Downloaded 64 times
![Why Treat Early?
Treatment is Prevention
• Large 2011 studies showing 92-96%
decrease in HIV transmission with
treatment
• Guidelines say offer ART to all at risk
of transmitting HIV (AI [hetero] or
AIII [other risk groups])](https://image.slidesharecdn.com/plushivtreatment-130805191912-phpapp01/75/August-2013-PLUS-HIV-Treatment-9-2048.jpg)
More Related Content
Similar to August 2013 PLUS HIV Treatment
August 2013 PLUS HIV Treatment
- 1. HIV Treatment: AnIntroduction August 4, 2013 Dr. Joanna Eveland, MS, MD HIV Medical Director, Clinica Esperanza Mission Neighborhood Health Center
- 2. Objectives • When, Whyand What treatment to start • Overcoming side effects • Working with your healthcare providers to get the most out of treatment
- 3.
- 4. 8/5/2013 10,000,000 1,000,000 100,000 10,000 1,000 100 10 HIV in plasma (copies/mL)HIV in plasma (“viral load”) 800 500 200 100 50 0 CD4 Count (cells/mL) CD4 (T Cell) count Months Years Average progression without treatment: 10 years from infection to AIDS diagnosis Source: HRSA HIV/AIDS Bureau
- 5. 2012 Treatment Guidelines ARTis recommended for all HIV+ individuals • Strength of the recommendation varies by CD4 count: o CD4 count <350 (AI) o CD4 count 350 to 500 (AII) o CD4 count >500 (BIII)
- 6. 2012 Treatment Guidelines Ratingscale A = Strong B = Moderate C = Optional Rating of Evidence: I = data from randomized controlled trials II = data from well- designed nonrandomized studies with long-term outcomes III = expert opinion
- 7. 2012 Treatment Guidelines Treatmentencouraged for special risk groups • Pregnancy (AI) • HIV-associated kidney disease (HIVAN) (AII) • Hepatitis B co-infection (AII) • Older patients (>50) (BIII)
- 8. Why Treat Early? ReduceInflammation Uncontrolled HIV might increase risk of non-AIDS diseases: • Heart disease • Kidney disease • Liver disease • Dementia • Cancers
- 9. Why Treat Early? Treatmentis Prevention • Large 2011 studies showing 92-96% decrease in HIV transmission with treatment • Guidelines say offer ART to all at risk of transmitting HIV (AI [hetero] or AIII [other risk groups])
- 10. Don’t start medsuntil… • You feel ready • You are well engaged in care • You can commit to taking your meds regularly • You feel that other life factors and potential barriers to adherence (drugs, drama, mental health) are under control
- 11. We have along way to go…
- 12.
- 13.
- 14. Where we arenow… • D
- 15. Take Home Points •HIV treatment continues to improve- for the better! • Each person’s combination of medicines is different • KNOW what you take, and why.
- 16. Know What You’reTaking • HIV drugs have two, sometimes three, different names – Scientific name, brand name, chemical name – Zidovudine = Retrovir = AZT • Some tablets contain more than one ingredient – Atripla = tenofovir + emtricitabine + efavirenz
- 17.
- 18. General Principles • Goals:less pills, less times/day, less side effects • Use at least 3 drugs, 2 classes of medicines • Sometimes 3 isn’t enough – Your Protease Inhibitor may need a “Booster” – Drug resistance usually = more pills
- 19. Treatment Principles: Chinese MenuMetaphor “Two scoops of rice plus chicken or beef” In other words, usually 2 “nukes”(NRTI) (2 scoops of rice) plus – 1 partner drug (main dish) Protease Inhibitor (beef) “non-nuke” NNRTI (chicken)
- 20. The Drugs… Each attacksthe virus at a different point…
- 21. Where Do HIVDrugs Act?
- 22.
- 23. NRTIs Continued • Backboneof treatment • Older drugs are more toxic (AZT, “D- drugs”) – Peripheral neuropathy – Lactic acidosis – Pancreatitis – Lipodystrophy • Watch kidney function with Tenofovir
- 24.
- 25. NNRTI: Pros andCons Ease (low pill burden) Well tolerated Less metabolic effects – No lipodystrophy, less dyslipidemia Resistance develops quickly if <95% adherent – Single mutation – Cross resistance among NNRTIs Rash; hepatotoxicity ADVANTAGES DISADVANTAGES
- 26. Efavirenz considerations • Mostcommonly prescribed NNRTI • Neuropsychiatric side effects: vivid dreams, sleep disturbance, “spaciness” • Caution for those with mental health issues
- 27.
- 28. PIs: Pros andCons • High potency • Less susceptible to resistance from virus • Second-line therapy when NNRTI fails • Metabolic complications - Increased cholesterol, blood sugar • GI side effects - Diarrhea, nausea • Drug interactions – Statins, viagra, anti- seizure, many others ADVANTAGES DISADVANTAGES
- 29.
- 30. Integrase Inhibitor • Approvedas first- line regimen • Less side effects • Twice daily dosing • Low barrier to resistance • Newer drug • Drug interactions ADVANTAGES DISADVANTAGES
- 31.
- 32. Entry Inhibitors • Currentlyused as salvage therapy for those with drug resistance • Fuzeon is injectable, rarely used • Maraviroc is well tolerated, requires CCR5 receptor on CD4 cells (not everyone has this)
- 33. Side Effects • Tendto be worst in the first 2 months of therapy • Severe side effects are a reason to change medications • Your expectations shape your experience
- 34. Getting The MostOut of Treatment
- 35. What If IMiss a Pill? • Risk of resistance increases with missing more than 1-2 doses/month • If you miss a dose, try and learn from it • If stopping your meds – All or none – Let us know!
- 36. Working With YourProvider • You deserve great care • Find the right fit • Educate yourself • Be engaged in care- regular visits • Uninsured? You can still get care!
- 37. Focus on Wellness •Manage stress • Exercise regularly • Quit smoking • Reduce harmful drug or alcohol use • Build a supportive community • Define and achieve your personal goals
- 38. Resources • Project Inform:1-800-342-2437, • http://www.projectinform.org/ • AIDSmeds.com • thebody.com • HIVinsite.org • www.aidsinfonet.org/
- 39. Thanks • Drs RickLoftus and Tri Do • The advocates and activists who gave us these treatments • My patients
- 40. More Questions? Dr. JoannaEveland Clinica Esperanza 240 Shotwell St., SF (415) 431-3212 – Clinic Info (415) 552-3870 # 303 –My extension [email protected]