PROHYLAXIS &TREATMENT

HIV

HIV YOGA SRINIVAS ANANTHA

Transmission prevention /

Safer sex

Abstinence from sexual relations

use of condoms

Male circumcision

sexual

Avoidance of sharing of needles and other paraphernalia

Avoiding sterile needles

IDA’S

Screening of all blood donors for HIV Antibody nucleic acid in addition clotting factor concentrates are heat treated, essentially eliminating the risk to haemophiliacs who require these products.

BloodMTCT

AZT (reduces risk by 3 fold)

Mother @before delivery

Baby @6 weeks

NEOVIRAPINE (reduce transmission by 50%)

Mother @at onset of labour

Neonate @1st three days

HIV

PRE EXPOSURE PROPHYLAXIS

A new strategy?

2011& 2012 results support this – TENOFOVIR

It prevented HIV transmission & new infections

HIV

Effectiveness of PEP depends on….

• Efficacy of PEP is best if administered within two hours of exposure.

• PEP need to be given within 72 hours of exposure.

• Do not delay PEP while waiting for result of HIV testing.

• Informed consent must be obtained before testing a source as per National guidelines.

• Base line rapid HIV testing before PEP.

• Negative result does not exclude HIV infection.

• Positive HIV result helps in stopping the PEP

TOPICAL MICROBICIDES

Reports from 2010 research

A candidate vaginal gel containing the antiviral drug TENOFOVIR reduced HIV acquisition by 39%

HIV

VACCINES AGAINST HIV

All candidate vaccines tested as of 2011 proved ineffective at preventing infection.

One goal of vaccine research is to design “IMMUNOGENS”

HIV

GENE THERAPY

BEING DEVELOPED TO ACHIEVE

“INTRA-CELLULAR IMMUNISATION”

HIV

HEALTH EDUCATION

It plays an important role and important part of prophylaxis

HIV

TREATMENT

ANTI RETRO VIRAL THERAPY

• GOALS

• CLINICAL GOALS

• VIROLOGICAL GOALS

• IMMUNOLOGICAL GOALS

• THERAPEUTIC GOALS

• REDUCTION OF HIV TRANSMISSION IN INDIVIGUALS

FUSION INHIBITORS @2003

ENTRY INHIBITORS @2007

INTERGRASE INHIBITORS @2007

ANTIVIRAL DRUGS

HIV

Nucleoside

&

Non nucleoside

inhibitors of viral

enzyme

Inhibitors of viral

“PROTEASE

ENZYME”

HAART

HIGHLIGHTES:

• It often can suppress viral replication below the limits of detection in plasma

• Decreases the viral load in lymphoid tissues

• Allow the recovery of immune response's

HIV

Recommended choices of first-line regimens• Principles for selecting the first-line regimen

• 1. Choose 3TC (lamivudine) in all regimens

• 2. Choose one NRTI to combine with 3TC (AZT or d4T)

• 3. Choose one NNRTI (NVP or EFV)

• First choice: AZT + 3TC + NVP

• for patients with Hb > 8 g/d Substitute NVP with EFV, for patients with TB or toxicity to NVP

What to Expect in the First Six Months of Therapy

CD4 recovery

Early ARV toxicity

IRIS

IRIS

• “occurrence or manifestations of new OIs or existing OIs within six weeks t six months after initiating ART; with an increase in CD4 count”.

Drug resistant variants in treatment of naïve patients

A NEW CHALLENGE ???

In 2004 & 2005; patients with newly diagnosed HIV were found to carry

drug resistant mutants 8% and10% of cases in USA & Europe

respectively.

Infants (PI) USA 2002, 19% - Resistant mutants

HIV

COMBINATION THERAPY

A BOON!!

CT turned HIV infection in to chronic treatable disease

Highlights:

• Suppression of viral replication can be achieved

• Restoration of immune function

DRAWBACKS

HIV

ZIDOVUDINE + LAMIVUDINE Combivir

ZIDOVUDINE + ABACAVIR Epzicom

ZIDOVUDINE + LAMIVUDINE + ABACAVIR Trizivir

TENOFOVIR + EMTRICITABINE Truveda

TENOFOVIR + EMTRICITABINE + EFAVIRENZ Atripla

STAVUDINE + LAMIVUDINE + NEVIRAPINE Triomune

COMBINATION FORMULATION