
Deferred-
Initiation
Group
(N=2359)
Hazard Ratio
(95% CI)
P Value
No.
No. /100
person-
yr
No.
No. /100
person-
yr
Composite Primary End Point 42 0.60 96 1.38 0.43 (0.30-0.62) <0.001
Components of the Primary End Point
Serious AIDS-Related Event 14 0.20 50 0.72 0.28 (0.15-0.50) <0.001
Serious Non-AIDS-Related Event 29 0.42 47 0.67 0.61 (0.38-0.97) 0.04
Death From Any Cause 12 0.17 21 0.30 0.58 (0.28-1.17) 0.13
Tuberculosis 6 0.09 20 0.28 0.29 (0.12-0.73) 0.008
Kaposi’s Sarcoma 1 0.01 11 0.16 0.09 (0.01-0.71) 0.02
Malignant Lymphoma 3 0.04 10 0.14 0.30 (0.08-1.10) 0.07
Cancer Not Related to AIDS 9 0.13 18 0.26 0.50 (0.22-1.11) 0.09
Cardiovascular Disease 12 0.17 14 0.20 0.84 (0.39-1.81) 0.65
Lundgren J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0301.
37. START Study:
Primary Endpoint Subgroup Analysis
Lundgren J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0301.
Subgroup
Percentage
in Group
Immediate
Initiation
Deferred
Initiation
Hazard Ratio (95% CI)
P Value for
Interaction
no. of patients with event
(rote per 100 person-yr)
Age 0.98
≤35yr 48.8 I5 (0.43) 31 (0.91) 0.47
>35yr 51.2 27 (0.78) 65 (1.85) 0.42
Sex 0.38
Male 73.2 35 (0.66) 74 (1.40) 0.47
Female 26.8 7 (0.42) 22 (1.34) 0.31
Race 0.65
Black 30.1 I5 (0.82) 28 (1.52) 0.57
White 44.5 21 (0.63) 53 (1.54) 0.40
Other 25.4 6 (0.34) 15 (0.91) 0.37
Geographic region 0.55
High income 46.0 20 (0.56) 51 (1.42) 0.39
Low or moderate income 54.0 22 (0.65) 45 (1.35) 0.48
Baseline CD4+ 0.71
<600 cells/mm3 31.5 10 (0.44) 35 (1.54) 0.28
600-800 cells/mm3 48.6 24 (0.70) 46 (1.38) 0.50
>800 cells/mm3 19.9 8 (0.63) 15 (1.14) 0.56
Baseline HIV RNA 0.25
<5000 copies/ml 31.8 12 (0.56) 18 (0.83) 0.66
5000-30,000 copies/ml 35.5 13 (0.53) 36 (1.41) 0.38
>30.000 copies/ml 32.5 17 (0.72) 42 (1.92) 0.37
Smoker 0.93
Yes 31.9 18 (0.78) 43 (1.81) 0.43
No 68.1 24 (0.52) 53 (1.16) 0.44
Framingham 10-yr CHD risk 0.56
<0.8 32.7 8 (0.35) 17 (0.77) 0.46
0.8-3.6 32.3 11 (0.48) 27 (1.23) 0.39
>3.6 33.5 23 (1.00) 50 (2.05) 0.50
0.25 0.50 1.00 2.00
Immediate Initiation
Better
Deferred Initiation
Better
38. 0
10
20
30
40
50
60
PercentofFollow-upTime
Latest CD4+ Count (Cells per Cubic Millimeter)
START Study:
CD4 at the Time of Events
Lundgren J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0301.
2 3 6 11 20
(4.7) (0.8) (0.4) (0.6) (0.6)
5 34 34 9 14
(1.8) (2.0) (1.5) (0.6) (1.1)
<350 350-49
9
500-64
9
650-79
9
≥ 800 <350 350-49
9
500-64
9
650-79
9
≥ 800
Immediate ART Deferred ART
Immediate Defer
Percent 88% 59%
Rate (/100 PY) 0.6 1.1
No. of Participants with Events (Rates per 100 PY)
Primary Events at Latest
CD4 count >500 c/mm3
39. START Study:
Adverse Events
End Point
Immediate-
Initiation
Group
(N=2326)
Deferred-Initiation
Group
(N=2359)
Hazard
Ratio
(95% CI)
P Value
No.
No. /100
person-yr No.
No. /100
person-yr
Other Secondary End Points
Grad 4 Event 73 1.06 73 1.05
1.01
(0.73-1.39)
0.97
Unscheduled Hospitalizations 262 4.02 287 4.40
0.91
(0.77-1.08)
0.28
Grade 4 Event, Unscheduled
Hospitalizations, or Death
from Any Cause
283 4.36 311 4.78
0.91
(0.77-1.07)
0.25
Lundgren J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOSY0301.
49. Vancouver 2015
Review from the 8th IAS Conference on HIV
pathogenesis, treatment, and prevention
Studies in Treatment-Experienced Patients
including investigational agents
19-22 July 2015
Vancouver, British Columbia
50. TDF/FTC + Doravirine vs EFV:
Study Design
Gatell J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUAB04.
Part 1
Dose Ranging Phase
(N=210)
Part 1
Extension Phase
DOR 25 mg
DOR 50 mg
DOR 100 mg (n=42) DOR 100 mg
DOR 200 mg
EFC mg (n=42) Continue EFV
Part 2
Additional Patients
(N=132)
DOR 100 mg (n=66)
EFC 600 mg (n=66)
Week 24 Week 96Week 48
Week 24 Week 96Week 48
Note: blinding maintained through Week 96 study visit
Patients:
HIV-1+ ART-naïve
HIV RNA ≥1,000 c/ml
CD4 count ≥100 cells/µL
51. TDF/FTC + Doravirine vs EFV:
Baseline Characteristics
Doravirine 100 mg
(N=108)
Efavirenz 600 mg
(N=108)
% Male 91.7 93.5
Age (years), median (range) 35 (19 – 67) 34 (20 – 57)
% White 79.6 79.6
% with AIDS 3.7 6.5
HIV RNA (log10 c/mL), median (range) 4.6 (2.6 – 6.5) 4.6 (3.0 – 6.7)
% with HIV RNA >100,000 c/mL, at screening 35.2 37.0
CD4 Count (cells/µL), median (range) 402 (92 – 1110) 430 (118 – 1121)
% with CD4 count ≤ 200 cells/µL 6.5 9.3
% with Clade B viral subtype 69.4 79.6
Gatell J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUAB04.
53. 83.3
92.4
60.5
92.1
85.7
92.1
65.8
94.7
0
20
40
60
80
100
% <40 c/mL % <200 c/mL % <40 c/mL % <200 c/mL
Doravirine 100 mg q.d. Efavirenz 600 mg q.d.
≤100,000%c/mL% >100,000%c/mL%
n/N:%%%%%55/66%%%%%%%54/63%
TDF/FTC + Doravirine vs EFV:
Results by Baseline HIV RNA
Gatell J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUAB04.
25:%%%%%51/66%%%%%%58/63% 11:%%%%%23/38%%%%%%25/38% """""35/38""""""36/38"
Virologic failures: DRV 17, EFV 11 -- mostly due to low-level viremia at week 24 (no resistance detected)
1 or more CNS adverse events: DRV 27%, EFV 46% -- difference -19.4% (95% CI -31.7, -6.6)
54. Switch to E/C/F/TAF in Virologically
Suppressed Adults
Primary Endpoint
HIV-1 RNA <50 c/mL
Week 0
Switch to E/C/F/TAF
Continue TDF-Based
Regimen
9648
Virologically
Suppressed
Adults
E/C/F/TDF
(n=459)
EFV/FTC/TDF
(n=376)
Boosted ATV + FTC/TDF
(n=601)
Randomized (2:1), active-controlled,
open-label study
n=959
n=477
Mills A, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUAB0102.
Baseline Characteristics E/C/F/TAF
n=959
TDF-Based Regimen
n=477
Median age, years 41 40
Female, % 11 11
Race, %
White 68 66
Black or African descent 18 21
Hispanic/Latino ethnicity 26 17
Median CD4 count, cells/mm3 675 662
Patients with <200 cells/mm3, % 0.5 0.8
Median estimated GFR, mL/min* 106 108
Dipstick proteinuria, %
Grade 1 8.5 9.2
Grade 2 0.4 0.6
55. 97
1 2
93
1
6
0
20
40
60
80
100
Success Failure No Virologic Data
E/C/F/TAF
n=959
TDF-Based Regimen n=477
Virologic Outcome
TDF Based E/C/F/TAF
0
HIV-1RNA<50c/mL,%
‒12% +12%
6.71.6
4.1
Switch to E/C/F/TAF in Suppressed Adults:
Results
54
932 444 10 6 17 27n=
Treatment Difference (95% CI)
Mills A, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUAB0102.
56. 97 96 97 98
93
90 92
97
0
20
40
60
80
100
All Prior Regimens Prior
EFV/FTC/TDF
Prior
Boosted
ATV + FTC/TDF
Prior
E/C/F/TDF
Switch to E/C/F/TAF in Suppressed Adults:
Virologic Outcome By Prior Treatment
55
PatientsWithHIV-1RNA<50c/mL,%
p <0.001 p=NSp=0.02 p=0.02
932
959
444
477
301
306
149
153
241
251
112
125
390
402
183
199
0.5—12.3 0.9—9.2 -1.9—3.91.6—6.795% CI =
TDF-Based RegimenE/C/F/TAF
Mills A, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUAB0102.
Primary Endpoint
57. ! Eligible
" HIV virologically suppressed
on any regimen
" HBSAg +
" Estimated GFR > 50
! Primary efficacy
endpoints (week 24)
" HIV RNA < 50
" HBV DNA < 29
Switch to E/C/F-TAF in HIV/HBV Co-infection:
Baseline Characteristics
N = 72
Demographi
cs
Median age, y (Q1, Q3) 51 (45, 55)
Male, n (%) 66 (92)
Asian, n (%) 7 (10)
Black, n (%) 13 (18)
HIV
Median Cockcroft-Gault eGFR, mL/
min (Q1, Q3)
95 (77,117)
Median CD4 count, cells/mm3 (Q1,
Q3)
605 (438,
789)
Median duration of HIV infection, y
(Q1, Q3)
18 (9, 24)
ART regimen characteristics
TDF-based ART (TDF and FTC or
3TC), n (%)
69 (96)*
FTC or 3TC only as part of ART, n 1
No TDF, FTC, or 3TC in ART, n 2
HBV
HBsAg+, n (%) 71 (99)†
HBeAg+, n (%) 30 (42)
HBV DNA <29 IU/mL, n (%) 62 (86)
Median duration of HBV, y (Q1, Q3) 12 (5, 20)
ALT ≤ULN, n (%) 62 (86)
FibroTest category moderate/severe
(F1-F2→F4), n (%)
43 (60)
Baseline Demographics and Disease Characteristics
Gallant J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. WELBPE13.
58. ! All 10 patients with detectable HBV DNA had declines, 7/10 < 29 at week 48
! By week 48, 2/70 lost HBSAg/gained HBSAb; 2/30 lost HBEAg
! Renal function, tubular proteinuria improved; markers of bone turnover decreased
Switch to E/C/F-TAF in HIV/HBV Co-infection:
HIV and HBV Results
94
1 4
92
3 6
0
20
40
60
80
100
Virologic Success Virologic Failure No Data
Patients(%)
HIV-1 RNA <50 Copies/mL (FDA Snapshot)
Week 24 Week 48
86
10
4
92
3 6
0
20
40
60
80
100
<29 IU/mL ≥29 IU/mL Missing
Patients(%)
HBV DNA <29 IU/mL (Missing=Failure)
Week 24 Week 48
Antiviral Efficacy at Weeks 24 (Primary Endpoint) and 48
Gallant J, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. WELBPE13.
Outcomes of 3 patients on non-TDF-based regimens
LPV/r+ABC/3TC: HIV RNA <50 copies/mL; HBV DNA declined from 143 to <20 IU/mL
RAL+ATV/r: HIV RNA remained <50 copies/mL; HBV DNA declined from 259,000,000 to 51 IU/mL
ATV/r: HIV RNA remained <50 copies/mL; HBV DNA remained <30 IU/mL
59. ! Eligible: Virologically suppressed for >6 months
on TDF/FTC or ABC/3TC
! N = 60 (30 per study arm)
Randomization
PROBE Study:
DRV/r + RPV as Maintenance Therapy
Maggiolo F, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUPEB270.
RPV + DRV/r
Continuing ongoing cART
24 48
weeks
Primary Secondary
0
Non inferiority
95%CI ± 12%
Snapshot analysis
VL <50 copies for ≥6 months
No resistance for NNRTI
HBsAg negative
Any 3 drugs,
boosted PI based cART
60. PROBE Study:
DRV/r + RPV as Maintenance Therapy
! No virologic failures in DRV/r + RPV arm
! BMD outcomes numerically better in DRV/r + RPV arm,
renal and lipid outcomes no different
HIV-RNA <50 copies/ml HIV RNA >50 copies/ml No data
0
10
20
30
40
50
60
70
80
90
100
T0 T24 T48 T24 T48 T24 T48
proportion
RPV + DRV/r Controls
Primary Endpoint: Virologic Response
Favors
Controls RPV+DRV/r
24 weeks
48 weeks
-12 +12
+13,5
+20,7-0,7
-7,5
Maggiolo F, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUPEB270.
62. BMS-955176
40 mg
+ ATV 300 mg
+ RTV 100 mg
N=8
BMS-955176
80 mg
+ ATV 400 mg
N=8
BMS-955176
40 mg
+ ATV 400 mg
N=8
Dosing period
Furloughed
Outpatient visits
Discharge
Day 30
Days 35‡
Day 42
Days 1–28
TDF/FTC
300/200 mg
+ ATV 300 mg
+ RTV 100 mg
N=4†
Inpatient days: Day -1 to Day 30
Hwang C, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUAB0106LB
Objectives
Change in plasma HIV-1 RNA levels from baseline to
Day 28
Safety and tolerability of BMS-955176 during combination
therapy
Key Inclusion Criteria
HIV-1 subtype B-infected subjects Plasma HIV-1 RNA ≥5,000 c/mL
Treatment-naïve (<1 week of
antiretroviral treatment) or -
experienced (PI naïve) subjects
CD4+ T-cell count ≥200 cells/µL
BMS-955176 Maturation Inhibitor:
Study Design
63. TDF/FTC 300 mg/200 mg + ATV 300 mg + RTV 100 mg
BMS-955176 40 mg + ATV 300 mg + RTV 100 mg
BMS-955176 40 mg + ATV 400 mg
BMS-955176 80 mg + ATV 400 mg
! Median change in HIV-1 RNA at Day 29 was between -1.66 and -2.18 log10 c/mL
for the BMS-955176 arms and was -2.22 log10 c/mL for the standard of care arm
–2.5
–2
–1.5
–1
–0.5
0
0.5
1
MedianChangeinHIV-1
RNA(log10c/mL)fromBaseline
Study Day
10 15 20 25 30 35 40 45 5050
Dosing Period
Hwang C, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUAB0106LB
BMS-955176 Maturation Inhibitor:
Median Change in HIV-1 RNA
64. ! BMS-955176 80 mg + ATV and BMS-955176 40 mg + ATV + RTV had similar
maximum median changes in HIV-1 RNA compared with the standard of care arm
! Greatest elevations in bilirubin seen in maturation inhibitor plus boosted ATV (arm 2)
MaximummedianchangeinHIV-1
RNA(log10copies/mL)
-2.39
-2.02
-1.86
-2.23
-2.5
-2
-1.5
-1
-0.5
0
TDF/FTC
300/200 mg
+ ATV 300 mg
+ RTV 100 mg*
(n=4)
BMS-955176
40 mg
+ ATV 300 mg
+ RTV 100 mg
(n=8)
BMS-955176
40 mg
+ ATV 400 mg
(n=8)
BMS-955176
80 mg +
ATV 400 mg
(n=8)
Hwang C, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. TUAB0106LB
BMS-955176 Maturation Inhibitor:
Maximum Median Decline in HIV-1 RNA from Baseline
73. Effectiveness of Contraception with ART
0
5
10
15
20
25
No Contraception Implant Injectable Oral
Incidence of Pregnancy/100pyrs
ART No ART
Pyra M, et al; 8th IAS, Vancouver, Canada, July 19-22, 2015; Abst. MOPD103.
Data from 5,282 HIV+ women in 3 longitudinal studies in Africa