THE BODY PRO The HIV Resource for Health Professionals Faculty: Benjamin Young, M.D., Ph.D. Assistant Clinical Professor of Medicine at the University.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
THE BODY PROThe HIV Resource for Health Professionals
Faculty: Benjamin Young, M.D., Ph.D. Assistant Clinical Professor of Medicine at theUniversity of Colorado
The Body PRO Covers ICAAC/IDSA 2008Washington, D.C.; October 25-28, 2008
This activity is jointly sponsored by Postgraduate Institute for Medicine and The Body PRO.
Benjamin Young, M.D., Ph.D.
Reappraising Key Issues in HIV Clinical Management:Highlights From ICAAC/IDSA 2008
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
2
Faculty for This ActivityFaculty for This Activity
Benjamin Young, M.D., Ph.D.
Benjamin Young, M.D., Ph.D. is assistant clinical professor of medicine at the University of Colorado and consultant physician for Denver ID Consultants at Rose Medical Center in Denver.
Dr. Young is the author of numerous journal articles, reviews and studies relating to HIV and its treatment. He is a principal investigator with the HIV Outpatient Study, a massive ongoing analysis of the health of HIV-positive people throughout the U.S. A member of the HIV Medicine Association and the American Academy of HIV Medicine, Dr. Young is also actively involved in educating health care professionals and community groups throughout the world on HIV-related subjects. He has devoted the past two years to training HIV physicians in Eastern Europe and Central Asia.
DisclosuresDr. Young has been a consultant for Bristol-Myers Squibb, Cerner Corporation, Gilead Sciences, GlaxoSmithKline, Hoffmann-La Roche, Inc., Merck & Co., Monogram Biosciences and Pfizer, Inc. He has served on speaker bureaus for Gilead Sciences, GlaxoSmithKline, Merck and Monogram. In addition, he has received research support from Bristol-Myers Squibb, Cerner Corporation, Gilead Sciences, GlaxoSmithKline, Hoffman-La Roche and Merck.
This activity is supported by an educational grant from
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
3HOPS: Incidence of High Frequency Infectious Opportunistic Infections, 1994 – 2006
HOPS: Incidence of High Frequency Infectious Opportunistic Infections, 1994 – 2006
JT Brooks et al. ICAAC/IDSA 2008; abstract H-2330. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
4
HOPS: Incidence Rates of Malignant Opportunistic Infections, 1994 – 2006HOPS: Incidence Rates of Malignant Opportunistic Infections, 1994 – 2006
JT Brooks et al. ICAAC/IDSA 2008; abstract H-2330. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
5HOPS: Median CD4+ Cell Counts at Opportunistic Infection Diagnosis, 1994 – 2006
HOPS: Median CD4+ Cell Counts at Opportunistic Infection Diagnosis, 1994 – 2006
JT Brooks et al. ICAAC/IDSA 2008; abstract H-2330. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
6
DUET: Study Design and Major Inclusion CriteriaDUET: Study Design and Major Inclusion Criteria
Richard Haubrich et al. ICAAC/IDSA 2008; abstract H-1239. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
7
DUET: Proportion of Patients With Any ADE or DeathDUET: Proportion of Patients With Any ADE or Death
Richard Haubrich et al. ICAAC/IDSA 2008; abstract H-1239. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
8
DUET: Proportion of Patients Hospitalized by Week 48*DUET: Proportion of Patients Hospitalized by Week 48*
Richard Haubrich et al. ICAAC/IDSA 2008; abstract H-1239. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
9
DUET: Cumulative Hospital Days Over 48 WeeksDUET: Cumulative Hospital Days Over 48 Weeks
Richard Haubrich et al. ICAAC/IDSA 2008; abstract H-1239. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
10
BENCHMRK 1 & 2: Study DesignBENCHMRK 1 & 2: Study Design
• Randomized, double-blind, placebo-controlled with Data and Safety Monitoring Board
• Primary analysis at Week 16; secondary analysis at Week 48
Protocol 018* (n = 352)Europe, Asia/Pacific and Peru
Protocol 019* (n = 351)North and South America
2:1
• OBT was selected by investigator based on baseline resistance testing and prior treatment history. Selected investigational ARTs, darunavir and tipranavir, were permitted.
*Protocol 018 (P018) is BENCHMRK-1; Protocol 019 (P019) is BENCHMRK-2
• Results were similar when restricting the analysis to the 77% of participants with baseline HIV RNA data• Adjusted RH for deferral vs. immediate treatment was also 1.7; 95% C.I. was 1.4, 2.2; and P value was < 0.0001• HIV RNA was not an independent predictor of mortality
RH = relative hazard; CI = confidence interval*Stratified by cohort and year
Adapted from Mari Kitahata et al. ICAAC/IDSA 2008; abstract H-896b.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
21
When to Start: Indications for Initiation of Antiretroviral TherapyWhen to Start: Indications for Initiation of Antiretroviral Therapy
U.S. Dept of Health and Human Services. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. 2008 Nov 3. Reprinted with permission.
Section of D.H.H.S. Guidelines for the
Use of Antiretroviral Agents in HIV-1
Infected Adults and Adolescents:
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
22Perceptions of HIV-Infected Women: Percentage Who Felt That Culture, Ethnicity Or Language Impacted the Care Received, By Race/Ethnicity
Perceptions of HIV-Infected Women: Percentage Who Felt That Culture, Ethnicity Or Language Impacted the Care Received, By Race/Ethnicity
Adapted from Sally Hodder et al. ICAAC/IDSA 2008; abstract H-443.
^P < 0.05 Caucasian vs. Hispanic and African American
*P < 0.05 Hispanic vs. Caucasian and African American
Total, n = 700Hispanic, n = 147
Caucasian, n = 105African American, n = 448
4129
6239
2132
1021
3838
2740
0 10 20 30 40 50 60 70
Percentage
Not At All
A Little
A Lot
Total Hispanic Caucasian African American
*
*
^
^
^
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
23Perceptions of HIV-Infected Women: Percentage Who Felt That Culture, Ethnicity Or Language Impacted the Care Received, By Provider Type
Perceptions of HIV-Infected Women: Percentage Who Felt That Culture, Ethnicity Or Language Impacted the Care Received, By Provider Type
Sally Hodder et al. ICAAC/IDSA 2008; abstract H-443. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
24Use of HAART Among HIV-Infected Women, 2002 – 2005: Characteristics of Study Sample
Use of HAART Among HIV-Infected Women, 2002 – 2005: Characteristics of Study Sample
Adapted from Marsha Lillie-Blanton et al. ICAAC/IDSA 2008; abstract H-444.
Never Used 593 40.5% 561 41.4%Used prior to study only 389 26.6% 320 23.6%
Used earlier during study 323 22.1% 316 23.3%Used in past 6 months 144 9.8% 130 9.6%
Missing 14 1.0% 27 2.0%1Women of “Other” racial/ethnic groups are not included in this analysis.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
25
Use of HAART Among HIV-Infected Women: Key Findings, Bivariate AnalysisUse of HAART Among HIV-Infected Women: Key Findings, Bivariate Analysis
Marsha Lillie-Blanton et al. ICAAC/IDSA 2008; abstract H-444. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
26Reported AIDS Cases in the United States Among Female Adults and Adolescents, by Region and Race/Ethnicity, 2006
Reported AIDS Cases in the United States Among Female Adults and Adolescents, by Region and Race/Ethnicity, 2006
Aadia I Rana et al. ICAAC/IDSA 2008; abstract H-453. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
27Pregnancies Among HIV-Infected Women in Mississippi: Baseline Demographic Data
Pregnancies Among HIV-Infected Women in Mississippi: Baseline Demographic Data
Aadia I Rana et al. ICAAC/IDSA 2008; abstract H-453. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
28
Pregnancies Among HIV-Infected Women In Mississippi: Clinical CharacteristicsPregnancies Among HIV-Infected Women In Mississippi: Clinical Characteristics
Aadia I Rana et al. ICAAC/IDSA 2008; abstract H-453. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
29Pregnancies Among HIV-Infected Women In Mississippi: Number of Visits to an HIV Provider Within 12 Months Postpartum
Pregnancies Among HIV-Infected Women In Mississippi: Number of Visits to an HIV Provider Within 12 Months Postpartum
Aadia I Rana et al. ICAAC/IDSA 2008; abstract H-453. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
30
Compliance With Breast Cancer Screening Guidelines in the HIV ClinicCompliance With Breast Cancer Screening Guidelines in the HIV Clinic
Eleni Patrozou et al. ICAAC/IDSA 2008; abstract H-2339. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
31SUN Study: Factors Associated with Low Bone Mineral Density in a Large Cohort of HIV-Infected U.S. Adults -- Baseline Results
SUN Study: Factors Associated with Low Bone Mineral Density in a Large Cohort of HIV-Infected U.S. Adults -- Baseline Results
Turner Overton et al. CROI 2007; abstract 836. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
32HIV-Infected and -Uninfected Interaction With Testosterone On Bone Mineral Density: T-Scores of Patients in Normal, Osteopenic And Osteoporotic Range
HIV-Infected and -Uninfected Interaction With Testosterone On Bone Mineral Density: T-Scores of Patients in Normal, Osteopenic And Osteoporotic Range
Ranjani Raghunathan et al. ICAAC/IDSA 2008; abstract H-2299. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
33HIV-Infected and -Uninfected Interaction With Testosterone On Bone Mineral Density: T-Scores of Patients With Low and Normal Free Testosterone Levels
HIV-Infected and -Uninfected Interaction With Testosterone On Bone Mineral Density: T-Scores of Patients With Low and Normal Free Testosterone Levels
Ranjani Raghunathan et al. ICAAC/IDSA 2008; abstract H-2299. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
34
Should Vitamin D Be Prescribed With TDF/FTC? (1)Should Vitamin D Be Prescribed With TDF/FTC? (1)
Kathryn Childs et al. ICAAC/IDSA 2008; abstract H-2300. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
35
Should Vitamin D Be Prescribed With TDF/FTC? (2)Should Vitamin D Be Prescribed With TDF/FTC? (2)
Kathryn Childs et al. ICAAC/IDSA 2008; abstract H-2300. Reprinted with permission.
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
36
SMART: Study DesignSMART: Study Design
Adapted from Wafaa El-Sadr, M.D., M.P.H., et al. N Engl J Med. 2006;355(22):2283-2296.
CD4+ Cell Count > 350 Cells/mm3
n = 5,472ART Experienced: 95.4%
HIV RNA < 400 Copies/mL: 72%Median CD4+ Count: 597 Cells/mm3
Drug Conservation (DC) StrategyDefer use of ART until CD4+ < 250;
then episodic ART based on CD4+ cell count to increase counts to > 350
n = 2,720
Virologic Suppression (VS) Strategy
Continuous use of ART to maintain viral load as low as possible
n = 2,752
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
37
SMART: Percent Change in Spine Bone Mineral Density, by DXASMART: Percent Change in Spine Bone Mineral Density, by DXA
Adapted from Birgit Grund et al. ICAAC/IDSA 2008; abstract H-2312a.
-4 -3 -2 -1 0 1 2
4
3
2
1
Ye
ars
Change From Baseline (%)
VS Group DC Group
n = 112
n = 88
n = 77
n = 54
n = 47
n = 10
n = 96
n = 15
Est. DC-VS Differences (Mean Change) and P Values
Est. Diff. P
1 Year 1.7 0.003
2 Years 0.8 0.26
3 Years 0.5 0.64
4 Years 2.1 0.40
Through Follow-Up
1.2 0.05
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
38
SMART: Percent Change in Total Hip Bone Mineral Density, by DXASMART: Percent Change in Total Hip Bone Mineral Density, by DXA
Adapted from Birgit Grund et al. ICAAC/IDSA 2008; abstract H-2312a.
-4 -3 -2 -1 0 1 2
4
3
2
1
Ye
ars
Change From Baseline (%)
VS Group DC Group
n = 109
n = 86
n = 75
n = 51
n = 47
n = 9
n = 95
n = 15
Est. DC-VS Differences (Mean Change) and P Values
Est. Diff. P
1 Year 1.3 0.002
2 Years 1.7 0.005
3 Years 1.0 0.27
4 Years 2.5 0.21
Through Follow-Up
1.4 0.002
The Body PRO
Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008
39
• This presentation was created to accompany The Body PRO's summaries of key research presented at ICAAC/IDSA 2008, by Benjamin Young, M.D., Ph.D.
• The Body PRO's extensive coverage of ICAAC/IDSA 2008 also includes:– Summaries and analyses of research on a wide array of clinical
subjects.– Interviews with top researchers discussing the results of noteworthy
studies.– Audio podcasts you can play online or download to your computer or
MP3 player.– Narrated, online slide presentations highlighting major study results.
• Visit TheBodyPRO.com/ICAAC2008 today for a full listing of our conference coverage!
Disclaimer:The Body PRO is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through The Body PRO should not be used for diagnosing or treating a health problem or a disease.