Catalyzing HIV and TB Research overview and rat… · Diane V. Havlir, MD University of California, San Francisco Chair, WHO HIV/TB Working Group, Stop TB . HIV/TB: Current Landscape

Catalyzing HIV and TB ResearchCatalyzing HIV and TB Research

Diane V. Havlir, MD

University of California,

San Francisco, CADiane V. Havlir, MD

University of California, San Francisco

Chair, WHO HIV/TB Working Group, Stop TB

HIV/TB: Current Landscape HIV/TB: Current Landscape

� 1.37 million new cases of TB in HIV+ population in 2007

� TB one of greatest threats to success of ART

� TB burden in HIV population is a major obstacle in realizing global TB reductions

� Universal HIV testing in TB clinics

� Expansion of TB case finding in HIV clinics

� TB prevention through IPT and infection control

� Prevention and treatment of MDR/XDR

� Increased models of integrated HIV/TB care

� Investment in TB/HIV research – children included

WHO HIV/TB Working Group Goals and Vision

TB POSES A RISK IN HIV THROUGHOUT THE COURSE OF DISEASE

RISK OF TB

Prevention Strategies for TB among persons with HIV

Prevention Strategies for TB among persons with HIV

� INH and beyond

� Antiretroviral therapy

� Identification and treatment of active cases

� TB vaccines

Infection Control in TB Infection Control in TB

� TB is being transmitted in the health care setting between patients

� Approximately half of cases of recent XDR outbreak of TB in South Africa were acquired in health care setting

� HCW are 5 fold more likely to acquire TB compared to general population

� Innovative and strategic approaches are needed

TB Diagnosis: MomentumTB Diagnosis: Momentum

Point of

care

dipstick

A5221/STRIDE CAMELIA SAPIT

ENDPT

SITES

N

ARMS

634/800

Africa, Asia, SA, NA

429/429660/660

Cambodia South Africa

Imm vs 8-24Imm vs 8Imm vs 8-12

Death, AIDS Death Death

When to Start ART during TB treatment

When to Start ART during TB treatment

194

4

195

2

195

6

196

5

196

8

Strep INH

PZA

Rifampin

EMB

199

8

RPT

TB Drug Development 1944-2009TB Drug Development 1944-2009

ZDVddI

ddCd4T

SQV

3TC

RTV

IDV

NVP

NFV

DLV

EFV

ABC

APV

LPV/

RTVTDF

TPV

DRV

ATV

FPV

ENF

FTC

Years

0

5

10

15

20

25

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

RTG

MVC

Adapted from clincaloptions.com/hiv (Oct, 2007)

NRTI

NNRTI

PI

FUSION INHIBITOR

CCR5 BLOCKER

INTEGRASE INHIBITOR

Antiretrovirals 1987-2009Antiretrovirals 1987-2009

TMC207 shortens time to culture conversion in MDR population

TMC207 shortens time to culture conversion in MDR population

p=0.003

(a) p-value from Cox proportional model adjusting for strata

9%

48%

Diacon, NEJM, 2009

N=47

6 HIV+

Countries with confirmed cases of XDR-TB as of November 2008

Meeting Outcomes Meeting Outcomes

� New ideas, collaborations and networking

� HIV/TB Research Priorities Publication

� TB satellite symposium Tuesday at IAS meeting