the african eye trust hiv treatment information event by badru male&elijah amooti
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The African Eye Trust HIV Treatment Information Event By Badru Male&Elijah Amooti. Background. HIV discovered within Gay communities in San Francisco, USA in 1982 as HTLV1. 1984 rediscovered in heterosexuals in Central Africa In France, a scientist discovered that HIV causes AIDS. - PowerPoint PPT PresentationTRANSCRIPT
Apr 21, 2023Apr 21, 2023Understanding HIV Treatment Understanding HIV Treatment
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The African Eye TrustThe African Eye Trust HIV Treatment Information HIV Treatment Information
EventEventBy Badru Male&Elijah By Badru Male&Elijah
Amooti Amooti
Apr 21, 2023Apr 21, 2023Understanding HIV Treatment Understanding HIV Treatment
and adherence.and adherence.
BackgroundBackground
HIV discovered within Gay communities in HIV discovered within Gay communities in San Francisco, USA in 1982 as HTLV1.San Francisco, USA in 1982 as HTLV1.
1984 rediscovered in heterosexuals in 1984 rediscovered in heterosexuals in Central AfricaCentral Africa
In France, a scientist discovered that HIV In France, a scientist discovered that HIV causes AIDS.causes AIDS.
1988 – Use of septrin to cure PCP and HIV 1988 – Use of septrin to cure PCP and HIV encephalopathy/Toxoplasmosisencephalopathy/Toxoplasmosis
AZT MonotherapyAZT Monotherapy
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The UK HIV deaths TrendThe UK HIV deaths Trend
2006 - 5,505 new diagnoses of HIV 2006 - 5,505 new diagnoses of HIV ((about 50% acquired in Africaabout 50% acquired in Africa))
84,730 Cumulative since 198284,730 Cumulative since 1982((33% do not know they are HIV positive)33% do not know they are HIV positive)
40% People of African ethnicity 40% People of African ethnicity (about 24,000)(about 24,000)
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The UK HIV deaths TrendThe UK HIV deaths Trend
19951995-- 1800 deaths1800 deaths
20002000-- 500 deaths500 deaths
20062006-- 419 deaths 419 deaths (down by 15%)(down by 15%)
22,745 Cumulative deaths22,745 Cumulative deaths
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HIV and AIDS diagnoses and deaths in HIV infected individuals, UK reports to end December 2006
Numbers, particularly for recent years, will rise as further reports are received.
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and adherence.and adherence.
History of HIV Anti-Retroviral History of HIV Anti-Retroviral Therapy (ART)Therapy (ART)
Nucleoside analoguesNucleoside analogues– 1988, A drug called Zidovudine (AZT) used to 1988, A drug called Zidovudine (AZT) used to
treat HIV infection.treat HIV infection.– 1989, Videx (DdI)1989, Videx (DdI)– 1990, Hivid (DdI)1990, Hivid (DdI)
Non-nucleoside analogues (1989)Non-nucleoside analogues (1989)
(Nevirapine/ viramune) (Nevirapine/ viramune)
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History of HIV Anti-Retroviral History of HIV Anti-Retroviral Therapy (ART)Therapy (ART)
1995 Protease inhibitors (PI)1995 Protease inhibitors (PI)
Combination Therapy – Vancouver (1998)Combination Therapy – Vancouver (1998)
1999 – Tenofovir (Nucleotide analogue)1999 – Tenofovir (Nucleotide analogue) 2001- Entry inhibitor – T/20 (Fuzeon)2001- Entry inhibitor – T/20 (Fuzeon) 2005 - Entry CCR5 receptors2005 - Entry CCR5 receptors
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Anti-Retro-Viral classes of drugsAnti-Retro-Viral classes of drugs
Nucleoside analogues (NUKES)Nucleoside analogues (NUKES) Non-Nucleoside analogues (NON-NUKES)Non-Nucleoside analogues (NON-NUKES) Protease Inhibitors (PIs)Protease Inhibitors (PIs) Entry/Fusion Inhibitors (FIs)Entry/Fusion Inhibitors (FIs)
– CCR5 blockersCCR5 blockers
Nucleotide analogues (Nukets)Nucleotide analogues (Nukets) Intergrase inhibitorsIntergrase inhibitors
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NukesNukes Non-nukesNon-nukes ProteaseProtease
InhibitorsInhibitors
Fusion/entry Fusion/entry
InhibitorsInhibitors
Integrase Integrase InhibitorsInhibitors
AZTAZT
ddIddI
ddCddC
FTCFTC
3TC3TC
d4Td4T
AbacavirAbacavir
Tenofovir Tenofovir (nt)(nt)
Combivir©Combivir©
Kivexa ©Kivexa ©
Trizivir ©Trizivir ©
Truvada ©Truvada ©
SustivaSustiva
NevirapineNevirapine
DelavirdineDelavirdine
TMC 125TMC 125
IndinavirIndinavir
SaquinavirSaquinavir
LopinavirLopinavir
FosamprenFosamprenaviravir
RitonavirRitonavir
AmprenavirAmprenavir
Kaletra ©Kaletra ©
NelfinavirNelfinavir
AtazanavirAtazanavir
TipranavirTipranavir
DuranavirDuranavir
(TMC114)(TMC114)
T-20T-20
CCR5 CCR5 inhibitorsinhibitors
GS-9137GS-9137
MK-0518MK-0518
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Viral EnzymesViral Enzymes
Reverse TranscriptaseReverse Transcriptase
IntergraseIntergrase
ProteaseProtease
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HIV ManifestationHIV Manifestation
protease inhibitors
entry inhibitors
nukes &non-nukes(NNRTIs)
HIV virus
CD4 cell
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Reverse transcriptas
e
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Gene for envelope changes
Gene for envelope changes
Body makesantibodies
Antibodies cannotrecognise virus
Genetic variability/mutation
Body makesnew antibodies
New antibodies cannot recognise
virus
Apr 21, 2023Apr 21, 2023 1414
How HIV infects T4 cellsHow HIV infects T4 cells
VIRUS
New viruses bud out of T4 cell
T4 CELL CYTOPLASM
CD4 receptor molecule
Enters host cell, loses envelope
RT enzyme
Viral RNA
RNADNA
Viral DNA
viral genome integrates with T4 cell genome
copies of viral RNA (messenger RNA)
NUCLEUS
T4 cellgenome
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GROUP EXERCISEGROUP EXERCISE
Assume that you are one of the viral Assume that you are one of the viral enzymesenzymes
Pick a card of a drug that you consider your Pick a card of a drug that you consider your enemyenemy
Place it in the right placePlace it in the right place Pick a friend from the other groups who will Pick a friend from the other groups who will
help you fight the virus and explainhelp you fight the virus and explain
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HIV Treatment issuesHIV Treatment issues
Starting treatmentStarting treatment AdherenceAdherence Side effects/ToxicitySide effects/Toxicity Drug Concentration (IQ)Drug Concentration (IQ) Drug ResistanceDrug Resistance Changing treatmentChanging treatment Drug interactionsDrug interactions
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STARTING HIV TREATMENTSTARTING HIV TREATMENT
Why start HIV treatmentWhy start HIV treatment
When to start HIV treatmentWhen to start HIV treatment
What to start withWhat to start with
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4-8 wks Up to 12 years 2-3 years
Infection
Seroconversion
Asymptomatic Symptomatic AIDS
Death
1000
500
0
CD4+ Cells/mm3
viral load
200
2-12 mo
2 million
0
copies/mL
Viral load & CD4 after HIV-1 Infection[without treatment]
Time
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ADHERENCE to ARVsADHERENCE to ARVs
The meaning – (KMS=A)The meaning – (KMS=A) What is non-adherenceWhat is non-adherence Factors affecting adherenceFactors affecting adherence Support needed for adherenceSupport needed for adherence Outcomes of adherenceOutcomes of adherence
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What is adherence?What is adherence?
Knowledge Knowledge – How drugs workHow drugs work– Why they workWhy they work– Why they may not work and consequencesWhy they may not work and consequences
MemoryMemory– Biopsychosocial issuesBiopsychosocial issues
SatisfactionSatisfaction– Benefits, lifestyle, Side/effects/QOLBenefits, lifestyle, Side/effects/QOL
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After HIV treatment (ARVs): effect on CD4 and viral load
1-12 yrs +1-6 moChronicInfection
Start treatment
1000
500
0
CD4+ cells/mm3
viral load (RNA)copies/mL
200
2 million
0
+ 1-40+ years !!
< 50 copies/mL
Viral load <50 copies/mL
Time
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dose
Increased risk of side effects
0
Increased risk of resistance
dose dose dose
Taking drugs at the exact time makes sure that you keep above a minimum level
Drug levels and resistance.1
MEC(Minimum Effective Concentration)
Drug concentration
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Side Effects/ToxicitySide Effects/Toxicity
Why it is better to know before starting.Why it is better to know before starting. What are “side effects”What are “side effects”
– Short term Short term – Long TermLong Term
How to manage side effectsHow to manage side effects The balance of benefitsThe balance of benefits
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Managing side effectsManaging side effects
Complimentary therapiesComplimentary therapies– TaichiTaichi– AcupunctureAcupuncture– ReflexologyReflexology– ShiatsuShiatsu– YogaYoga
New fill for lipodystrophyNew fill for lipodystrophy Exercising for high LDLExercising for high LDL
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Changing treatment combinationChanging treatment combination
Why should some one change treatmentWhy should some one change treatment What should someone change toWhat should someone change to When should someone change treatmentWhen should someone change treatment Why are consultants usually against changeWhy are consultants usually against change
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Drug interactionsDrug interactions
ARVs / ARVsARVs / ARVs ARVs / AnelgesicsARVs / Anelgesics ARVs /AntibacterialsARVs /Antibacterials ARVs / AnticonvulsantsARVs / Anticonvulsants ARVs AntiviralsARVs Antivirals ARVs / NeoplasticsARVs / Neoplastics ARVs / AntiprotozoalsARVs / Antiprotozoals
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Drug interactionsDrug interactions
ARvs / SedativesARvs / Sedatives ARVs / Gastrointestinal agentsARVs / Gastrointestinal agents ARVs / Illicit recreationalARVs / Illicit recreational ARVs / ImmunosuppressantsARVs / Immunosuppressants ARVs / SteroidsARVs / Steroids ARVs / HerbalsARVs / Herbals ARvs / Beta blockers ARvs / Beta blockers ARVs / AntipsychoticsARVs / Antipsychotics
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New DrugsNew Drugs PI – TMC114 (Darunavir, PI – TMC114 (Darunavir, PREZISTA)PREZISTA)
600mg/boosted with 100mg Rit. BD600mg/boosted with 100mg Rit. BD
NNRTI – TMC125NNRTI – TMC125 CCR5 Inhibitors (in pipeline)CCR5 Inhibitors (in pipeline)
– AplavirocAplaviroc– VincrivirocVincriviroc– MaravirocMaraviroc
CXCR4 Inhibitors (in pipeline)CXCR4 Inhibitors (in pipeline) Integrase InhibitorsIntegrase Inhibitors