Incidencia y Características Clínicas del Síndrome Inflamatorio de Reconstitución Inmune (IRIS) en el Contexto de la Coinfección VIH-TB

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Incidencia y Características Clínicas del Síndrome Inflamatorio de Reconstitución Inmune (IRIS) en el Contexto de la Coinfección VIH-TB"

Transcription

1 Incidencia y Características Clínicas del Síndrome Inflamatorio de Reconstitución Inmune (IRIS) en el Contexto de la Coinfección VIH-TB Dr. Christian Manzardo Hospital Clínic/IDIBAPS- Universidad de Barcelona

2 Globally, an estimated 1.37 million persons were coinfected with HIV and tuberculosis in 2009 (WHO)

3 C Events at HIV Diagnosis in Late Presenters From Italy, Spain, UK & Canada Mussini C, Manzardo C, Johnson M. et al. AIDS 2008, 22: P. jirovecii pneumonia (PCP) Tuberculosis Esophageal candidiasis CNS toxoplasmosis CMV disease Kaposi s s sarcoma NHL Other Opportunistic Infections 268 (35%) 168 (22%) 94 (12%) 65 (9%) 51 (7%) 65 (9%) 28 (4%) 115 (15%)

4 Timing of cart in HIV-infected Patients with Opportunistic Infections (OIs) Acute therapy Immediate cart Maintenance therapy Deferred cart - High pill burden - Overlapping side effects - PK interactions - Risk of IRIS? cells/mm3 - High risk of HIV disease progression and death in patients with advanced disease (CD4<50 )

5 IRIS: Definition IRIS is a paradoxical clinical deterioration in patients receiving effective treatment, remains the major obstacle to antiretroviral therapy (ART) initiation during tuberculosis treatment. The syndrome results from the immune system s restored ability to mount an inflammatory response after ART.

6 Treg IL-7 IL-10 TGF-β Treg Treg Treg Anti-inflammatory (9) Th2 CTL CD8 IL-2 Granzymes and perforin Infected cell Viruses CD4 CD4 CD4 CD4 CD4 CD4 Naïve cells Th0 IL-6 (4) IL-2, IFN-γ Th17 IL-17 Pro-inflammatory (2) Th1 Memory cells IL-2 (3) T effector cell (Th1) (8) CD4 IL-12 IFN-γ (4) DC [Ag] (6) CD4 CD4 CD4 IL-2 CD4+ T cell count (5) CD4 AICD (1) HIV-infected CD4+ nonfunctional (6) Mo IL-6 Pro-inflammatory effects Bacteria and fungi HIV-RNA levels Treg (7) ART days Manzardo et al. EID 2012 [In Press] weeks time months

7 IRIS: Definitions Early IRIS: appears during the first 3 months after initiation of cart. Late IRIS: appears from 3 months up to years after initiation of cart. Paradoxical IRIS: worsening of symptoms of a previously diagnosed OI for which the patient is receiving treatment. Unmasking (or cart-related) IRIS: diagnosis of a new OI with inflammatory characteristics after initiation of cart. cart-associated OIs: diagnosis of a new OI after initiation of cart, but without clinical criteria for IRIS.

8 IRIS:Diagnostic Criteria

9 Illustrative Cases of Paradoxical TB-associated IRIS Marais S et al. Current HIV/AIDS Reports 2009, 6: Anti-TB Rx +cart +Prednisone CMV retinitis

10 Illustrative Cases of Paradoxical TB-associated IRIS Meintjes G et al. Lancet Infect Dis 2008; 8: days Anti-TB Rx + cart + 18 mo mo.

11 Illustrative Cases of Paradoxical TB-associated IRIS Miro Miro JM JM et et al. al. (unpublished) (unpublished) Day 0 Anti-TB Rx + ART Day +15

12 Timing of cart in HIV-infected Patients with Opportunistic Infections (OIs) Acute therapy Immediate cart Maintenance therapy Deferred cart - High pill burden - Overlapping side effects - PK interactions - Risk of IRIS? cells/mm3 - High risk of HIV disease progression and death in patients with advanced disease (CD4<50 )

13 N Engl J Med. October 20 th, 2011; 365:

14 When to Start cart During TB Treatment A5221/STRIDE CAMELIA SAPIT No. 800/ / /215 Sites Africa, Asia, SA, NA Cambodia South Africa Arms Imm vs wk Imm vs. 8 wk Imm vs wk Endpoints Death, AIDS Death Death Immediate = First 2 weeks.

15 IRIS: Incidence Uncontrolled studies (Achenbach et al CID 2012) Tuberculosis 15.7% Controlled studies (RTCs) SapiT Trial (Abdool Karim et al NEJM 2011) Overall Early treatment arm- Deferred treatment arm STRIDE trial (Havlir et al NEJM 2011) Overall Early treatment arm Deferred treatment arm CAMELIA trial (Blanc et al NEJM 2011) Overall Early treatment arm Deferred treatment arm 14.2% 20.1% 8.3% 8% 11% 5% Not analyzed 3.76/100 persons/month 1.53/100 persons/month

16 IRIS: Risk Factors Figure Legend: Kaplan Meier estimates of cumulative probability of IRIS, by study group. IRIS = immune reconstitution inflammatory syndrome. Ann Intern Med. 2012;157(5):

17 IRIS: Risk Factors Ann Intern Med. 2012;157(5):

18 Effects of ART timing on TB-IRIS among patients in STRIDE and SAPIT trials IRD p=0.009 STRIDE Immediate p=0.02 SAPIT Early Havlir DV, NEJM. 2011; 365:1482. Abdool Karim SS, NEJM. 2011; 365:1492.

19 Effect of ART timing on death (CAMELIA, SAPIT) or death/aids % p=0.004 (STRIDE) 19% p= % p=0.73 CAMELIA STRIDE SAPIT Immediate Early Blanc F-X, NEJM. 2011; 365: Havlir DV, NEJM. 2011; 365:1482. Abdool Karim SS, NEJM. 2011; 365:1492.

20 Effects of ART timing on death/aids among patients with CD4 > 50 in STRIDE and SAPIT AIDS or death p=0.67 STRIDE Immediate p=0.34 SAPIT Early Havlir DV, NEJM. 2011; 365:1482. Abdool Karim SS, NEJM. 2011; 365:1492.

21 Effects of ART timing on outcomes in CAMELIA and patients with CD4 < 50 in STRIDE and SAPIT % p= % p= % p= CAMELIA STRIDE SAPIT Immediate Early Blanc F-X, NEJM. 2011; 365: Havlir DV, NEJM. 2011; 365:1482. Abdool Karim SS, NEJM. 2011; 365:1492.

22 SapiT: IRIS Clinical Manifestations Ann Intern Med. 2012;157(5):

23 SapiT: IRIS Severity, by Study Group Ann Intern Med. 2012;157(5):

24 21/09/ /11/2012

25 Immediate cart Deferred cart - High pill burden - Overlapping side effects - PK interactions - Risk of IRIS - High risk of HIV disease progression and death in patients with advanced disease (CD4<50 cells/mm 3 )

26 Timing of cart in HIV-infected Patients with TB According to CD4+ T-cell Count months HRZE CD4 < 50 HR CD4 >50 No after TB TB Rx TB Rx HAART Caution with CNS TB!!!

27 Conclusions 10-15% of HIV-TB co-infected patients develop IRIS IRIS is more common in patients with low CD4 T cell counts (< 50/mmc), high viral loads and in patients starting HAART earlier (<2 weeks) Clinical manifestations could vary from mild to severe forms but usually they are not life-thretering HAART should be started in the first two weeks in patients with CD4 T cell counts lower than 50 cells/mmc, in the intensive treatment period for other patients. Fear of IRIS should not be anymore an obstacle for early start of HAART in HIV-TB co-infected patients.

28

Guideline. Treatment of tuberculosis in patients with HIV co-infection. Version 3.0

Guideline. Treatment of tuberculosis in patients with HIV co-infection. Version 3.0 Guideline Treatment of tuberculosis in patients with HIV co-infection Version 3.0 Key critical points Co-infection with Tuberculosis (TB) and HIV is common in many parts of the world, especially sub-saharan

More information

Challenges of TB in the HIVinfected. CORE Group SOTA Douglas Watson, M.D. University of Maryland, Baltimore 6 October 2009

Challenges of TB in the HIVinfected. CORE Group SOTA Douglas Watson, M.D. University of Maryland, Baltimore 6 October 2009 Challenges of TB in the HIVinfected child CORE Group SOTA Douglas Watson, M.D. University of Maryland, Baltimore 6 October 2009 Challenges of TB in the HIVinfected child Epidemiology: Common, but incidence

More information

HIV/AIDS Care: The Diagnosis Code Series 2. Prepared By: Stacey L. Murphy, MPA, RHIA, CPC AHIMA Approved ICD-10-CM/ICD-10-CM Trainer

HIV/AIDS Care: The Diagnosis Code Series 2. Prepared By: Stacey L. Murphy, MPA, RHIA, CPC AHIMA Approved ICD-10-CM/ICD-10-CM Trainer HIV/AIDS Care: The Diagnosis Code Series 2 Prepared By: Stacey L. Murphy, MPA, RHIA, CPC AHIMA Approved ICD-10-CM/ICD-10-CM Trainer Learning Outcomes Identify and explain the difference between ICD-9-CM

More information

Immunology Platform 2012

Immunology Platform 2012 Immunology Platform 2012 The scientific activity report of Immunology Platform of the Institut Pasteur du Cambodge for the period January 1st to December 31st, 2012. Scientific activity report Prepared

More information

VIH/SIDA en Pediatría: Epidemiología Mundial, Transmisión Perinatal, Manejo Integral.

VIH/SIDA en Pediatría: Epidemiología Mundial, Transmisión Perinatal, Manejo Integral. VIH/SIDA en Pediatría: Epidemiología Mundial, Transmisión Perinatal, Manejo Integral. Juan Carlos Salazar, M.D. Universidad de Connecticut, EE.UU. End-1998 global estimates Children (

More information

Combination Anti-Retroviral Therapy (CART) - Rationale and Recommendation. M Dinaker. Fig.1: Effect of CART on CD4 and viral load

Combination Anti-Retroviral Therapy (CART) - Rationale and Recommendation. M Dinaker. Fig.1: Effect of CART on CD4 and viral load Combination Anti-Retroviral Therapy (CART) - Rationale and Recommendation M Dinaker INTRODUCTION The wide availability of effective, safe and mostly well tolerated combined anti-retroviral therapy (CART)

More information

What is the Difference Between HIV and AIDS?

What is the Difference Between HIV and AIDS? What is AIDS? What causes AIDS? AIDS stands for Acquired Immune Deficiency Syndrome. An HIV-positive person receives an AIDS diagnosis after developing one of the CDC-defined AIDS indicator illnesses.

More information

DISCUSSION GUIDE 6. The difference between HIV and AIDS

DISCUSSION GUIDE 6. The difference between HIV and AIDS DISCUSSION GUIDE 6 DG6 Does a person with HIV have AIDS? 1. HIV is a virus. HIV AIDS 1. AIDS is a disease. Objective: To create an understanding of the difference. 54 2. HIV has no symptoms. 3. An HIV

More information

HIV 201: What I Wish I Knew as a NEW RN

HIV 201: What I Wish I Knew as a NEW RN NORTHWEST AIDS EDUCATION AND TRAINING CENTER HIV 201: What I Wish I Knew as a NEW RN Andrea Carriedo, RN The New Hope Clinic NO CONFLICTS OF INEREST OR RELATIONSHIPS TO DISCLOSE Objectives Describe the

More information

Chapter 21. What Are HIV and AIDS?

Chapter 21. What Are HIV and AIDS? Section 1 HIV and AIDS Today What Are HIV and AIDS? Human immunodeficiency virus (HIV) is the virus that primarily affects cells of the immune system and that causes AIDS. Acquired immune deficiency syndrome

More information

Clinical response to Highly Active Antiretroviral Treatment (HAART) in a patient with Kaposi's sarcoma: A case presentation

Clinical response to Highly Active Antiretroviral Treatment (HAART) in a patient with Kaposi's sarcoma: A case presentation ISPUB.COM The Internet Journal of Infectious Diseases Volume 6 Number 2 Clinical response to Highly Active Antiretroviral Treatment (HAART) in a patient with Kaposi's sarcoma: A case presentation Y Graza,

More information

What is HIV? What is AIDS? The HIV pandemic HIV transmission Window period Stages of HIV infection

What is HIV? What is AIDS? The HIV pandemic HIV transmission Window period Stages of HIV infection Module 1 Overview of HIV Infection Purpose Pre-requisite Modules Learning Objectives To provide you with the basic terms and concepts related to HIV infection. None At the end of this module, you will

More information

CD4 T cell Enumeration in the Diagnosis and Management of Pediatric HIV infection

CD4 T cell Enumeration in the Diagnosis and Management of Pediatric HIV infection CD4 T cell Enumeration in the Diagnosis and Management of Pediatric HIV infection Maurice (Mo) R.G. O Gorman, Ph.D. Professor of Pathology and Pediatrics Keck School of Medicine, U. of Southern California

More information

HIV and Neurological complications in Thailand

HIV and Neurological complications in Thailand HIV and Neurological complications in Thailand Khuanchai Supparatpinyo Division of Infectious Disease Department of Medicine Chiang Mai University, Thailand Agenda Epidemiology of HIV in Thailand Epidemiology

More information

TB treatment outcomes among TB-HIV co-infections in Karnataka, India: how do these compare with non-hiv tuberculosis outcomes in the province?

TB treatment outcomes among TB-HIV co-infections in Karnataka, India: how do these compare with non-hiv tuberculosis outcomes in the province? TB treatment outcomes among TB-HIV co-infections in Karnataka, India: how do these compare with non-hiv tuberculosis outcomes in the province? Shastri S 1, Naik B 2, Shet A 3,4, Rewari B 5, De Costa A

More information

Epidemiology of HIV Infection United States 2013

Epidemiology of HIV Infection United States 2013 Epidemiology of HIV Infection United States 2013 John T. Brooks, M.D. Epidemiology Branch Division of HIV/AIDS Prevention, CDC The findings and conclusions in this presentation are those of the author

More information

Cytomegalovirus (CMV)

Cytomegalovirus (CMV) Opportunistic Infections Cytomegalovirus (CMV) Cytomegalovirus, or CMV, is a virus. It is a herpes virus, a family of viruses that also includes the herpes zoster virus (responsible for chicken pox and

More information

CMV infection in HIV infected patient. Nia Kurniati Cipto Mangunkusumo Hospital Jakarta, Indonesia

CMV infection in HIV infected patient. Nia Kurniati Cipto Mangunkusumo Hospital Jakarta, Indonesia CMV infection in HIV infected patient Nia Kurniati Cipto Mangunkusumo Hospital Jakarta, Indonesia Background CMV infection are commonly found as HIV co-infection Vertical transmission is the important

More information

Cryptococcal disease screen & treat intervention : Phase 1 implementation update

Cryptococcal disease screen & treat intervention : Phase 1 implementation update Cryptococcal disease screen & treat intervention : Phase 1 implementation update 6 th FIDSSA Congress 6 November 2015, Drakensburg Charlotte Sriruttan for the Cryptococcal Disease Screen & Treat Group

More information

TB Intensive San Antonio, Texas November 11 14, 2014

TB Intensive San Antonio, Texas November 11 14, 2014 TB Intensive San Antonio, Texas November 11 14, 2014 TB in the HIV Patient Lisa Armitige, MD, PhD November 13, 2014 Lisa Armitige, MD, PhD has the following disclosures to make: No conflict of interests

More information

Core Competencies: HIV/AIDS: HIV Basics HIV/AIDS JEOPARDY* Overview. To change category names: Instructions. 2. Introduce session.

Core Competencies: HIV/AIDS: HIV Basics HIV/AIDS JEOPARDY* Overview. To change category names: Instructions. 2. Introduce session. Core Competencies: HIV/AIDS: HIV Basics HIV/AIDS JEOPARDY* ABOUT THIS ACTIVITY Time: 60 minutes Objectives: By the end of this session, participants will be able to: Reviewed their knowledge of HIV/AIDS

More information

Module 3 TREATMENT OF CHILDHOOD TB

Module 3 TREATMENT OF CHILDHOOD TB Module 3 TREATMENT OF CHILDHOOD TB Burden of TB in children Tuberculosis (TB) in children is common wherever TB is common in adults i.e. TB endemic settings TB is an important cause of illness and death

More information

Appendix E-- The CDC s Current and Proposed Classification System for HIV Infection

Appendix E-- The CDC s Current and Proposed Classification System for HIV Infection Appendix E-- The CDC s Current and Proposed Classification System for HIV Infection The Centers for Disease Control (CDC) has developed a classification system for human immunodeficiency virus (HIV) infection

More information

Management of HIV and TB Co-infection in South Africa

Management of HIV and TB Co-infection in South Africa Management of HIV and TB Co-infection in South Africa Halima Dawood Department of Medicine Case Report 39 yr old female Referred to clinic on 14/06/2006 for consideration to commence antiretroviral therapy

More information

Outline: STOP HIV/AIDS: Seek and Treat for Optimal Prevention of HIV/AIDS. STOP HIV/AIDS Provincial HIV/AIDS Collaborative

Outline: STOP HIV/AIDS: Seek and Treat for Optimal Prevention of HIV/AIDS. STOP HIV/AIDS Provincial HIV/AIDS Collaborative STOP HIV/AIDS Provincial HIV/AIDS Collaborative Rolando Barrios, MD, FRCPC Assistant Director BC Centre for Excellence in HIV/AIDS Assistant Medical Director HIV/AIDS Program Providence Health Care Adjunct

More information

Aim of Presentation. The Role of the Nurse in HIV Care. Global Epidemic 7/24/09

Aim of Presentation. The Role of the Nurse in HIV Care. Global Epidemic 7/24/09 Aim of Presentation The Role of the Nurse in HIV Care Eileen Nixon HIV Nurse Consultant Brighton and Sussex University Hospitals Overview of key issues that affect people with HIV Identify the role of

More information

Up to $402,000. Insight HIV. Drug Class. 1.2 million people in the United States were living with HIV at the end of 2011 (most recent data).

Up to $402,000. Insight HIV. Drug Class. 1.2 million people in the United States were living with HIV at the end of 2011 (most recent data). HIV Background, new developments, key strategies Drug Class Insight INTRODUCTION Human Immunodeficiency Virus (HIV) is the virus that can lead to Acquired Immunodeficiency Syndrome, or AIDS. No safe and

More information

GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS IN SOUTH AFRICA

GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS IN SOUTH AFRICA GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS IN SOUTH AFRICA 2010 1 TB prophylaxis GUIDELINES FOR TUBERCULOSIS PREVENTIVE THERAPY AMONG HIV INFECTED INDIVIDUALS Background

More information

Antiretroviral therapy for HIV infection in infants and children: Towards universal access

Antiretroviral therapy for HIV infection in infants and children: Towards universal access Antiretroviral therapy for HIV infection in infants and children: Towards universal access Executive summary of recommendations Preliminary version for program planning 2010 Executive summary Tremendous

More information

Chapter 22. Sexually Transmitted Diseases

Chapter 22. Sexually Transmitted Diseases 1 Chapter 22 Sexually Transmitted Diseases 2 1 Outline Bacterial Infections Chlamydia Gonorrhea Syphilis Viral Infections Herpes Hepatitis Other Infections Vaginal Infections AIDS 3 Chlamydia. Bacterial

More information

Collaborating with Private Providers. Barbarah Martinez, RN, BSN March 18, 2015. TB Nurse Case Management March 17 19, 2015 San Antonio, Texas

Collaborating with Private Providers. Barbarah Martinez, RN, BSN March 18, 2015. TB Nurse Case Management March 17 19, 2015 San Antonio, Texas Collaborating with Private Providers Barbarah Martinez, RN, BSN March 18, 2015 TB Nurse Case Management March 17 19, 2015 San Antonio, Texas EXCELLENCE EXPERTISE INNOVATION Barbarah Martinez, RN, BSN has

More information

SMOKING IN HIV. Michelle Wong Division of Pulmonology, Chris Hani Baragwanath Academic Hospital University of the Witwatersrand

SMOKING IN HIV. Michelle Wong Division of Pulmonology, Chris Hani Baragwanath Academic Hospital University of the Witwatersrand SESSION 16D: LIFESTYLE DISEASES AND HIV SMOKING IN HIV Michelle Wong Division of Pulmonology, Chris Hani Baragwanath Academic Hospital University of the Witwatersrand 15 April 2016 Smoking accounts for

More information

HIV / AIDS Education & Prevention Program

HIV / AIDS Education & Prevention Program HIV / AIDS Education & Prevention Program The Human Immunodeficiency Virus or HIV virus as it is commonly known is a unique type of virus (a retrovirus). The human immunodeficiency virus is a lentivirus

More information

Tuberculosis and HIV/AIDS Co-Infection: Epidemiology and Public Health Challenges

Tuberculosis and HIV/AIDS Co-Infection: Epidemiology and Public Health Challenges Tuberculosis and HIV/AIDS Co-Infection: Epidemiology and Public Health Challenges John B. Kaneene, DVM, MPH, PhD University Distinguished Professor of Epidemiology Director, Center for Comparative Epidemiology

More information

TB-HIV Co-Infection in Children. Reené Naidoo Paediatric HIV/TB Symposium August 2013

TB-HIV Co-Infection in Children. Reené Naidoo Paediatric HIV/TB Symposium August 2013 TB-HIV Co-Infection in Children Reené Naidoo Paediatric HIV/TB Symposium August 2013 Introduction TB & HIV are two of the leading causes of morbidity & mortality in children in South Africa HIV infection

More information

Mountain West AIDS Education and Training Center

Mountain West AIDS Education and Training Center Mountain West AIDS Education and Training Center Back to Basics: CMV Shireesha Dhanireddy, MD 21 July 2016 This presentation is intended for educational use only, and does not in any way constitute medical

More information

Lymphatic/Immune System Vocabulary Key

Lymphatic/Immune System Vocabulary Key Term Acquired Immunity Adenoids Antibody Antigen Axillary nodes B cell (B lymphocyte) Cervical nodes Complement system Cytokines Cytotoxic T cell Dendritic cell Helper T cell Immunity Immunoglobulins Immunotherapy

More information

HIV Treatment & Adherence Update 2014

HIV Treatment & Adherence Update 2014 NORTHWEST AIDS EDUCATION AND TRAINING CENTER HIV Treatment & Adherence Update 2014 Lara Strick, MD, MS Infectious Disease Physician, WA DOC Corrections Program Director, Northwest AETC Clinical Assistant

More information

Management of a child failing first line TB treatment.

Management of a child failing first line TB treatment. Management of a child failing first line TB treatment. Robert Gie Desmond Tutu Tuberculosis Centre Department of Paediatric and Child Health Stellenbosch University South Africa. Tygerberg Hospital Complex

More information

Recurrent meningitis after ART initiation in 2 patients known with cryptococcal meningitis

Recurrent meningitis after ART initiation in 2 patients known with cryptococcal meningitis Recurrent meningitis after ART initiation in 2 patients known with cryptococcal meningitis Graeme Meintjes University of Cape Town Case 1 23 year old woman Known HIV infection, CD4 = 37, but ART-naïve

More information

IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME (IRIS) IN HIV-INFECTED PATIENTS

IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME (IRIS) IN HIV-INFECTED PATIENTS IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME (IRIS) IN HIV-INFECTED PATIENTS I. INTRODUCTION The goal of ARV therapy in immunocompromised HIV-infected individuals is immune reconstitution. However, an aberrant

More information

+ HIV: Clinical Manifestations and Treatment. Dr Denise Borg 24 th November 2014

+ HIV: Clinical Manifestations and Treatment. Dr Denise Borg 24 th November 2014 HIV: Clinical Manifestations and Treatment Dr Denise Borg 24 th November 2014 HIV: Global Statistics HIV Cases in Malta YEAR OF DIAGNOSIS NUMBER 2003 9 2004 11 2005 15 2006 23 2007 22 2008 36 2009 18

More information

Global Update on HIV Treatment 2013: Results, Impact and Opportunities

Global Update on HIV Treatment 2013: Results, Impact and Opportunities June 2013 Global Update on HIV Treatment 2013: Results, Impact and Opportunities WHO/UNAIDS/UNICEF v2 Outline Results: Progress towards Global Targets - Antiretroviral treatment - Prevention of mother-to-child

More information

Journal of Infectious Diseases Advance Access published January 26, 2015

Journal of Infectious Diseases Advance Access published January 26, 2015 Journal of Infectious Diseases Advance Access published January 26, 2015 1 Effect of immune status on serial QuantiFERON-TB Gold In-Tube LTBI screening in persons with HIV in a low TB incidence country

More information

Routine HIV Monitoring

Routine HIV Monitoring Routine HIV Monitoring Guideline of the HIV/AIDS Division at San Francisco General Hospital Statement of Guideline: Patients will be routinely evaluated and monitored for HIV parameters, antiretroviral

More information

HIV Drug Resistance in the Asia- Pacific

HIV Drug Resistance in the Asia- Pacific HIV Drug Resistance in the Asia- Pacific David A Cooper National Centre in HIV Epidemiology and Clinical Research The University of New South Wales Sydney, Australia HIVDR in Asia Pacific Transmitted resistance

More information

Service Learning. HIV/AIDS Prevention

Service Learning. HIV/AIDS Prevention Service Learning & HIV/AIDS Prevention Sponsored by: Anne Arundel County Department of Health 1 Harry S. Truman Parkway Annapolis, Maryland 21401 PHONE: 410-222-7108 FAX: 410-222-7231 Maryland Relay (TTY

More information

In Tanzania, ARVs were introduced free-of-charge by the government in 2004 and, by July 2008, almost 170,000 people were receiving the drugs.

In Tanzania, ARVs were introduced free-of-charge by the government in 2004 and, by July 2008, almost 170,000 people were receiving the drugs. ANTIRETROVIRAL TREATMENT What is ART and ARV? ART is a short form for Antiretroviral Therapy (or Treatment). Antiretroviral therapy is a treatment consisting of a combination of drugs which work against

More information

Using HIV Surveillance Data to Calculate Measures for the Continuum of HIV Care

Using HIV Surveillance Data to Calculate Measures for the Continuum of HIV Care Using HIV Surveillance Data to Calculate Measures for the Continuum of HIV Care Anna Satcher Johnson, MPH Symposium on Measuring the HIV Care Continuum Center for AIDS Research University of Washington

More information

Guidelines for the Prevention and Treatment of Opportunistic Infections Among HIV-Exposed and HIV-Infected Children

Guidelines for the Prevention and Treatment of Opportunistic Infections Among HIV-Exposed and HIV-Infected Children Guidelines for the Prevention and Treatment of Opportunistic Infections Among HIV-Exposed and HIV-Infected Children Visit the AIDSinfo website to access the most up-to-date guideline. Register for e-mail

More information

ACCESS TO AFFORDABLE TREATMENT FOR HIV/AIDS: THE ISSUES

ACCESS TO AFFORDABLE TREATMENT FOR HIV/AIDS: THE ISSUES ACCESS TO AFFORDABLE TREATMENT FOR HIV/AIDS: THE ISSUES AIDS Law Unit Legal Assistance Centre July, 2002 INTRODUCTION Although there is currently no cure for HIV/Aids, treatment has, however, been developed

More information

TB Prevention, Diagnosis and Treatment. Accelerating advocacy on TB/HIV 15th July, Vienna

TB Prevention, Diagnosis and Treatment. Accelerating advocacy on TB/HIV 15th July, Vienna TB Prevention, Diagnosis and Treatment Accelerating advocacy on TB/HIV 15th July, Vienna Diagnosis Microscopy of specially stained sputum is the main test for diagnosing TB (1 2 days) TB bacilli seen in

More information

Treatment of TB a pharmacy perspective

Treatment of TB a pharmacy perspective Treatment of TB a pharmacy perspective Colm McDonald, Antimicrobial Stewardship Pharmacist (Acting) National TB Conference, St. James s Hospital 6 th May 2011 Overview of presentation Role of the pharmacist

More information

Predictors for antiretroviral therapy (ART) failure in an urban HIV/AIDS clinic in Addis Ababa, Ethiopia

Predictors for antiretroviral therapy (ART) failure in an urban HIV/AIDS clinic in Addis Ababa, Ethiopia Predictors for antiretroviral therapy (ART) failure in an urban HIV/AIDS clinic in Addis Ababa, Ethiopia Katherine Niemeyer, Akilah King, Sophie Mengistu, Nils Hennig Department of Medical Education, Department

More information

Thinking about TB elimination at home and abroad

Thinking about TB elimination at home and abroad Global tuberculosis incidence Thinking about TB elimination at home and abroad Neil W. Schluger, M.D. Professor of Medicine, Epidemiology, and Environmental Health Science Columbia University Overall:

More information

HIV/AIDS MORTALITY. SPAIN,

HIV/AIDS MORTALITY. SPAIN, SECRETARÍA GENERAL DE SANIDAD DIRECCIÓN GENERAL DE SALUD PÚBLICA Y SANIDAD EXTERIOR HIV/AIDS MORTALITY. SPAIN, 1981-2008 May 2010 MORTALITY FROM HIV/AIDS IN SPAIN, 1981-2008 INTRODUCTION Despite greatly

More information

Natalizumab (Tysabri) and PMLthe current figures. Paul-Ehrlich-Institut Brigitte Keller Stanislawski Paul-Ehrlich-Str. 51-59 63225 Langen GERMANY

Natalizumab (Tysabri) and PMLthe current figures. Paul-Ehrlich-Institut Brigitte Keller Stanislawski Paul-Ehrlich-Str. 51-59 63225 Langen GERMANY Natalizumab (Tysabri) and PMLthe current figures Paul-Ehrlich-Institut Brigitte Keller Stanislawski Paul-Ehrlich-Str. 51-59 63225 Langen GERMANY Humanised MAB Natalizumab Specific binding to a4-integrin

More information

Cascade of Care and its relevance to Seek, Test, Treat and Retain Strategy. Carlos del Rio, MD Emory Center for AIDS Research

Cascade of Care and its relevance to Seek, Test, Treat and Retain Strategy. Carlos del Rio, MD Emory Center for AIDS Research Cascade of Care and its relevance to Seek, Test, Treat and Retain Strategy Carlos del Rio, MD Emory Center for AIDS Research In order for a person to benefit from HIV treatment success it is necessary

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: renal_kidney_transplantation 4/1980 4/2016 4/2017 4/2016 Description of Procedure or Service A kidney transplant

More information

CIBMTR Infection Data and the New Infection Inserts.

CIBMTR Infection Data and the New Infection Inserts. CIBMTR Infection Data and the New Infection Inserts. Marcie Tomblyn, MD, MS Scientific Director, CIBMTR Infection and Immune Reconstitution Working Committee Overview Indication for expanded data collection

More information

HIV Drug resistanceimplications

HIV Drug resistanceimplications HIV Drug resistanceimplications for therapy Deenan Pillay Africa Centre for Health and Population Studies, UKZN University College London Potential implications of HAART without virological monitoring:

More information

MM Thorell PhD University of the Sciences in Philadelphia, 600 South 43rd Street, Philadelphia, Pennsylvania, , USA.

MM Thorell PhD University of the Sciences in Philadelphia, 600 South 43rd Street, Philadelphia, Pennsylvania, , USA. Medical Journal of Therapeutics Africa 2007 Vol 1, No 2 Page 148 SUMMARY OF GUIDELINES FOR THE USE OF ANTIRETROVIRAL AGENTS IN HIV-INFECTED ADULTS AND ADOLESCENTS. MM Thorell PhD University of the Sciences

More information

HIV surveillance in Northern Ireland 2014

HIV surveillance in Northern Ireland 2014 HIV surveillance in Northern Ireland 2014 Contents Page 1 Surveillance arrangements 3 2 Introduction and key points 4 3 Trend information 5 - New diagnoses Route of transmission Age and gender CD4 surveillance

More information

New Features of PML in the HAART and natalizumab era

New Features of PML in the HAART and natalizumab era New Features of PML in the HAART and natalizumab era Igor J. Koralnik, M.D. HIV/Neurology Center Beth Israel Deaconess Medical Center Harvard Medical School Classical AIDS-associated PML in the pre-haart

More information

HIV Case Conference: HIV Associated Lymphoma

HIV Case Conference: HIV Associated Lymphoma F/C AETC Faculty General HIV Tuesday, July 22, 2014 12:30 1:30pm (EDT) Facilitator Todd S. Wills, MD University of South Florida Didactic Presenter Jose Castro, MD University of Miami Case Discussant(s)

More information

HIV/AIDS. HIV- Human Immunodeficiency Virus. AIDS immume system severely damaged

HIV/AIDS. HIV- Human Immunodeficiency Virus. AIDS immume system severely damaged HIV/AIDS HIV- Human Immunodeficiency Virus Person is infected with virus. May have no s/s (but may transmit virus) More common to have brief flu-like illness 2-6 wks after becoming infected (swollen lymph

More information

Screening and preventive therapy for MDR/XDR-TB exposed/infected children (and adults)

Screening and preventive therapy for MDR/XDR-TB exposed/infected children (and adults) Screening and preventive therapy for MDR/XDR-TB exposed/infected children (and adults) H S Schaaf Department of Paediatrics and Child Health, and Desmond Tutu TB Centre Stellenbosch University, and Tygerberg

More information

HIV Treatment As HIV Prevention

HIV Treatment As HIV Prevention HIV Treatment As HIV Prevention HIV/AIDS and Substance Abuse Nora D. Volkow, M.D. Director National Institute on Drug Abuse National Institutes of Health Few could have imagined that we d be talking about

More information

Tuberculousmeningitis: what is the best treatment regimen?

Tuberculousmeningitis: what is the best treatment regimen? Tuberculousmeningitis: what is the best treatment regimen? H S Schaaf Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University

More information

TREATING DRUG-SENSITIVE TB IN INDIA: IMPLEMENTATION OF DAILY THERAPY WITH FIXED DOSE COMBINATIONS

TREATING DRUG-SENSITIVE TB IN INDIA: IMPLEMENTATION OF DAILY THERAPY WITH FIXED DOSE COMBINATIONS TREATING DRUG-SENSITIVE TB IN INDIA: IMPLEMENTATION OF DAILY THERAPY WITH FIXED DOSE COMBINATIONS Policy brief, March 2015 Tuberculosis (TB), a communicable disease that affects 9 million people worldwide,

More information

sammanchester September 2015 HIV/AIDS: Symptoms, Prevention and Treatment

sammanchester September 2015 HIV/AIDS: Symptoms, Prevention and Treatment sammanchester 10 11 September 2015 HIV/AIDS: Symptoms, Prevention and Treatment Dr Pippa Newton Consultant in Infectious Diseases Wythenshawe Hospital, Manchester Stages of HIV infection CDC WHO Overview

More information

TB at Edendale Hospital: Operational Guidelines for Doctors and Nurses. Dr. Michael Clark Medical Officer Edendale Hospital

TB at Edendale Hospital: Operational Guidelines for Doctors and Nurses. Dr. Michael Clark Medical Officer Edendale Hospital TB at Edendale Hospital: Operational Guidelines for Doctors and Nurses Dr. Michael Clark Medical Officer Edendale Hospital The Burden What? Tuberculosis (TB) HIV/TB co-infection Drug resistance Where?

More information

Journal of Epidemiology Vol. 14, No. 6 November 2004

Journal of Epidemiology Vol. 14, No. 6 November 2004 Journal of Epidemiology Vol. 14, No. 6 November 2004 HIV/AIDS surveillance, which reveals trends in the numbers of patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome

More information

INTEGRATED CLINICAL SYSTEMS MANAGEMENT QUALITY IMPROVEMENT OF CARE OF PLWHA

INTEGRATED CLINICAL SYSTEMS MANAGEMENT QUALITY IMPROVEMENT OF CARE OF PLWHA INTEGRATED CLINICAL SYSTEMS MANAGEMENT QUALITY IMPROVEMENT OF CARE OF PLWHA Dr.Henry Sunpath SAHIVSOC CONFERENCE CAPE TOWN 25/09/14 Why -PHC re-engineering? The health system needs to find its focus Outwards

More information

GROWTH AND DEVELOPMENT

GROWTH AND DEVELOPMENT Open Access Research Journal Medical and Health Science Journal, MHSJ www.pradec.eu ISSN: 1804-1884 (Print) 1805-5014 (Online) Volume 8, 2011, pp. 16-20 GROWTH AND DEVELOPMENT OF CHILDREN WITH HIV/AIDS

More information

African Americans, of people in the United States with AIDS are women, injection drug users,

African Americans, of people in the United States with AIDS are women, injection drug users, Appendix D-- Epidemiology of AIDS in Women, Injection Drug Users, African Americans, and Hispanics The epidemic of acquired immunodeficiency syndrome (AIDS) in the United States has now entered its second

More information

TB preventive therapy in children. Introduction

TB preventive therapy in children. Introduction TB preventive therapy in children H S Schaaf Department of Paediatrics and Child Health, and Desmond Tutu TB Centre Stellenbosch University, and Tygerberg Children s Hospital Introduction Children are

More information

Bromodeoxyuridine (BrdU): Current Status

Bromodeoxyuridine (BrdU): Current Status Studies of Lymphocyte Kinetics in HIV Infection To understand the effects on lymphocyte turnover of: HIV infection HAART therapy Interleukin-2 therapy Methods-in vivo labeling BrdU Deuterated glucose Bromodeoxyuridine

More information

HIV Diagnosis. HIV Diagnosis and Pathogenesis. Laboratory Diagnosis of Established HIV Infection: Antibody Detection

HIV Diagnosis. HIV Diagnosis and Pathogenesis. Laboratory Diagnosis of Established HIV Infection: Antibody Detection HIV Diagnosis HIV Diagnosis and Pathogenesis Scott M. Hammer, M.D. Consider in anyone presenting with symptoms and signs compatible with an HIV-related syndrome or in an asymptomatic person with a risk

More information

Diagnosis, Treatment, and Prevention of Selected Common HIV-Related Opportunistic Infections in the Caribbean Region

Diagnosis, Treatment, and Prevention of Selected Common HIV-Related Opportunistic Infections in the Caribbean Region International AIDS Society USA Topics in HIV Medicine Perspective Diagnosis, Treatment, and Prevention of Selected Common HIV-Related Opportunistic Infections in the Caribbean Region The Caribbean region,

More information

HIV Guidelines. New Strategies.

HIV Guidelines. New Strategies. HIV Guidelines. New Strategies. Santiago Moreno Hospital Universitario Ramón y Cajal Madrid HIV Guidelines. New Strategies. Outline HIV Guidelines What is new? New strategies Treatment as Prevention HIV

More information

Sexually Transmitted Diseases

Sexually Transmitted Diseases Sexually Transmitted Diseases Chapter Fourteen 2013 McGraw-Hill Higher Education. All rights reserved. The Major Sexually Transmitted Diseases Also known as sexually transmitted infections The Major STDs

More information

Referral Guidelines for TB/HIV co-management. (First Edition)

Referral Guidelines for TB/HIV co-management. (First Edition) Referral Guidelines for TB/HIV co-management (First Edition) Government of Lesotho April 2011 1 REFERRAL GUIDELINES FOR TB/HIV CO-MANAGEMENT INTRODUCTION Many TB patients are infected with HIV. Many people

More information

TUBERCULOSIS CONTROL INDIA

TUBERCULOSIS CONTROL INDIA TUBERCULOSIS CONTROL INDIA In terms of population coverage, India now has the second largest DOTS (Directly Observed Treatment, Short course) programme in the world. However, India's DOTS programme is

More information

EYE DISEASES IN HIV-INFECTED INDIVIDUALS IN RURAL SOUTH AFRICA

EYE DISEASES IN HIV-INFECTED INDIVIDUALS IN RURAL SOUTH AFRICA EYE DISEASES IN HIV-INFECTED INDIVIDUALS IN RURAL SOUTH AFRICA In our Western world where treatment is available, HIV/AIDS has become a chronic disease. In all other parts of the globe, HIV/AIDS is still

More information

The Stigma of HIV and AIDS. A Brief History of HIV/AIDS. A Brief History of HIV/AIDS. Opportunistic Infections and Modes of Transmission

The Stigma of HIV and AIDS. A Brief History of HIV/AIDS. A Brief History of HIV/AIDS. Opportunistic Infections and Modes of Transmission Nurse Caring Concepts 1A The Stigma of HIV and AIDS Opportunistic Infections and Modes of Transmission Week 17 12-8 -03 1926-1945 HIV may have spread from monkeys to humans (may have first jumped from

More information

TB and HIV Co-infection Update: Global Becomes Local

TB and HIV Co-infection Update: Global Becomes Local TB and HIV Co-infection: Some Resources http://www.cdc.gov/tb TB and HIV Co-infection Update: Global Becomes Local Henry Fraimow, MD Consultant, Southern N.J. Regional Chest Clinic New Jersey State TB

More information

Nucala. (mepolizumab) New Product Slideshow

Nucala. (mepolizumab) New Product Slideshow Nucala (mepolizumab) New Product Slideshow Introduction Brand name: Nucala Generic name: Mepolizumab Pharmacological class: Interleukin-5 antagonist Strength and Formulation: 100mg per vial; lyophilized

More information

Richard H. Needle, PhD, MPH Lin Zhao, PhD candidate (UCSF School of Nursing) CSIS Africa Program Roundtable June 10, 2010

Richard H. Needle, PhD, MPH Lin Zhao, PhD candidate (UCSF School of Nursing) CSIS Africa Program Roundtable June 10, 2010 Richard H. Needle, PhD, MPH Lin Zhao, PhD candidate (UCSF School of Nursing) CSIS Africa Program Roundtable June 10, 2010 Reference Group to the United Nations on HIV and Injecting Drug Use 2010 Mathers:

More information

Monitoring HIV/AIDS Programs: Participant Guide

Monitoring HIV/AIDS Programs: Participant Guide Monitoring HIV/AIDS Programs: Participant Guide A USAID Resource for Prevention, Care and Treatment Module 10: September 2004 Family Health International In July 2011, FHI became FHI 360. FHI 360 is a

More information

MANAGEMENT OF TUBERCULOSIS

MANAGEMENT OF TUBERCULOSIS MANAGEMENT OF TUBERCULOSIS Dean B. Ellithorpe, M.D. Clinical Professor of Medicine Section of Pulmonary Diseases, Critical Care and Environmental Medicine Tulane University School of Medicine INTRODUCTION

More information

Chapter 1 Overview of Tuberculosis Epidemiology in the United States

Chapter 1 Overview of Tuberculosis Epidemiology in the United States Chapter 1 Overview of Tuberculosis Epidemiology in the United States Table of Contents Chapter Objectives.... 1 Progress Toward TB Elimination in the United States.... 3 TB Disease Trends in the United

More information

HCV in 2020: Any cases left? Rafael Esteban Hospital General Universitario Valle Hebron Barcelona. Spain

HCV in 2020: Any cases left? Rafael Esteban Hospital General Universitario Valle Hebron Barcelona. Spain HCV in 2020: Any cases left? Rafael Esteban Hospital General Universitario Valle Hebron Barcelona. Spain Yes, still too many Measures to eradicate an Infectious Disease Prevention: Vaccination Screening

More information

FAQs HIV & AIDS. What is HIV? A virus that reduces the effectiveness of your immune system, meaning you are less protected against disease.

FAQs HIV & AIDS. What is HIV? A virus that reduces the effectiveness of your immune system, meaning you are less protected against disease. HIV & AIDS What is HIV? A virus that reduces the effectiveness of your immune system, meaning you are less protected against disease. What does HIV stand for? Human Immunodeficiency Virus Where did HIV

More information

TB and the rising tide of chronic pulmonary aspergillosis

TB and the rising tide of chronic pulmonary aspergillosis TB and the rising tide of chronic pulmonary aspergillosis David W. Denning National Aspergillosis Centre University Hospital of South Manchester The University of Manchester Chronic pulmonary aspergillosis

More information

AIDS (acquired immune deficiency syndrome) is the final stage of HIV disease, which causes severe damage to the immune system.

AIDS (acquired immune deficiency syndrome) is the final stage of HIV disease, which causes severe damage to the immune system. AIDS Definition AIDS (acquired immune deficiency syndrome) is the final stage of HIV disease, which causes severe damage to the immune system. Causes Important facts about the spread of AIDS include: AIDS

More information

Cryptococcal Screening Program Case Studies

Cryptococcal Screening Program Case Studies Slide 1 Cryptococcal Screening Program Case Studies Image courtesy of World Health Organization National Center for Emerging and Zoonotic Infectious Diseases Mycotic Diseases Branch Slide 2 Note to trainers

More information

HBV screening and management in HIV-infected children and adolescents

HBV screening and management in HIV-infected children and adolescents HBV screening and management in HIV-infected children and adolescents Linda Aurpibul M.D. Research Institute for Health Sciences, Chiang Mai University 8% HIV and Hepatitis B Co-infection Among Perinatally

More information

Borderless Diseases By Sunny Thai

Borderless Diseases By Sunny Thai Borderless Diseases By Sunny Thai Millennium Development Goal #6 6. Combat HIV/AIDS, malaria and other borderless diseases. A. Halt and begin reversing spread of HIV by 2015. B. Achieve universal access

More information

Hepatitis B and C Co-infection. Mark Hull MHSc, FRCPC Clinical Assistant Professor Division of AIDS

Hepatitis B and C Co-infection. Mark Hull MHSc, FRCPC Clinical Assistant Professor Division of AIDS Hepatitis B and C Co-infection Mark Hull MHSc, FRCPC Clinical Assistant Professor Division of AIDS Objectives Review natural history of hepatitis coinfection Brief overview of treatment indications for

More information