Современное лечение ВИЧ: АРТ у пациентов с сопутствующими заболеваниями.Contemporary Management of HIV. Managing ART in HIV-Infected Patients With Common Comorbidities. 2016
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
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
Новые данные с конференции по ВИЧ-инфекции CROI 2017/Clinical Impact of New D...hivlifeinfo
Clinical Impact of New Data From CROI 2017
Expert faculty members Joel E. Gallant, MD, MPH, and Charles B. Hicks, MD, summarize key studies from this important annual conference.
Format: Microsoft PowerPoint (.ppt)
File size: 1.25 MB
Date posted: 3/3/2017
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
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
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
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.
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
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
Новые данные с конференции по ВИЧ-инфекции CROI 2017/Clinical Impact of New D...hivlifeinfo
Clinical Impact of New Data From CROI 2017
Expert faculty members Joel E. Gallant, MD, MPH, and Charles B. Hicks, MD, summarize key studies from this important annual conference.
Format: Microsoft PowerPoint (.ppt)
File size: 1.25 MB
Date posted: 3/3/2017
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
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
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
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.
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
Современное лечение ВИЧ.Усилить или не усилить : преимущества и недостатки бу...hivlifeinfo
Современное лечение ВИЧ.Усилить или не усилить : преимущества и недостатки бустированных режимов АРТ / Contemporary Management of HIV.To Boost or Not to Boost-Advantages and Disadvantages of Boosted ART.2017
In this downloadable slideset, Eric S. Daar, MD, and Program Director Joseph J. Eron, Jr., MD, review advantages and disadvantages of boosted ART regimens for managing patients with HIV.
Format: Microsoft PowerPoint (.ppt)
File size: 514 KB
Date posted: 6/16/2017
Contemporary Management of HIV.How Common Comorbidities Affect ART Management...hivlifeinfo
In this downloadable slideset, expert faculty review key data and offer important guidance on managing HIV treatment in patients with frequently encountered comorbidities, including cardiovascular disease, osteopenia, and HCV coinfection.
Format: Microsoft PowerPoint (.ppt)
File size: 2.27 MB
Date posted: 2/12/2018
Современное лечение ВИЧ: лечение ВИЧ у женщин.2017/Contemporary Management of...hivlifeinfo
In this downloadable slideset, Kathleen E. Squires, MD, and Program Director Joseph J. Eron, Jr., MD, review key data and optimal strategies in caring for HIV-infected women, including ART safety and efficacy in women, reproductive health management, ART and pregnancy, and preventing HIV infection in women.
Format: Microsoft PowerPoint (.ppt)
File size: 1.59 MB
Date posted: 4/25/2017
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
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.
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
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 : 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
Начало АРТ впервые.Наилучшая практика.Best Practices in Antiretroviral Therap...hivlifeinfo
Best Practices in Antiretroviral Therapy: Initiating First-line Therapy
In this downloadable slideset, Charles B. Hicks, MD, discusses data on initiating antiretroviral therapy in HIV-infected patients.
Format: Microsoft PowerPoint (.ppt)
File size: 2.16 MB
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
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
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
АРТ в 2016-2017 гг: неизменная потребность в индивидуализации лечения для улу...hivlifeinfo
In this downloadable slideset, Danielle Ciuffetelli, PharmD, and Elly Fatehi, PharmD, BCPS, review important considerations when selecting initial ART and explore how formularies can be better managed to ensure delivery of optimal care for diverse populations of HIV-infected patients. Illustrative cases provide useful examples of key factors involved in treatment selection, including comorbidities, patient preferences and disposition, concomitant medications, and childbearing potential.
Format: Microsoft PowerPoint (.ppt)
File size: 2.46 MB
Date posted: 1/10/2017
In this downloadable slideset, Joseph J. Eron, Jr., MD, reviews the evidence behind the latest antiretroviral guidelines and offers a glimpse at potential future agents and strategies currently under investigation.
Format: Microsoft PowerPoint (.ppt)
File size: 2.06 MB
Date posted: 6/1/2016
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
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.
Современное лечение ВИЧ.Усилить или не усилить : преимущества и недостатки бу...hivlifeinfo
Современное лечение ВИЧ.Усилить или не усилить : преимущества и недостатки бустированных режимов АРТ / Contemporary Management of HIV.To Boost or Not to Boost-Advantages and Disadvantages of Boosted ART.2017
In this downloadable slideset, Eric S. Daar, MD, and Program Director Joseph J. Eron, Jr., MD, review advantages and disadvantages of boosted ART regimens for managing patients with HIV.
Format: Microsoft PowerPoint (.ppt)
File size: 514 KB
Date posted: 6/16/2017
Contemporary Management of HIV.How Common Comorbidities Affect ART Management...hivlifeinfo
In this downloadable slideset, expert faculty review key data and offer important guidance on managing HIV treatment in patients with frequently encountered comorbidities, including cardiovascular disease, osteopenia, and HCV coinfection.
Format: Microsoft PowerPoint (.ppt)
File size: 2.27 MB
Date posted: 2/12/2018
Современное лечение ВИЧ: лечение ВИЧ у женщин.2017/Contemporary Management of...hivlifeinfo
In this downloadable slideset, Kathleen E. Squires, MD, and Program Director Joseph J. Eron, Jr., MD, review key data and optimal strategies in caring for HIV-infected women, including ART safety and efficacy in women, reproductive health management, ART and pregnancy, and preventing HIV infection in women.
Format: Microsoft PowerPoint (.ppt)
File size: 1.59 MB
Date posted: 4/25/2017
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
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.
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
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 : 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
Начало АРТ впервые.Наилучшая практика.Best Practices in Antiretroviral Therap...hivlifeinfo
Best Practices in Antiretroviral Therapy: Initiating First-line Therapy
In this downloadable slideset, Charles B. Hicks, MD, discusses data on initiating antiretroviral therapy in HIV-infected patients.
Format: Microsoft PowerPoint (.ppt)
File size: 2.16 MB
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
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
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
АРТ в 2016-2017 гг: неизменная потребность в индивидуализации лечения для улу...hivlifeinfo
In this downloadable slideset, Danielle Ciuffetelli, PharmD, and Elly Fatehi, PharmD, BCPS, review important considerations when selecting initial ART and explore how formularies can be better managed to ensure delivery of optimal care for diverse populations of HIV-infected patients. Illustrative cases provide useful examples of key factors involved in treatment selection, including comorbidities, patient preferences and disposition, concomitant medications, and childbearing potential.
Format: Microsoft PowerPoint (.ppt)
File size: 2.46 MB
Date posted: 1/10/2017
In this downloadable slideset, Joseph J. Eron, Jr., MD, reviews the evidence behind the latest antiretroviral guidelines and offers a glimpse at potential future agents and strategies currently under investigation.
Format: Microsoft PowerPoint (.ppt)
File size: 2.06 MB
Date posted: 6/1/2016
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
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.
Integrating Recent Data When Selecting First-line Antiretroviral Therapy.2015...
Similar to Современное лечение ВИЧ: АРТ у пациентов с сопутствующими заболеваниями.Contemporary Management of HIV. Managing ART in HIV-Infected Patients With Common Comorbidities. 2016
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
Confronting the Challenges of HIV Care in an Aging Population.2019hivlifeinfo
Еxpert faculty use case-based examples to examine considerations for aging patients with HIV. Topics include ART modification, bone loss, renal impairment, cardiovascular risk, and cognitive decline.
Key Slides on ART for HIV : Evolving Concepts and Innovative Strategies.2020hivlifeinfo
Expert-authored slides on evolving ART concepts, including simplification to 2-drug therapy, ART safety during pregnancy, weight gain, and long-acting injectable ART.
File Size: 580 KB
Released: October 20, 2020
Оптимизация лечения ВИЧ в 2018 году / HIV Treatment Optimization: 2018hivlifeinfo
HIV Treatment Optimization: 2018
In this downloadable slideset, Eric S. Daar, MD, provides a comprehensive update on ART management.
Format: Microsoft PowerPoint (.ppt)
File Size: 723 KB
Released: April 26, 2018
ВИЧ-инфекция у женщин : стратегии 3 ключевых глобальных проблем.2016.HIV In...hivlifeinfo
ВИЧ-инфекция у женщин : стратегии 3 ключевых глобальных проблем.2016.HIV Infection Among Women- Strategies to Address 3 Key Global Challenges .2016
In this downloadable slideset, Catherine Hankins, MD, PhD, FRCPC, CM, reviews current global challenges for HIV-infected women and explores methods for HIV prevention and ART delivery, particularly in resource-limited settings.
Format: Microsoft PowerPoint (.ppt)
File size: 1.03 MB
Date posted: 9/1/2016
Современное лечение и профилактика ВИЧ : передовые стратегии лечения у пациен...hivlifeinfo
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
Challenging Cases in HIV Management.2014 Hivlife Info
Challenging Cases in HIV Management,including poorly adherent patients,individuals with cryptococcal meningitis,HBV coinfection, and diabetes and hypertension.2014
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
Fall 2014 HIV Update.Clinical Impact of New Data From ICAAC 2014, IDWeek 2014...Hivlife Info
In this downloadable slideset, Joseph J. Eron, Jr., MD and Jürgen K. Rockstroh, MD, review key HIV studies presented at the 2014 Interscience Conference on Antimicrobial Agents and Chemotherapy, 2014 IDWeek, and 2014 HIV Drug Therapy Glasgow.
Format: Microsoft PowerPoint (.ppt)
File size: 1.70 MB
Fall 2014 HIV Update.Clinical Impact of New Data From ICAAC 2014, IDWeek 2014...hivlifeinfo
In this downloadable slideset, Joseph J. Eron, Jr., MD and Jürgen K. Rockstroh, MD, review key HIV studies presented at the 2014 Interscience Conference on Antimicrobial Agents and Chemotherapy, 2014 IDWeek, and 2014 HIV Drug Therapy Glasgow.
Format: Microsoft PowerPoint (.ppt)
File size: 1.70 MB
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)
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Released: April 14, 2020
Slides to Guide Management of Patients With HCV/HIV Coinfection.2018hivlifeinfo
Slides to Guide Management of Patients With HCV/HIV Coinfection.2018
Gain expert perspective on selecting optimal DAA and ARV combinations for patients with HCV/HIV coinfection in this downloadable slideset.
Mark S. Sulkowski, MD
Format: Microsoft PowerPoint (.ppt)
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Released: July 20, 2018
Выбор начальной схемы АРТ у пациентов старшего возраста.Choosing and Using F...hivlifeinfo
In this downloadable slideset, José R. Arribas, MD, and Hans-Jürgen Stellbrink, MD, review essential considerations for providing first-line antiretroviral therapy to older HIV patients.
Format: Microsoft PowerPoint (.ppt)
File size: 3.38 MB
Date posted: 9/4/2015
Similar to Современное лечение ВИЧ: АРТ у пациентов с сопутствующими заболеваниями.Contemporary Management of HIV. Managing ART in HIV-Infected Patients With Common Comorbidities. 2016 (20)
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
Основы ведения АРТ у многократно леченных пациентов (2022)
Тактики ведения пациентов с большим опытом лечения, включая анализ резистентности, последние рекомендации и данные по новым схемам АРТ
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.
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.
Слайдсет о новом в лечении ВИЧ.Key Slides on What’s Hot in HIV Treatment.2020 hivlifeinfo
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.
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
Современное лечение ВИЧ.Объединенные данные с конференции IAS 2019 / Contemp...hivlifeinfo
Review key HIV data from IAS 2019 on the updated NTD risk in women receiving ART at conception, PrEP, first-line and switch options, and early-phase investigational strategies.
Clinical Impact of New Data From IAS 2019hivlifeinfo
July 21-24, 2019; Mexico City, Mexico
Download slide highlights of key studies addressing current issues in HIV care, as reported at this important annual conference.
Предиабет-определение, риски, подходы к диагностике и профилактике сахарного ...hivlifeinfo
Предиабет-определение, риски, подходы к диагностике и профилактике сахарного диабета 2 типа и сердечно-сосудистых осложнений.Консенсус экспертов РКО.2019
"Результаты международного эпидемиологического проекта HAPIEЕ показали, что распространенность преддиабета в Российской Федерации (РФ), определяемого по нарушенной гликемии натощак, может быть еще выше — от 28,1% при отрезной точке по уровню глюкозы плазмы ≥6,1 ммоль/л (критерий Российской ассоциации эндокринологов) до 54.8 % при при отрезной точке по уровню глюкозы плазмы ≥5,6 ммоль/л (критерий ADA), соответственно."
Случаи и разногласия по ВИЧ в 2019 году: европейские перспективы / Cases and...hivlifeinfo
Learn unique perspectives across Europe on PrEP, rapid ART initiation, ART in women, and options for switching ART.
Format: Microsoft PowerPoint (.ppt)
File Size: 1.33 MB
Released: July 10, 2019
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Современное лечение ВИЧ: АРТ у пациентов с сопутствующими заболеваниями.Contemporary Management of HIV. Managing ART in HIV-Infected Patients With Common Comorbidities. 2016
1. Contemporary Management of HIV:
Managing ART in HIV-Infected
Patients With Common Comorbidities
This program is supported by an independent educational grant from
ViiV Healthcare.
2. Slide credit: clinicaloptions.com
About These Slides
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of these slides in your noncommercial presentations
to colleagues or patients
When using our slides, please retain the source
attribution:
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details
3. Program Director and Core Faculty
Program Chair
Eric S. Daar, MD
Chief, Division of HIV Medicine
Harbor-UCLA Medical Center
Professor of Medicine
David Geffen School of
Medicine at UCLA
Los Angeles, California
David A. Wohl, MD
Associate Professor of
Medicine
School of Medicine
Site Leader, AIDS Clinical
Trials Unit-Chapel Hill
University of North Carolina at
Chapel Hill
Director, North Carolina AIDS
Training and Education Center
Chapel Hill, North Carolina
Co-Director for HIV Services
North Carolina Department of
Correction
Raleigh, North Carolina
4. Faculty Disclosure Information
Eric S. Daar, MD, has disclosed that he has received
consulting fees from AbbVie, Bristol-Myers Squibb, Gilead
Sciences, Janssen, Merck, Teva, and ViiV and funds for
research support from Bristol-Myers Squibb, Gilead
Sciences, Merck, and ViiV.
David A. Wohl, MD, has disclosed that he has received
consulting fees from Gilead Sciences and Janssen and funds
for research support from Gilead Sciences and Merck.
6. Case 1: Pt With CVD Risk and Substance
Abuse
LH is a 56-yr-old black woman diagnosed with HIV
infection 4 yrs ago
She fell out of care 2.5 yrs ago and stopped ART
2 mos ago, she was admitted to the hospital with angina,
and her workup revealed the following:
– MI ruled out
– Toxicology screen positive for cocaine
Since discharge from the hospital, she has been in an
outpatient substance abuse treatment program and has
been receiving enalapril for hypertension
Smokes 1 pack cigarettes per day for > 30 yrs
Slide credit: clinicaloptions.com
7. Case 1: HIV/ART History
Laboratory values at the time of HIV diagnosis
– CD4+ cell count: 458 cells/mm3
– HIV-1 RNA: 11,000 copies/mL
Started on EFV/TDF/FTC
– HIV-1 RNA was suppressed except for occasional blips
Prior to falling out of care, her last CD4+ cell count was
762 cells/mm3
and HIV-1 RNA was 430 copies/mL
Stopped ART when she started using cocaine more
frequently
Slide credit: clinicaloptions.com
8. Case 1: Recent History and Current
Presentation
Returned to care 1 mo ago
– HIV-1 RNA: 24,000
copies/mL
– CD4+ count: 376 cells/mm3
– HCV negative; HBV immune
– Serum creatinine: 1.08
mg/dL (MDRD: > 60
mL/min/1.73m2
)
– HIV genotype: wild-type
virus
Current presentation today
– BP: 142/88 mm Hg
– BMI: 29 kg/m2
– Urinalysis: trace protein
– Toxicology screen: negative
– HLA-B*5701 negative
– TC: 207 mg/dL; HDL:
42 mg/dL; LDL: 130 mg/dL;
TG: 176 mg/dL
Slide credit: clinicaloptions.com
9. Case 1: Issues for Discussion
Should LH be prescribed a statin?
What ART should LH be prescribed?
What else can be done to reduce LH’s risk for new or
worsening comorbidities?
Slide credit: clinicaloptions.com
56-yr-old black woman diagnosed with HIV and initiated ART 4 yrs ago
Fell out of care and discontinued ART 2.5 yrs ago, now returned to care
HIV-1 RNA: 24,000 copies/mL; CD4+ cell count: 376 cells/mm3
HIV GT WT, but was viremic on EFV/TDF/FTC 2.5 yrs ago
HBV immune, HCV negative, HLA-B*5701 negative
Serum creatinine: 1.08 mg/dL (MDRD > 60 mL/min/1.73m2
); dyslipidemia
Recovering from substance abuse (cocaine); receiving enalapril for HTN
10. Case 1: Issues for Discussion
Should LH be prescribed a statin?
What ART should LH be prescribed?
What else can be done to reduce LH’s risk for new or
worsening comorbidities?
Slide credit: clinicaloptions.com
56-yr-old black woman diagnosed with HIV and initiated ART 4 yrs ago
Fell out of care and discontinued ART 2.5 yrs ago, now returned to care
HIV-1 RNA: 24,000 copies/mL; CD4+ cell count: 376 cells/mm3
HIV GT WT, but was viremic on EFV/TDF/FTC 2.5 yrs ago
HBV immune, HCV negative, HLA-B*5701 negative
Serum creatinine: 1.08 mg/dL (MDRD > 60 mL/min/1.73m2
); dyslipidemia
Recovering from substance abuse (cocaine); receiving enalapril for HTN
11. CVD Deaths in Era of Modern ART: D:A:D
Smith C, et al. Lancet. 2014:384:241-248.
Most Common Causes of Death, 1999-2011
AIDS related
CVD related
Other
100
80
60
40
20
0
AllDeaths(%)
Total
(N = 3909)
1999-2000
(n = 256)
2001-02
(n = 788)
2003-04
(n = 862)
2005-06
(n = 718)
2007-08
(n = 658)
2009-11
(n = 627)
Liver related
Non-AIDS cancer
Unknown
Slide credit: clinicaloptions.com
12. Declines in MI, Stroke in United States:
Kaiser Permanente CA Cohort
After adjusting for stroke risk factors:
No increased risk in HIV+ with recent
CD4+ count ≥ 500 cells/mm3
or recent
HIV-1 RNA
< 500 c/mL
Increased risk in HIV+ with recent CD4+
count < 500 cells/mm3
or recent HIV-1
RNA ≥ 500 c/mL
Recent reduced MI rates for HIV+
likely due to:
CVD risk reduction, lipid-friendly ART,
reduced immunodeficiency
1. Klein DB, et al. CROI 2014. Abstract 737.
2. Klein DB, et al. Clin Infect Dis. 2015;60:1278-1280.
3. Marcus JL, et al. CROI 2014. Abstract 741.
4. Marcus JL, et al. AIDS. 2014;28:1911-1919.
200
150
100
50
1996-1999
2000-2003
2004-2007
2008-2009
2010-2011
250
0
Stroke Rates by HIV Status and Yr[3,4]
Cases/100,000PYs
400
MIs/100,000PYs
300
200
100
0
1996-99
2000-03
2004-07
2008-09
2010-11
HIV+
HIV-
MI Rates Over Time by HIV Status[1,2]
HIV+
HIV-
Slide credit: clinicaloptions.com
16. CVD risk scores calculated with data from 2006-2009 for pts in Partners HealthCare
System Cohort[1]
An outpatient study cohort (n = 2392)had similar findings of underestimated CVD risk
[2]
1. Regan S, et al. CROI 2015. Abstract 751.
2. Thompson-Paul A, et al. CROI 2015. Abstract 747.
5-Yr Predicted Rate (%)
Framingham Risk Score[1]
5-YrEventRate(%)
5-YrEventRate(%)
ACC/AHACVD Risk Calculator[1]
5-Yr Predicted Rate (%)
Observed
Predicted
Observed
Predicted
CVD Outcomes Underestimated in HIV-
Positive Pts by Risk Calculators
n = 2270 n = 2152
25
20
15
10
5
0
< 2.5 2.5-4.9 5.0-7.4 7.5-9.9
25
20
15
10
5
0
< 2.5 2.5-4.9 5.0-7.4 7.5-9.9
Slide credit: clinicaloptions.com
17. Case 1: Issues for Discussion
Should LH be prescribed a statin?
What ART should LH be prescribed?
What else can be done to reduce LH’s risk for new or
worsening comorbidities?
56-yr-old black woman diagnosed with HIV and initiated ART 4 yrs ago
Fell out of care and discontinued ART 2.5 yrs ago; now returned to care
HIV-1 RNA: 24,000 copies/mL; CD4+ cell count: 376 cells/mm3
HIV GT WT, but was viremic on EFV/TDF/FTC 2.5 yrs ago
HBV immune, HCV negative, HLA-B*5701 negative
Serum creatinine: 1.08 mg/dL (MDRD: > 60 mL/min/1.73m2
); dyslipidemia
ASCVD 10-yr risk: 18%
Slide credit: clinicaloptions.com
18. Case 1 Question: Assuming LH is now
committed to adhering to ART, which of the
following regimens would you prescribe?
A. Restart EFV/TDF/FTC
B. RPV/TDF/FTC
C. Boosted PI + TDF/FTC
D. DTG + TDF/FTC
E. DTG/ABC/3TC
F. RAL + TDF/FTC
G. EVG/COBI/TDF/FTC
H. EVG/COBI/TAF/FTC
I. Something else
HIV-1 RNA: 24,000 copies/mL; CD4+ cell count: 376 cells/mm3
HIV GT WT, but was viremic on EFV/TDF/FTC 2.5 yrs ago
HBV immune, HCV negative, HLA-B*5701 negative
Serum creatinine: 1.08 mg/dL (MDRD: > 60 mL/min/1.73m2
); dyslipidemia
ASCVD 10-yr risk: 18%
Slide credit: clinicaloptions.com
19. ART and Effects on Lipids
TDF ABCRAL
DTG
ATV/RTV or ATV/COBI
DRV/RTV or DRV/COBI
EVG/COBI
EFVRPV
ETV
Slide credit: clinicaloptions.com
20. Studies 104 and 111: Wk 48 Combined
Analysis of Fasting Lipids
Total
Cholesterol
LDL HDL Triglycerides TC:HDL Ratio
MedianValues(mg/dL)
Sax PE, et al. Lancet. 2015;385:2606-2615.
189
177
115 109
51 48
108
3.7
114
3.7
E/C/F/TAF
Baseline
Wk 48
E/C/F/TDF
Baseline
Wk 48P < .001
P < .001
P < .001
P = .027
P = .84
Slide credit: clinicaloptions.com
200
150
100
50
0
160
101
44
95
163
104
44
100
5
4
3
2
0
1
3.6 3.6
21. Case 1: Issues for Discussion
Should LH be prescribed a statin?
What ART should LH be prescribed?
– What if LH’s serum creatinine was 1.9 mg/dL and
MDRD was 42 mL/min/1.73m2
?
What else can be done to reduce LH’s risk for new or
worsening comorbidities?
HIV-1 RNA: 24,000 copies/mL; CD4+ cell count: 376 cells/mm3
HIV GT WT, but was viremic on EFV/TDF/FTC 2.5 yrs ago
HBV immune, HCV negative, HLA-B*5701 negative
Serum creatinine: 1.9 mg/dL (MDRD: 42 mL/min/1.73m2
); dyslipidemia
ASCVD 10-yr risk: 18%
Slide credit: clinicaloptions.com
22. Case 1 Question: Would you prescribe an
ABC-based regimen?
A. Yes
B. No
Slide credit: clinicaloptions.com
HIV-1 RNA: 24,000 copies/mL; CD4+ cell count: 376 cells/mm3
HIV GT WT, but was viremic on EFV/TDF/FTC 2.5 yrs ago
HBV immune, HCV negative, HLA-B*5701 negative
Serum creatinine: 1.9 mg/dL (MDRD: 42 mL/min/1.73m2
); dyslipidemia
ASCVD 10-yr risk: 18%
23. Summary of Key Analyses Showing ABC
Associated With Risk of MI
Study
Study
Design
Age, Yrs
(Range)
Event
(n)
Pts,
N
ABC
CV Effect
Time on
ABC, Mos
Risk of MI
(95% CI)
D:A:D[1]
Cohort
40
(35-47)
MI, validated
(387)
22,625 Yes ≥ 6
2.04
(1.66-2.51)
D:A:D 2015[2]
Cohort
39
(33-46)
MI
(493)
32,663 Yes Current
1.47
(1.26-1.71)
SMART[3]
RCT
45
(39-51)
MI, validated
(19)
2752 Yes Current
4.3
(1.4-13.0)
STEAL[4]
RCT
45.7
±8.8
MI
(4)
357 Yes 96
2.79*
(1.76-4.43)
QPHID[5]
CC
47
(22-67)
MI
(125)
7053 Yes Any
1.79
(1.16-2.76)
Danish[6]
Cohort
39
(33-47)
MI
(67)
2952
Yes > 6
2.00
(1.07-3.76)
VA (Choi)[7]
Cohort 46
CVD event
(501)
10,931 Yes Recent
1.64
(0.88-3.08)
Swiss[8]
Cohort Not given
CVD event
(365)
11,856 Yes Recent
4.06†
(2.24-7.34)
MAGNIFICENT[9]
CC
50
(22-85.5)
CVD event
(571)
1875 Yes Current
1.56
(1.17-2.07)
NA-ACCORD[10]
Cohort
MI, validated
(301)
16,733 Yes Recent 1.33
References in slidenotes Slide credit: clinicaloptions.com
*Risk for serious non-AIDS events (most common was CVD, including MI); HR for CVD with TDF vs
ABC: 0.12 (95% CI: 0.02-0.98; P = .048).
†
Risk for CVD event, including MI, invasive CV procedure, or CV-related death.
24. Summary of Key Analyses Showing ABC
NOT Associated With Risk of MI
References in slidenotes
Study Study
Design
Age, Yrs
(Range)
Event
(n)
Pts,
N
ABC
CV
Effect
Time on
ABC,
Mos
Adj Risk of
MI
(95% CI)
FHDH[1]
CC
47
(41-54)
MI
(289)
74,958 No
< 12/
recent
1.27*
(0.64-2.49)
ALLRT/
ACTG[2] Cohort
37
(26-51)
MI
(36)
5056 No 72
0.6
(0.3 -1.4)
VA[3]
Cohort 46
MI
(278)
19,424 No Per 12
1.18
(0.92-1.50)
FDA[4]
Meta-
analysis of
RCTs
36-42
MI
(46)
9868 No 19
1.02
(0.56-1.84)
NA-
ACCORD[5] Cohort
MI,
validated
(301)
16,733 No Recent 1.33
*Without adjustment for cocaine use OR: 2.01 (1.11-3.64).
Slide credit: clinicaloptions.com
25. TAF in Pts With Renal Insufficiency
Open-label trial of 242 virologically suppressed pts with stable eGFRCG
30-69 mL/min switched from TDF and non-TDF regimens to E/C/F/TAF
Pozniak A, CROI 2015. Abstract 795. Slide credit: clinicaloptions.com
15
10
5
0
-5
-10
Median(Q1,Q3)
eGFRChange
FromBaseline
(mL/min)
Change in eGFR (Cockcroft-Gault)
0 4 8 12 16 24 36 48 Baseline eGFR
< 50 mL/min
≥ 50 mL/min
Primary Endpoint
0.6
-1.4
15
10
5
0
-5
-10
Median(Q1,Q3)
eGFRChange
FromBaseline
(mL/min/1.73m2
)
Change in eGFR (CKD-EPI, Cystatin C)
0 4 8 12 16 24 36 48
Primary Endpoint
1.8
1.1
Wks
Wks
26. Novel TDF- and ABC-Sparing ART
Strategies Under Investigation
1. Cahn P, et al. EACS 2015. Abstract 961.
2. Raffi F, et al. Lancet. 2014;384:1942-1951.
3. Figueroa MI, et al. EACS 2015. Abstract 1066.
4. Perez-Molina JA, et al. Lancet Infect Dis. 2015;15:775-784.
5. Di Giambenedetto S, et al. EACS 2015. Abstract 867.
6. Arribas JR, et al. Lancet Infect Dis. 2015;15:785-792.
7. Casado JL, et al. J Antimicrob Chemother. 2015;70:630-632.
8. Margolis DA, et al. Lancet Infect Dis. 2015;15:1145-1155. Slide credit: clinicaloptions.com
Study
Initial or Switch
From Suppr. ART
N Regimen Results
GARDEL[1]
Initial 426 LPV/RTV + 3TC Similar efficacy as LPV/RTV + 2 NRTIs
PADDLE[2]
Initial 20 DTG + 3TC Small study; encouraging efficacy
NEAT001/
ANRS143[3] Initial 805 DRV/RTV + RAL Similar efficacy as DRV/RTV + TDF/FTC
SALT[4]
Switch 286 ATV/RTV + 3TC Similar efficacy as ATV/RTV + 2 NRTIs
ATLAS-M[5]
Switch 266 ATV/RTV + 3TC
Similar (improved in post hoc analysis)
efficacy vs ATV/RTV + 2 NRTIs
OLE[6]
Switch 250 LPV/RTV + 3TC
Similar efficacy as continued standard
ART
NA[7]
Switch 48 DRV/RTV + 3TC Small study; encouraging efficacy
LATTE[8]
Switch 243 CAB + RPV
Similar efficacy as continued standard
ART
28. Drug–Drug Interactions With First-line
ART and Lipid-Lowering Therapy
Antiretroviral Contraindicated Titrate Dose No Dose Adjustment
EFV Atorvastatin
Simvastatin
Pravastatin
Rosuvastatin
Pitavastatin
RPV Atorvastatin
Pitavastatin
ATV/RTV
ATV/COBI
Lovastatin
Simvastatin
Atorvastatin
Rosuvastatin
Pitavastatin
DRV/RTV
DRV/COBI
Lovastatin
Simvastatin
Atorvastatin
Pravastatin
Rosuvastatin
Pitavastatin
EVG/COBI/TAF/FTC Lovastatin
Simvastatin
Atorvastatin
EVG/COBI/TDF/FTC Lovastatin
Simvastatin
Atorvastatin
Rosuvastatin
DTG All
RAL All
DHHS Adult Guidelines. April 2015. US Food and Drug Administration. Slide credit: clinicaloptions.com
29. Case 1: Issues for Discussion
Should LH be prescribed a statin?
What ART should LH be prescribed?
What else can be done to reduce LH’s risk for new or
worsening comorbidities?
56-yr-old black woman diagnosed with HIV and initiated ART 4 yrs ago
Fell out of care and discontinued ART 2.5 yrs ago; now returned to care
HIV-1 RNA: 24,000 copies/mL; CD4+ cell count: 376 cells/mm3
HIV GT WT, but was viremic on EFV/TDF/FTC 2.5 yrs ago
HBV immune, HCV negative, HLA-B*5701 negative
Serum creatinine: 1.08 mg/dL (MDRD: > 60 mL/min/1.73m2
); dyslipidemia
Recovering from substance abuse (cocaine); receiving enalapril for HTN
Slide credit: clinicaloptions.com
30. Case 1: Additional Considerations
Is aspirin indicated?
Is LH’s blood pressure adequately controlled?
Should you order a chest CT?
Avoiding future comorbidities[1]
– Colonoscopy
– PAP smear
– Mammogram
– DXA
– Vaccinations
– STI screening
1. Aberg JA, et al. Clin Infect Dis. 2014;58:1-10. Slide credit: clinicaloptions.com
31. Case 1: Take-Home Points
CVD is prevalent among HIV-infected individuals,
many of whom have major CVD risk factors
The ASCVD risk calculator replaces the Framingham
estimation and has established a threshold for statin
initiation as a 7.5% 10-year risk
Different antiretroviral agents have varying affects on
lipids and drug interactions with medications used to
treat CVD
The potential impact of antiretroviral agents on CVD
risk must be considered when selecting HIV therapy
Slide credit: clinicaloptions.com
32. Case 2: Patient on Long-term
Suppressive ART With Low BMD
Identified After Fracture
33. Case 2: Pt on Long-term ART With Low
BMD Identified After Fracture
RB is a 60-yr-old HIV-infected man with suppressed
HIV-1 RNA for > 8 yrs
– Nadir CD4+ cell count: 110 cells/mm3
– Baseline HIV genotype: wild-type
– Initial and current ART: ATV/RTV + TDF/FTC, initiated
during a clinical trial that has since ended
– HCV negative and HBV immune
– HLA-B*5701: negative
Slide credit: clinicaloptions.com
34. Case 2: Medical History and Current
Medications
Past medical history and current medications
– Depression, citalopram
– Alcohol abuse
– Sober for 2 yrs
– COPD
Former smoker
Slide credit: clinicaloptions.com
35. Case 2: Current Presentation
At routine visit 3 wks ago, presented in orthopedic boot s/p
recent ankle fracture sustained when stepping out of his
high pickup truck
– HIV-1 RNA: < 20 copies/mL
– CD4+ cell count: 438 cells/mm3
– Serum creatinine: 1.2 mg/dL (MDRD: > 60 mL/min/1.73m2
)
– Urinalysis: trace protein
– ASCVD 10-yr risk: < 7.5%
– Vitamin D (25OH): 19 ng/mL
– DXA T-scores: L-spine: -2.6; femoral neck: -2.7; hip: -2.6
Slide credit: clinicaloptions.com
36. Case 2: Issues for Discussion
Should RB’s ART be modified?
Is any further assessment or intervention needed for
RB?
60-yr-old HIV-infected man with suppressed HIV-1 RNA for > 8 yrs
Initial and current ART: ATV/RTV + TDF/FTC
HIV baseline GT WT, HBV immune, HCV negative, HLA-B*5701 negative
Recent fracture
DXA T-scores: L-spine: -2.6; femoral neck: -2.7; hip: -2.6
Depression; former smoker; previous heavy alcohol use (sober 2 yrs)
COPD
Serum creatinine: 1.2 mg/dL (MDRD: > 60 mL/min/1.73m2
)
Slide credit: clinicaloptions.com
37. Case 2: Issues for Discussion
Should RB’s ART be modified?
Is any further assessment or intervention needed for
RB?
60-yr-old HIV-infected man with suppressed HIV-1 RNA for > 8 yrs
Initial and current ART: ATV/RTV + TDF/FTC
HIV baseline GT WT, HBV immune, HCV negative, HLA-B*5701 negative
Recent fracture
DXA T-scores: L-spine: -2.6; femoral neck: -2.7; hip: -2.6
Depression; former smoker; previous heavy alcohol use (sober 2 yrs)
COPD
Serum creatinine: 1.2 mg/dL (MDRD: > 60 mL/min/1.73m2
)
Slide credit: clinicaloptions.com
38. Case 2 Question: How would you manage
RB’s low BMD?
A. Continue ATV/RTV + TDF/FTC and start calcium/vitamin D ±
bisphosphonate
B. Continue ATV/RTV, but switch TDF/FTC to ABC/3TC
C. Continue TDF/FTC, but switch ATV/RTV to boosted DRV or an INSTI
or RPV
D. Switch to EVG/COBI/TAF/FTC
E. Switch to DTG + RPV
F. Something else
60-yr-old HIV-infected man with suppressed HIV-1 RNA for > 8 yrs; initial/current ART:
ATV/RTV + TDF/FTC; HIV baseline GT WT, HBV immune, HCV negative, HLA-B*5701
negative; low BMD and recent fracture; treated depression; former smoker; previous
heavy alcohol use (sober 2 yrs); COPD; serum Cr: 1.2 mg/dL (MDRD: > 60
mL/min/1.73m2
)
Slide credit: clinicaloptions.com
39. Do HIV-Positive Pts Have Increased Risk
of Bone Loss and Fractures?
Meta-analysis: HIV-positive pts had 6.4-fold increased risk of low BMD
and 3.7-fold increased risk of osteoporosis[1]
8525 HIV-infected pts compared with 2,208,792 uninfected pts in
Partners HealthCare System, 1996-2008[2]
Women Men
1. Brown TT, et al. AIDS. 2006;20:2165-2174.
2. Triant V, et al. J Clin Endocrinol Metab. 2008;93:3499-3504.
Age (Yrs)
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0
FracturePrevalence/
100Persons
30-39 40-49 50-59 60-69 70-79
P = .002
(overall comparison)
HIV
Non-HIV
HIV
Non-HIV
Age (Yrs)
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0
FracturePrevalence/
100Persons
20-29 30-39 40-49 50-59 60-69
P < .0001
(overall comparison)
Slide credit: clinicaloptions.com
40. ART Associated With ~ 2% to 6% Loss in
BMD During First 1-2 Yrs After Initiation
1. Gallant JE, et al. JAMA. 2004;292:191-201.
2. Brown TT, et al. JAIDS. 2009;51:554-561.
3. Duvivier C, et al. AIDS. 2009;23:817-824.
4. van Vonderen MG, et al. AIDS. 2009;23:1367-1376.
5. Stellbrink HJ, et al. CID. 2010;51:963-972.
6. McComsey GA, et al. JID. 2011;203:1791-1801.
Study Pts,
N
Duration,
Wks
ART Change in BMD, %
Spine Hip Total
Gallant 2004[1]
602 144 EFV + TDF/3TC
EFV + D4T/3TC
-2.2
-1.0
-2.8
-2.4
-
-
Brown 2009[2]
106 96
LPV/RTV + ZDV/3TC
EFV + ZDV/3TC
-
-
-
-
-2.5
-2.3
Duvivier 2009[3]
71 48
PI
Non-PI
-4.4 to -5.8
-1.5
-2.4 to -3.7
-2.7
-
-
van Vonderen
2009[4] 50 104
LPV/RTV + ZDV/3TC
LPV/RTV + NPV
-5.1
-2.6
-6.3
-2.3
-
-
Stellbrink
2010[5] 385 48
EFV + TDF/FTC
EFV + ABC/3TC
-3.6
-1.9
-2.4
-1.6
-
-
McComsey
2011[6] 269 96
TDF/FTC
ABC/3TC
ATV/RTV
EFV
-3.3
-1.3
-3.1
-1.7
-4.0
-2.6
-3.4
-3.1
-
-
-
-
Slide credit: clinicaloptions.com
41. START: Immediate vs Deferred ART
START: International, randomized phase IV study involving 215 sites
in 35 countries
Study stopped by DSMB following results of interim analysis
– Overall HR: 0.43 (P < .001)
– HR for serious AIDS-related events: 0.28 (P < .001)
– HR for non-AIDS–related events: 0.61 (P = .04)
Serious AIDS and
Non-AIDS Events, n
42
96
Lundgren JD, et al. N Engl J Med. 2015;373:795-807.
Immediate ART
Delayed ART
(until CD4+ ≤ 350 cells/mm³)
Treatment-naive
pts with CD4+ count
> 500 cells/mm³
(N = 4685)
Slide credit: clinicaloptions.com
42. START Substudy: BMD Changes With
Immediate vs Deferred ART Over 3 Yrs
Substudy included 193 pts in
early ART arm and 204 pts in
deferred ART arm with f/u
Greater BMD loss in hip and
spine with immediate vs
deferred ART
– Estimated mean difference for
hip: -1.5% (95% CI: -2.3% to
-0.8%; P < .001)
– Estimated mean difference for
spine: -1.6% (95% CI: -2.2% to
-1.0%; P < .001)
Osteoporosis incidence similar
between arms (P = .27)
Hoy JF, et al. EACS 2015. Abstract ADRLH-62.
ChangeFromBL(%)ChangeFromBL(%)
Total Hip BMD
0
-1
-2
-3
-4
-5
0 12 24 36
Immediate ART
Deferred ART
Total Spine BMD
0
-1
-2
-3
-4
-5
0 12 24 36
Mos From Randomization
Slide credit: clinicaloptions.com
43. A5224s: Mean Percent Change in Hip and
Spine BMD
Substudy of A5202:
TDF/FTC vs ABC/3TC
with either ATV/RTV vs
EFV
N = 269
– 85% male, 47% white,
median age: 38 yrs
Significantly greater
spine and hip BMD loss
with TDF/FTC vs
ABC/3TC
Significantly greater
BMD loss in spine but
not hip with ATV/RTV vs
EFV
McComsey GA, et al. J Infect Dis. 2011;203:1791-1801.
Wk
Wk
P = .004
P = .024
P = .61
Slide credit: clinicaloptions.com
SpineBMD%
ChangeFromWk0
0
-1
-2
-3
-4
-5
0
1
NRTI Component:
1° Analysis
24 48 96 144 192
TDF/FTC
ABC/3TC
HipBMD%
ChangeFromWk0
0
-1
-2
-3
-4
-5
0
1
24 48 96 144 192
TDF/FTC
ABC/3TC
0
-1
-2
-3
-4
-5
0
1
NNRTI/PI Component:
2° Analysis
24 48 96 144 192
EFV
ATV/RTV
P = .035
0
-1
-2
-3
-4
-5
0
1
24 48 96 144 192
EFV
ATV/RTV
44. A5260s Substudy of ACTG 5257: BMD
Loss With RAL vs Boosted PIs
A5257: Phase III trial in which
treatment-naive pts with HIV-1
RNA ≥ 1000 copies/mL were
randomized to:
– RAL + TDF/FTC (n = 603)
– ATV/RTV + TDF/FTC (n = 605)
– DRV/RTV + TDF/FTC (n = 601)
In A5260s metabolic substudy (N =
328), all arms associated with
significant loss of BMD through Wk
96 (P < .001)
At hip and spine, similar loss of
BMD in the PI arms
– Significantly greater loss in
combined PI arms than in RAL arm
ATV/RTV + TDF/FTC
DRV/RTV + TDF/FTC
Combined PI arms
RAL + TDF/FTC
-5
-4
0
-3
-2
-1
-3.9
-3.4
-3.7
-2.4
-1.8
-4.0
-3.8
-3.6
P = .36
Total Hip Lumbar Spine
P = .005
P = .42
P < .001
Brown TT, et al. J Infect Dis. 2015;212:1241-1249. Slide credit: clinicaloptions.com
45. TAF vs TDF in Studies 104/111: BMD
Changes by Age in Treatment-Naive Pts
Difference
E/C/F/TAF
E/C/F/TDF
Mean%ChangeinBMDFromBaseline
DifferenceinLSM(%)
HipSpine
18-25 Yrs of Age
All Ages All Ages
Wohl D, et al. EACS 2015. Abstract 1091. Slide credit: clinicaloptions.com
0
-1
-2
-3
-4 0
2
1
3
4
0
-1
-2
-3
-4 0
2
1
3
4
0 24 48 72 96
0
-1
-2
-3
-4 0
2
1
3
4
18-25 Yrs of Age0
-1
-2
-3
-4 0
2
1
3
4
0 24 48 72 96
Wk Wk
46. Switch From TDF to ABC or From TDF to
RAL in Pts With Low BMD
Negredo E, et al. J Antimicrob Chemother. 2014;69:3368-3371.
Bloch M, et al. HIV Med. 2014;15:373-380.
Switch From TDF to ABC Switch From TDF to RAL
Slide credit: clinicaloptions.com
Tenofovir Abacavir Raltegravir
3.5
2.5
1.5
0.5
0
-0.5
-1.5
-2.5
-3.5
ChangeinBMDOver48Wks(%)
Femoral
Neck
Lumbar
Spine
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0
Total
Hip
Lumbar
Spine
2.1
-0.7
0.7
-1.2
3.0
2.5
47. Study 109: Switch From E/C/F/TDF to
E/C/F/TAF in Suppressed Pts
Randomized, active-controlled, open-label study
– Primary endpoint: HIV-1 RNA < 50 c/mL at Wk 48
Thompson M, et al. IDWeek 2015. Abstract 725.
Pts with HIV-1 RNA
< 50 copies/mL (≥ 48 wks)
on stable TDF-based
regimen and eGFR
≥ 50 mL/min
(N = 1436)
Switch to EVG/COBI/FTC/TAF QD
(n = 959)
Continue Previous TDF-Based Regimen*
(n = 477)
Primary Endpoint
Wk 48
*Previous TDF-based regimens: EVG/COBI/FTC/TDF (n = 459), EFV/TDF/FTC (n = 376), ATV/COBI
or ATV/RTV + TDF/FTC (n = 601).
Continue
through
Wk 96
Slide credit: clinicaloptions.com
48. Study 109: Bone Outcomes in Pts
Receiving EVG/COBI/FTC/TDF at BL
Thompson M, et al. IDWeek 2015. Abstract 725.
Spine
Hip
3
2
1
0
-1
-2
-3
3
2
1
0
-1
-2
-3
BL Wk 48Wk 24
BL Wk 48Wk 24
1.33 (3.6)
-0.50 (3.4)
1.15 (2.7)
-0.24 (2.7)
E/C/F/TAF
E/C/F/TDF
E/C/F/TAF
E/C/F/TDF
Mean%ChangeinBMD
(SD)
Mean%ChangeinBMD
(SD)
P<.001P<.001
Slide credit: clinicaloptions.com
49. Case 2: Issues for Discussion
Should RB’s ART be modified?
Is any further assessment or intervention needed for
RB?
60-yr-old HIV-infected man with suppressed HIV-1 RNA for > 8 yrs
Initial and current ART: ATV/RTV + TDF/FTC
HIV baseline GT WT, HBV immune, HCV negative, HLA-B*5701 negative
Recent fracture
DXA T-scores: L-spine: -2.6; femoral neck: -2.7; hip: -2.6
Depression; former smoker; previous heavy alcohol use (sober 2 yrs)
COPD
Slide credit: clinicaloptions.com
51. Brown TT, et al. Clin Infect Dis. 2015;60:1242-1251. Slide credit: clinicaloptions.com
Recommendations for Evaluation of Bone
Disease in HIV
52. Calculating Fracture Risk: FRAX Tool
Developed by WHO to evaluate fracture risk, based on cohort
study data from North America, Europe, Asia, Australia
Integrates clinical risk factors (smoking status, alcohol
consumption, rheumatoid arthritis) as well as BMD at the
femoral neck, age, and sex
Provides 10-yr probability of hip fracture and 10-yr probability of
major osteoporotic fracture (clinical fracture in spine, forearm,
hip, or shoulder)
Online risk calculators and paper charts for white, black,
Hispanic, and Asian populations in the United States and for
other countries available at: http://www.shef.ac.uk/FRAX/
FRAX tool. http://www.shef.ac.uk/FRAX/ Slide credit: clinicaloptions.com
54. VA Study: FRAX Underestimated Fracture
Risk in HIV-Positive Men
97% of HIV-positive men
with an actual fracture
would not have been
flagged for treatment
based on their FRAX
score
Adding HIV infection as a
“secondary” cause of
osteoporosis increased
the accuracy of the score
Yin M, et al. CROI 2015. Abstract 141.
10-YrFractureIncidence(%)
Major
Osteopor. Fracture
HIV infected HIV uninfected
Observed
Estimated by
Modified FRAX
Hip
Fracture
Major
Osteopor. Fracture
Hip
Fracture
P < .0001
P < .0001
P < .0001
P = .0008
5
4
2
0
1
3
Slide credit: clinicaloptions.com
55. Secondary Causes of Low BMD
Conditions Lab Test
Vitamin D deficiency 25-hydroxyvitamin D
Hyperparathyroidism iPTH, Ca, PO4
Renal phosphate wasting in pts on
TDF
Fractional excretion of phosphate
Subclinical hyperthyroidism TSH
Hypogonadism Morning free testosterone,
menstrual history, FSH
Idiopathic hypercalciuria 24-hr urinary calcium
National Osteoporosis Foundation.
http://nof.org/files/nof/public/content/file/2791/upload/919.pdf
Slide credit: clinicaloptions.com
56. Case 2: Additional Management
Calcium and vitamin D supplementation
Weight-bearing exercise
Fall risk assessment
Bisphosphonate?
Slide credit: clinicaloptions.com
57. Case 2: Take-Home Points
Low bone density is common in patients living with
HIV
Traditional and HIV-related factors, including
antiretroviral therapy, can lead to bone density loss
There are recommendations for bone density
screening for HIV-infected men and women
DXA scanning and the FRAX calculator can be used
to assess bone health
Secondary causes of low BMD should be sought and,
if found, addressed
Slide credit: clinicaloptions.com
59. Case 3: Pt With HIV/GT1a HCV Coinfection
SC is a 42-yr-old woman diagnosed with HIV and HCV
coinfection 8 mos ago
– Active IDU (oxymorphone, heroin)
– Current medications: ranitidine for GERD
She was screened for HIV when a small HIV outbreak was
detected among IDU in her community
Slide credit: clinicaloptions.com
HCV parameters at
diagnosis
– HCV genotype: 1a
– HCV RNA: 1.2 million IU/mL
HIV parameters at
diagnosis
– HIV-1 RNA: 38,000
copies/mL
– CD4+ cell count: 592
cells/mm3
– HIV genotype: WT only virus
61. Case 3: Current Presentation
She has been receiving DRV/COBI + TDF/FTC for
6 mos
– HIV-1 RNA: < 40 copies/mL
– CD4+ cell count: 658 cells/mm3
She is injecting less and only uses clean needles
provided by a local advocacy group. After counseling,
she is also now using condoms with her boyfriend
She wants to start HCV therapy
Slide credit: clinicaloptions.com
62. Case 3: Issues for Discussion
How best to manage SC’s HIV and HCV coinfection
‒ What HCV therapy should be prescribed?
‒ Does SC’s ART need to be modified?
42-yr-old HIV/GT1a HCV–coinfected woman with suppressed HIV-1 RNA on
DRV/COBI + TDF/FTC
F3 liver fibrosis
HIV baseline GT WT, HBV immune
HCV RNA: 1.2 million IU/mL
Serum creatinine: 0.9 mg/dL (MDRD: > 60 mL/min/1.73m2
)
Current substance abuse (heroin)
Receiving ranitidine for GERD
Slide credit: clinicaloptions.com
63. NA-ACCORD (1996-2010): ESLD and
Modern ART in HIV/HCV Coinfection
Risk for ESLD* in modern
ART era (adjusted IR [ref:
HIV monoinfection])
– HIV/HCV: 6.9
– HIV/HBV: 5.9
– HIV/HCV/HBV: 17.9
No clear reduction in
ESLD risk over the 3 ART
eras
ESLD Incidence Rates
HIV
Incidence(per1000Person-Yrs)
HIV/HCV HIV/HBV HIV/HCV/
HBV
Early ART era (1996-2000, n = 10,395)
Middle ART era (2001-2005, n = 21,188)
Modern ART era (2006-2010, n = 22,472)
Klein MB, et al. CROI 2015. Abstract 638.
Infection
*ESLD as indicated by events such as ascites,
spontaneous bacterial peritonitis, bleeding varices,
encephalopathy, hepatoma
Slide credit: clinicaloptions.com
25
20
15
10
5
0
64. Trials of HCV Therapy in HIV/HCV-
Coinfected Patients
1. Naggie S, et al. N Engl J Med. 2015;373:705-713. 2. Sulkowski
MS, et al. JAMA. 2015;313:1223-1231. 3. Wyles DL, et al. N Engl J
Med. 2015;373:714-725. 4. Molina JM, et al. Lancet. 2015;385:1098-
1106. 5. Osinusi A, et al. JAMA. 2015;313:1232-1239.
Study Population HCV Regimens
SVR12,
%
ION-4[1]
N = 335; GT1 (98%) or 4 LDV/SOF 12 wks 96
TURQUOISE-I[2]
N = 63; GT1
OBV/PTV/RTV + DSV + RBV
12 wks
OBV/PTV/RTV + DSV + RBV
24 wks
94
91
ALLY-2[3] N = 151; GT1 (83%), 2, 3,
or 4
Tx-naive:
SOF + DCV 12 wks
SOF + DCV 8 wks
Tx-expd: SOF + DCV 12 wks
97
76
98
PHOTON-2[4]
N = 275; GT1, 2, 3, or 4 SOF + RBV 24 wks
GT1: 85
GT2: 88
GT3: 89
GT4: 84
NIH[5]
N = 50; GT1 LDV/SOF 12 wks 98
Slide credit: clinicaloptions.com
65. SMV + SOF SOF LDV/SOF DCV + SOF
OBV/PTV/RTV
+ DSV
Atazanavir + RTV Χ √ ≈ ≈ √
Darunavir + RTV Χ √ ≈ √ Χ
Lopinavir/RTV Χ √ ≈ √ Χ
Tipranavir + RTV Χ Χ Χ Χ Χ
Efavirenz Χ √ ≈ ≈ Χ
Rilpivirine √ √ √ √ Χ
Etravirine ≈ √ √ ≈ ≈
Raltegravir √ √ √ √ √
Elvitegravir + COBI Χ ≈ ≈ ≈ ≈
Dolutegravir √ √ √ √ √
Maraviroc √ √ √ √ ≈
Tenofovir DF √ √ ≈ √ √
AASLD/IDSA. HCV guidelines. December 2015.
No clinically significant
interaction expected
Potential interaction may require adjustment to
dosage, timing of administration, or monitoring
Do not coadminister
Slide credit: clinicaloptions.com
AASLD Guidance on HIV/HCV DDIs
66. Case 3: HCV Therapy Selection
Given potential drug–drug interactions between HCV
and HIV therapies, you prescribe ledipasvir/sofosbuvir
However, the state Medicaid board lists ombitasvir/
paritaprevir/ritonavir + dasabuvir + RBV as the
preferred regimen for GT1a HCV infection and denies
your request
Slide credit: clinicaloptions.com
67. Case 3 Management Question: If you decide not to appeal, how
would you manage SC’s ART regimen (DRV/COBI + TDF/FTC)
when treating her HCV infection with OBV/PTV/RTV + DSV +
RBV?
A. Stay on current regimen
B. Switch to EVG/COBI/TAF/FTC
C. Switch to DTG/ABC/3TC or DTG + TDF/FTC
D. Switch to DRV/COBI + ABC/3TC
E. Switch to RAL + TDF/FTC
F. Switch to RPV/TDF/FTC
G. Something else
Slide credit: clinicaloptions.com
68. Case 3 Management Question: If you appeal and win approval
for LDV/SOF, how would you manage SC’s ART regimen
(DRV/COBI + TDF/FTC) when treating her HCV infection with
LDV/SOF?
A. Stay on current regimen
B. Switch to EVG/COBI/TAF/FTC
C. Switch to DTG/ABC/3TC or DTG + TDF/FTC
D. Switch to DRV/COBI + ABC/3TC
E. Switch to RAL + TDF/FTC
F. Switch to RPV/TDF/FTC
G. Something else
Slide credit: clinicaloptions.com
69. AASLD Guidance on HCV/HIV DDIs:
LDV/SOF
LDV increases TFV levels in patients receiving TDF
and increase is highest when LDV and TDF are used
in combination with RTV-boosted PIs
Avoid combination of LDV and TDF if CrCl
< 60 mL/min or if receiving TDF with a boosted PI
TFV levels increased with efavirenz, rilpivirine, or
dolutegravir when administered with LDV/SOF and
TDF
When LDV/SOF is coadministered with TDF-
containing ART, monitor closely for nephrotoxicity
AASLD/IDSA. HCV guidelines. December 2015. Slide credit: clinicaloptions.com
70. No Relevant DDIs Between LDV/SOF and
E/C/F/TAF or R/F/TAF*
2 multiple-dose phase I DDI studies in healthy volunteers
Custodio JM, et al. IDWeek 2015. Abstract 727.
GMR for AUC
(90% CI)
E/C/F/TAF +
LDV/SOF vs
E/C/F/TAF
R/F/TAF +
LDV/SOF vs
R/F/TAF
E/C/F/TAF +
LDV/SOF vs
LDV/SOF
R/F/TAF +
LDV/SOF vs
LDV/SOF
TAF 0.86 (0.78-0.95) 1.32 (1.25-1.40) NA NA
TDF 1.27 (1.23-1.31) 1.75 (1.69-1.81) NA NA
EVG 1.1 (1.0-1.2) NA NA NA
COBI 1.5 (1.5-1.6) NA NA NA
RPV NA 0.95 (0.91-0.98) NA NA
FTC 0.97 (0.93-1.00) 1.00 (0.98-1.02) NA NA
LDV NA NA 1.79 (1.63-1.96) 1.02 (0.97-1.06)
SOF NA NA 1.47 (1.35-1.59) 1.05 (1.01-1.09)
GS-331007 NA NA 1.48 (1.44-1.53) 1.08 (1.06-1.10)
Slide credit: clinicaloptions.com
*Note that RPV/FTC/TAF is not currently approved by the US FDA.
71. Other Important Drug–Drug Interactions:
Ledipasvir
Acid-reducing agents: increased gastric pH
decreases concentration of ledipasvir
– Separate antacids (eg, aluminum and magnesium
hydroxide) by 4 hrs
– H2 blockers can be given at same time or 12 hrs apart
at doses equivalent to famotidine 40 mg BID or lower
– PPIs at doses equivalent to omeprazole 20 mg/day or
lower can be given simultaneously under fasted
conditions
LDV/SOF prescribing information, 2015. Slide credit: clinicaloptions.com
73. 1. Sulkowski M, et al. JAMA. 2015;313:1223-1231. 2. DHHS Guidelines. April 2015.
3. AASLD/IDSA. HCV guidelines. December 2015.
Guidance on HCV/HIV DDIs:
OBV/PTV/RTV + DSV
Phase III study of OBV/PTV/RTV + DSV + RBV in HCV/HIV
coinfection included pts with ATV or RAL only, pts with DRV
being evaluated in ongoing part 1b[1]
Do not coadminister OBV/PTV/RTV with:[2]
– DRV (DRV Cmin decreases 43% to 48%)
– LPV (PTV AUC increases 117%)
– ATV/COBI, DRV/COBI, FPV, SQV, TPV, EFV, EVG (no data)
– RPV (RPV AUC increases 150% to 225%)
– ETR, NPV (DAA decrease possible)
Adjust/withhold RTV if receiving a boosted PI with
OBV/PTV/RTV + DSV[3]
Slide credit: clinicaloptions.com
74. Case 3: Take-Home Points
There has been an increase in injecting drug use in
the United States and with it transmission of HCV
New direct-acting antiviral regimens for treating HCV
infection are potent but differ in their potential for
drug-drug interactions with antiretroviral agents and
other medications
Treatment of HIV/HCV coinfection may require
consideration for the modification of HIV therapy
during HCV treatment
Slide credit: clinicaloptions.com
75. Go Online for More CCO
Coverage of HIV!
Additional slidesets on contemporary management of HIV with expert
faculty commentary
Postconference Clinical Updates available following CROI, the
International AIDS Conference, and IDWeek
clinicaloptions.com/hiv
Editor's Notes
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.
BMI, body mass index; BP, blood pressure; HBV, hepatitis B virus; HCV, hepatitis C virus; HDL, high density lipoprotein; LDL, low density lipoprotein; MDRD, Modification of Diet in Renal Disease; TC, total cholesterol; TG, triglycerides.
EFV, efavirenz; FTC, emtricitabine; GT, genotype; HBV, hepatitis B virus; HCV, hepatitis C virus; HTN, hypertension; MDRD, Modification of Diet in Renal Disease; TDF, tenofovir disoproxil fumarate; WT, wild type.
EFV, efavirenz; FTC, emtricitabine; GT, genotype; HBV, hepatitis B virus; HCV, hepatitis C virus; HTN, hypertension; MDRD, Modification of Diet in Renal Disease; TDF, tenofovir disoproxil fumarate; WT, wild type.
C, cobicistat; E, elvitegravir; F, emtricitabine; HDL, high density lipoprotein; LDL, low density lipoprotein; TAF, tenofovir alafenamide; TC, total cholesterol; TDF, tenofovir disoproxil fumarate.
ASCVD, atherosclerotic cardiovascular disease; EFV, efavirenz; FTC, emtricitabine; GT, genotype; HBV, hepatitis B virus; HCV, hepatitis C virus; MDRD, Modification of Diet in Renal Disease; TDF, tenofovir disoproxil fumarate; WT, wild type.
ABC, abacavir; ASCVD, atherosclerotic cardiovascular disease; EFV, efavirenz; FTC, emtricitabine; GT, genotype; HBV, hepatitis B virus; HCV, hepatitis C virus; MDRD, Modification of Diet in Renal Disease; TDF, tenofovir disoproxil fumarate; WT, wild type.
ABC, abacavir; CC, case-control; CI, confidence interval; CV, cardiovascular; CVD, cardiovascular disease; HR, hazard ratio; MI, myocardial infarction; RCT, randomized controlled trial.
1. Friis-Moller N, et al. Eur J Cardiovasc Prev Rehabil. 2010;17:491-501. 2. Friis-Moller N, et al. Eur J Prev Cardiol. 2015;[Epub ahead of print]. 3. SMART/INSIGHT Study Group. AIDS. 2008;22:F17-24. 4. Martin A, et al. Clin Infect Dis. 2009;49:1591-1601. 5. Durand M, et al. J Acquir Immune Defic Syndr. 2011;57:245-253. 6. Obel N, et al. HIV Med. 2010;11:130-136. 7. Choi AI, et al. AIDS. 2011;25:1289-1298. 8. Young J, et al. J Acquir Immune Defic Syndr. 2015;69:413-421. 9. Rotger M, et al. Clin Infect Dis. 2013;57:112-121. 10. Palella F, et al. CROI 2015. Abstract 749LB.
AASLD, American Association for the Study of Liver Diseases; CrCl, creatinine clearance; HCV, hepatitis C virus; LDV, ledipasvir; PI, protease inhibitor; RTV, ritonavir; SOF, sofosbuvir; TDF, tenofovir disoproxil fumarate; TFV, tenofovir.
AUC, area under the concentration curve; C, cobicistat; COBI, cobicistat; DDI, drug–drug interaction; E, elvitegravir; EVG, elvitegravir; F, emtricitabine; FTC, emtricitabine; LDV, ledipasvir; NA, not applicable; R, rilpivirine; RPV, rilpivirine; SOF, sofosbuvir; TAF, tenofovir alafenamide fumarate; TDF, tenofovir disoproxil fumarate.