In this downloadable slideset, Eric S. Daar, MD, and Joel E. Gallant, MD, MPH, review best practices and provide expert opinion in using newly approved ART options for treating patients with HIV.
Format: Microsoft PowerPoint (.ppt)
File size: 816 KB
Date posted: 5/12/2016
Choosing Among Current Antiretroviral Regimens.The Relevance of Drug–Drug Int...hivlifeinfo
In this downloadable slideset, Jürgen K. Rockstroh, MD, reviews how selection of antiretroviral therapy is influenced by drug–drug interactions and differing antiretroviral genetic barriers to resistance.
Format: Microsoft PowerPoint (.ppt)
File size: 1.17 MB
Date posted: 11/4/2016
HIV Alert :Updating Your Practice Based on New Guideline Recommendations.2016hivlifeinfo
In this downloadable slideset, Eric S. Daar, MD, and Paul E. Sax, MD, review recent updates to expert guideline recommendations for ART—including new initial therapy recommendations, revised guidance on switch strategies for virologically suppressed patients, and other key recommendation updates.
Format: Microsoft PowerPoint (.ppt)
File size: 1.09 MB
Date posted: 9/19/2016
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
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.
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: 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
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.
Choosing Among Current Antiretroviral Regimens.The Relevance of Drug–Drug Int...hivlifeinfo
In this downloadable slideset, Jürgen K. Rockstroh, MD, reviews how selection of antiretroviral therapy is influenced by drug–drug interactions and differing antiretroviral genetic barriers to resistance.
Format: Microsoft PowerPoint (.ppt)
File size: 1.17 MB
Date posted: 11/4/2016
HIV Alert :Updating Your Practice Based on New Guideline Recommendations.2016hivlifeinfo
In this downloadable slideset, Eric S. Daar, MD, and Paul E. Sax, MD, review recent updates to expert guideline recommendations for ART—including new initial therapy recommendations, revised guidance on switch strategies for virologically suppressed patients, and other key recommendation updates.
Format: Microsoft PowerPoint (.ppt)
File size: 1.09 MB
Date posted: 9/19/2016
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
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.
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: 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
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.
This document summarizes an expert panel discussion on innovative antiretroviral therapy (ART) paradigms. The panel discussed whether positive results from two-drug and long-acting injectable regimens in clinical trials will translate to long-term efficacy and safety. They also considered the potential risks of resistance emerging with two-drug regimens and the impact of missed doses with long-acting injectables. The panel agreed that maintaining cold storage requirements for long-acting injectables may pose challenges for implementation in low- and middle-income countries but that qualitative research found patients highly satisfied with the convenience of long-acting ART.
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
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
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: 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.
Современное лечение ВИЧ.Обобщённые данные с конференции CROI 2020 / Contempor...hivlifeinfo
This document summarizes data presented at CROI 2020 on current and investigational antiretroviral therapies (ART) for HIV. Key findings include:
- A pooled analysis found the 3-drug regimen bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) was effective and well-tolerated in people over age 50 similar to younger patients.
- The switch to BIC/FTC/TAF was noninferior to remaining on baseline regimens even in people with baseline nucleoside reverse transcriptase inhibitor resistance.
- Through week 96, dolutegravir plus lamivudine was similarly effective
Современное лечение ВИЧ: модификация АРТ у пациентов с вирусологической супре...hivlifeinfo
This document discusses modifying antiretroviral therapy (ART) in virologically suppressed patients with HIV. It describes two phase 3 trials, ATLAS and FLAIR, that evaluated switching to long-acting injectable cabotegravir plus rilpivirine (CAB/RPV) every 4 weeks in suppressed patients. Both trials found CAB/RPV to be noninferior to continued oral ART at 48 weeks. Common reasons to consider an ART switch include simplifying regimens or improving tolerability. Key factors that may increase risk of treatment failure with CAB/RPV include presence of rilpivirine resistance mutations at baseline and lower rilpivirine drug levels. The FDA
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
Аллопуринол и прогрессирование ХБП и кардиоваскулярные события. РКИ / Allopur...hivlifeinfo
Allopurinol and Progression of CKD and Cardiovascular Events- Long-term Follow-up of a Randomized Clinical Trial.Am J Kidney Dis. 2015 Apr
Background:Asymptomatic hyperuricemia increases renal and cardiovascular (CV) risk. We previously
conducted a 2-year, single-blind, randomized, controlled trial of allopurinol treatment that showed improved
estimated glomerular filtration rate and reduced CV risk.
Study Design:Post hoc analysis of a long-term follow-up after completion of the 2-year trial.
Setting & Participants:113 participants (57 in the allopurinol group and 56 in the control group) initially
followed up for 2 years and 107 participants followed up to 5 additional years.
Intervention: Continuation of allopurinol treatment, 100 mg/d, or standard treatment.
Outcome:Renal event (defined as starting dialysis therapy and/or doubling serum creatinine and/or$50%
decrease in estimated estimated glomerular filtration rate) and CV events (defined as myocardial infarction,
coronary revascularization or angina pectoris, congestive heart failure, cerebrovascular disease, and peripheral vascular disease).
Results:During initial follow-up, there were 2 renal and 7 CV events in the allopurinol group compared with
6 renal and 15 CV events in the control group. In the long-term follow-up period, 12 of 56 participants taking
allopurinol stopped treatment and 10 of 51 control participants received allopurinol. During long-term follow-up,
an additional 7 and 9 participants in the allopurinol group experienced a renal or CV event, respectively, and an
additional 18 and 8 participants in the control group experienced a renal or CV event, respectively. Thus,
during the initial and long-term follow-up (median, 84 months), 9 patients in the allopurinol group had a
renal event compared with 24 patients in the control group (HR, 0.32; 95% CI, 0.15-0.69; P50.004;
adjusted for age, sex, baseline kidney function, uric acid level, and renin-angiotensin-aldosterone system
blockers). Overall, 16 patients treated with allopurinol experienced CV events compared with 23 in the
control group (HR, 0.43; 95% CI, 0.21-0.88;P50.02; adjusted for age, sex, and baseline kidney function).
Limitations:Small sample size, single center, not double blind, post hoc follow-up and analysis.
Conclusions: Long-term treatment with allopurinol may slow the rate of progression of kidney disease and
reduce CV risk.
Incorporating New ART Options Into First-line and Switch Strategies for HIV C...hivlifeinfo
This document discusses several new HIV treatment regimens approved between 2017-2019, including three-drug fixed-dose combinations of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF), and darunavir/cobicistat/emtricitabine/tenofovir alafenamide (DRV/COBI/FTC/TAF). Clinical trials showed BIC/FTC/TAF and DOR/3TC/TDF were
Expert Insights in Selecting a Switch Regimen for Virologically Suppressed HI...hivlifeinfo
Expert Insights in Selecting a Switch Regimen for Virologically Suppressed HIV-Infected Patients.2018
In this slideset, Babafemi Taiwo, MBBS, discusses expert approaches to selecting an HIV switch regimen in a series of cases studies involving HIV-infected patients with virologic suppression on their current ART regimen.
Format: Microsoft PowerPoint (.ppt)
File Size: 1.10 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
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.
Современное лечение ВИЧ: лечение многократно леченных пациентов с резистентно...hivlifeinfo
This document discusses management of HIV in heavily treatment-experienced patients with multiclass resistance and limited treatment options. It provides an overview of the problem, including that some older patients were treated early in the HIV epidemic with less potent regimens, resulting in resistance. Younger patients may have congenital HIV and been treated long-term. Assessment of virologic failure and resistance testing are important to select an effective new regimen. Current options for active drugs in these patients include maraviroc, ibalizumab, fostemsavir, and enfuvirtide, which have novel mechanisms of action. Adherence assessment is also critical to determine if the current regimen may still be effective if taken as prescribed.
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
This document discusses contemporary management of HIV with a focus on individualizing first-line antiretroviral therapy (ART). It provides an overview of recommended first-line ART regimens including integrase strand transfer inhibitors (INSTIs), discusses clinical trial data comparing different INSTI and protease inhibitor options, and considers factors in choosing among available single-tablet regimen options. It also addresses the potential roles of newer non-nucleoside reverse transcriptase inhibitors and tenofovir alafenamide versus tenofovir disoproxil fumarate in first-line ART.
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.
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
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
Thermogym is an expert in designing and producing customized heat exchangers and thermal solutions. They have over 9 years of experience meeting customer needs across industries. Thermogym offers a full range of standard and customized heat exchanger products and services from design to production. Their dedicated team provides high quality, cost-efficient thermal solutions.
How can gamification increase the Performance of employees in a multicultural...Louis Bonfils
This document summarizes a master's thesis that studied the effects of gamification on employee performance in a multicultural work environment. The thesis aimed to see if gamification techniques could help solve issues related to diversity management, such as intercultural communication problems, while also improving overall company performance. Semi-structured interviews were conducted with gamification professionals. Key areas examined included performance, motivation, engagement, culture, and how games and gamification mechanics work. The thesis hypothesized that a gamified system is well-suited to raise intrinsic motivation, higher intrinsic motivation likely increases company performance, and gamification increases team cohesion.
This document summarizes an expert panel discussion on innovative antiretroviral therapy (ART) paradigms. The panel discussed whether positive results from two-drug and long-acting injectable regimens in clinical trials will translate to long-term efficacy and safety. They also considered the potential risks of resistance emerging with two-drug regimens and the impact of missed doses with long-acting injectables. The panel agreed that maintaining cold storage requirements for long-acting injectables may pose challenges for implementation in low- and middle-income countries but that qualitative research found patients highly satisfied with the convenience of long-acting ART.
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
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
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: 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.
Современное лечение ВИЧ.Обобщённые данные с конференции CROI 2020 / Contempor...hivlifeinfo
This document summarizes data presented at CROI 2020 on current and investigational antiretroviral therapies (ART) for HIV. Key findings include:
- A pooled analysis found the 3-drug regimen bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) was effective and well-tolerated in people over age 50 similar to younger patients.
- The switch to BIC/FTC/TAF was noninferior to remaining on baseline regimens even in people with baseline nucleoside reverse transcriptase inhibitor resistance.
- Through week 96, dolutegravir plus lamivudine was similarly effective
Современное лечение ВИЧ: модификация АРТ у пациентов с вирусологической супре...hivlifeinfo
This document discusses modifying antiretroviral therapy (ART) in virologically suppressed patients with HIV. It describes two phase 3 trials, ATLAS and FLAIR, that evaluated switching to long-acting injectable cabotegravir plus rilpivirine (CAB/RPV) every 4 weeks in suppressed patients. Both trials found CAB/RPV to be noninferior to continued oral ART at 48 weeks. Common reasons to consider an ART switch include simplifying regimens or improving tolerability. Key factors that may increase risk of treatment failure with CAB/RPV include presence of rilpivirine resistance mutations at baseline and lower rilpivirine drug levels. The FDA
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
Аллопуринол и прогрессирование ХБП и кардиоваскулярные события. РКИ / Allopur...hivlifeinfo
Allopurinol and Progression of CKD and Cardiovascular Events- Long-term Follow-up of a Randomized Clinical Trial.Am J Kidney Dis. 2015 Apr
Background:Asymptomatic hyperuricemia increases renal and cardiovascular (CV) risk. We previously
conducted a 2-year, single-blind, randomized, controlled trial of allopurinol treatment that showed improved
estimated glomerular filtration rate and reduced CV risk.
Study Design:Post hoc analysis of a long-term follow-up after completion of the 2-year trial.
Setting & Participants:113 participants (57 in the allopurinol group and 56 in the control group) initially
followed up for 2 years and 107 participants followed up to 5 additional years.
Intervention: Continuation of allopurinol treatment, 100 mg/d, or standard treatment.
Outcome:Renal event (defined as starting dialysis therapy and/or doubling serum creatinine and/or$50%
decrease in estimated estimated glomerular filtration rate) and CV events (defined as myocardial infarction,
coronary revascularization or angina pectoris, congestive heart failure, cerebrovascular disease, and peripheral vascular disease).
Results:During initial follow-up, there were 2 renal and 7 CV events in the allopurinol group compared with
6 renal and 15 CV events in the control group. In the long-term follow-up period, 12 of 56 participants taking
allopurinol stopped treatment and 10 of 51 control participants received allopurinol. During long-term follow-up,
an additional 7 and 9 participants in the allopurinol group experienced a renal or CV event, respectively, and an
additional 18 and 8 participants in the control group experienced a renal or CV event, respectively. Thus,
during the initial and long-term follow-up (median, 84 months), 9 patients in the allopurinol group had a
renal event compared with 24 patients in the control group (HR, 0.32; 95% CI, 0.15-0.69; P50.004;
adjusted for age, sex, baseline kidney function, uric acid level, and renin-angiotensin-aldosterone system
blockers). Overall, 16 patients treated with allopurinol experienced CV events compared with 23 in the
control group (HR, 0.43; 95% CI, 0.21-0.88;P50.02; adjusted for age, sex, and baseline kidney function).
Limitations:Small sample size, single center, not double blind, post hoc follow-up and analysis.
Conclusions: Long-term treatment with allopurinol may slow the rate of progression of kidney disease and
reduce CV risk.
Incorporating New ART Options Into First-line and Switch Strategies for HIV C...hivlifeinfo
This document discusses several new HIV treatment regimens approved between 2017-2019, including three-drug fixed-dose combinations of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF), and darunavir/cobicistat/emtricitabine/tenofovir alafenamide (DRV/COBI/FTC/TAF). Clinical trials showed BIC/FTC/TAF and DOR/3TC/TDF were
Expert Insights in Selecting a Switch Regimen for Virologically Suppressed HI...hivlifeinfo
Expert Insights in Selecting a Switch Regimen for Virologically Suppressed HIV-Infected Patients.2018
In this slideset, Babafemi Taiwo, MBBS, discusses expert approaches to selecting an HIV switch regimen in a series of cases studies involving HIV-infected patients with virologic suppression on their current ART regimen.
Format: Microsoft PowerPoint (.ppt)
File Size: 1.10 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
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.
Современное лечение ВИЧ: лечение многократно леченных пациентов с резистентно...hivlifeinfo
This document discusses management of HIV in heavily treatment-experienced patients with multiclass resistance and limited treatment options. It provides an overview of the problem, including that some older patients were treated early in the HIV epidemic with less potent regimens, resulting in resistance. Younger patients may have congenital HIV and been treated long-term. Assessment of virologic failure and resistance testing are important to select an effective new regimen. Current options for active drugs in these patients include maraviroc, ibalizumab, fostemsavir, and enfuvirtide, which have novel mechanisms of action. Adherence assessment is also critical to determine if the current regimen may still be effective if taken as prescribed.
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
This document discusses contemporary management of HIV with a focus on individualizing first-line antiretroviral therapy (ART). It provides an overview of recommended first-line ART regimens including integrase strand transfer inhibitors (INSTIs), discusses clinical trial data comparing different INSTI and protease inhibitor options, and considers factors in choosing among available single-tablet regimen options. It also addresses the potential roles of newer non-nucleoside reverse transcriptase inhibitors and tenofovir alafenamide versus tenofovir disoproxil fumarate in first-line ART.
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.
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
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
Thermogym is an expert in designing and producing customized heat exchangers and thermal solutions. They have over 9 years of experience meeting customer needs across industries. Thermogym offers a full range of standard and customized heat exchanger products and services from design to production. Their dedicated team provides high quality, cost-efficient thermal solutions.
How can gamification increase the Performance of employees in a multicultural...Louis Bonfils
This document summarizes a master's thesis that studied the effects of gamification on employee performance in a multicultural work environment. The thesis aimed to see if gamification techniques could help solve issues related to diversity management, such as intercultural communication problems, while also improving overall company performance. Semi-structured interviews were conducted with gamification professionals. Key areas examined included performance, motivation, engagement, culture, and how games and gamification mechanics work. The thesis hypothesized that a gamified system is well-suited to raise intrinsic motivation, higher intrinsic motivation likely increases company performance, and gamification increases team cohesion.
The document contains statistics about the disproportionate impact of HIV/AIDS on gay and bisexual men and black Americans. It shows that while gay and bisexual men make up only 2% of the US population, they account for 55% of HIV infections and 58% of people currently living with HIV. It also shows that black Americans, who make up 12% of the population, account for 41% of AIDS deaths and 43% of current HIV infections.
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
Calculating Member Cost Sharing for Pharmacy ClaimsJohn Long
The document discusses challenges in calculating member pharmacy costs for health insurance plans. It describes how chronic conditions often require significant pharmacy utilization, but medications may not be covered by plans or may be on high-cost tiers. The Medicare Part D Plan Finder tool aims to help members find low-cost plans but has limitations. State health exchange data is available for some plans but may not provide full details needed. Calculating costs accurately is challenging due to issues like combined deductibles, drug pricing differences between pharmacies, and modeling non-formulary drugs.
Americans and hiv aids - selected 2014 national survey findings from the kais...KFF
The document summarizes findings from two 2014 surveys by the Kaiser Family Foundation regarding Americans' awareness and knowledge of HIV/AIDS. Some key findings include: over half of respondents know someone living with or who died from HIV/AIDS; HIV/AIDS is rarely or never discussed with family or intimate partners for many; and less than 40% of respondents were aware of major scientific advances in HIV treatment and prevention. The surveys found that while most had been tested for HIV at some point, relatively few reported getting tested regularly as advised.
Improvement in adherence to HAART: Best practices in adherence education by t...CDC NPIN
The document summarizes a study that evaluated adherence education interventions by three AIDS service organizations (ASOs). It found that all three interventions significantly improved clients' HIV disease management knowledge, experience taking medications, viral load, CD4 count, and perceived health over multiple time periods. The interventions incorporated individual counseling, peer support, medication education, and incentives. Characteristics of the populations served and details of each ASO's intervention approach are provided.
Humana is a large health benefits company that provides coverage to 7 million medical members and over 2 million dental members across the United States. It has implemented an enterprise data warehouse that integrates data from various sources and provides business intelligence capabilities. The data warehouse stores over 4.3 billion rows of information from medical claims, pharmacy claims, web logs, and other sources. It supports a variety of business functions including utilization reporting, financial analysis, underwriting, customer reporting, and health management programs. The data warehouse enables Humana to gain insights, innovate new offerings, manage costs and risks, and tailor support to members' health needs.
PrEP Update from the International HIV Treatment, Prevention, and Adherence C...Office of HIV Planning
Jen Chapman, Co-Chair of the Philadelphia HIV Prevention Planning Group (HPG) presented an update from the 10th annual International HIV Treatment, Prevention, and Adherence conference at the July 2015 HPG meeting.
Aetna care pass challenge webinar 8.1.12health2dev
This document provides information about the Aetna CarePass Developer Challenge, which aims to develop mobile applications to improve medication adherence. It introduces Aetna CarePass and the need for medication reminder solutions. The challenge will award $75,000 to the first place winner and $25,000 to the second place winner for developing an app that allows users to enter medications and receive reminders to take them. The app is also encouraged to provide medication cost information and integrate with the Aetna CarePass platform. The submission deadline is August 17th and winners will be announced in October.
Improving Adherence in HIV Treatment with Once-Daily TherapiesDocKretschmar
1. Several studies examined the relationship between adherence to antiretroviral drug regimens and virologic outcomes in HIV/AIDS patients. Simpler once-daily dosing was associated with improved adherence and clinical outcomes compared to more complex twice-daily regimens.
2. Other research showed that once-daily dosing of hypertension and diabetes medications led to better adherence rates and health outcomes over twice-daily administration.
3. The data supported transitioning select HIV-infected patients with undetectable viral loads on a twice-daily protease inhibitor regimen to a simplified once-daily regimen, which maintained viral suppression and improved CD4 counts in the majority of patients.
This document provides guidelines for antiretroviral therapy in Malaysia. It outlines contributors and reviewers, then covers goals of ART including reducing morbidity and mortality while improving quality of life. It discusses factors to consider when initiating ART, available drug classes and fixed dose combinations, guidelines for assessing newly diagnosed and experienced patients, and important laboratory tests for evaluation and monitoring during treatment.
This document discusses using analytics to optimize medication adherence interventions. It begins by introducing GNS Healthcare and their Meaningful Adherence solution, which uses predictive modeling to precisely match individuals to specific adherence interventions that will maximize the return on investment. It then provides examples showing how value-based selection identifies more individuals who could benefit from interventions compared to rules-based selection based solely on medication possession ratio. The document concludes by outlining GNS's approach and analytics platform for planning, implementing, and continuously optimizing population health management programs and adherence interventions.
The document promotes Walgreens' API program which allows developers to integrate their apps with Walgreens' 8,000+ stores and services. The API provides access to prescription refills and transfers, printing services to stores, and opportunities to increase customer engagement like photo cards. Developers are encouraged to use the API by signing up on the developer portal to gain an API key and onboarding assistance.
In this downloadable slideset, expert faculty members Andrew Carr, MBBS, MD, FRACP, FRCPA; Daniel R. Kuritzkes, MD; and Ian M. Sanne, MBBCH, FCP(SA), review key studies presented at the 2016 International AIDS Conference.
Format: Microsoft PowerPoint (.ppt)
File size: 1.28 MB
Date posted: 8/5/2016
Chelsey Strand is a clinical review pharmacist at Prime Therapeutics in Edina, MN who reviews requests for insurance approval or denial based on plan criteria. She previously worked as a medication therapy management specialist and staff pharmacist at Walgreens pharmacies in Eden Prairie and Minneapolis, MN between 2007-2016. She holds a Doctor of Pharmacy degree from North Dakota State University and a pharmacy license in Minnesota.
D1 Highly Active Antiretroviral Treatment (HAART) DHHS Guidelines 2009 DuffusDSHS
The document discusses guidelines for initiating highly active antiretroviral treatment (HAART) based on CD4 count and viral load. Guidelines from 1998-2009 increasingly recommended treating HIV at higher CD4 counts and without a specific viral load threshold. Studies show the magnitude of CD4 increase is greatest when starting HAART at low counts, but normalization is more likely the earlier therapy begins. A CD4 count below 350 cells/mm3 increases the risk of cardiovascular and other non-AIDS complications.
HIV Alert- Options for Integrase Inhibitor Therapy Following Recent Drug Appr...hivlifeinfo
In this downloadable slideset, Paul E. Sax, MD, and Brian R. Wood, MD, provide expert insight into the use of recently-approved INSTI regimens and discuss how these regimens fit into the current HIV treatment landscape.
Format: Microsoft PowerPoint (.ppt)
File size: 331 KB
Date posted: 3/6/2018
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HCV Alerts- Rapid Response to Practice-Changing Advances From EASL 2015Hivlife Info
In this downloadable slideset, Mark S. Sulkowski, MD, discusses key practice-changing data from the 2015 liver disease meeting in Vienna.
Format: Microsoft PowerPoint (.ppt)
File size: 751 KB
HCV Alerts- Rapid Response to Practice-Changing Advances From EASL 2015hivlifeinfo
This document provides a summary of presentations from the EASL 2015 conference on advances in treating hepatitis C virus (HCV) infection. It discusses three key areas: managing HCV in patients with renal disease, the role of resistance testing in HCV retreatment, and advances in treating genotype 3 HCV infection. The document outlines several clinical trials presenting safety and efficacy results on using various direct-acting antiviral regimens to treat HCV in these special patient populations and clinical scenarios.
Integrating Recent Data When Selecting First-line Antiretroviral Therapy.2015...hivlifeinfo
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.
HIV Alert:Emerging Updates on Dual Therapy.2018hivlifeinfo
In this downloadable slideset, Joseph J. Eron, Jr., MD, and Babafemi Taiwo, MBBS, provide expert insight into the use of a recently-approved dual-therapy regimen and review data surrounding investigational two-drug regimens.
Format: Microsoft PowerPoint (.ppt)
File size: 375 KB
Date posted: 1/5/2018
АРТ в 2016-2017 гг: неизменная потребность в индивидуализации лечения для улу...hivlifeinfo
PB has several considerations for her antiretroviral regimen:
- She wants a single tablet regimen
- Her CD4+ count and viral load make her a good candidate for most regimens
- She has HCV genotype 1a infection
- She takes lovastatin for hyperlipidemia
The best regimen for PB would be:
- DTG/ABC/3TC as it is recommended for most patients, has few drug interactions, and does not interact with lovastatin.
Close monitoring of her liver function would be needed if she initiates HCV treatment in the future while on an antiretroviral regimen.
HIV Alert:Новые стратегии и агенты в лечении ВИЧ/Novel Strategies and Agents ...hivlifeinfo
HIV Alert-Новые стратегии и агенты в лечении ВИЧ/Novel Strategies and Agents for HIV Management.2017
In this downloadable slideset, Daniel R. Kuritzkes, MD, and Paul E. Sax, MD, review potential future HIV treatment strategies—including dual-therapy regimens, long-acting ART, and investigational agents—and discuss where these might fit into the current therapeutic landscape.
Format: Microsoft PowerPoint (.ppt)
File size: 570 KB
Date posted: 9/27/2017
Should Integrase Inhibitors Be Your First Choice When Starting HIV Therapy- E...hivlifeinfo
The document discusses a debate between two HIV experts on whether integrase inhibitors should be the first choice for starting HIV therapy. It summarizes several key studies that have compared integrase inhibitors like raltegravir, elvitegravir, and dolutegravir to efavirenz or boosted protease inhibitors in treatment-naive patients. The studies showed integrase inhibitors were generally noninferior to alternatives in virologic suppression, and had fewer tolerability issues like gastrointestinal side effects.
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
Highlights of AIDS 2014 .CCO Official Conference Coverage of the 20th Interna...Hivlife Info
The document summarizes highlights from the 20th International AIDS Conference held in Melbourne, Australia in July 2014. It includes results from several clinical trials presented at the conference evaluating new antiretroviral regimens for initial therapy and treatment switches in suppressed patients. One study found maraviroc plus darunavir/ritonavir was not non-inferior to tenofovir/emtricitabine plus darunavir/ritonavir for initial therapy. Another study found switching suppressed patients to a dual regimen of lopinavir/ritonavir plus lamivudine or emtricitabine was non-inferior to continuing a triple regimen. A sub-
Boosted Protease Inhibitors. Current and Future Role in HIV Therapy.2014hivlifeinfo
The document discusses boosted protease inhibitors and their current and future role in HIV therapy. It provides an overview of boosted protease inhibitors, including their evolution from multiple pills per day to current once-daily single tablet regimens. It reviews clinical trial data supporting the use of atazanavir/ritonavir and darunavir/ritonavir as recommended first-line treatment options for treatment-naive patients.
Managing cirrhotic HCV patients. Whom to treat, how to treat.2014Hivlife Info
Marc Bourlière, MD and Graham R. Foster, FRCP, PhD presented on managing cirrhotic HCV patients. They discussed which cirrhotic patients should be treated, how to treat them, and ensuring informed decision making. Patients with Child-Pugh A cirrhosis should be strongly advised to undergo therapy, while more advanced cases require careful consideration. New direct-acting antiviral regimens have increased sustained virologic response rates in cirrhotic patients, but they still face higher risks of side effects and disease progression if treatment is delayed. Physicians must fully inform patients of risks from both immediate treatment and deferring treatment to facilitate shared decision making.
Managing cirrhotic HCV patients. Whom to treat, how to treat.2014hivlifeinfo
Cirrhotic patients are the most in need of HCV treatment but also face challenges. Treatment is recommended for Child-Pugh A patients but more advanced cirrhosis requires caution. New drug combinations with direct-acting antivirals and pegylated interferon/ribavirin have increased sustained virologic response rates in cirrhotic patients, though they remain at risk for side effects and worsening liver function. Careful monitoring is needed when treating cirrhotic patients, especially those with significant risk factors like low platelet count or albumin level. Promising interferon-free regimens show high response rates even in prior treatment failures and may improve options for cirrhotic patients.
Highlights of IAS 2013.CCO Official Conference Coverage of the 7th IAS Confer...Hivlife Info
The document summarizes highlights from the 7th IAS Conference on HIV Pathogenesis, Treatment, and Prevention held in Kuala Lumpur, Malaysia in June-July 2013. Key findings included the WHO updating treatment guidelines to recommend initiating ART at CD4 counts ≤500 cells/mm3 and preferring TDF+3TC(FTC)+EFV as the initial regimen. Studies found noninferiority of 400mg EFV and demonstrated the efficacy of second-line LPV/r-based ART and PrEP with TDF in specific populations. Adherence to treatment was an important factor in outcomes.
What’s New in Coformulated Antiretroviral Regimens.2014hivlifeinfo
This document discusses a presentation on new coformulated antiretroviral regimens given by Dr. Andrew Zolopa. It provides information on:
1) Currently available coformulated antiretroviral agents and regimens, including those containing cobicistat as a new boosting agent.
2) Clinical trial results showing noninferiority of elvitegravir/cobicistat/tenofovir/emtricitabine to efavirenz- and atazanavir/ritonavir-based regimens.
3) Ongoing studies of dolutegravir-containing regimens in treatment-naive patients.
First and foremost choosing and using first line antiretroviral therapy.2013Hivlife Info
This document discusses guidelines for initial antiretroviral therapy and recent clinical trials comparing different first-line regimens. The 2013 DHHS and 2012 IAS-USA guidelines recommend efavirenz (EFV) plus tenofovir/emtricitabine (TDF/FTC) or abacavir/lamivudine (ABC/3TC) as preferred initial regimens. Recent trials found rilpivirine (RPV) to be noninferior to EFV through week 96, though with more virologic failures, especially in those with high baseline viral load. Elvitegravir/cobicistat/TDF/FTC was noninfer
This document discusses treatment simplification strategies for HIV management. It defines treatment simplification as changing an established effective therapy to reduce pill burden, dosing frequency, or other requirements to enhance tolerability. Optimal candidates are those with controlled viremia and no tolerability issues. Simplification strategies discussed include within-class changes like protease inhibitor substitutions and out-of-class changes such as switching from a protease inhibitor regimen to an NNRTI or integrase inhibitor. Clinical trials support the efficacy and safety of certain simplification approaches.
Colorectal Cancer Research & Treatment News - recap from the May 2014 ASCO co...Fight Colorectal Cancer
This document summarizes key findings from the PRIME trial evaluating the addition of panitumumab to FOLFOX4 as first-line treatment for metastatic colorectal cancer. Biomarker analysis found that KRAS exon 2 wild-type tumors derived greater benefit from the addition of panitumumab, with a progression-free survival advantage compared to FOLFOX4 alone. Further biomarker testing found mutations in other RAS isoforms or BRAF reduced likelihood of benefit from panitumumab. The results support use of RAS/BRAF mutation testing to select patients for first-line anti-EGFR therapy in combination with chemotherapy.
Shaping the Future.Clinicians and Faculty Define - Strategies for the Next Er...hivlifeinfo
This document discusses strategies for treating hepatitis C virus (HCV) infection in the next era of therapy. It summarizes discussions from a panel of international HCV experts on key questions regarding HCV treatment. One expert discussed whether a "one-size-fits-all" treatment approach is possible, noting that current data is moving in that direction with new all-oral regimens achieving high SVR rates across patient types. However, treatment may still need to be tailored to some degree for certain difficult-to-treat groups like genotype 3 patients with cirrhosis. The panel evaluated priorities for optimizing genotype 1 regimens and the potential role of shorter, simpler treatments. Management of treatment failures and how treatment may shift to primary
Similar to HIV Alert: Best Practices in ART Following Recent Drug Approvals.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.
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
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
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."
Tsepamo: DTG Exposure at Conception Associated With Smaller Increase in Incid...hivlifeinfo
This updated analysis of the Tsepamo birth outcomes surveillance study in Botswana found:
1) The prevalence of neural tube defects was slightly higher among women who conceived while receiving dolutegravir compared to other antiretroviral regimens, but lower than initially reported.
2) There was no significant difference in the risk of other major structural malformations or additional adverse birth outcomes between dolutegravir and efavirenz at conception.
3) Based on these updated findings, the WHO reconfirmed the use of dolutegravir-based antiretroviral therapy as the preferred first-line and second-line regimen.
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
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
HIV Alert: Best Practices in ART Following Recent Drug Approvals.2016
1. HIV Alert: Best Practices in ART
Following Recent Drug Approvals
This program is supported by independent educational grants from
Gilead Sciences and ViiV Healthcare.
2. Slide credit: clinicaloptions.com
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of these slides in your noncommercial presentations
to colleagues or patients
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details
3. Faculty
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
Joel E. Gallant, MD, MPH
Medical Director of Specialty
Services
Southwest CARE Center
Santa Fe, New Mexico
Adjunct Professor of Medicine
Division of Infectious Diseases
Johns Hopkins University
School of Medicine
Baltimore, Maryland
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.
Joel E. Gallant, MD, MPH, has disclosed that he has
received consulting fees from Bristol-Myers Squibb, Gilead
Sciences, Janssen, Merck, and ViiV and funds for research
support from AbbVie, Bristol-Myers Squibb, Gilead Sciences,
Janssen, Merck, Sangamo, and ViiV.
5. Slide credit: clinicaloptions.com
Program Overview
Indications and Supporting Data for FTC/TAF
How FTC/TAF Compares With Other NRTI
Backbones
Expert Perspective
– When I’ll Use FTC/TAF… and When I Won’t
6. Slide credit: clinicaloptions.com
FTC/TAF Recently FDA Approved
Label information:
– Indicated in combination with other ARVs for the treatment of HIV infection
– Not recommended for pts with CrCl < 30 mL/min
– No dose adjustment necessary CrCl ≥ 30 mL/min; FTC/TDF requires dose
adjustment CrCl 30-49 mL/min
– Not indicated for PrEP or for pts coinfected with HBV
– Dose: FTC 200 mg, TAF 25 mg
Joins other approved TAF-containing fixed-dose combinations
– EVG/COBI/FTC/TAF
– RPV/FTC/TAF
FTC/TAF [package insert]. April 2016. FTC/TDF [package insert].
April 2016.
7. Clinical Trials Supporting FTC/TAF Use
Study Pt Population Treatment
GS-104/111[1] Treatment naive
(N = 1733)
Pts randomized to
EVG/COBI/FTC/TAF* or
EVG/COBI/FTC/TDF
GS-109[2]
Virologically suppressed on
TDF-based regimen
(N = 1436)
Pts switched to EVG/COBI/FTC/TAF*
or remained on TDF-based regimen
GS-1089[3]
Virologically suppressed on
FTC/TDF + third ARV
(N = 663)
Pts switched to FTC/TAF†
+ continued
third ARV or remained on FTC/TDF +
third ARV
GS-112[4]
Virologically suppressed on
varied regimens;
stable eGFRCG 30-69 mL/min
(N = 242)
Pts switched to EVG/COBI/FTC/TAF*
Slide credit: clinicaloptions.com
1. Sax PE, et al. Lancet. 2015;385:2606-2615. 2. Mills A, et al. Lancet Infect
Dis. 2016;16:43-52. 3. Gallant JE, et al. Lancet HIV. 2016;3:e158-e165.
4. Pozniak A, et al. J Acquir Immune Defic Syndr. 2016;71:530-537.
*EVG/COBI/FTC/TAF dosing: 150/150//200/10 mg.
†
FTC/TAF dosing: 200/10 mg with boosted PIs; 200/25 mg with unboosted third drug.
8. Wk 48 Efficacy: TAF-Based Treatment
Noninferior to TDF-Based Treatment
1. Sax PE, et al. Lancet. 2015;385:2606-2615. 2. Mills A, et al. Lancet Infect Dis.
2016;16:43-52. 3. Gallant JE, et al. Lancet HIV. 2016;3:e158-e165.
100
80
60
40
20
0
Wk48HIV-1RNA
<50c/mL(%)
GS-104/111[1]
Tx Naive*
TAF-based regimen
TDF-based regimen
92 90
97
93 94 93
Slide credit: clinicaloptions.com
GS-109[2]
Switch†
GS-1089[3]
Switch‡
2.0%
(-0.7% to 4.7%)
Tx Difference
(95% CI)
4.1%
(1.6% to 6.7%)
P = .0002
1.3%
(-2.5% to 5.1%)
*GS-104/111: EVG/COBI/FTC/TAF vs EVG/COBI/FTC/TDF. †
GS-109: Switched to EVG/COBI/FTC/TAF
or remained on TDF-based ART. ‡
GS-1089: Switched to FTC/TAF + third ARV or remained on FTC/TDF +
third ARV.
n/N =
932/
959
444/
477
314/
333
307/
330
800/
866
784/
867
9. TAF Associated With Improvements in
Renal Markers vs TDF
In each of the GS-104/111,[1]
GS-109,[2]
and GS-1089[3]
studies, FTC/TAF-based treatment was associated
with each of the following (vs TDF-based treatment)
at treatment Wk 48:
– Higher eGFRCG
– Less proteinuria (urinary protein, albumin, RBP, and
β2-microglobulin to Cr ratio)
No proximal renal tubulopathy or Fanconi syndrome
associated with FTC/TAF-based treatment
Slide credit: clinicaloptions.com
1. Sax PE, et al. Lancet. 2015;385:2606-2615.
2. Mills A, et al. Lancet Infect Dis. 2016;16:43-52.
3. Gallant JE, et al. Lancet HIV. 2016;3:e158-e165.
10. TAF Associated With Improved BMD vs TDF
GS-104/111[1]
: smaller declines in spine and hip BMD associated with starting
EVG/COBI/FTC/TAF vs EVG/COBI/FTC/TDF at Wk 48 (P < .0001)
GS-109[2]
and GS-1089[3]
: switching to FTC/TAF-based treatment improved
spine and hip BMD vs remaining on FTC/TDF-based treatment at Wk 48
Slide credit: clinicaloptions.com
1. Sax PE, et al. Lancet. 2015;385:2606-2615.
2. Mills A, et al. Lancet Infect Dis. 2016;16:43-52.
3. Gallant JE, et al. Lancet HIV. 2016;3:e158-e165.
Spine4
2
0
Mean%Change
inBMD(95%CI)
1.5
-0.2
P < .001
BL Wk 24 Wk 48
Hip4
2
0
1.1
-0.2
BL Wk 24 Wk 48
GS-1089: Mean % BMD Change From BL
FTC/TAF
FTC/TDF
P < .001
11. Lipid Increases Greater With TAF Than TDF
TAF lacks lipid-lowering effects of TDF but does not have negative impact on lipids
Similar lipid effects observed in GS-109[2]
and GS-1089[3]
Slide credit: clinicaloptions.com
GS-104/111: Median Lipid Changes in Treatment-Naive Pts[1]
1. Sax PE, et al. Lancet. 2015;385:2606-2615.
2. Mills A, et al. Lancet Infect Dis. 2016;16:43-52.
3. Gallant JE, et al. Lancet HIV. 2016;3:e158-e165.
200
150
100
50
0
5
4
3
2
1
0
189
160
177
163
115
101
109
104
51
44 44
48
114
95
108
100
3.7
3.6
3.7
3.6
TC:HDL Ratio
P = .84
Triglycerides
P = .027
HDL
P < .001
LDL
P < .001
TC
P < .001
EVG/COBI/FTC/TAF
Wk 48
Baseline
EVG/COBI/FTC/TDF
Wk 48
Baseline
MedianValues(mg/dL)
12. GS-1249: Switching Pts With HIV/HBV
Coinfection to EVG/COBI/FTC/TAF
International, multicenter, single-arm, open-label phase IIIb trial (N = 72)
– Pts with virologically suppressed HIV infection on any regimen, chronic HBV
coinfection, and eGFR > 50 mL/min switched to EVG/COBI/FTC/TAF for 48 wks
By Wk 48, 2/70 (3%) pts lost HBsAg/gained HBsAb; 2/30 (7%) pts had lost
HBeAg; 1/30 (3%) pts gained HBeAb
20
Gallant J, et al. IAS 2015. Abstract WELBPE13.
Pts(%)
94 92
Wk 24
Wk 48
100
80
60
40
20
0
HBV DNA < 29 IU/mL
86 92
HIV-1 RNA < 50 c/mL
100
80
60
40
0
Slide credit: clinicaloptions.com
13. GS-119: Switch to EVG/COBI/FTC/TAF +
DRV in Treatment-Experienced Pts
Multicenter, open-label, randomized trial in which virologically suppressed,
treatment-experienced pts on DRV-containing ART with history of drug
resistance* switched to EVG/COBI/FTC/TAF + DRV (n = 89) or continued on
baseline ART (n = 46)
– 39% of pts receiving ≥ 6 pills/day at BL; median pills/day at BL = 5
2
100
Huhn G, et al. IDWeek 2015. Abstract 726. Slide credit: clinicaloptions.com
*Resistance to ≥ 2 ARV classes, including ≤ 3 thymidine analogue mutations and K65R, but not
integrase inhibitors, unless currently receiving raltegravir, and there is no DRV resistance.
HIV-1 RNA < 50 c/mL
94
80
60
40
20
0
Virologic Failure No Data
76
11
3
13
EVG/COBI/FTC/TAF + DRV
Baseline ART
Treatment difference: 18.3%
(95% CI: 3.5% to 33.0%; P = .004)
Pts,Wk48(%)
15. Slide credit: clinicaloptions.com
Considerations With NRTI Backbones and
Associated Regimens
NRTIs Considerations
ABC/3TC
DTG/ABC/3TC* only STR including unboosted INSTI
Mixed data on CVD risk with ABC in high-risk pts
Cannot be used in HLA-B*5701–positive pts
Not recommended for pts with CrCl < 50 mL/min
FTC/TDF
STRs: EVG/COBI/FTC/TDF,* EFV/FTC/TDF, RPV/FTC/TDF
Potential for renal toxicity and proximal tubulopathy
EVG/COBI/FTC/TDF should not be initiated in pts with CrCl < 70 mL/min;
discontinue in pts with CrCl < 50 mL/min
EFV/FTC/TDF or RPV/FTC/TDF: not for use in pts with CrCl < 50 mL/min
FTC/TDF must be dose adjusted when CrCl 30-49 mL/min
Potential for decreases in BMD
Lipid-lowering effects
FTC/TAF
STRs: EVG/COBI/FTC/TAF* and RPV/FTC/TAF
Comparable efficacy and improved renal and bone profiles vs FTC/TDF
No dose adjustment necessary when CrCl ≥ 30 mL/min
*DHHS guideline–recommended initial regimen.
References in slidenotes.
17. Slide credit: clinicaloptions.com
Key Questions and Considerations
Surrounding Use of FTC/TAF
Should TDF-based regimens be dropped from
consideration of “optimal” first-line regimens?
When considering DTG, what are the pros and cons
of DTG/ABC/3TC vs DTG + FTC/TAF?
Are there specific pts for whom the FTC/TAF
backbone should ALWAYS be used? Specific pts for
whom it should NEVER be used?
Should all pts on TDF-based regimens be switched
proactively to TAF-based regimens?
18. Slide credit: clinicaloptions.com
Should TDF-Based Regimens Still Be
Considered as Initial Therapy?
DHHS-Recommended First-line Regimens, January 2016
INSTI based
DTG/ABC/3TC
RAL + FTC/TDF
DTG + FTC/TDF
EVG/COBI/FTC/TDF
EVG/COBI/FTC/TAF
Boosted PI
based
DRV/RTV + FTC/TDF
DHHS ART Guidelines. January 2016.
19. Slide credit: clinicaloptions.com
Should TDF-Based Regimens Still Be
Considered as Initial Therapy?
EFV/FTC/TDF remains effective, economical,
convenient choice for many pts in resource-
constrained settings
DHHS ART Guidelines. January 2016.
DHHS-Recommended First-line Regimens With TAF Replacements
INSTI based
DTG/ABC/3TC
RAL + FTC/TAF
DTG + FTC/TAF
EVG/COBI/FTC/TAF
Boosted PI
based
DRV/RTV + FTC/TAF
20. Slide credit: clinicaloptions.com
If DTG Is Your Preferred INSTI, How Do
You Choose DTG/ABC/3TC vs DTG +
FTC/TAF?
Consideration
Potential Choice
DTG/ABC/3TC DTG + FTC/TAF
Pt might benefit from STR vs MTR
(adherence or preference)
Pt has high CVD risk
Pt is HLA-B*5701 positive
Pt has osteopenia or osteoporosis
Pt has renal impairment *
*DTG/ABC/3TC not recommended for pts with CrCl < 50 mL/min as 3TC dose adjustment required.
DTG/ABC/3TC [package insert]. September 2015.
FTC/TAF [package insert]. April 2016.
21. Slide credit: clinicaloptions.com
Opinion: For Which Pts Will I Always/
Never Use TAF-Based Therapy?
Always/usually
– Pts with high CVD risk
Relative contraindications
– Pts with potential COBI drug
interactions (EVG/COBI/FTC/
TAF)
– Pt receiving PPIs or H2
blockers (RPV/FTC/TAF)
– Pt with CD4+ cell count
< 200 c/mm3
(RPV/FTC/TAF)
Never/unlikely
– Pt with CrCl < 30 mL/min
– Pt with severe hepatic
impairment (EVG/COBI/FTC/
TAF)
– Pt with HIV-1 RNA > 100,000
copies/mL (RPV/FTC/TAF)
– Pt receiving rifamycin
– Pregnant pt
– As PrEP
References in slidenotes.
22. Slide credit: clinicaloptions.com
Should All Pts on TDF-Based Regimens
Be Switched to TAF-Based Regimens?
Considerations for switching to TAF-based regimen
– Efficacy maintained
– Renal and bone improvements
Considerations for maintaining therapy
– Does switch require adjustment from STR to MTR?
– Relevant for pts on EFV/FTC/TDF
– Long-term data with TDF-based regimens
23. Slide credit: clinicaloptions.com
Take-Home Points
Guideline-recommended regimens for first-line therapy likely to evolve
to FTC/TAF + an INSTI or DRV/RTV or DTG/ABC/3TC
TAF-based treatment noninferior to TDF-based treatment in terms of
efficacy in first-line and switch settings
– TAF-based treatment associated with improved BMD and renal function vs
TDF-based treatment
TAF-based regimens should be considered:
– To replace TDF-based regimens as optimal agents in the first-line setting
– As switch options for pts on TDF-based regimens
Use of FTC/TAF-containing vs ABC/3TC-containing regimens should
be considered for each individual pt
24. Go Online for More CCO
Coverage of HIV!
Timely Webinars with expert faculty that address important
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Editor's Notes
These slides include notes based on commentary provided by Joel E. Gallant, MD, MPH.
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.
FTC, emtricitabine; TAF, tenofovir alafenamide.
ARV, antiretroviral; COBI, cobicistat; CrCl, creatinine clearance; EVG, elvitegravir; FDA, US Food and Drug Administration; FTC, emtricitabine; HBV, hepatitis B virus; PrEP, pre-exposure prophylaxis; RPV, rilpivirine; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate; WT, wild type.
FTC/TAF has recently been FDA approved and is indicated for use in combination with other antiretrovirals for HIV treatment. It is not recommended for patients with creatinine clearances lower than 30 mL/min. However, a difference from FTC/TDF—which requires dose adjustment at creatinine clearances of 30 to 49 mL/min—is that with FTC/TAF, you do not have to reduce or adjust the dose with creatinine clearances down to 30 mL/min. It is not indicated for PrEP or yet for patients coinfected with HBV, and the dose is the same for everybody: FTC 200 mg with TAF 25 mg. FTC/TAF now joins 2 other approved TAF-containing fixed-dose combinations: EVG/COBI/FTC/TAF with elvitegravir and cobicistat and RPV/FTC/TAF with rilpivirine.
ARV, antiretroviral; COBI, cobicistat; EVG, elvitegravir; FTC, emtricitabine; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate.
This slide highlights some of the most important trials supporting FTC/TAF use. GS-104 and -111 were 2 identical trials conducted simultaneously to compare EVG/COBI/FTC/TAF with EVG/COBI/FTC/TDF in a large number of treatment-naive patients; these were the most important studies to get EVG/COBI/FTC/TAF approved.
Then in GS-109, virologically suppressed patients on TDF-containing regimens were randomized to stay on their preexisting regimens or to switch to EVG/COBI/FTC/TAF.
Another switch study just presented at CROI this year was GS-1089. Patients who were virologically suppressed on FTC/TDF with a third agent were randomized to either continue their current regimen or to switch to FTC/TAF plus a third agent in a placebo-controlled, blinded fashion.
ARV, antiretroviral; COBI, cobicistat; EVG, elvitegravir; FTC, emtricitabine; RNA, ribonucleic acid; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate; Tx, treatment.
Here are the efficacy results for GS-104/111, -109, and -1089. Clearly, noninferiority is established. Quite frankly, efficacy here is reassuring, but not really the most interesting part of any of these studies, because the efficacy is similar between arms in each study. What is more interesting with these studies, of course, is looking at differences in toxicity between TAF and TDF, which will be discussed in the following slides.
Cr, creatinine; eGFRCG, estimated glomerular filtration rate by Cockcroft-Gault formula; FTC, emtricitabine; RBP, renal-binding protein; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate.
In terms of kidney issues, we know that TAF is associated with improvements in renal markers compared to TDF. Compared with FTC/TDF in GS-104/111, -109, and -1089, FTC/TAF-based treatment was associated with higher estimated GFRs (using the Cockcroft-Gault equation) and less proteinuria; that includes both overall proteinuria, as measured by urine protein or albumin to creatinine ratios, and tubular proteinuria, as measured by retinol-binding protein and β2-microglobulin to creatinine ratios. There has not been, so far, proximal renal tubulopathy or Fanconi syndrome seen in patients on FTC/TAF, whereas that is sometimes seen with TDF.
BL, baseline; BMD, bone mineral density; COBI, cobicistat; EVG, elvitegravir; FTC, emtricitabine; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate.
TAF is also associated with improved bone mineral density compared to TDF in all of the aforementioned studies. In the GS-104/111studies of treatment-naive patients, there were smaller declines in spine and hip BMD for EVG/COBI/FTC/TAF vs EVG/COBI/FTC/TDF. In the GS-109 and -1089 switch studies, BMD for patients who remained on TDF stayed fairly stable because they had presumably already experienced their decline early on when starting TDF, but those who switched from TDF to TAF had a significant bone mineral density increase over 48 weeks.
COBI, cobicistat; EVG, elvitegravir; FTC, emtricitabine; HDL, high density lipoprotein, LDL, low density lipoprotein; TAF, tenofovir alafenamide; TC, total cholesterol; TDF, tenofovir disoproxil fumarate.
Lipids tend to rise when you switch from TDF to TAF, and they tend to be higher on TAF than TDF if you start with TAF. The reason is not because TAF increases lipids. The reason is that TDF—tenofovir, in general—has lipid-lowering effects, and TDF achieves greater plasma levels of tenofovir than TAF. So, TAF does not have a negative impact; it just fails to have the positive impact, but these differences are fairly small. Also, notice that the total cholesterol to HDL ratio is really no different between TAF and TDF, and though this particular graph is from the GS-104/111 studies, you see the same effects with GS-109 and GS-1089.
COBI, cobicistat; eGFR, estimated glomerular filtration rate; EVG, elvitegravir; FTC, emtricitabine; HBeAb, hepatitis B e antibody; HBeAg, hepatitis B e antigen; HBsAb, hepatitis B surface antibody; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; RNA, ribonucleic acid; TAF, tenofovir alafenamide.
The GS-1249 study switched HIV/HBV coinfected patients who were already HIV suppressed, but not necessarily HBV suppressed, to EVG/COBI/FTC/TAF. Post-switch, these patients maintained HIV suppression. Interestingly, by Week 48, 3% of patients had lost their HBV surface antigen and gained surface antibody; 7% had lost E antigen; and 3% had gained E antibody. It is hard to know what to make of that because we do not have a comparison group; we do not know what would have happened to them had they stayed on their existing regimen.
ART, antiretroviral therapy; ARV, antiretroviral; COBI, cobicistat; DRV, darunavir; eGFR,, estimated glomerular filtration rate; EVG, elvitegravir; FDA, US Food and Drug Administration; FTC, emtricitabine; TAF, tenofovir alafenamide.
The GS-119 study randomized treatment-experienced patients (in some cases fairly highly treatment-experienced patients) to either stay on their existing salvage regimen or to switch to a 2-pill regimen of EVG/COBI/FTC/TAF plus darunavir. Now, what is important to note is resistance. To get into the study, patients had to have resistance to at least 2 classes of drugs, but they could not have more than 3 thymidine analogue mutations; they could not have integrase resistance unless they were currently receiving raltegravir and suppressed; and they could not have darunavir resistance, so this is a selected group. Still, 39% of these patients were on 6 or more pills per day at baseline, and the median number of pills was 5. You can see that switching to EVG/COBI/FTC/TAF plus darunavir was actually associated with a better outcome than remaining on previous therapy. The better outcome was not just due to easier regimens and less toxicity, because you do see that there was a difference between the 2 regimens in virologic failure. Thus, a switch to EVG/COBI/FTC/TAF may be an option for some heavily-treated, experienced patients, but remember that this cannot be applied to all of them because of the restrictions on resistance.
3TC, lamivudine; ABC, abacavir; ART, antiretroviral therapy; BMD, bone mineral density; COBI, cobicistat; CrCl, creatinine clearance; CVD, cardiovascular disease; DHHS, US Department of Health and Human Services; DTG, dolutegravir; EFV, efavirenz; EVG, elvitegravir; FTC, emtricitabine; INSTI, integrase strand-transfer inhibitor; STR, single-tablet regimen; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate.
References:
DHHS ART Guidelines. January 2016.
DTG/ABC/3TC [package insert]. September 2015.
FTC/TAF [package insert]. April 2016.
FTC/TDF [package insert]. April 2016.
EVG/COBI/FTC/TAF [package insert]. March 2016.
Sax PE, et al. Lancet. 2015;385:2606-2615.
Mills A, et al. Lancet Infect Dis. 2016;16:43-52.
Gallant JE, et al. Lancet HIV. 2016;3:e158-e165.
Let&apos;s talk about the NRTI backbones that we are currently using. I would say that there are 3. The first one is abacavir/lamivudine. Considerations here are that there is a single-table regimen (STR), with dolutegravir, and this is the only STR right now to not include a tenofovir component and to include an unboosted integrase inhibitor. Lingering controversy about the risk of cardiovascular disease and MI with abacavir still exists, so DHHS guidelines recommend avoiding it in high-risk patients with multiple risk factors or with known cardiovascular disease, and, of course, you cannot use it in HLA-B*5701-positive patients. The ABC/3TC NRTI backbone is also not recommended for patients with creatinine clearances lower than 50 mL/min because technically you&apos;re supposed to reduce the dose of lamivudine, which means breaking up the combination.
Next, there&apos;s FTC/TDF, which we&apos;ve been using for a long time. It&apos;s available in 3 different single-tablet regimens, but there is the potential for nephrotoxicity and proximal tubulopathy, and so you should not use these STRs in patients with creatinine clearances lower than 70 mL/min, and you should discontinue use when the creatinine clearance is below 50 mL/min. Remember that FTC/TDF itself is supposed to be dose adjusted if the creatinine clearance is between 30 and 49 mL/min. Again, there are potentials for decreases in bone mineral density that are greater than what we see with other nucleoside-based regimens, and there is the advantage of the lipid-lowering effects, which sort of came as a surprise to people after we started using TDF.
Then, finally, we now have FTC/TAF, which is available as a single-tablet regimen with elvitegravir and cobicistat or with rilpivirine. It has comparable efficacy compared to TDF-based regimens but improved kidney and bone profiles, and you don&apos;t have to adjust doses down to a creatinine clearance of 30 mL/min.
3TC, lamivudine; ABC, abacavir; DTG, dolutegravir; FTC, emtricitabine; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate.
Let&apos;s talk about how we select therapy given the new availability of TAF-based agents. Some of the key questions we will want to talk about are: if TDF-based regimens should be dropped from the recommended regimens and guidelines and replaced by TAF; when considering dolutegravir, the pros and cons of using it in the single-tablet formulation with abacavir/lamivudine vs using it with FTC/TAF; if there are specific patients for whom the FTC/TAF backbone should always be used or never be used; and if all patients on TDF-based regimens should be switched proactively regardless of whether they are having any trouble with TDF.
3TC, lamivudine; ABC, abacavir; COBI, cobicistat; DHHS, Department of Health and Human Services; DRV, darunavir; DTG, dolutegravir; EVG, elvitegravir; FTC, emtricitabine; RAL, raltegravir; RTV, ritonavir; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate.
Should TDF-based regimens still be considered? These are the current DHHS guidelines as of January 2016. Right now, everything has either abacavir or TDF with the exception of EVG/COBI/FTC/TAF, which is now a recommended regimen. I&apos;m told that there may be an update maybe in July based on these new regimens.
3TC, lamivudine; ABC, abacavir; COBI, cobicistat; DHHS, Department of Health and Human Services; DRV, darunavir; DTG, dolutegravir; EFV, efavirenz; EVG, elvitegravir; FTC, emtricitabine; RAL, raltegravir; RTV, ritonavir; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate.
This is what the DHHS guidelines would look like if we replaced all of the TDF-based regimens with TAF-based regimens. Efavirenz/FTC/TDF is no longer a recommended regimen, but it is on the alternative list, and it is still an effective, relatively economical, and convenient choice, especially for patients in resource-constrained settings where it is the most widely used regimen. Keep in mind that this single-tablet regimen containing TDF will not have an equivalent TAF-containing version.
3TC, lamivudine; ABC, abacavir; CVD, cardiovascular disease; DTG, dolutegravir; EFV, efavirenz; FTC, emtricitabine; MTR, multiple-tablet regimen; STR, single-tablet regimen; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate.
Let&apos;s say that dolutegravir is your preferred integrase inhibitor. How do you choose between using it as a coformulation with abacavir/lamivudine or as a separate tablet with FTC/TAF? Clearly, in patients who really want or who would really benefit from a single-tablet regimen from an adherence standpoint, your choice is going to be DTG/ABC/3TC. In patients who have multiple cardiac risk factors or who are HLA-B*5701 positive, FTC/TAF is likely going to be your choice. Osteopenia and osteoporosis are harder; I don&apos;t know that we know which one is better. The 2 have not yet been compared, although studies are ongoing. I think we need a head-to-head comparison to know that, so either regimen would be acceptable here. In patients with renal impairment, you could also use either one. Keep in mind that the abacavir/lamivudine regimen would not be recommended for creatinine clearances lower than 50 mL/min.
COBI, cobicistat; CrCl, creatinine clearance; CVD, cardiovascular disease; EVG, elvitegravir; FTC, emtricitabine; HBV, hepatitis B virus; PPI, proton pump inhibitor; PrEP, pre-exposure prophylaxis; RNA, ribonucleic acid; RPV, rilpivirine; TAF, tenofovir alafenamide.
References:
DTG/ABC/3TC [package insert]. September 2015.
EVG/COBI/FTC/TDF [package insert]. March 2016.
FTC/TAF [package insert]. April 2016.
FTC/TDF [package insert]. April 2016.
RPV/FTC/TAF [package insert]. March 2016.
Are there patients for whom you would always use TAF? For hepatitis B coinfection, you clearly should be using tenofovir of some kind; TDF is currently indicated for hepatitis B, but there are data supporting TAF as an HBV drug, and I suspect that TAF will eventually get an approval for that indication. In patients with high cardiovascular risk, you&apos;re going to want to avoid abacavir.
There are very few contraindications to TAF itself, but there are relative contraindications to some of the TAF-containing regimens. For example, cobicistat in EVG/COBI/FTC/TAF has a lot of drug interactions, so that is an important consideration. Patients using proton pump inhibitors or H2 blockers should avoid use of RPV/FTC/TAF; similarly, patients with CD4 counts below 200 probably should not be on RPV/FTC/TAF either.
Are there patients for whom you would never use TAF at all? We have discussed not using TAF in patients with creatinine clearances lower than 30 mL/min, but you might also avoid EVG/COBI/FTC/TAF use in patients with severe hepatic impairment and RPV/FTC/TAF use in patients with viral loads above 100,000 copies/mL.
EFV, efavirenz; FTC, emtricitabine; MTR, multiple-tablet regimen; STR, single-tablet regimen; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate.
Should all patients on TDF-based regimens be switched to TAF? The considerations in favor of that approach are that we know that efficacy is maintained with TAF in multiple switch studies, and we see renal and bone improvements vs TDF. Why would you consider not switching? Well, in one case, if you have somebody who really, really likes being on efavirenz/FTC/TDF, you are not going to be able to switch them to TAF without breaking up the single-tablet regimen, so that may be a consideration in some patients. Of course, we also have longer-term data with TDF-based regimens, but I would say that the overall benefit of switching seems to outweigh the risk. This is especially true because we saw, in many of those studies, that even though patients may not have had clinically significant kidney disease on TDF, they did have more proteinuria, including proximal tubular proteinuria. You have to wonder whether, over time, this would lead to an increased risk of tubulopathy and kidney disease.
3TC, lamivudine; ABC, abacavir; BMD, bone mineral density; DRV, darunavir; DTG, dolutegravir; FTC, emtricitabine; TAF, tenofovir alafenamide; TDF, tenofovir disoproxil fumarate.
Here are some take-home points for this HIV Alert program. Guideline-recommended regimens for first-line therapy are very likely to evolve to FTC/TAF. I&apos;m fairly confident that FTC/TAF with a third agent will become a recommended regimen. The question is whether TDF will be removed or whether they&apos;ll both just be there. TAF-based treatment is noninferior to TDF-based treatment in terms of efficacy, both in first-line and switch settings, and TAF-based treatment has been associated with improvements in bone mineral density and renal function compared to TDF-based treatment.
I think that TAF-based regimens should be considered to replace TDF-based regimens as optimal agents in first-line settings and as switch options for patients currently on TDF-based regimens. Whether or not to use FTC/TAF vs abacavir/lamivudine depends on the patient. There are very good arguments for both, and these 2 nucleoside backbones will and should become the 2 that we use in the vast majority of our patients.