CMEonHIV.com is dedicated to providing online CME presentations (slides with voiceover) on HIV/AIDS for healthcare professionals given by local and international experts to keep you up-to-date on the ongoing developments in the field.
Conference
"Lifelong treatment of HIV: Challenges and promises" Dr. Jürgen Rockstroh (biography) English - 2006-01-20 - 44 minutes
(48 slides)
Summary : Dr. Rockstroh discusses the challenges in HIV treatment beginning firstly by addressing the noticeable differences in antiretroviral accessibility in low to middle income countries. Sub Saharan Africa remains to be the most affected with the least accessibility to antiretrovirals.
The question of when and how to initiate antiretroviral therapy (ART) is still a debatable one. The International AIDS society has brought forth several recommendations in the last decade, all of which have had their promises and pitfalls. With the extensive list of HIV drugs available, various treatment options are available. Throughout this presentation, Dr. Rockstroh examines many different ART regimens and their toxicities.
It is well know that complications arise from HAART. These include hepatic toxicity, adherence issues, lipodystrophy, gastrointestinal complications, cardiovascular disease, and resistance emergence. Mitochondrial DNA depletion contributing to lipodystrophy was found to vary among NRTI based regimens but is highest with thymidine analogue regimens such as d4T. Fortunately, the MITOX and RAVE studies demonstrate a degree of reversibility of lipoatrophy when switched to abacavir or tenofovir. Dr. Rockstroh introduces an interesting technique to measure lipoatrophy known as surface laser imaging.
Other adverse events include the well defined hypersensitivity reaction (HSR) induced by abacavir which has been linked to a specific HLA allele; the HLA-B*5701. HSR occurs early on in treatment and is independent of dosage, be it a once daily or twice daily regimen. Prospective genetic screening for HLA-B*5701 show promising outcomes in avoiding HSRs in these predisposed individuals.
Cardiovascular disease is another complication of HIV infections and is speculated to be attributed to inflammation which induces alterations in lipid metabolism. It was made apparent by the ABCDE study that HAART regimens show beneficial effects on lipid profiles. It is important to recognize that this varied depending on the backbone regimen administered thus providing a means of controlling for adverse cardiovascular events.
Furthermore, Dr. Rockstroh discusses the current issues surrounding drug resistance and the effectiveness of genotyping prior to initiating ART. Other important matters to consider when choosing ART are pharmacokinetic profiles of drugs, and potential drug/drug interactions. Finally, Dr. Rockstroh concludes by addressing the challenges of Hepatitis C co-infections and the effects of HAART on liver disease progression.
Learning objectives : After viewing this presentation, participants will be able to discuss:
- The epidemiology and accessibility of ART;
- When and how to initiate ART;
- Prevention and management of short and long term toxicities;
- The importance of drug resistance, interactions and pharmacokinetic profiles when choosing an appropriate ART regimen;
- Hepatitis C co-infections.
Bibliographic references : Charles C. J. Carpenter; Margaret A. Fischl; Scott M. Hammer; Martin S. Hirsch; Donna M. Jacobsen; David A. Katzenstein; Julio S. G. Montaner; Douglas D. Richman; Michael S. Saag; Robert T. Schooley; Melanie A. Thompson; Stefano Vella; Patrick G. Yeni; Paul A. Volberding. Antiretroviral Therapy for HIV Infection in 1998: Updated Recommendations of the International AIDS Society–USA Panel. Journal of the American Medical Association, July 1998. 280(1), 78-86.
Patrick G. Yeni; Scott M. Hammer; Charles C. J. Carpenter; David A. Cooper; Margaret A. Fischl; Jose M. Gatell; Brian G. Gazzard; Martin S. Hirsch; Donna M. Jacobsen; David A. Katzenstein; Julio S. G. Montaner; Douglas D. Richman; Michael S. Saag; Mauro Schechter; Robert T. Schooley; Melanie A. Thompson; Stefano Vella; Paul A. Volberding. Antiretroviral Treatment for Adult HIV Infection in 2002: Updated Recommendations of the International AIDS Society-USA Panel. Journal of the American Medical Association, July 2002. 288(2), 222-235.
Patrick G. Yeni; Scott M. Hammer; Martin S. Hirsch; Michael S. Saag; Mauro Schechter; Charles C. J. Carpenter; Margaret A. Fischl; Jose M. Gatell; Brian G. Gazzard; Donna M. Jacobsen; David A. Katzenstein; Julio S. G. Montaner; Douglas D. Richman; Robert T. Schooley; Melanie A. Thompson; Stefano Vella; Paul A. Volberding. Treatment for Adult HIV Infection: 2004 Recommendations of the International AIDS Society-USA Panel. Journal of the American Medical Association, July 2004. 292(2), 251-265.
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