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
"Management Following Multiple Failures" Dr. Julio Montaner (biography) English - 2003-03-29 - 45 minutes
Summary : There is a lack of objective data on the topic of salvage therapy, unfortunately, and so much of what we discuss here today is opinion-based. Clinical (ART cohort) studies show a virological failure rate of over 25% of patients within the first 6 months of therapy, which is unacceptably high. The advent of routine testing is therefore welcome at this time, and with appropriate genotyping and susceptibility testing, doctors should better be able to choose therapies. The use of the Virtual Virus method is superior to baseline testing, in terms of predicting the kinds of mutations the patient may be harbouring. With regard to therapeutic drug monitoring (TDM), the virtual inhibitory quotient, which relates the IC50 of the virus to the Ctrough of the medication, is a very good method of finding an optimal regimen, through drug boosting, synergies or addition of other compounds. Dealing with treatment failure is a special challenge, which has the possibility to be overcome by multidrug rescue therapy (MDRT), or perhaps with newer agents. New data presented at the CROI 2003 conference are favourable for STIs, as seen in the GIGA-HAART study. The issue of whether to use STIs remains, though a debate, and is not generally recommended, but can be used depending on the clinical circumstances.
Learning objectives : The participant will get an expert opinion on how to deal with multiple class failure:
- Think carefully before starting therapy
- Identify and correct the reason for failure
- Switch early and avoid cross-resistance
- Consider cumulative drug exposure
- Use resistance – PK liberally
- Aim for full suppression, be ready to compromise
- Role of STI unclear (not recommended)
Bibliographic references : http://www.aidsonline.com/article.asp?ISSN=0269-9370&VOL=16&ISS=12&PAGE=1627
AIDS 2002;16:1627-1632
Consecutive rebounds in plasma viral load are associated with virological failure at 52 weeks among HIV-infected patients
Janet M. Raboud; Sandra Raeb; Ryan Woods; Marianne Harris; Julio S. G. Montaner; and the INCAS and AVANTI Study Groups
USER ACKNOWLEDGES AND AGREES THAT ALL DECISIONS MADE WITH THE ASSISTANCE OR USE OF THE SOFTWARE AND/OR THE WEBSITE AND/OR BASED ON CONTENT FOUND HEREIN WILL BE EXCLUSIVELY THE RESPONSIBILITY OF THE USER.
