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- 1. Principles of HIV Therapy Simple is Better! Adeel A. Butt, MD Assistant Professor of Medicine and Infectious Diseases University of Pittsburgh Director, VAPHS HIV-ID Clinics Center for Health Equity Research and Promotion Member of Academic Research Council A non-profit organization dedicated to improving medical education and fostering research
- 4. Estimated number of adults and children newly infected with HIV during 2002 Total: 5 million Western Europe 30 000 North Africa & Middle East 83 000 Sub-Saharan Africa 3.5 million Eastern Europe & Central Asia 250 000 East Asia & Pacific 270 000 South & South-East Asia 700 000 Australia & New Zealand 500 North America 45 000 Caribbean 60 000 Latin America 150 000
- 5. Estimated adult and child deaths from HIV/AIDS during 2002 Total: 3.1 million Western Europe 8 000 North Africa & Middle East 37 000 Sub-Saharan Africa 2.4 million Eastern Europe & Central Asia 25 000 East Asia & Pacific 45 000 South & South-East Asia 440 000 Australia & New Zealand <100 North America 15 000 Caribbean 42 000 Latin America 60 000
- 7. Estimated adult and child deaths due to HIV/AIDS from the beginning of the epidemic to end 1999 Western Europe 210 000 North Africa & Middle East 70 000 Sub-Saharan Africa 13.7 million Eastern Europe & Central Asia 17 000 East Asia & Pacific 40 000 South & South-East Asia 1.1 million Australia & New Zealand 8 000 North America 450 000 Caribbean 160 000 Latin America 520 000 Total: 16.3 million Over 20 million dead by now
- 8. Projected changes in life expectancy in selected African countries with high HIV prevalence, 1995–2000 Source: United Nations Population Division, 1996 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 Average life expectancy at birth, in years 65 60 55 50 45 40 35 Zimbabwe Zambia Uganda Botswana Malawi
- 9. Goals of Antiretroviral Therapy Control of viral replication Prevention or delay of progressive immunodeficiency Delayed progression to AIDS Prolonged Survival Decreased selection of resistant virus
- 10. Treatment Impact: CD4 Cell Count and Plasma HIV-1 RNA Level 150 100 50 0 -50 -100 -150 -200 CD4 + Cell Count Plasma HIV-1 RNA 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Monotherapy Double RTI Combinations Highly Active Antiretroviral Therapy Years +
- 18. Choice of Initial Regimen 2 PI (ritonavir as booster) 2 NRTI 1 nucloeotide RTI (tenofovir) 2 NRTI 3 rd NRTI is abacavir 3 NRTI 1 NNRTI 2 NRTI 1 PI 2 NRTI
- 25. What Non-Adherence Can Do Paterson Ann Int Med 2000;133:21-30
- 27. Adherence at Week 24* in CNA3014 Percentage of Subjects 56% 25% 74% 45%
- 28. Enfuvirtide (ENF, T-20) in Combination with an Optimized Background (OB) Regimen vs. OB Alone in Patients with Prior Experience or America and Brazil (TORO 1) Resistance to Each of the Three Classes of Approved Antiretrovirals (ARVs) in North
- 29. TORO 1: Demographics and Baseline Characteristics ENF+OB OB Total (N=326) (N=165) (N=491) Baseline RNA 5.2 5.2 5.2 (median, log 10 ) Baseline CD4+ cell count 76 87 80 (median, cells/mm 3 ) Prior ARVs (median) 12 12 12 Years ARV use (median) 7.0 7.1 7.0 Prior ADEs (N, %) 273 (84%) 148 (90%) 421 (86%) PSS at entry (mean) 1.7 1.8 1.7
- 30. TORO 1: Primary Study Endpoint HIV-1 RNA Log Change from Baseline at Week 24 -1.70 -0.76 -2 -1 0 (Delta=0.93 P<0.0001) Least Squared Means Log Change from Baseline - Intent-to-Treat Population (LOCF) OB alone ENF (T-20) + OB N=165 N=326 Change from BL (log 10 copies/ml)
- 31. TORO 1: CD4+ Cell Count Change from Baseline at Week 24 76 32 0 50 100 Change from BL (Cells/mm 3 ) P=0.0001 Least Squared Means Change from Baseline Intent-to-Treat Population (LOCF) OB alone ENF (T-20) + OB
Notas do Editor
- This picture shows the global distribution of HIV as of the end of 2002. An estimated 42 million persons are infected with HIV worldwide. Unfortunately, like most other scourges and infectious diseases, the burden of the disease is the highest in countries and regions most ill equipped and least resourceful to combat it. The most resource poor countries of sub-Saharan Africa and South and SE Asia are the worst hit areas.
- In 2002 alone, the number of new HIV infections was a staggering 5 million. Again, the preponderance of these infections was in sub-saharan Africa followed by south and SE Asia.
- If you look at the death numbers, the geographic distribution is similar to the incidence and prevalence of HIV and AIDS. In 2002 over 3 million persons died from AIDS displacing TB as the number one killer infectious disease in the world. This ranking of TB vs. AIDS has been debated by many, since a large number of patients with AIDS, especially those in Africa and Asia, go on to develop TB, and it is unclear to me how many of TB deaths were classified as AIDS. Regardless of how you classify it, the underlying message is very clear – there are far too many people dying with this disease.
- These numbers translate to about 14,000 new infections per day. Which means that by the time I finish this presentation, about 600 persons would have acquired infection, or by the time I finish reading this slide, about 10 new infections would have occurred. 95% of these occur in the developing countries and a large number in children under the age 15.
- AIDS has extorted a huge toll in terms of lives lost, since the beginning of the epidemic. In the first 20 years over 20 million persons have succumbed to this infection, most of them in the developing world, impacting those countries in manners unimaginable – both in terms of human tragedy which can never be adequately quantified and economically.
- Slide courtesy of C. J. Cohen, MD.
- CID 2001;33:1417 Fischl 8 th CROI 2001; Abst. 528
- * Regimen adherence measurement at week 24 or last assessment while on randomized therapy
- Gender, race and age were balanced across treatments PSS = Number of drugs in OB regimen to which virus was phenotypically sensitive
- Sources: Davey et al. In: Abstracts of the 39th Interscience Conference on Antimicrobial Agents and Chemotherapy; September 26-29, 1999; San Francisco, Calif./Justice et al. In: Abstracts of the 39th Interscience Conference on Antimicrobial Agents and Chemotherapy; September 26-29, 1999; San Francisco, Calif.