Cardiovascular Disease in HIV-Infected Patients.Predict It and Prevent It.2015Hivlife Info
In this downloadable slideset, Priscilla Y. Hsue, MD, and David A. Wohl, MD, discuss data on using traditional and newer markers and modalities to predict and prevent cardiovascular disease in HIV-infected patients.
Format: Microsoft PowerPoint (.ppt)
File size: 3.21 MB
Date posted: 7/16/2015
HIV and Cardiovascular Disease.How Worried Should We Be ? 2015Hivlife Info
In this downloadable slideset, David A. Wohl, MD, reviews the association between HIV and cardiovascular disease, including potential contributing factors and best practices in prevention.
Format: Microsoft PowerPoint (.ppt)
File size: 5.01 MB
Date posted: 6/26/2015
Integrating Recent Data When Selecting First-line Antiretroviral Therapy.2015...Hivlife Info
Joseph J. Eron Jr., MD
W. David Hardy, MD
Paul E. Sax, MD
How do leading experts select first-line antiretroviral therapy for their HIV-infected patients?
Review these downloadable slides for key clinical trial data and the latest DHHS recommendations for first-line antiretroviral therapy.
Why, when, and how to use pre exposure prophylaxis for hiv acquisition. 2014Hivlife Info
In this downloadable slide set, Marcy S. Gelman, RN, MSN, MPH, and Kevin M. O’Hara, PA, review essential considerations for midlevel providers administering PrEP
Format: Microsoft PowerPoint (.ppt)
File size: 825 KB
Date posted: 9/29/2014
Современное лечение ВИЧ: лечение ВИЧ у пациентов с вирусными гепатитами.Conte...hivlifeinfo
Современное лечение ВИЧ: лечение ВИЧ у пациентов с вирусными гепатитами.Contemporary Management of HIV. Managing HIV in Viral Hepatitis Coinfection.2016
In this downloadable slideset, David L. Wyles, MD, and Program Director Eric S. Daar, MD, review key data and optimal approaches for ART management in patients with HIV and viral hepatitis coinfection.
Format: Microsoft PowerPoint (.ppt)
File size: 1.85 MB
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
Cardiovascular Disease in HIV-Infected Patients.Predict It and Prevent It.2015Hivlife Info
In this downloadable slideset, Priscilla Y. Hsue, MD, and David A. Wohl, MD, discuss data on using traditional and newer markers and modalities to predict and prevent cardiovascular disease in HIV-infected patients.
Format: Microsoft PowerPoint (.ppt)
File size: 3.21 MB
Date posted: 7/16/2015
HIV and Cardiovascular Disease.How Worried Should We Be ? 2015Hivlife Info
In this downloadable slideset, David A. Wohl, MD, reviews the association between HIV and cardiovascular disease, including potential contributing factors and best practices in prevention.
Format: Microsoft PowerPoint (.ppt)
File size: 5.01 MB
Date posted: 6/26/2015
Integrating Recent Data When Selecting First-line Antiretroviral Therapy.2015...Hivlife Info
Joseph J. Eron Jr., MD
W. David Hardy, MD
Paul E. Sax, MD
How do leading experts select first-line antiretroviral therapy for their HIV-infected patients?
Review these downloadable slides for key clinical trial data and the latest DHHS recommendations for first-line antiretroviral therapy.
Why, when, and how to use pre exposure prophylaxis for hiv acquisition. 2014Hivlife Info
In this downloadable slide set, Marcy S. Gelman, RN, MSN, MPH, and Kevin M. O’Hara, PA, review essential considerations for midlevel providers administering PrEP
Format: Microsoft PowerPoint (.ppt)
File size: 825 KB
Date posted: 9/29/2014
Современное лечение ВИЧ: лечение ВИЧ у пациентов с вирусными гепатитами.Conte...hivlifeinfo
Современное лечение ВИЧ: лечение ВИЧ у пациентов с вирусными гепатитами.Contemporary Management of HIV. Managing HIV in Viral Hepatitis Coinfection.2016
In this downloadable slideset, David L. Wyles, MD, and Program Director Eric S. Daar, MD, review key data and optimal approaches for ART management in patients with HIV and viral hepatitis coinfection.
Format: Microsoft PowerPoint (.ppt)
File size: 1.85 MB
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
Сравнение режимов лечения ВИЧ в разрезе различных клинических сценариев.ART...hivlifeinfo
This downloadable slideset summarizes optimal evidence-based antiretroviral therapy management strategies for a series of challenging clinical cases and is based on a satellite symposium presented at HIV Glasgow 2016.
Format: Microsoft PowerPoint (.ppt)
File size: 1.32 MB
Date posted: 11/11/2016
HIV/AIDS Update From Boston 2014.CCO Official Conference Coverage.March 3-6,2014Hivlife Info
Topics covered include:
* First -line raltegravir, atazanavir/ritonavir, or darunavir/ritonavir
* Switching to elvitegravir-based therapy
* 92-week data on first-line dolutegravir
* Risk of HIV transmission with undetectable viral load
* Latest insights from cure research
New hepatitis C virus treatments
Современное лечение ВИЧ : лечение возрастных пациентов.2017/Contemporary Management of HIV. Management of Aging Patients.2017
In this downloadable slideset, Edgar Turner Overton, MD, and Program Director Joseph J. Eron, Jr., MD, review key data on managing aging patients with HIV.
Source: Contemporary Management of HIV
Date Posted: 4/24/2017
Clinical Impact of New HIV Data From the 2016 Comorbidities-Adverse Drug Reac...hivlifeinfo
In this downloadable slideset, expert faculty members Todd T. Brown, MD, PhD, and Jordan E. Lake, MD, MSc, review key studies presented at the 2016 Comorbidities/Adverse Drug Reactions Workshop.
Format: Microsoft PowerPoint (.ppt)
File size: 1.37 MB
Date posted: 10/14/2016
Should Integrase Inhibitors Be Your First Choice When Starting HIV Therapy- E...Hivlife Info
In this downloadable slideset, Joseph J. Eron, Jr., MD, and Daniel Kuritzkes, MD, review key data on the evolving use of INSTIs in patients beginning HIV therapy.
Format: Microsoft PowerPoint (.ppt)
File size: 2.29 MB
Современное лечение ВИЧ : АРТ как профилактика.Contemporary Management of HIV...hivlifeinfo
Contemporary Management of HIV. Antiretroviral Therapy As Prevention.2016
In this downloadable slideset, Kenneth Mayer, MD, and Program Director Eric S. Daar, MD, review key data and optimal approaches for pre- and post-exposure prophylaxis in patients at risk for HIV infection.
Format: Microsoft PowerPoint (.ppt)
File size: 2.13 MB
What’s New in Coformulated Antiretroviral Regimens.2014Hivlife Info
Andrew R. Zolopa, MD, discusses how new agents are contributing to the development of novel coformulated antiretroviral agents and regimens.
Format: Microsoft PowerPoint (.ppt)
File size: 1.33 MB
Современное лечение ВИЧ: модификация АРТ у пациентов с вирусной супрессией и ...hivlifeinfo
Современное лечение ВИЧ: модификация АРТ у пациентов с вирусной супрессией и у пациентов с вирусологической неудачей. /Contemporary Management of HIV. Modifying Antiretroviral Therapy in Virologically Suppressed Patients and Those With Treatment Failure.2016
In this downloadable slideset, W. David Hardy, MD, and Program Director Eric S. Daar, MD review key data and optimal approaches for modifying ART in patients who are virologically suppressed or have experienced treatment failure.
Format: Microsoft PowerPoint (.ppt)
File size: 2.07 MB
Топ достижений лечения ВИЧ в 2017 г / Top Advances in ART for 2017hivlifeinfo
Top Advances in ART for 2017
In this downloadable slideset, Joel E. Gallant, MD, MPH, provides a comprehensive update on ART management.
Format: Microsoft PowerPoint (.ppt)
File size: 579 KB
Date posted: 3/29/2017
In this downloadable slideset, Joel E. Gallant, MD, MPH, and Anton L. Pozniak, MD, FRCP, review key studies presented at the 2015 ICAAC, IDWeek, and EACS meetings.
Format: Microsoft PowerPoint (.ppt)
File size: 2.64 MB
Date posted: 11/10/2015
Современное лечение ВИЧ: АРТ у пациентов с сопутствующими заболеваниями.Conte...hivlifeinfo
Современное лечение ВИЧ:АРТ у пациентов с сопутствующими заболеваниями.//Contemporary Management of HIV. Managing ART in HIV-Infected Patients With Common Comorbidities. 2016
In this downloadable slideset, David A. Wohl, MD, and Program Director Eric S. Daar, MD, review key data and optimal approaches for managing ART in the context of common comorbidities.
Format: Microsoft PowerPoint (.ppt)
File size: 3.51 MB
Модификация схем АРТ у пациентов с вирусной супрессией и после вирусологичес...hivlifeinfo
Best Practices in Antiretroviral Therapy: Switching ART in Virologically Suppressed Patients and After Virologic Failure
In this downloadable slideset, Joseph J. Eron, Jr., MD, discusses data on changing antiretroviral therapy in HIV-infected patients.
Format: Microsoft PowerPoint (.ppt)
File size: 2.06 MB
HIV Alert:ART Considerations for Aging Patients.2018hivlifeinfo
In this downloadable slideset, Eric S. Daar, MD, and David A. Wohl, MD, provide expert recommendations for older patients with HIV, both in terms of ART selection and general management.
Format: Microsoft PowerPoint (.ppt)
File size: 545 KB
Date posted: 2/12/2018
Современное лечение ВИЧ: новые подходы к оптимизации АРТ/Contemporary Managem...hivlifeinfo
Вопросы, связанные с АРТ первого ряда, смена арв-стратегии для пациентов с вирусной супрессией, акцентом на возрастающую роль новыхантиретровирусных стратегий.
Contemporary Management of HIV.How Aging Affects ART Management.2018hivlifeinfo
In this downloadable slideset, Expert Faculty review key data on managing aging patients with HIV.
Format: Microsoft PowerPoint (.ppt)
File size: 720 KB
Date posted: 3/7/2018
IAS 2015.8th IAS Conference on HIV Pathogenesis, Treatment and Preventionhivlifeinfo
Highlights of IAS 2015
In this downloadable slideset, Andrew Carr, MBBS, MD, FRACP, FRCPA; Joel E. Gallant, MD, MPH; and Anton L. Pozniak, MD, FRCP, review key studies presented at the 2015 International AIDS Society conference.
Format: Microsoft PowerPoint (.ppt)
File size: 1.73 MB
What I Use and Why: Expert Strategies for Selecting the Best ART Regimen for ...hivlifeinfo
In this case-based downloadable slideset, Joseph J. Eron, Jr., MD, summaries optimal evidence-based ART management strategies for a variety of patients with HIV infection based on 2 recent expert faculty panel discussions.
Format: Microsoft PowerPoint (.ppt)
File size: 1.64 MB
Date posted: 11/25/2015
Сравнение режимов лечения ВИЧ в разрезе различных клинических сценариев.ART...hivlifeinfo
This downloadable slideset summarizes optimal evidence-based antiretroviral therapy management strategies for a series of challenging clinical cases and is based on a satellite symposium presented at HIV Glasgow 2016.
Format: Microsoft PowerPoint (.ppt)
File size: 1.32 MB
Date posted: 11/11/2016
HIV/AIDS Update From Boston 2014.CCO Official Conference Coverage.March 3-6,2014Hivlife Info
Topics covered include:
* First -line raltegravir, atazanavir/ritonavir, or darunavir/ritonavir
* Switching to elvitegravir-based therapy
* 92-week data on first-line dolutegravir
* Risk of HIV transmission with undetectable viral load
* Latest insights from cure research
New hepatitis C virus treatments
Современное лечение ВИЧ : лечение возрастных пациентов.2017/Contemporary Management of HIV. Management of Aging Patients.2017
In this downloadable slideset, Edgar Turner Overton, MD, and Program Director Joseph J. Eron, Jr., MD, review key data on managing aging patients with HIV.
Source: Contemporary Management of HIV
Date Posted: 4/24/2017
Clinical Impact of New HIV Data From the 2016 Comorbidities-Adverse Drug Reac...hivlifeinfo
In this downloadable slideset, expert faculty members Todd T. Brown, MD, PhD, and Jordan E. Lake, MD, MSc, review key studies presented at the 2016 Comorbidities/Adverse Drug Reactions Workshop.
Format: Microsoft PowerPoint (.ppt)
File size: 1.37 MB
Date posted: 10/14/2016
Should Integrase Inhibitors Be Your First Choice When Starting HIV Therapy- E...Hivlife Info
In this downloadable slideset, Joseph J. Eron, Jr., MD, and Daniel Kuritzkes, MD, review key data on the evolving use of INSTIs in patients beginning HIV therapy.
Format: Microsoft PowerPoint (.ppt)
File size: 2.29 MB
Современное лечение ВИЧ : АРТ как профилактика.Contemporary Management of HIV...hivlifeinfo
Contemporary Management of HIV. Antiretroviral Therapy As Prevention.2016
In this downloadable slideset, Kenneth Mayer, MD, and Program Director Eric S. Daar, MD, review key data and optimal approaches for pre- and post-exposure prophylaxis in patients at risk for HIV infection.
Format: Microsoft PowerPoint (.ppt)
File size: 2.13 MB
What’s New in Coformulated Antiretroviral Regimens.2014Hivlife Info
Andrew R. Zolopa, MD, discusses how new agents are contributing to the development of novel coformulated antiretroviral agents and regimens.
Format: Microsoft PowerPoint (.ppt)
File size: 1.33 MB
Современное лечение ВИЧ: модификация АРТ у пациентов с вирусной супрессией и ...hivlifeinfo
Современное лечение ВИЧ: модификация АРТ у пациентов с вирусной супрессией и у пациентов с вирусологической неудачей. /Contemporary Management of HIV. Modifying Antiretroviral Therapy in Virologically Suppressed Patients and Those With Treatment Failure.2016
In this downloadable slideset, W. David Hardy, MD, and Program Director Eric S. Daar, MD review key data and optimal approaches for modifying ART in patients who are virologically suppressed or have experienced treatment failure.
Format: Microsoft PowerPoint (.ppt)
File size: 2.07 MB
Топ достижений лечения ВИЧ в 2017 г / Top Advances in ART for 2017hivlifeinfo
Top Advances in ART for 2017
In this downloadable slideset, Joel E. Gallant, MD, MPH, provides a comprehensive update on ART management.
Format: Microsoft PowerPoint (.ppt)
File size: 579 KB
Date posted: 3/29/2017
In this downloadable slideset, Joel E. Gallant, MD, MPH, and Anton L. Pozniak, MD, FRCP, review key studies presented at the 2015 ICAAC, IDWeek, and EACS meetings.
Format: Microsoft PowerPoint (.ppt)
File size: 2.64 MB
Date posted: 11/10/2015
Современное лечение ВИЧ: АРТ у пациентов с сопутствующими заболеваниями.Conte...hivlifeinfo
Современное лечение ВИЧ:АРТ у пациентов с сопутствующими заболеваниями.//Contemporary Management of HIV. Managing ART in HIV-Infected Patients With Common Comorbidities. 2016
In this downloadable slideset, David A. Wohl, MD, and Program Director Eric S. Daar, MD, review key data and optimal approaches for managing ART in the context of common comorbidities.
Format: Microsoft PowerPoint (.ppt)
File size: 3.51 MB
Модификация схем АРТ у пациентов с вирусной супрессией и после вирусологичес...hivlifeinfo
Best Practices in Antiretroviral Therapy: Switching ART in Virologically Suppressed Patients and After Virologic Failure
In this downloadable slideset, Joseph J. Eron, Jr., MD, discusses data on changing antiretroviral therapy in HIV-infected patients.
Format: Microsoft PowerPoint (.ppt)
File size: 2.06 MB
HIV Alert:ART Considerations for Aging Patients.2018hivlifeinfo
In this downloadable slideset, Eric S. Daar, MD, and David A. Wohl, MD, provide expert recommendations for older patients with HIV, both in terms of ART selection and general management.
Format: Microsoft PowerPoint (.ppt)
File size: 545 KB
Date posted: 2/12/2018
Современное лечение ВИЧ: новые подходы к оптимизации АРТ/Contemporary Managem...hivlifeinfo
Вопросы, связанные с АРТ первого ряда, смена арв-стратегии для пациентов с вирусной супрессией, акцентом на возрастающую роль новыхантиретровирусных стратегий.
Contemporary Management of HIV.How Aging Affects ART Management.2018hivlifeinfo
In this downloadable slideset, Expert Faculty review key data on managing aging patients with HIV.
Format: Microsoft PowerPoint (.ppt)
File size: 720 KB
Date posted: 3/7/2018
IAS 2015.8th IAS Conference on HIV Pathogenesis, Treatment and Preventionhivlifeinfo
Highlights of IAS 2015
In this downloadable slideset, Andrew Carr, MBBS, MD, FRACP, FRCPA; Joel E. Gallant, MD, MPH; and Anton L. Pozniak, MD, FRCP, review key studies presented at the 2015 International AIDS Society conference.
Format: Microsoft PowerPoint (.ppt)
File size: 1.73 MB
What I Use and Why: Expert Strategies for Selecting the Best ART Regimen for ...hivlifeinfo
In this case-based downloadable slideset, Joseph J. Eron, Jr., MD, summaries optimal evidence-based ART management strategies for a variety of patients with HIV infection based on 2 recent expert faculty panel discussions.
Format: Microsoft PowerPoint (.ppt)
File size: 1.64 MB
Date posted: 11/25/2015
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.
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
Evolving Switch Strategies for Virologically Suppressed HIV-Infected Patients...Hivlife Info
Доктор David A. Wohl при участии группы экспертов, рассматривает основные исследования о том, когда и как, при каких условиях переводить пациентов со стабильной супрессией ВИЧ на новые методы лечения .
Clinical Impact of New HIV Data From CROI 2019hivlifeinfo
March 4-7, 2019; Seattle, Washington
In this downloadable slideset, expert faculty members summarize key studies from this important annual conference.
Format: Microsoft PowerPoint (.ppt)
File Size: 576 KB
Released: March 22, 2019
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.
Amutha Rajagopal, MD
Associate Physician Diplomate
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Best Practices in the Management of HCV/HIV Coinfection: Optimizing Treatment...Hivlife Info
Jürgen K. Rockstroh, MD, provides an update on the importance of HCV screening and the latest emerging treatment options for patients with HCV/HIV coinfection.
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
Современное лечение ВИЧ: когда начинать, чем начинать. Contemporary Managemen...hivlifeinfo
.Contemporary Management of HIV. When to Start, What to Start.2016/Современное лечение ВИЧ: когда начинать, чем начинать.
In this downloadable slideset, Daniel R. Kuritzkes, MD, and Program Director Eric S. Daar, MD review key data and optimal approaches for first-line ART with contemporary HIV regimens.
Format: Microsoft PowerPoint (.ppt)
File size: 2.53 MB
Date posted: 2/9/2016
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Дискуссии о здоровом старении с ВИЧ /Key Slides on Healthy Aging With HIV.2022hivlifeinfo
Дискуссии о здоровом старении с ВИЧ
Узнайте о медицинских и немедицинских проблемах, с которыми сталкиваются стареющие пациенты с ВИЧ, включая дополнительные проблемы, с которыми сталкиваются пожилые женщины и пожилые люди, живущие в условиях ограниченных ресурсов.
Основы ведения АРТ у многократно леченных пациентов 2022 / Foundations of ART...hivlifeinfo
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Тактики ведения пациентов с большим опытом лечения, включая анализ резистентности, последние рекомендации и данные по новым схемам АРТ
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Стратегии смены АРТ у пациентов с вирусной супрессией, включая смену АРТ при резистентности, рекомендации по инъекционным препаратам длительного действия , смена АРТ до или во время беременности
Ключевые слайды по индивидуальному выбору АРТ / Key Slides on Individualized ...hivlifeinfo
Слайды с последними данные и рекомендациями по выбору АРТ, как для пациентов, ранее не получавших лечения, так и пациентов с вирусологической супрессией. Оценки разных вариантов лечения, индивидуализация АРТ для женщин детородного возраста и во время беременности, пациентов с опортунистическими инфекциями и новые данные об исследовательских стратегиях АРТ.
Современное лечение ВИЧ: модификация АРТ у пациентов с вирусологической супре...hivlifeinfo
Современное лечение ВИЧ: модификация АРТ у пациентов с вирусологической супрессией (2021) / Contemporary Management of HIV: Modifying ART in Virologically Suppressed Patients 2021
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Expert-authored slides on evolving ART concepts, including simplification to 2-drug therapy, ART safety during pregnancy, weight gain, and long-acting injectable ART.
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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.
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Expert-authored slides on the latest issues relating to HIV care, featuring patient cases and considerations for optimal treatment approaches. Topics include integrating newer ARVs, individualizing ART for women of childbearing potential and during pregnancy, adverse events during ART, and anticipated roles of emerging ART strategies.
Гиперлипопротеидемия(а) как опасное генетически обусловленное нарушение липид...hivlifeinfo
Гиперлипопротеидемия(а) как опасное генетически обусловленное нарушение липидного обмена и фактор риска атеротромбоза и сердечно-сосудистых заболеваний
Липопротеид(а) [Лп(а)] представляет собой сложный надмолекулярный комплекс, принадлежащий к апоВ100 содержащим липопротеидам. Лп(а) состоит из ЛНП-подобной частицы, в которой молекула апобелка В100 ковалентно связана дисульфидной связью с уникальной полиморфной молекулой апобелка(а). Концентрация Лп(а) генетически контролируется, при этом варьирует в очень широком диапазоне. Повышенный уровень Лп(а) является независимым фактором риска атеросклероза коронарных, сонных и периферических артерий, ИБС и стеноза аортального клапана, сопутствующих сердечно-сосудистых осложнений, а также осложнений после операций реваскуляризации миокарда. Несмотря на это, уровень Лп(а) по-прежнему не учитывается в стратификации риска сердечно-сосудистых заболеваний. Отчасти, это может быть связано с тем, что ни современная лекарственная терапия, ни новые поколения биологических гиполипидемических препаратовтерапия практически не влияют на концентрацию Лп(а), за исключением 20-30% снижения Лп(а) никотиновой кислотой и ингибиторами пропротеиновой конвертазы субтилизин-кексин 9 типа (PCSK9).
Лекция освящает современные представления о Лп(а), как факторе риска сердечно-сосудистых заболеваний, возможности и целесообразности его определения, а также посвящена современным возможностям коррекции гиперлипопротеидемии(а).
Физическая активность и физические тренировки как метод профилактики сердечно...hivlifeinfo
Чушкин М.И., Мандрыкин С.Ю., Карпина Н.Л., Попова Л.А. Физическая активность и физические тренировки как метод профилактики сердечно-сосудистых заболеваний. Кардиология. 2018;58(9S):10-18
Большое число данных свидетельствует, что функциональные возможности кардиореспираторной системы являются не менее важным фактором прогноза летальности, чем курение, артериальная гипертензия, ожирение, гиперхолестеринемия, СД. Пациенты с большей физической активностью имеют значительно меньший риск ССЗ, чем пациенты, ведущие неактивный образ жизни. В данном обзоре авторы показали возможности оценки физической активности и основные положения назначения физических тренировок для сохранения и повышения функциональных возможностей кардиореспираторной системы.
Key Slides on Individualizing ART Management Based on Treatment Safety and To...hivlifeinfo
Обзор последних рекомендаций DHHS , индивидуализация лечения в отдельных группах пациентов, минимизация побочных эффектов и межлекарственных взаимодействий
Современное лечение ВИЧ.Обобщённые данные с конференции CROI 2020 / Contempor...hivlifeinfo
Современное лечение ВИЧ.Обобощенные данные с конференции CROI 2020 / Contemporary Management of HIV.Integrating New Data From CROI 2020
Широкий спектр вопросов, включая стратегии АРТ на поздних стадихя заболевания, менеджмент ожирения, метаболические исходы АРТ, данные по АРТ во время беременности и пр
Format: Microsoft PowerPoint (.ppt)
File Size: 554 KB
Released: April 14, 2020
Свобода интернета 2018: делегирование репрессий.Доклад Международной Агорыhivlifeinfo
«Настоящий доклад посвящен обзору вмешательства в свободу интернета в России в 2018 году и основан на данных постоянного мониторинга ситуации, который мы ведем более 10 лет.
Как обычно, доклад состоит из двух основных разделов, первый из которых посвящен описанию результатов мониторинга с приведением наиболее показательных примеров, а второй – авторской оценке состояния свободы интернета. В приложении даны сводные результаты мониторинга в виде таблицы со ссылкой на дату, источник, регион и вид ограничения по каждому известному эпизоду, а также карта нарушений, на которой цветом обозначен уровень относительной свободы интернета в отдельных субъектах Федерации.»
https://guides.files.bbci.co.uk/bbc-russian/AGORA_Freedom-of-the-Internet-2018.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
A New Options for HIV Prevention.The Role of Antiretrovirals
1. New Options for HIV Prevention:
The Role of Antiretrovirals
This program is supported by an educational grant from
2. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
About These Slides
Users are encouraged to use these slides in their own
noncommercial presentations, but we ask that content
and attribution not be changed. Users are asked to honor
this intent
These slides may not be published or posted online
without permission from Clinical Care Options
(email permissions@clinicaloptions.com)
Disclaimer
The materials published on the Clinical Care Options Web site reflect the views of the authors of the
CCO material, not those of Clinical Care Options, LLC, the CME providers, or the companies providing
educational grants. The materials may discuss uses and dosages for therapeutic products that have not
been approved by the United States Food and Drug Administration. A qualified healthcare professional
should be consulted before using any therapeutic product discussed. Readers should verify all information
and data before treating patients or using any therapies described in these materials.
3. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Program Director and Core Faculty
Jeanne Marrazzo, MD, MPH
Professor of Medicine
Division of Infectious Diseases
University of Washington
Medical Director
Seattle STD/HIV Prevention Training
Center
Seattle, Washington
Jared M. Baeten, MD, PhD
Associate Professor, Departments of
Global Health and Medicine
University of Washington
Seattle, Washington
Kenneth Mayer, MD
Infectious Disease Attending and
Director of HIV Prevention Research
Beth Israel Deaconess Medical Center
Visiting Professor of Medicine
Harvard Medical School
Medical Research Director
Fenway Community Health
Boston, Massachusetts
4. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Other Faculty Who Contributed to This
Program
Laura H. Bachmann, MD, MPH
Associate Professor
Division of Infectious Diseases
Department of Medicine
Wake Forest University Health
Sciences
Winston-Salem, North Carolina
Susan Buchbinder, MD
Associate Clinical Professor
Departments of Medicine,
Epidemiology and Biostatistics
Director, HIV Research Section
San Francisco Department of
Public Health
San Francisco, California
Connie Celum, MD, MPH
Professor, Department of Global
Health and Medicine
University of Washington
Seattle, Washington
Khalil Ghanem, MD, PhD
Associate Professor of Medicine
Division of Infectious Diseases
Johns Hopkins University
School of Medicine
Baltimore, Maryland
5. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Other Faculty Who Contributed to This
Program
Katherine Hsu, MD, MPH
Associate Professor
Department of Pediatrics
Boston University School of Medicine
Medical Director
Division of STD Prevention and
HIV Surveillance
Massachusetts Department of
Public Health
Boston, Massachusetts
Raphael J. Landovitz, MD, MSc
Associate Professor of Medicine
University of California, Los Angeles
Los Angeles, California
Albert Liu, MD, MPH
Assistant Clinical Professor
Department of Medicine
University of California, San Francisco
Director, HIV Prevention Intervention
Studies
HIV Research Section
San Francisco Department of
Public Health
San Francisco, California
6. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Other Faculty Who Contributed to This
Program
Anne Rompalo, MD, ScM
Professor of Medicine
Division of Infectious Diseases
Department of Medicine
Johns Hopkins School of Medicine
Baltimore, Maryland
Mark Thrun, MD
Associate Professor
Division of Infectious Diseases
Department of Medicine
University of Colorado
Director, HIV/STD Prevention and
Control
Denver Public Health
Denver, Colorado
7. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Faculty Disclosures
Jared M. Baeten, MD, PhD; Susan Buchbinder, MD; Connie
Celum, MD, MPH; Khalil Ghanem, MD, PhD; Katherine Hsu,
MD, MPH; Albert Liu, MD, MPH; Jeanne Marrazzo, MD, MPH;
Anne Rompalo, MD, ScM; and Mark Thrun, MD, have no
significant financial relationships to disclose.
Laura H. Bachmann, MD, MPH, has disclosed that she has
received funds for research support from Cepheid
Raphael J. Landovitz, MD, MSc, has disclosed that he has
received funds for research support from Gilead Sciences,
GlaxoSmithKline, and ViiV.
Kenneth Mayer, MD, has disclosed that he has received funds for
research support from Bristol-Myers Squibb, Gilead Sciences, and
Merck.
8. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
The Need for HIV Prevention:
Continued HIV Risk in the US
Estimated new HIV infections in the United States for the
most affected subpopulations, 2008-201
CDC. HIV in the United States: 2013.
Yr
2008 2009 2010 2011
0
30
40
50
60
70
Diagnoses(%)
20
10
Male-to-male sexual contact
Heterosexual contact
IDU
Male-to-male sexual
contact and IDU
Other
10. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
ART for HIV Prevention: The Hypothesis
The quantity of HIV in plasma
(and genital secretions) is the
prime determinant of whether
someone with HIV will transmit
the virus to a sexual partner[1]
Initiation of ART results in early
and sustained reductions in
plasma and genital HIV levels
Led to the hypothesis that ART
use would result in decreased
infectiousness
1. Quinn TC, et al. N Engl J Med. 2000;342:921-929.
35
30
25
20
15
10
5
0
TransmissionRateper100Person-Yrs
<
400
400-3499
3500-9999
10,000-49,000
≥
50,000
HIV-1 RNA (copies/mL)
12. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
HPTN 052: Immediate vs Delayed ART for
HIV Prevention in Serodiscordant Couples
Primary efficacy endpoint: virologically linked HIV transmission
Primary clinical endpoints: WHO stage IV events, pulmonary TB,
severe bacterial infection and/or death
Couples received intensive counseling on risk reduction and use of
condoms
Cohen MS, et al. N Engl J Med. 2011;365:493-505.
Immediate ART
Initiate ART at CD4+ cell count 350-550 cells/mm3
(n = 886 couples)
Delayed ART
Initiate ART at CD4+ cell count ≤ 250 cells/mm3
*
(n = 877 couples)
HIV-infected, sexually
active serodiscordant
couples; CD4+ cell count
of the infected partner:
350-550 cells/mm3
(N = 1763 couples)
*Based on 2 consecutive values ≤ 250 cells/mm3
.
13. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
HPTN 052: HIV Transmission Reduced by
96% in Serodiscordant Couples
Total HIV-1 Transmission Events: 39
(4 in immediate arm and
35 in delayed arm; P < .0001)
Linked
Transmissions: 28
Unlinked or TBD
Transmissions: 11
P < .001
Immediate
Arm: 1
Delayed
Arm: 27
Cohen MS, et al. N Engl J Med. 2011;365:493-505.
96% reduction in risk of HIV
transmission within the
partnership (95% CI: 73% to 99%)
14. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
HPTN 052: HIV Transmission Reduced by
96% in Serodiscordant Couples
Single transmission in patient in
immediate ART arm believed
to have occurred close to time
therapy began and prior to
suppression of genital tract HIV
Total HIV-1 Transmission Events: 39
(4 in immediate arm and
35 in delayed arm; P < .0001)
Linked
Transmissions: 28
Unlinked or TBD
Transmissions: 11
P < .001
Immediate
Arm: 1
Delayed
Arm: 27
Cohen MS, et al. N Engl J Med. 2011;365:493-505.
15. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Adherence and ART for HIV Prevention
In HPTN 052, viral suppression was nearly universal in
those receiving ART, reflecting intensive strategies to
achieve nearly perfect adherence
– Adherence counselors with detailed checklists; patients
received extensive education about ART[1]
– Adherence assessed at Wk 2, monthly x 3, and then
quarterly
Real-world adherence to ART is not as high as achieved in
HPTN 052
1. Cohen MS, et al. N Engl J Med. 2011;365:493-505. Supplementary appendix.
16. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
CDC: Breaks in the Continuum of Care in
HIV-Infected Patients in the US
CDC study shows that only ~ 25% of US patients with HIV have
suppressed HIV-1 RNA
Hall HI, et al. JAMA Intern Med. 2013;17:1-7.
100
80
60
40
20
0
Diagnosed Linked
to Care
Retained
in Care
Prescribed
ART
Viral
Suppression
82
66
37
33
25
Patients(%)
17. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
2006 Recommendations From CDC:
Routine Opt-Out Testing for HIV
Routine voluntary testing for
patients aged 13-64 yrs in
healthcare settings—not
based on patient risk
Opt-out testing
No separate consent for HIV
Pretest counseling not
required
Repeat HIV testing at least
annually for persons at high
risk
Branson BM, et al. MMWR Recomm Rep. 2006;55(RR-14):1-17.
18. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
DHHS Guidelines 2013: When to Start
ART recommended for all HIV-infected patients in US
Strength of recommendation varies depending on CD4+ count
– CD4+ < 350 (AI); CD4+ 350-500 (AII); CD4+ > 500 (BIII)
Certain groups highlighted as priorities for therapy
– History of AIDS-defining illness
– Pregnancy
– HIV-associated nephropathy
– HBV coinfection (AII); HCV coinfection
– At risk of transmitting HIV to sexual partners
– Acute HIV infection
?
DHHS Guidelines for Antiretroviral Therapy in Adults and Adolescents. February 2013.
19. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Limitations of Current Data on ART for HIV
Prevention
ART may mediate different degree of risk reduction when other
modes of transmission (eg, needles, anal intercourse) taken
into account
Adherence to lifelong ART may be difficult when initiated in
asymptomatic individuals
Observational studies of the effect of ART on transmission
among HIV serodiscordant couples have shown lower HIV risk
reduction, likely as a result of lower adherence to ART[1]
28% of infections in HPTN 052 occurred from outside of study
partnerships, for which ART use by the HIV-infected partner
offered no protection[2]
1. Anglemyer A, et al. Cochrane Database Syst Rev. 2013;4:CD009153.
2. Cohen MS, et al. N Engl J Med. 2011;365:493-505.
20. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Summary: ART as Prevention
Initiation of effective ART results in a substantial decrease in
HIV infectiousness and transmission risk
Adherence (with viral suppression) is key to preventive effects
of ART
Prescribing guidelines now include risk of transmission as an
indication to initiate ART
– However, no formal indication for prevention of transmission exists
for any antiretroviral
Providers should talk about prevention as part of ART’s benefits
22. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
What Is PrEP?
For PrEP, an HIV-uninfected individual takes antiretroviral
medication(s) before potential HIV exposure
The idea of providing a medication as prophylaxis against
an infectious disease is well established
– For example, taking medications for diseases such as
malaria before traveling to high-risk areas reduces risk of
infection establishing itself if exposure occurs
23. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Pre- vs Postexposure Prophylaxis
HIV
infection
0 hr 36 hrs 72 hrs
HIV
1 mos 3 mos 5 mos
After exposure to
HIV, infection may
become established
24. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Pre- vs Postexposure Prophylaxis
Postexposure
prophylaxis
HIV
infection
0 hr 36 hrs 1 mos 3 mos 5 mos
Postexposure
prophylaxis—
initiated soon after
an exposure—reduces
the chance of infection
HIV
72 hrs
25. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Pre- vs Postexposure Prophylaxis
Pre-exposure
prophylaxis
HIV
infection
0 hr 36 hrs 1 mos 3 mos 5 mos
Pre-exposure
prophylaxis begins
treatment earlier—
before exposure—
which might increase
the prophylactic
effect
HIV
72 hrs
26. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Pre- vs Postexposure Prophylaxis
HIV HIV
Postexposure
prophylaxis
0 hr 36 hrs 1 mos 3 mos 5 mos
For persons with ongoing/
repeated HIV exposure,
intermittent postexposure
prophylaxis may not be sufficient
HIV
72 hrs
27. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Pre- vs Postexposure Prophylaxis
HIV HIV
Pre-exposure
prophylaxis
0 hr 36 hrs 1 mos 3 mos 5 mos
Pre-exposure prophylaxis
might protect against a period
of ongoing risk by having a
continuing level of medication
available
HIV
72 hrs
28. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
PrEP Clinical Trials
Phase III clinical trials of PrEP tested daily oral TDF-based
tablets (alone or in combination with FTC)
Factors that supported testing of TDF-based PrEP in
clinical trials
– Potency: rapid antiretroviral activity
– Safety: high tolerability, substantial treatment safety
experience
– Ease: once-daily dosing, few drug–drug interactions
– Preclinical/early clinical evidence: animal model data found
high efficacy of PrEP for HIV protection[1]
1. Garcia-Lerma JG, et al. Current Opin HIV AIDS. 2012;7:505-513.
29. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
PrEP Trials Have Shown Efficacy in MSM,
Heterosexual Men and Women, and IDUs
Trial Population/Setting Intervention HIV Infections, n Reduction in
HIV Infection Rate,
% (95% CI)
PrEP Placebo
iPrEX[1]
(N = 2499)
MSM, transgender women,
11 sites in US, South
America, Africa, Thailand
TDF/FTC 36 64 44 (15-63)
Partners
PrEP[2]
(N = 4747)
Serodiscordant couples
in Africa
TDF 17
52
67 (44-81)
TDF/FTC 13 75 (55-87)
TDF2[3]
(N = 1219)
Heterosexual males and
females in Botswana
TDF/FTC 9 24 62 (21-83)
Thai IDU[4]
(N = 2413)
Volunteers from 17 drug
treatment centers in
Thailand
TDF 17 33 49 (10-72)
1. Grant RM, et al. N Engl J Med. 2010;363: 2587-2599. 2. Baeten JM, et al. N Engl J Med.
2012;367:399-410. 3. Thigpen MC, et al. N Engl J Med. 2012;367:423-434. 4. Choopanya K, et al.
Lancet. 2013;381:2083-2090.
30. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Adherence Is a Key Determinant of PrEP
Trial Outcomes
Study
Detection of TFV in Plasma, %
HIV Seroconverters HIV Uninfected
iPrEx[1]
51
Partners PrEP[2]
(TDF/FTC arm)
81
Thai IDU[3]
67
In the large iPrEx, Partners PrEP, and Thai IDU studies,
TFV was detected in blood samples of the majority of subjects who
remained HIV uninfected during the study
1. Grant RM, et al. N Engl J Med. 2010;363:2587-2599. 2. Baeten JM, et al. N Engl J Med.
2012;367:399-410. 3. Choopanya K, et al. Lancet. 2013;381:2083-2090.
31. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Adherence Is a Key Determinant of PrEP
Trial Outcomes
Study
Detection of TFV in Plasma, %
HIV Seroconverters HIV Uninfected
iPrEx[1]
9 51
Partners PrEP[2]
(TDF/FTC arm)
25 81
Thai IDU[3]
39 67
By contrast, TFV was detected in only a minority of subjects who
acquired HIV, arguing that adherence to taking the study
medication was related to remaining HIV uninfected
1. Grant RM, et al. N Engl J Med. 2010;363:2587-2599. 2. Baeten JM, et al. N Engl J Med.
2012;367:399-410. 3. Choopanya K, et al. Lancet. 2013;381:2083-2090.
32. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Adherence Is a Key Determinant of PrEP
Trial Outcomes
Study
Detection of TFV in Plasma, %
HIV Seroconverters HIV Uninfected
iPrEx[1]
9 51
Partners PrEP[2]
(TDF/FTC arm)
25 81
Thai IDU[3]
39 67
This difference in TFV detection translated into a
relative risk reduction of acquiring HIV:
iPrEx: 92% (95% CI: 40% to 99%; P < .001)
Partners PrEP TDF/FTC: 90% (95% CI: 56% to 98%; P = .002)
Thai IDU: 70% (95% CI: 2% to 91%; P = .04)
1. Grant RM, et al. N Engl J Med. 2010;363:2587-2599. 2. Baeten JM, et al. N Engl J Med.
2012;367:399-410. 3. Choopanya K, et al. Lancet. 2013;381:2083-2090.
33. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
PrEP (Like ART) Works When Taken
2 additional trials of PrEP (FEM-PrEP and VOICE), both conducted
among high-risk African women, did not demonstrate protection against
HIV; in both trials, PrEP adherence was very low (< 30%)
Study Blood Samples With
TFV
Detected, %
HIV Protection Efficacy
in Randomized
Comparison,%
Partners PrEP[1]
81 75
TDF2[2]
80 62
iPrEx[3]
51 44
Thai IDU[4]
67 49
FEM-PrEP[5]
and VOICE[6]
< 30 No HIV protection
1. Baeten JM, et al. N Engl J Med. 2012;367:399-410. 2. Thigpen MC, et al. N Engl J Med.
2012;367:423-434. 3. Grant RM, et al. N Engl J Med. 2010;363:2587-2599. 4. Choopanya K, et al.
Lancet. 2013;381: 2083-2090. 5. Van Damme L, et al. N Engl J Med. 2012;367:411-422. 6. Marrazzo J,
et al. CROI 2013. Abstract 26LB.
34. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Partners PrEP: Comparable Efficacy in
Heterosexual Men and Women
Arm Groups Efficacy, %
(95% CI)
P Value vs Placebo
TDF
Women
(n = 595)
Men
(n = 984)
71
(37-87)
63
(20-83)
.002
.01
TDF/FTC
Women
(n = 566)
Men
(n = 1010)
66
(28-84)
84
(54-94)
.005
< .001
Baeten JM, et al. N Engl J Med. 2012;367:399-410.
35. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
PrEP Safety
Rates of death, serious adverse events, and laboratory
abnormalities (including renal dysfunction) low and not
significantly different between those receiving PrEP and those
receiving placebo
PrEP was well tolerated
– Adverse events occurred in minority of subjects
– GI adverse events (eg, nausea) more common in those receiving
PrEP than placebo
– Occurred in < 10% and primarily during the first month only (PrEP
“start up” symptoms)
PrEP associated with a small change (~ 1%) in bone mineral
density but without increased risk of fracture
36. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
iPrEx[1]
Partners PrEP[2]
50
30
10
0
0 6 12 18 24 30
Follow-up Time (Mos)
40
20
3 9 15 21 27 33
SubjectsReporting
UnprotectedSex(%)
TDF
FTC/TDF
Placebo
PrEP Trials Found Decreasing Risk
Behavior Over Time
100
80
0
0
Wks Since Randomization
48 72 96 120 144
SubjectsReportingUnprotected
ReceptiveAnalSex(%)
40
60
20
24
FTC/TDF
Placebo
1. Grant RM, et al. N Engl J Med. 2010;363: 2587-2599.
2. Baeten JM, et al. N Engl J Med. 2012;367:399-410.
37. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
PrEP and HIV Drug Resistance
Resistance rare (consistent with subjects who acquired
HIV not taking PrEP)
– Exception: those with undiagnosed (seronegative) acute HIV
infection at time PrEP was initiated
Resistance mutations seen: K65R (TDF) or M184V/I
(FTC)
Liegler T, et al. CROI 2011. Abstract 97LB. Grant RM, et al. N Engl J Med. 2010;363:2587-2599.
Baeten JM, et al. N Engl J Med. 2012;367:399-410 (supplementary appendix). Thigpen MC, et al. N
Engl J Med. 2012;367:423-434 (supplementary appendix). Choopanya K, et al. Lancet. 2013;381:2083-2090.
38. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
FDA Approval of TDF/FTC Fixed-Dose
Combination for PrEP
In July 2012, the FDA approved the fixed-dose combination
TDF/FTC as PrEP in combination with safer sex practices to
reduce the risk of sexually acquired HIV infection in adults at
high risk
Must be used only by individuals who are confirmed to be HIV
negative
– Prior to prescribing the drug and at least every 3 mos during use
Once-daily dosing (no evidence for any other prescribing
frequency)
Manufacturer required to have training and education program
to assist prescribers in counseling individuals who are receiving
or considering TDF/FTC for PrEP
– Patient assistance available: 855.330.5479
39. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Prescribing PrEP: CDC Interim Guidance
for MSM, Heterosexual Couples, IDUs
CDC. MMWR Morb Mortal Wkly Rep. 2011;60:65-68. CDC. MMWR Morb Mortal Wkly Rep. 2012;61:586-
589. CDC. MMWR Morb Mortal Wkly Rep. 2013;62;463-465.
Component Recommendation
Risk
assessment
PrEP indicated for those at high HIV risk
Eligibility HIV negative, adequate renal function
Dosing 1 FDC tablet, once daily
Follow-up Testing for HIV every 3 mos
Counseling on risk reduction and testing creatinine at 3 mos
and then annually
Testing for STIs every 6 mos, even if asymptomatic
Discontinuation PrEP not meant for lifelong administration but rather for
periods of highest risk
40. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Limitations of Current Data
Long-term adherence to PrEP and long-term health
effects of TDF/FTC in HIV-negative persons and HIV
seroconverters not known
Adherence, risk behavior, and PrEP interest likely to be
different now that PrEP HIV protection benefits known
CDC. MMWR Morb Mortal Wkly Rep. 2011;60:65-68. Grant RM, et al. N Engl J Med. 2010;363:2587-
2599.
41. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Summary: PrEP
TDF/FTC is approved as PrEP in combination with safer
sex practices to reduce the risk of sexually acquired HIV
infection in adults at high risk (July 2012)
Adherence appears to be key to PrEP efficacy
Providers should be prepared to do risk assessment,
counseling, and prescribe PrEP for high-risk individuals
43. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Talking About Treatment and PrEP
A common belief is that antiretroviral medications are
awful; this delays treatment and is a prominent patient
concern for PrEP
New messages from
providers are needed
45. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
PrEP Works Together With Other HIV
Prevention Strategies
Example from Partners PrEP Study: package of HIV prevention
services, including ongoing risk-reduction counseling, HIV testing,
ART, treatment of STIs, and other strategies plus PrEP synergize to
maximally reduce HIV risk
HIVIncidence
10% to 15%/yr
Serodiscordant
Couples Outside of
Clinical Trials[1]
Partners PrEP
Placebo Arm[2]
2%/yr
0.5%/yr
Partners PrEP
TDF/FTC Arm[2]
1. Quinn TC, et al. N Engl J Med. 2000;342:921-929. 2. Baeten JM, et al. N Engl J Med. 2012;367:399-410.
46. clinicaloptions.com/hiv
Strengthening HIV Prevention in Primary Care
Putting This Together
2 incredibly powerful prevention strategies
HIV Prevention Effect With High Adherence
Antiretroviral
treatment for HIV
prevention
96%
(HPTN 052,
near-perfect adherence)
PrEP for HIV prevention
90% to 92%
(With high adherence as
measured by TFV levels in
iPrEx and Partners PrEP)
Editor's Notes
This slide lists the disclosure information of the faculty and staff involved in the development of these slides.
IDU, injection drug user.
ART, antiretroviral therapy.
ART, antiretroviral therapy.
ART, antiretroviral therapy; TB, tuberculosis; WHO, World Health Organization.
ART, antiretroviral therapy.
ART, antiretroviral therapy.
ART, antiretroviral therapy; CDC, Centers for Disease Control and Prevention.
CDC, Centers for Disease Control and Prevention.
ART, antiretroviral therapy; DHHS, US Department of Health and Human Services; HBV, hepatitis B virus; HCV, hepatitis C virus.