Podcasts about antiretroviral

Infectious Disease Puscast

Play Episode Listen Later Nov 15, 2023 29:06

In this second of 3 episodes, global HIV experts and advocates discuss how HIV care can better meet the diverse needs of people living with HIV as new treatment strategies emerge and continue to evolve, including:How the emergence of long-acting injectable HIV treatment has been a game-changer for many people living with HIVEmerging strategies that are expanding the application of long-acting ART to address unmet treatment needsPotential for future innovations in ART that are hoped will further address unmet needs and preferences of people living with HIVFaculty: Ann Avery, MDProfessor of MedicineCase Western Reserve UniversityDivision of Infectious DiseasesMetroHealth Medical CenterCleveland, OhioJennifer Blanchette, PhDIndependent ContractorClinical Care OptionsColorado, United StatesIsolde Butler, MD, MPHChief Medical OfficerCrescentCareNew Orleans, LouisianaMonica Gandhi, MD, MPHProfessor of MedicineDivision of HIV, Infectious Diseases, and Global MedicineDirector, Center for AIDS Research (CFAR)Medical Director, Ward 86 HIV ClinicUniversity of California, San Francisco (UCSF)San Francisco, CaliforniaMarissa GonzalezChair Community Advisory Board The Well ProjectAngelina Namiba Founder Member4M Network of Mentor MothersLondon, United KingdomChloe Orkin, MBChB, FRCP, MDProfessor of Infection and InequitiesFaculty of Medicine and DentistryQueen Mary University of LondonBlizard InstituteBarts Health NHS TrustLondon, United KingdomLink to full program:https://bit.ly/3QFwv7nLinks to programs discussed in the episode:www.4mmm.org

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Antiretroviral Therapies

Let's Know Things

Play Episode Listen Later Sep 19, 2023 21:54

This week we talk about HIV, AIDS, and ART.We also discuss HAART, the Berlin Patient, and potential future cures.Recommended Book: Allergic by Theresa MacPhailShow Notes* https://www.unaids.org/en/resources/fact-sheet* https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-treatment-basics* https://clinicalinfo.hiv.gov/en/glossary/antiretroviral-therapy-art* https://www.paho.org/en/topics/antiretroviral-therapy* https://journals.lww.com/jaids/fulltext/2010/01010/declines_in_mortality_rates_and_changes_in_causes.13.aspx* https://link.springer.com/article/10.1007/s13181-013-0325-8* https://academic.oup.com/jac/article/73/11/3148/5055837?login=false* https://journals.lww.com/jaids/fulltext/2016/09010/narrowing_the_gap_in_life_expectancy_between.6.aspx* https://en.wikipedia.org/wiki/Tenofovir_disoproxil* https://en.wikipedia.org/wiki/Management_of_HIV/AIDS* https://www.verywellhealth.com/cart-hiv-combination-antiretroviral-therapy-48921* https://www.cdc.gov/hiv/risk/art/index.html* https://www.freethink.com/health/cured-of-hiv* https://www.jstor.org/stable/3397566?origin=crossref* https://www.nytimes.com/1982/05/11/science/new-homosexual-disorder-worries-health-officials.html* https://pubmed.ncbi.nlm.nih.gov/23444290/* https://my.clevelandclinic.org/health/diseases/4251-hiv-aids* https://web.archive.org/web/20080527201701/http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf* https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(23)00028-0/fulltextTranscriptIn mid-May of 1981, the queer community-focused newspaper, the New York Native, published what would become the first-ever article on a strange disease that seemed to be afflicting community members in the city.What eventually became known as AIDS, but which was at the time discussed by medical professionals primarily in terms of its associated diseases, was clinically reported upon for the first time less than a month later, five official cases having been documented in an interconnected group of gay men and users of injectable drugs, who came to the attention of doctors for not being inherently immunocompromised, but still somehow contracting a rare type of pneumonia that only really impacted folks with severely impaired immune systems.In subsequent years, doctors started using a range of different terms for HIV and AIDS, calling them at different times and in different contexts the lymphotophic retrovirus, Kaposi's sarcoma and opportunistic infections, and the 4H disease, referring to heroine users, hemophiliacs, homosexuals, and Haitians, the four groups that seemed to make up almost all of the confirmed afflicted patients.The acronym GRID, for gay-related immune deficiency was also used for a time, but that one was fairly rapidly phased out when it became clear that this condition wasn't limited to the gay community—though those earlier assumptions and the terminology associated with them did manage to lock that bias into mainstream conversation and understanding of AIDS and HIV for a long time, and in some cases and in some locations, to this day.By the mid-80s, two research groups had identified different viruses that seemed to be associated with or responsible for cases of this mysterious condition, and it was eventually determined (in 1986) that they were actually the same virus, and that virus was designated HIV.HIV, short for Human Immunodeficiency Virus, is a retrovirus that, if left untreated, leads to Acquired Immunodeficiency Syndrome, or AIDS, in about 50% of patients within ten years of infection.So HIV is the virus, AIDS is a condition someone with HIV can develop after their immune system is severely damaged by the infection, and there are a bunch of diagnostic differentiations that determine when someone has transitioned from one category to the other, but in general folks with HIV will experience moderate flu- or mono-like symptoms, alongside swollen lymph nodes and rashes and throat problems and sores across their bodies in the early stages of infection, and as things progress, they develop opportunistic infections of the kind that can only really latch onto a human when their immune system is weakened or shut down. While AIDS, arriving after the immune system is well and truly damaged, brings with it a slew of opportunistic infections and associated issues, the afflicted person potentially developing all sorts of cancers, sarcomas, persistent infections, and extreme versions of the flu-like, mono-like symptoms they may have suffered earlier on.We don't know for certain how and where HIV originated—and that's true of both kinds, as there's an HIV-1 and HIV-2 virus, the former of which accounts for most infections, the latter of which is less common, and less overall infectious—but both HIV types seem to have been transmitted to humans from non-human primates somewhere in West-central Africa in the early 20th century, possibly from chimpanzees in southern Cameroon, but that's pretty speculative, and there's some evidence that these diseases may have made the leap several times; so while there's a pretty good chance, based on what we know now, that the disease made it into humans and mutated approximately somewhere in that vicinity, sometime in the early 20th century, possibly via chimps hunted and eaten by locals as bushmeat, we really don't know for certain.There are reports of what were probably HIV as far back as 1959 in the Belgian Congo, but that's a bit speculative, too, and based on imperfect notes from the time.Back then, though, and through the 1980s, folks who contracted HIV and who were not treated would typically die within 11 years of being infected, and more than half of those diagnosed with AIDS in the US from 1981 through 1992 died within 2 years of their diagnosis; such a diagnosis was a death sentence, basically; it was a really horrible and scary time.Today, the outlook for folks who contract HIV is substantially better: the life expectancy of someone who contracts the virus and who is able to get treatment is about the same as someone who is not infected; the disease isn't cured, but the level of HIV virus in the blood of a person receiving treatment is so small that it's no longer transmissible, or even detectable.What I'd like to talk about today is a new therapy that's making those sorts of outcomes possible, how some few people have now been cured of HIV entirely, and what's on the horizon in this space.—Antiretroviral therapy, or ART, typically consists of a combination of drugs based on those that were originally combined in this way in 1996 by researchers who announced their findings at the International AIDS Conference in Vancouver—they called their approach highly active antiretroviral therapy, or HAART, and this combo was based on findings from earlier drugs that addressed one of HIV's seven stages of development—but because they all hit that same, single stage, the virus was rapidly developing an immunity to them, and they were universally pretty toxic, with horrible side-effects.What's more, this drug cocktail increased patients' life expectancy by about 24 months, on average—which is a lot, about two years, but considering all those side effects, which included severe liver problems and anemia, the extra months of life generally weren't very pleasant extra months.In 1995, a class of drugs called protease inhibitors were introduced, which prevented HIV from making copies of itself using the body's structural proteins.That, combined with the effects of other, existing retrovirals, which hindered the virus's ability to hijack the body's cells to make more of itself, turned out to be a substantial improvement over just one or the other approach.The announcement in 1996 was notable because the researchers involved were able to knock the viral load in their patients down to an undetectable level, and then keep it there, by using three drugs from each of those two antiviral classes, those two different approaches.So HAART was a major improvement over what came before, but it was still imperfect; deaths tied to HIV plummeted by 50% in the US and Europe in just three years, but the life expectancy of folks using this therapy was still low compared to other people; someone who contracted HIV in their 20s and went on this therapy was still only expected to live till their early 50s; way better than a two-year increase, but still plenty of room for improvement.In addition to that lifespan duration limitation, the HAART bundle of therapies was just really difficult to maintain.Some people experienced a dramatic redistribution of body fat, some developed heart arrhythmias or insulin resistance or peripheral neuropathy or lactic acidosis—which is basically a toxic buildup of the acid that results from metabolism, which is usually cleared naturally, but when it doesn't, it's potentially deadly.Anything less than absolutely perfect adherence to the treatment schedule was also potentially deleterious to the desired outcomes; it wasn't a forgiving regimen, with some of the drugs requiring three capsules be taken every 8 hours, and there was a chance that if a portion of a dose of one drug was missed, or not administered on time, the virus could develop an immunity to it and the whole thing would fall apart.Consequently, the HAART regimen was generally reserved until things got really bad, and that meant it didn't have a very large effect on the infected population, and those who did benefit from it suffered consequences, alongside those benefits.The change in terminology from HAART to ART arrived in 2001 when a drug called Viread, the brand name for tenofovir disoproxil, was released and added into the mix, replacing some of the most toxic and cumbersome of the previous therapies with a single pill per day, and one that came with far fewer, and far less extreme, side effects.In 2005 it was finally demonstrable, with a bunch of data, that beginning this type of therapy early rather than waiting until things get really bad was worth the trade-offs—researchers showed that if folks received access to ART upon diagnosis, severe HIV associated and non HIV associated illnesses were reduced by 61%.As of 2016 there was still an average life expectancy gap between folks with HIV who received early care and people who were not infected of about 8 years, but that gap has been steadily closing with the introduction of new, easier to use, less side effect prone drugs—drugs that tend to attack the virus at different stages, and which take different approaches to hindering and blocking it—alongside innovations in how the drugs are delivered, like introducing substances that are converted by the body into the desired drug, which massively cuts the requisite dosage, in turn lessening the strain on the body's organs and the potential side effects associated with taking a higher dose of the drug, itself.We've also seen the advent of fixed-dose combination drugs, which are exactly what they sound like: a single pill containing the entire combination of drugs one must take each day, which makes a combination therapy much easier to administration and stick with, which in turn has substantially reduced the risk of severe side effects, and prevented mutations that might otherwise make a patient's virus more immune to some component of the drug cocktail.Some newer options just use two drugs, too, compared to the previous three-or-more, and most of these have been shown to be just as effective as the earlier, more bodily stressful combinations, and a recent, 2021 drug is injectable, rather than deliverable in pill-form, and can be administered just once a month—though a version of this drug, sold under the name Cabenuva, has been approved for administration every other month.So things in this corner of the medical world are looking pretty good, due new approaches and innovations to existing therapy models.These models remain imperfect, but they're getting better every year, and contracting HIV is no longer a death sentence, nor does it mean you'll always be infectious, or even detectably infected: the amount of HIV virus in one's blood can be kept undetectably low for essentially one's entire life, so long as one is able to get on the right therapy or combination of therapies and stick with it.That said, the global HIV pandemic is far from over, and access to these drugs–many of which are pricy, if you don't have insurance that will cover them—is not equally distributed.As of late-2022, the UN's official numbers indicate that about 39 million people, globally, have HIV, about 1.3 million were infected in 2022, and about 630,000 died from AIDS-related illnesses that year.That said, of those 39 million or so who are infected, nearly 30 million are receiving some kind of antiretroviral therapy, and about 86% of people who are estimated to be infected know their status, so they can seek such therapies, and/or take other precautious to protect themselves and others; though that also means about 5.5 million people, globally, have HIV and don't realize it.Here's a really remarkable figure, though: among people who are infected and know they are infected, about 93% of them were virally suppressed as of 2022.That's astonishing; 93% of people who have HIV and are aware of it are on some kind of therapy that has allowed them to suppress the virus so that it's nearly undetectable—the difference between the two, by the way, is that suppressed means 200 copies of the HIV virus per milliliter of blood, while undetectable is generally considered to be less than 50 copies per milliliter.So huge leaps in a relatively short period of time, and a massive improvement in both duration and quality of life for folks who might otherwise suffer mightily, and then die early, because of this virus and its associated symptoms.That said, there are some interesting, new approaches to dealing with HIV on the horizon, and some of them might prove to be even more impactful than this current batch of incredibly impactful ART options.As of September 2023, five people have been confirmed cured of HIV; not suppressed and not with viral loads at undetectable levels: cured.The first of these cured people, often referred to as the Berlin Patient, received a stem cell transplant from a bone marrow donation database that contained a genetic mutation called CCR5 Delta 32, which makes those who have it essentially immune to HIV infection.Three months after he received the transplant and stopped taking ART, doctors were unable to find any trace of the virus in his blood.He died from cancer in 2020, but there didn't seem to be any HIV in his blood from when he received the stem cell transplant, onward, and that happened in the early 2000s, and was formally announced to the medical community in 2008.At least two other people—two that we know about, anyway—have been cured of HIV using the same method; though at the moment at least, this option is severely limited as it requires that patients have a bone marrow match in donor databases, and that one of those donors have that specific, relatively rare mutation; so with existing science and techniques, at least, this is unlikely to be a widespread solution to this problem—though a 2017 experiment used stem cells derived from umbilical cord blood from a baby with that mutation to treat a woman' leukemia and cure her HIV, so there's a chance other approaches that make use of the same basic concept might be developed, opening this up to more people.Cancer drugs may also help some people with HIV: a drug that's been approved to treat several cancers called Venetoclax seems to also bind to a protein that helps HIV-infected T cells dodge the body's immune system and survive, and that realization has led to a series of experiments that showed HIV was suppressed in mice receiving this drug—though it bounced back a week later, and two weeks later in mice receiving both this drug and ART.This is unlikely to be a solution unto itself, then, but there's a chance either an adjusted version of this drug, or this drug in combination with other therapies, might be effective; and there's a clinical trial testing the efficacy of Venetoclax in human HIV patients at the end of this year, and another in 2024, so we may soon know if its safe and desirable to use this drug alongside ART, and that may, in turn, lead to a better understanding of how to amplify the drug's effects, or apply this method of hindering HIV from a different angle.CRISPR, the gene-editing technology borrowed from bacteria that allows for the cutting and removing and adding of genetic information, has enabled the development of several new potential HIV cures, one of which, called EBT-101, basically enters the body, finds helper T cells, and then cuts out chunks of the HIV virus's DNA, which prevents it from being able to replicate itself or hide away, reemerging later after another treatment has suppressed it.The benefit of this approach is that it could kill the viral reservoirs that otherwise allow HIV to persist in people who have undergone treatments, and a version of it that targets SIV, which is similar to HIV, but found in non-human primates—performed exactly as they hoped it would, finding and editing the targeted DNA, raising hopes than an HIV-targeting variation may manage similar wonders in human patients.This would be great if it ends up working, as one injection would theoretically clear all HIV from a person's system in relatively short-order, but the trials done so far have been small and on monkeys, and because of the nature of the research, it's not clear the monkeys were cured of HIV—just that the treatment got where it was supposed to go and made some DNA edits.A human trial of EBT-101 will finish up in March of 2025, though the researchers plan to follow up with their subjects for up to 15 years following the trial, to assess any long-term effects from their treatment, since CRISPR and this approach to messing with genes is still such a new thing.So while this may be a solution at some point, there's a good chance it won't be a real-deal, available option for another decade, minimum.So we've come a long way in a very short period of time with HIV and AIDS treatments, and the future is looking pretty good, with even more options and approaches on the horizon, including some actual cures, alongside high-quality, actually useable treatments.But there's still room to grow in terms of infection awareness, there are still distribution issues for some of these drugs, and there's still a fair bit of prejudice, the consequence of ignorance and historical misunderstandings and biases, keeping folks and institutions from doing as much as they otherwise could in many parts of the world; so a lot to be proud of, a lot to look forward to, but still plenty of room for improvement across the board. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit letsknowthings.substack.com/subscribe

Infectious Disease Puscast #33

Play Episode Listen Later Jul 25, 2023 33:53

On episode #33 of the Infectious Disease Puscast, Daniel reviews the infectious disease literature for the weeks of 7/6 – 7/19/23. Host: Daniel Griffin Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of Puscast! Links for this episode Early antiretroviral therapy not associated with higher cryptococcal Meningitis mortality in people with HIV in high-income countries (CID) Implementing a rapid Antiretroviral therapy program using starter packs for emergency department patients diagnosed with HIV infection (OFID) Efficacy of a clinical decision rule to enable direct oral challenge in patients with low-risk Penicillin allergy (JAMA) Infectious diseases consultation associated with reduced mortality in gram-negative bacteremia (CID) Positive impact of [18F]FDG-PET/CT on mortality in patients with Staphylococcus aureus Bacteremia explained by immortal time bias (CID) Azithromycin for bacterial watery diarrhea (JID) Periprosthetic joint infection: current clinical challenges (CID) Old World medieval Treponema pallidum complex treponematosis (JID) Clinical Impact of polymerase chain reaction–based Aspergillus and Azole resistance detection in invasive aspergillosis (CID) Superior accuracy of Aspergillus plasma cell-free DNA PCR over serum galactomannan for the diagnosis of invasive aspergillosis (CID) Tafenoquine co-administered with dihydroartemisinin–piperaquine for the radical cure of Plasmodium vivax malaria (The Lancet) Doubling of cyclosporiasis cases partially attributable to a salad kit (CDC) Efficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia (BMC) Music is by Ronald Jenkees

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KESIHATAN EPISOD 42 - Antiretroviral Meningkatkan Kualiti Hidup Pesakit HIV - 07/12/22

IKIM

Play Episode Listen Later Jan 5, 2023 48:03

KESIHATAN EPISOD 42 - Antiretroviral Meningkatkan Kualiti Hidup Pesakit HIV - 07/12/22 by IKIM

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Infectious Disease Puscast #17

Infectious Disease Puscast

Play Episode Listen Later Dec 19, 2022 32:00

On episode #17 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the previous two weeks, 11/24/22 – 12/8/22. Hosts: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of Puscast! Links for this episode Antiretroviral drugs for treatment and prevention of HIV infection in adults (JAMA) Outcomes of short versus long duration of antibiotic therapy for residual osteomyelitis in diabetic foot infection (Journal of Antimicrobial Chemotherapy) Rectal culture-based versus empirical antibiotic prophylaxis to prevent infectious complications in men undergoing transrectal prostate biopsy (CID) Outbreak of Burkholderia stabilis infections associated with contaminated nonsterile multiuse ultrasound gel (CDC) Factors associated with receiving longer than recommended therapy among culture-negative pulmonary tuberculosis patients (OFID) Seasonality of healthcare-associated Stenotrophomonas maltophilia (ASHE) Rezafungin versus caspofungin for treatment of candidaemia and invasive candidiasis (The Lancet) Characteristics of antifungal utilization for hospitalized children in the United States (ASHE) Cutaneous blastomycosis presenting as a nonhealing wound (NIH) Evaluation of the diagnostic accuracy and clinical utility of fungla profile (OFID) Parasitic infection increases risk-taking in a social, intermediate host carnivore (Nature) Efficacy and safety of acoziborole in patients with human African trypanosomiasis caused by Trypanosoma brucei gambiense (The Lancet) Simple nodular cutaneous Leishmaniasis caused by Autochthonous Leishmania orientalis (AJTMH) Emerging and Reemerging Infectious Diseases (NEJM) Music is by Ronald Jenkees

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What Patients Want in HIV Treatment and Prevention: Africa

treatments consequences credit hiv really matters adherence people living people living with hiv antiretroviral

Play Episode Listen Later Dec 14, 2022 33:33

In this episode, Winnie Sseruma and Linda-Gail Bekker, MBChB, DTM&H, DCH, FCP(SA), PhD, discuss some of the barriers to genuinely patient-centered HIV care in Africa and offer calls to action for healthcare professionals for responding to patient preferences.They discuss the efforts to improve patient-centered HIV care in the foundations and organizations for which they work. They also address issues related to stigma around HIV and complacency and lack of visibility for HIV.You will then hear them talk through differentiated service delivery in South Africa and Mozambique as models for other parts of Africa. They focus on HIV prevention and some of the difficulties of reaching certain populations to better communicate effective prevention practices.They end with a discussion about the importance of documenting the experiences and stories of people living with HIV.Winnie SserumaInternational Development Consultant London, United KingdomLinda-Gail Bekker, MBChB, DTM&H, DCH, FCP(SA), PhDDirectorDesmond Tutu HIV CentrePast PresidentInternational AIDS SocietyFaculty of Health SciencesUniversity of Cape TownCape Town, South AfricaLink to full program:https://bit.ly/3Fxsfkz

When Antiretroviral Treatment Adherence Really Matters: Consequences and Communication for People Living With HIV

Keeping Current CME

Play Episode Listen Later Dec 7, 2022 28:14

Can you identify the drivers and risk factors of suboptimal treatment adherence for people living with HIV? Learn from expert faculty how best to support patients. Credit available for this activity expires: 12/05/23 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/984441?src=mkm_podcast_addon_984441

HIV/AIDS: Optimism and New Directions for Ending the Epidemic

USF Health’s IDPodcasts

Play Episode Listen Later Aug 22, 2022 52:37

Dr. Jamie Morano, Associate Professor at the USF Morani College of Medicine, presents an overview of HIV/AIDS care in 2022. Dr. Morano begins by reviewing HIV epidemiology, including national regions of high HIV prevalence. She then discusses the “Test and Treat” approach to management. Antiretroviral treatment updates are presented, included the use of TAF and the new availability of longer acting injectable agents. HIV testing issues are also discussed, including testing barriers and HIV-related stigma. The concept of Undetectable=Untransmissable is also discussed. Lastly, Dr. Morano reviews PREP (preexposure prophylaxis) and nPEP (non-Occupational Post exposure Prophylaxis) for HIV.

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My Perspective: Living With HIV Is Life Changing but Not Life Limiting

Play Episode Listen Later Jun 21, 2022 11:48

In this episode, Yvette Raphael provides her perspectives and advice as an individual living with HIV in South Africa for more than 20 years. She shares her experiences and ideas for how to improve processes related to HIV diagnosis, care linkage, and treatment.Presenter:Yvette RaphaelContent based on an online CME program supported by an independent educational grant from Gilead Sciences, Inc.Link to full program: https://bit.ly/3tmgozy

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Key Decisions in HIV Care: ART Considerations in the Inpatient Setting

Play Episode Listen Later Mar 14, 2022 17:55

In this episode, Jason Schafer, PharmD, MPH, explores recommendations and data on managing antiretroviral therapy (ART) in the inpatient setting.Listen as he gives his perspectives on:Antiretroviral stewardship to prevent medication errors in the inpatient setting and at transitions of careRenal and hepatic dosing considerations for ARTDrug–drug interaction considerations between ART and medications commonly encountered in the inpatient settingAntiretroviral food effectsAdministration of antiretrovirals in persons with swallowing difficultiesPresenter:Jason Schafer, PharmD, MPHProfessor and Vice ChairJefferson College of PharmacyThomas Jefferson UniversityPhiladelphia, Pennsylvania Follow along with the slides at:https://bit.ly/36h5tOCSee the entire program at: https://bit.ly/3q2DlGd

Contemporary Management of HIV 2021: New Data From IAS 2021—Audio Recap, Part 2

Play Episode Listen Later Sep 14, 2021 42:25

In this second of 2 episodes, Shobha Swaminathan, MD, and Eric S. Daar, MD, review key data influencing their practice following the IAS 2021 Conference, including data on investigational antiretroviral agents, lenacapavir and islatravir, and alternative dosing of BPaL for MDR-TB. This episode includes discussion of:An extension of FLAIR, demonstrating virologic efficacy and safety of long-acting CAB plus RPV at Week 124A Week 26 safety and efficacy analysis of CAPELLA, a study of lenacapavir in heavily treatment–experienced PWHCALIBRATE, a study of the safety and efficacy of lenacapavir in treatment-naive PWHA Week 96 safety analysis of Protocol 011, evaluating islatravir plus DOR in treatment-naive patientsA Week 24 safety and pharmacokinetic analysis of Protocol 016, evaluating oral islatravir once monthly for PrEPZeNix, a phase III trial of pretomanid, bedaquiline, and linezolid (BPaL) in patients with highly resistant TBPresenters:Eric S. Daar, MDChief, Division of HIV MedicineHarbor-UCLA Medical CenterProfessor of MedicineDavid Geffen School of Medicine at UCLALos Angeles, CaliforniaShobha Swaminathan, MDAssociate ProfessorDivision of Infectious Diseases Department of MedicineRutgers New Jersey Medical SchoolNewark, New JerseyFollow along with the slides at:https://bit.ly/3hvRN5bContent based on an online CME program supported by an educational grant from ViiV Healthcare.

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Contemporary Management of HIV 2021: New Data From IAS 2021—Audio Recap, Part 1

Play Episode Listen Later Sep 8, 2021 29:31

In this first of 2 episodes, Shobha Swaminathan, MD, and Eric S. Daar, MD, review key data influencing their practice following the IAS 2021 Conference, including results from studies on HIV and COVID-19 outcomes; virologic and metabolic outcomes of DTG/3TC; long-acting CAB plus RPV for ART in treatment-naive PWH. This episode includes discussion of:A Global Clinical Platform that evaluated outcomes of PWH hospitalized with COVID-19A post hoc analysis of TANGO, evaluating the virologic and metabolic outcomes when switching to DTG/3TC vs continued 3- or 4-drug TAF-based regimensA Week 48 analysis of SALSA, demonstrating virologic efficacy and favorable safety profile of switching to DTG/3TC vs continuing a 3-drug ART regimenPresenters:Eric S. Daar, MDChief, Division of HIV MedicineHarbor-UCLA Medical CenterProfessor of MedicineDavid Geffen School of Medicine at UCLALos Angeles, CaliforniaShobha Swaminathan, MDAssociate ProfessorDivision of Infectious Diseases Department of MedicineRutgers New Jersey Medical SchoolNewark, New JerseyFollow along with the slides at:https://bit.ly/2WZu7zmContent based on an online CME program supported by an educational grant from ViiV Healthcare.

covid-19 art management medicine conference md prep hiv contemporary tango salsa pk daar flair tuberculosis cme dor isl cab new data capella ias calibrate arv pharmacokinetics taf dtg viiv healthcare antiretroviral rpv hte audio recap antiretroviral therapy linezolid pwh pre-exposure prophylaxis

Contemporary Management of HIV 2021: Heavily Treatment–Experienced Patients—Audio Recap, Part 3

Science Friction - ABC RN

Play Episode Listen Later Sep 7, 2021 16:01

In this series of 3 episodes, Geeta Gupta, MD, discusses strategies for optimizing ART in heavily treatment–experienced patients with HIV, including management of virologic failure and switching ART in virologically suppressed patients with underlying resistance. The 3 episodes will include analyses from:BENCHMRK, which demonstrated that the number of active drugs predicts outcomes in treatment-experienced patientsTMB-301, a study that added the monoclonal antibody ibalizumab in pretreated patients with multidrug-resistant HIV and demonstrated significant decreases in HIV-1 RNABRIGHTE, which showed that the addition of fostemsavir in heavily treatment–experienced patients with HIV led to a significant decrease in HIV-1 RNAVIKING-3, a study that demonstrated the addition of DTG dosed BID in INI-resistant patients was effective in decreasing HIV-1 RNASWITCHMRK, a study that showed underlying resistance matters when deciding to switch regimens in a treatment-experienced, virologically suppressed patient, especially when switching to a regimen with a low barrier to resistanceDAWNING, a study that demonstrated that DTG, when added to 2 NRTIs, was superior to RTV-boosted LPV in patients with virologic failure on an NNRTI plus 2 NRTIsBRAAVE, which evaluated safety and efficacy of switching to BIC/FTC/TAF in Black patients virologically suppressed on 2 NRTIs plus a third agentIn addition, Dr. Gupta reviews current DHHS ART guideline recommendations related to managing virologic failure, including drug resistance testing and drug selection, as well as switching recommendations in patients with viral suppression and underlying drug resistance.Presenter:Geeta Gupta, MDProfessorDirector, AIDS Education and Training CenterUniversity of California, IrvineOrange, CaliforniaFollow along with the slides at:https://bit.ly/3zxKBfLContent based on an online CME program supported by an educational grant from ViiV Healthcare.Link to full program:https://bit.ly/3ux6FF8

Virus busters: how do you kill something that's not really alive?

Play Episode Listen Later Sep 5, 2021 25:43

Beyond vaccines, can history help us quash this coronavirus?

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The virus busters: how do you kill something that's not really alive?

Science Friction - ABC RN

Play Episode Listen Later Sep 5, 2021 25:43

Raymond Schinazi has been fighting viruses his whole career, with some mighty wins against these molecular mischief makers. Can we learn from the past to treat this coronavirus?

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Contemporary Management of HIV 2021: Heavily Treatment–Experienced Patients—Audio Recap Part 2

Play Episode Listen Later Sep 2, 2021 11:19

In this series of 3 episodes, Geeta Gupta, MD, discusses strategies for optimizing ART in heavily treatment–experienced patients with HIV, including management of virologic failure and switching ART in virologically suppressed patients with underlying resistance. The 3 episodes will include analyses from:BENCHMRK, which demonstrated that the number of active drugs predicts outcomes in treatment-experienced patientsTMB-301, a study that added the monoclonal antibody ibalizumab in pretreated patients with multidrug-resistant HIV and demonstrated significant decreases in HIV-1 RNA BRIGHTE, which showed that the addition of fostemsavir in heavily treatment–experienced patients with HIV led to a significant decrease in HIV-1 RNA VIKING-3, a study that demonstrated the addition of DTG dosed BID in INI-resistant patients was effective in decreasing HIV-1 RNASWITCHMRK, a study that showed underlying resistance matters when deciding to switch regimens in a treatment-experienced, virologically suppressed patient, especially when switching to a regimen with a low barrier to resistanceDAWNING, a study that demonstrated that DTG, when added to 2 NRTIs, was superior to RTV-boosted LPV in patients with virologic failure on an NNRTI plus 2 NRTIsBRAAVE, which evaluated safety and efficacy of switching to BIC/FTC/TAF in Black patients virologically suppressed on 2 NRTIs plus a third agentIn addition, Dr. Gupta reviews current DHHS ART guideline recommendations related to managing virologic failure, including drug resistance testing and drug selection, as well as switching recommendations in patients with viral suppression and underlying drug resistance.Presenter:Geeta Gupta, MDProfessorDirector, AIDS Education and Training CenterUniversity of California, IrvineOrange, CaliforniaFollow along with the slides at:https://bit.ly/3zxKBfLContent based on an online CME program supported by an educational grant from ViiV Healthcare.Link to full program:https://bit.ly/3ux6FF8

Contemporary Management of HIV 2021: Heavily Treatment–Experienced Patients—Audio Recap, Part 1

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Play Episode Listen Later Sep 1, 2021 13:44

In this series of 3 episodes, Geeta Gupta, MD, discusses strategies for optimizing ART in heavily treatment–experienced patients with HIV, including management of virologic failure and switching ART in virologically suppressed patients with underlying resistance. The 3 episodes will include analyses from:BENCHMRK, which demonstrated that the number of active drugs predicts outcomes in treatment-experienced patientsTMB-301, a study that added the monoclonal antibody ibalizumab in pretreated patients with multidrug-resistant HIV and demonstrated significant decreases in HIV-1 RNABRIGHTE, which showed that the addition of fostemsavir in heavily treatment–experienced patients with HIV led to a significant decrease in HIV-1 RNA VIKING-3, a study that demonstrated the addition of DTG dosed BID in INI-resistant patients was effective in decreasing HIV-1 RNASWITCHMRK, a study that showed underlying resistance matters when deciding to switch regimens in a treatment-experienced, virologically suppressed patient, especially when switching to a regimen with a low barrier to resistanceDAWNING, a study that demonstrated that DTG, when added to 2 NRTIs, was superior to RTV-boosted LPV in patients with virologic failure on an NNRTI plus 2 NRTIsBRAAVE, which evaluated safety and efficacy of switching to BIC/FTC/TAF in Black patients virologically suppressed on 2 NRTIs plus a third agentIn addition, Dr. Gupta reviews current DHHS ART guideline recommendations related to managing virologic failure, including drug resistance testing and drug selection, as well as switching recommendations in patients with viral suppression and underlying drug resistance.Presenter:Geeta Gupta, MDProfessorDirector, AIDS Education and Training CenterUniversity of California, IrvineOrange, CaliforniaFollow along with the slides at:https://bit.ly/3zxKBfLContent based on an online CME program supported by an educational grant from ViiV Healthcare.Link to full program:https://bit.ly/3ux6FF8

Right in Two | GameChangers

Pharmacy Podcast Network

Play Episode Listen Later Dec 29, 2020 29:06

The efficacy of antiretroviral therapy has led to persons with HIV living a near-normal lifespan. But medications only work when used appropriately. The International Antiviral Society-USA Panel published updated recommendations for the treatment and prevention of HIV infections. Treatment of HIV may be distilled into a simple idea - two "nucs" and something else. Learn how to optimize care for your patients. This episode is accredited for CPE. Subscribe at CEimpact (https://www.ceimpact.com/pharmacist) and claim your CE today! Reference: Saag MS, Gandhi RT, Hoy JF, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2020 recommendations of the International Antiviral Society-USA Panel. JAMA. 2020;324(16):1651-1669. Available at: https://www.iasusa.org/2020/11/12/antiretroviral-drugs-treatment-prevention-hiv-infection-adults-2020-recommendations-of-the-international-antiviral-society-usa-panel/ The CE for this episode is supported by an educational grant from Xellia Pharmaceuticals, a specialty pharmaceutical company focused on providing important anti-infective treatments against serious and often life-threatening infections. See omnystudio.com/listener for privacy information.

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Right in Two | GameChangers

GameChangers | CEimpact

Play Episode Listen Later Dec 29, 2020 29:06

The efficacy of antiretroviral therapy has led to persons with HIV living a near-normal lifespan. But medications only work when used appropriately. The International Antiviral Society-USA Panel published updated recommendations for the treatment and prevention of HIV infections. Treatment of HIV may be distilled into a simple idea - two "nucs" and something else. Learn how to optimize care for your patients. This episode is accredited for CPE. Subscribe at CEimpact (https://www.ceimpact.com/pharmacist) and claim your CE today! Reference: Saag MS, Gandhi RT, Hoy JF, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2020 recommendations of the International Antiviral Society-USA Panel. JAMA. 2020;324(16):1651-1669. Available at: https://www.iasusa.org/2020/11/12/antiretroviral-drugs-treatment-prevention-hiv-infection-adults-2020-recommendations-of-the-international-antiviral-society-usa-panel/ The CE for this episode is supported by an educational grant from Xellia Pharmaceuticals, a specialty pharmaceutical company focused on providing important anti-infective treatments against serious and often life-threatening infections. See omnystudio.com/listener for privacy information.

treatments hiv game changers jama cpe pharmacy podcast network antiretroviral ceimpact

Right in Two | GameChangers

Pharmacy Podcast Network

Play Episode Listen Later Dec 29, 2020 30:21

The efficacy of antiretroviral therapy has led to persons with HIV living a near-normal lifespan. But medications only work when used appropriately. The International Antiviral Society-USA Panel published updated recommendations for the treatment and prevention of HIV infections. Treatment of HIV may be distilled into a simple idea - two "nucs" and something else. Learn how to optimize care for your patients. This episode is accredited for CPE. Subscribe at CEimpact (https://www.ceimpact.com/pharmacist) and claim your CE today! Reference: Saag MS, Gandhi RT, Hoy JF, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2020 recommendations of the International Antiviral Society-USA Panel. JAMA. 2020;324(16):1651-1669. Available at: https://www.iasusa.org/2020/11/12/antiretroviral-drugs-treatment-prevention-hiv-infection-adults-2020-recommendations-of-the-international-antiviral-society-usa-panel/ The CE for this episode is supported by an educational grant from Xellia Pharmaceuticals, a specialty pharmaceutical company focused on providing important anti-infective treatments against serious and often life-threatening infections. See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

treatments hiv game changers jama cpe antiretroviral ceimpact

Right in Two | GameChangers

CEimpact Podcast

Play Episode Listen Later Dec 29, 2020 29:06

The efficacy of antiretroviral therapy has led to persons with HIV living a near-normal lifespan. But medications only work when used appropriately. The International Antiviral Society-USA Panel published updated recommendations for the treatment and prevention of HIV infections. Treatment of HIV may be distilled into a simple idea - two "nucs" and something else. Learn how to optimize care for your patients.This episode is accredited for CPE. Subscribe at CEimpact (https://www.ceimpact.com/pharmacist) and claim your CE today!Reference: Saag MS, Gandhi RT, Hoy JF, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2020 recommendations of the International Antiviral Society-USA Panel. JAMA. 2020;324(16):1651-1669. Available at: https://www.iasusa.org/2020/11/12/antiretroviral-drugs-treatment-prevention-hiv-infection-adults-2020-recommendations-of-the-international-antiviral-society-usa-panel/ The CE for this episode is supported by an educational grant from Xellia Pharmaceuticals, a specialty pharmaceutical company focused on providing important anti-infective treatments against serious and often life-threatening infections. See omnystudio.com/listener for privacy information.

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Categories of Antiretroviral Drugs

Third Time's the Charm

Play Episode Listen Later Oct 29, 2020 1:53

This episode covers categories of antiretroviral drugs!

drugs antiretroviral

Pre-Exposure Prophylaxis for HIV (PrEP) in a Capsule

Breaking The Capsule

Play Episode Listen Later May 28, 2020 19:17

We have come a long way since the day HIV was discovered. In the past, HIV patients were isolated due to stigma. However, with the advance of science people understand more about this condition and HIV patients are no different from the rest of the World. In this episode, Nhan & Ishaan explore medication which help prevent the spread of HIV through sex.If you like this episode, be sure to subscribe and leave us a review on iTunes!!https://podcasts.apple.com/au/podcast/breaking-the-capsule/id1479407995Follow us on Facebook and Instagram:https://www.facebook.com/Breaking-the-Capsule-110257606996674/https://www.instagram.com/breakthecap/?hl=enEmail us at contact@breakingthecapsule.com with any questions

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MDG #6 - MDG 6: Combat HIV/AIDS, malaria and other major diseases

MDG

Play Episode Listen Later Feb 10, 2020

Target 6.A:Have halted by 2015 and begun to reverse the spread of HIV/AIDSNew HIV infections fell by approximately 40 per cent between 2000 and 2013.Globally, an estimated 35 million people were still living with HIV in 2013.More than 75 per cent of the new infections in 2013 occurred in 15 countries.Worldwide, an estimated 0.8 per cent of adults aged 15 to 49 were living with HIV in 2013.Target 6.B:Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need itBy June 2014, 13.6 million people living with HIV were receiving antiretroviral therapy (ART) globally, an increase from 800,000 in 2003.In 2013 alone, the number of people receiving ART rose by 1.9 million in the developing regions.ART averted 7.6 million deaths from AIDS between 1995 and 2013.Antiretroviral medicines to treat HIV were delivered to 12.1 million people in developing regions in 2014.Target 6.C:Have halted by 2015 and begun to reverse the incidence of malaria and other major diseasesBetween 2000 and 2015, the substantial expansion of malaria interventions led to a 58 per cent decline in malaria mortality rates globally.Since 2000, over 6.2 million deaths from malaria were averted, primarily in children under five years of age in Sub-Saharan Africa.Due to increased funding, more children are sleeping under insecticide-treated bed nets in sub-Saharan Africa.Tuberculosis prevention, diagnosis and treatment interventions have saved some 37 million lives between 2000 and 2013.

HIV / AIDS

Pro Pharma Talks

Play Episode Listen Later Dec 4, 2019 30:09

Update on HIV/AIDS HIV-1 is a more dangerous virus than HIV-2: AIDS developed in 54% of people with HIV-1 and 43% of people with HIV-2. After eight years, half of those with HIV-1 had died. In comparison, after 15 years, half of those with HIV-2 had died. The Food and Drug Administration (FDA) recently announced the approval of Dovato, the first complete two-drug HIV treatment regimen for people who previously have not been on antiretroviral therapy. Why is Dovato significant? It offers the potential for these people to take their two-drug regimen in one single tablet. PrEP: Truvada is a brand-name prescription medication that's used for treating HIV infection. It's also used for preventing HIV infection in people who have a high risk of getting HIV. This use, in which the treatment is given before the person may be exposed to HIV, is called pre-exposure prophylaxis (PrEP). Antiretroviral therapy may soon be obsolete, as scientists have successfully used immune cells to kick the dormant form of HIV out of its hiding place and destroy it. The findings may soon lead to an HIV vaccine. Main Points: PrEP works HIV can be detected within weeks Late testing can be lethal Undetectable viral load can be an effective HIV prevention Repeated exposures increase the risk of an activity Not every HIV exposure leads to an infection Rectal fluid can transmit HIV People aren’t using condoms correctly People with AIDS can have a near-normal life expectancy Prepare for an aging HIV epidemic ______ Make sure to subscribe to get the latest episode. Contact Us: Pharmacy Benefit News: http://www.propharmaconsultants.com/pbn.html Email: info@propharmaconsultants.com Website: http://www.propharmaconsultants.com/ Facebook: https://www.facebook.com/propharmainc Twitter: https://twitter.com/ProPharma/ Instagram: https://www.instagram.com/propharmainc/ LinkedIn: https://www.linkedin.com/company/pro-pharma-pharmaceutical-consultants-inc/ Podcast: https://anchor.fm/pro-pharma-talks

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Episode 14: Advocate Yourself!

At Your Cervix

Play Episode Listen Later Jun 20, 2019 57:50

Denae, Vanessa, and “The Shaft” sit down with a Registered Nurse, who is also a Birth Doula. Our conversation focuses on the importance of patient advocacy to receive quality and honest care from providers. Her experience as a patient, nurse, and doula provides a unique perspective on how to advocate and why it is necessary! She is passionate, smart, and so funny. As always, Vanessa, Denae, and "The Shaft" have a weekly check-in -- this week we talk colonoscopies and being put under. In this episode we talk about: - Antiretroviral medicines (ART) after being potentially exposed to HIV: https://www.cdc.gov/hiv/basics/pep.html - Propofol: https://www.rxlist.com/diprivan-drug.htm - CUSSing Communication: https://medical-dictionary.thefreedictionary.com/CUS - A doula is an advocate: https://doulatrainingsinternational.com/advocate-doulas-role/ - Expecting Joy Doulas: https://www.expectingjoy.com/our-team-draft/ - Doulas in a C-section: https://www.washingtonpost.com/national/health-science/doulas-are-playing-a-role-in-c-section-births/2018/07/13/79323372-6447-11e8-a768-ed043e33f1dc_story.html?noredirect=on&utm_term=.60091e11d997 Subscribe today on any podcast listening app and leave a rating and review to let us know what you think! Your feedback makes our day. Connect with us on Facebook, Instagram, and Twitter! If email is your thing, send us a note at hello@atyourcervix.us Just a reminder, the purpose of this podcast is to educate and empower, it is no substitute for professional care by a doctor or other qualified medical professional. Guests who speak in this podcast express their own opinions, experience, and conclusions. If you have any specific questions about any medical matter, you should consult your doctor or another professional healthcare provider.

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On the Path to Least Resistance in HIV: Long-Term Strategies to Mitigate the Risk of Antiretroviral Resistance

PeerVoice Internal Medicine Video

Play Episode Listen Later Apr 26, 2019 21:09

On the Path to Least Resistance in HIV: Long-Term Strategies to Mitigate the Risk of Antiretroviral Resistance

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On the Path to Least Resistance in HIV: Long-Term Strategies to Mitigate the Risk of Antiretroviral Resistance

PeerVoice Immunology & Infectious Disease Video

Play Episode Listen Later Apr 26, 2019 21:09

On the Path to Least Resistance in HIV: Long-Term Strategies to Mitigate the Risk of Antiretroviral Resistance

strategy risk long term mitigate least resistance antiretroviral

On the Path to Least Resistance in HIV: Long-Term Strategies to Mitigate the Risk of Antiretroviral Resistance

PeerVoice Clinical Pharmacology Video

Play Episode Listen Later Apr 26, 2019 21:09

On the Path to Least Resistance in HIV: Long-Term Strategies to Mitigate the Risk of Antiretroviral Resistance

strategy risk long term mitigate least resistance antiretroviral

Cannabis Connection World Episode 11

Cannabis Connection World Podcast

Play Episode Listen Later Mar 18, 2018 31:36

In episode 11 we learn about the newest study published last month from the University of Washington in Seattle. This research proves that along with Antiretroviral treatment, Heavy cannabis users had better results. You will hear the second part of my interview with Shira Adler, author of “The ABC’s of CBD” Finally we bring back the Cannabis Connection Calendar. Some important events and dates coming up on the schedule.

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REPLAY: Bugs & Drugs – Duration of Antibiotic Therapy in Community-Acquired Pneumonia and Early Antiretroviral Treatment for HIV

Play Episode Listen Later Dec 30, 2016 39:12

Bugs, drugs, and optimal duration for antibiotic therapy? New frontiers in HIV treatment? Listen this week as Kieran and Jay Spiegel, a resident in General Internal Medicine in Toronto, discuss two studies: It's hard to remember what the right drug is to treat a certain bug, let alone the correct duration of therapy. Further, for ... The post REPLAY: Bugs & Drugs – Duration of Antibiotic Therapy in Community-Acquired Pneumonia and Early Antiretroviral Treatment for HIV appeared first on Healthy Debate.

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REPLAY: Bugs & Drugs – Duration of Antibiotic Therapy in Community-Acquired Pneumonia and Early Antiretroviral Treatment for HIV

Play Episode Listen Later Dec 30, 2016 39:12

Bugs, drugs, and optimal duration for antibiotic therapy? New frontiers in HIV treatment? Listen this week as Kieran and Jay Spiegel, a resident in General Internal Medicine in Toronto, discuss two studies: It's hard to remember what the right drug is to treat a certain bug, let alone the correct duration of therapy. Further, for ...The post REPLAY: Bugs & Drugs – Duration of Antibiotic Therapy in Community-Acquired Pneumonia and Early Antiretroviral Treatment for HIV appeared first on Healthy Debate.

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Bugs & Drugs – Duration of Antibiotic Therapy in Community-Acquired Pneumonia and Early Antiretroviral Treatment for HIV

Play Episode Listen Later Sep 23, 2016 39:12

Bugs, drugs, and optimal duration for antibiotic therapy? New frontiers in HIV treatment? Listen this week as Kieran and Jay Spiegel, a resident in General Internal Medicine in Toronto, discuss two studies: It's hard to remember what the right drug is to treat a certain bug, let alone the correct duration of therapy. Further, ...The post Bugs & Drugs – Duration of Antibiotic Therapy in Community-Acquired Pneumonia and Early Antiretroviral Treatment for HIV appeared first on Healthy Debate.

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Bugs & Drugs – Duration of Antibiotic Therapy in Community-Acquired Pneumonia and Early Antiretroviral Treatment for HIV

AIDS/HIV: Past, Present, and Future (Video)

Play Episode Listen Later Sep 23, 2016 39:12

Bugs, drugs, and optimal duration for antibiotic therapy? New frontiers in HIV treatment? Listen this week as Kieran and Jay Spiegel, a resident in General Internal Medicine in Toronto, discuss two studies: It's hard to remember what the right drug is to treat a certain bug, let alone the correct duration of therapy. Further, ... The post Bugs & Drugs – Duration of Antibiotic Therapy in Community-Acquired Pneumonia and Early Antiretroviral Treatment for HIV appeared first on Healthy Debate.

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Sexand Drugs today - Damon L. Jacobs and Dr. Jim Kubiln M.D., M.P.H.

Between The Scripts

Play Episode Listen Later Aug 11, 2016 97:22

Dr. Jim Kublin, M.D., M.P.H. Dr. Jim Kublin is currently Executive Director of the HIV Vaccine Trials Network based at Fred Hutchinson Cancer Research Center. He is also the Medical Director of the Seattle Malaria Clinical Trials Center, a translational research center established by Fred Hutch and the Center for Infectious Disease Research (CIDR) to test experimental malaria vaccines and drugs in human clinical trials. Jim is also a faculty member in the Department of Global Health at the University of Washington. Jim has conducted extensive research on HIV and malaria in South America, SE Asia, and Africa, including clinical trials of novel therapies and vaccines. The Gates Foundation awarded Jim a Grand Challenges Exploration award to apply high-throughput system analyses to malaria vaccine development. Before moving to Seattle, Jim was Director, HIV Vaccines – Infectious Diseases, for Merck & Co., Inc where he played a key role in the development and implementation of HIV vaccine studies, overseeing the coordination of clinical assays, site identification and development, government and ethical approvals and providing guidance on vaccine policy issues. Jim completed his B.S. and M.D. at Georgetown University and received his M.P.H. and completed a residency in Preventive Medicine at Johns Hopkins University. Jim continued work in vaccine development and molecular epidemiology while attending the University of Maryland’s School of Medicine for his fellowship in Vaccinology at the Center for Vaccine Development. Article By By Mary Engel Many paths led Dr. Jim Kublin to where he is today: executive director of the HIV Vaccine Trials Network (HVTN), based at Fred Hutchinson Cancer Research Center. A good place to start is the 16 days he spent struggling to finish the 1,000-mile Yukon Quest sled-dog race — the lesser known and more demanding cousin to Alaska’s Iditarod. “You talk about the long haul, and the incredible patience that’s required to really see it through to the finish, and the perseverance,” he said recently. Kublin was recalling the 1992 race from Fairbanks, Alaska, to Whitehorse, Yukon, when he was 30 years old. But he could have been talking about leading the world’s largest clinical trials network in the marathon quest to develop and test an HIV vaccine. Finding a vaccine can seem less like a race than a slog through blowing snow, sub-zero temperatures and more darkness than daylight. Kublin’s been there. On average, a third of the mushers who attempt the Yukon Quest scratch. Kublin finished, but for the first half of the race, he was dead last. With up to 300 miles between checkpoints, he had plenty of time to face — and accept — his vulnerabilities, an experience he described as “enormously humbling.” He used the same words to describe the bond he established with lead dogs Woodrow, Aspen and the rest of his team as he knelt in the snow every couple hours, checking their feet, making sure they rested and ate. “If I were to say, ‘I can’t do this anymore, these dogs can’t do it, we need help’ — there wasn’t any,” he said. “[The dogs] knew they were entirely dependent on me, and I knew I was entirely dependent on them. And it was just beautiful.” TURNING POINT Kublin grew up in a blue-collar iron-ore mining town on Michigan’s harshly beautiful Upper Peninsula. The son of an ophthalmologist (who at age 80 is still practicing), he found both work and role models in the town’s iron-ore mine warehouse and foundry during high school. “I was surrounded by people who hadn’t had a lot of advantages growing up,” he said. “It just gave me an appreciation of the struggles that many people experience in this country.” Moving from the sparsely populated, hardscrabble U.P. to Washington D.C.’s Georgetown University added to the Camus-reading teenager’s sense of bridging two worlds. He dropped out after his first two years to accompany a college group going to Nicaragua to do public health work. If growing up in a job-depressed mining town exposed him to disadvantage, Nicaragua showed him true poverty. To this day, he keeps a photo on his bedside table that he took there of a malnourished child. But Nicaragua in 1981-82, just after the 1979 revolution, was also a place of excitement and idealism. The new government was launching programs to improve literacy, education and health care. Inspired by Liberation Theology’s ideas on social justice and galvanized by his first foray into epidemiology, Kublin, then 20, worked on the country’s malaria eradication campaign — only to come down with the disease himself. Anyone who knows that curiosity is a vital part of being a scientist will recognize his response to enduring malarial rigors and hallucinating that his reflection in the bathroom mirror was his face in a coffin. “That’s when I first learned about malaria,” he said, “and became fascinated by just the elegance and biology of this parasite life cycle.” It was to become a lifelong love affair. In addition to his work heading the HVTN network, Kublin is medical director of the Malaria Clinical Trials Center at Seattle Biomed. Nicaragua proved a turning point. Returning to Georgetown to focus on biology and pre-med, Kublin went from uninspired student to the dean’s list. He did his undergraduate thesis on how parasites attach to the liver cell. Entering medical school, he continued to do malaria research on the side, dissecting the salivary glands of mosquitos to collect the parasite. He was in his first year at Georgetown’s School of Medicine in 1984, the year HIV was found to cause AIDS. Jim Kublin provides pediatric care as a volunteer medic at a Cambodian refugee camp on the Thai-Khmer border in 1988. FROM MALARIA TO HIV Kublin’s internship at New York’s St. Vincent’s Hospital in 1988 put him in the AIDS epidemic’s West Village epicenter. The hospital was filled to capacity, with gurneys in hallways and a cadre of young doctors who felt both energized and besieged by the challenge. Despite their dedication, in the years before antiretroviral therapy, AIDS was essentially a death sentence. Still, Kublin found a lesson in the madness. “I learned in that year that some of the most honorable work out there is hospice care,” he said, “and was fortunate myself to do some of that, helping people with their unfinished business, even if it’s just calling somebody they needed to talk to before they die.” But even that did not prepare him for sub-Saharan Africa. He and his wife, Zara, and their young sons Gus and Henno moved to Malawi in 1998, where he ran a research program and worked as scientific coordinator for an initiative sponsored by the U.S. Centers for Disease Control and the Malawi Ministry of Health and Population. Once there, he found whole villages decimated by HIV, with no one left but elders and orphans. Antiretroviral treatment, by then resurrecting patients from near death in developed countries, was not yet available in Africa. So Kublin started doing what other U.S. and European workers were doing — getting colleagues back home to send expired but still usable drugs. Then came wrenching decisions on who should get his tiny stash of pills. The drugs were no match for the immensity of HIV in Malawi. The hospital morgue overflowed daily. Like Nicaragua, Malawi was transformative for Kublin. Having come to work on malaria, he left to help find an HIV vaccine. STAYING THE COURSE ON THE ROAD TO A VACCINE In 2004, after a three-year stint working on an HIV vaccine at Merck Research Labs, Kublin was lured by Dr. Larry Corey, a world-renowned virologist and now Fred Hutch’s president and director emeritus, to coordinate operations across the HVTN. The HVTN conducts all phases of clinical trials, from evaluating experimental vaccines for safety and the ability to stimulate immune responses to testing vaccine efficacy. A model for collaborative global research, its vaccine trial units are located at leading research institutions in more than 30 cities on five continents. The road to an HIV vaccine has proved challenging. One of the deepest disappointments came in 2007, just before Kublin took over as executive director. A major trial had to be halted when it was found that the vaccine neither prevented HIV infection nor reduced the amount of virus in the blood among vaccine recipients who became infected with HIV. In some cases, it could make the recipient more susceptible to the virus. The trial was the biggest one in the field at the time, and the vaccine being tested had been considered the best hope. Despite an effort at scientific detachment, the HVTN staff was devastated. “We designed the trial correctly because it delivered an answer very quickly,” said Niles Eaton, HVTN director of site operations. “But it wasn’t the answer we wanted.” Kublin too was caught short by how much he had emotionally invested in that vaccine. He was home when the call came, and the news brought him to tears. When he told his children what had happened, his then 9-year-old-son, Gus, after a pause, replied, “But you’re not going to give up, are you? It’s too important.” The next day, Kublin called the team together and told them what Gus had said. “He conveyed that to us to keep us going,” said Eaton. “We needed to hear that.” Kublin takes a dog team, led by Woodrow and Storm, on a run near Skandia, Michigan, in 1994. RENAISSANCE MAN For his 50th birthday three years ago, Kublin’s colleagues made a word cloud of phrases used to describe him. Renaissance man topped the list, though “brilliant” and “approachable” — traits not always seen together — were not far behind. So was “steady leadership” and “calm in the storm,” qualities that turn out to be as useful for leading a team of researchers through the ups and downs of vaccine clinical trials as for getting a rookie musher to the finish line. “In science, an experiment doesn’t fail, it informs us. He reminds us of that,” said HVTN project manager Sue Ferguson, Kublin’s assistant. “There have been rough waters, but he’s a phenomenal leader. He gives you so much room to bring your best every day.” Last October, the HVTN opened a new, state-of-the-art laboratory in South Africa, which has the highest rates of HIV/AIDS in the world. Next year it will launch a series of clinical trials there. One will test a modified version of a vaccine that prevented about 32 percent of new infections in a six-year trial involving more than 16,000 adult volunteers in Thailand. The study, published in 2009, was the first to show that a safe and effective HIV vaccine is possible. A vaccine may be the prize at the end of the marathon, but the man described as driven to make a difference savors interim victories as well. The huge effort that goes into setting up trials provides humanitarian benefits that often go unrecognized. “Large trials require formidable infrastructure and training and raise standards of clinical care—a lasting resource,” he said. THE LONG HAUL The first time Kublin got on a sled behind a team of dogs was on May 12, 1990. Yes, he remembers the exact date. A late spring snowfall had dumped 12 inches on the Upper Peninsula, where he had returned after his internship intending to practice medicine, pay off school loans and recover from a tumultuous year. The friend who had invited him along chose six dogs to harness from the dozen spinning, yipping and pleading to go. Kublin stepped onto the sled runner, and up a hill they flew, like an elevator on speed. The cacophony of the dog yard gave way to the whistle of wind and his friend’s soft “gees” and “haws” directing the dogs left or right around one treefall after another. Kublin was transfixed. He still is. View article – http://www.fredhutch.org/en/news/hutch-magazine/2014-06/quest-to-develop-an-HIV-vaccine.html

Town Hall: HIV Cure Research

Play Episode Listen Later Jun 12, 2015 77:29

Although antiretroviral therapy has dramatically extended the life of HIV infected individuals, the life-long daily regimen of pills is not a cure. The drugs' side effects lead to various complications such as increased incidence of heart disease and cancer that significantly reduces lifespans. Based on this reality, the recent isolated reports of individuals being cured of HIV infection have brought a lot of excitement as well as cautiousness. Brief presentations by a distinguished lineup of clinicians, researchers and advocates, many of whom have dedicated their life's work toward finding a cure for HIV infection, address where we are with a cure for HIV. Series: "California Institute for Regenerative Medicine" [Health and Medicine] [Show ID: 28243]

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Town Hall: HIV Cure Research

AIDS/HIV: Past, Present, and Future (Audio)

Play Episode Listen Later Jun 12, 2015 77:29

Although antiretroviral therapy has dramatically extended the life of HIV infected individuals, the life-long daily regimen of pills is not a cure. The drugs' side effects lead to various complications such as increased incidence of heart disease and cancer that significantly reduces lifespans. Based on this reality, the recent isolated reports of individuals being cured of HIV infection have brought a lot of excitement as well as cautiousness. Brief presentations by a distinguished lineup of clinicians, researchers and advocates, many of whom have dedicated their life's work toward finding a cure for HIV infection, address where we are with a cure for HIV. Series: "California Institute for Regenerative Medicine" [Health and Medicine] [Show ID: 28243]

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Multiple Sclerosis Discovery -- Episode 8 with Dr. Wendy Macklin

Multiple Sclerosis Discovery: The Podcast of the MS Discovery Forum

Play Episode Listen Later Aug 19, 2014 15:49

[intro music] Host – Dan Keller Hello, and welcome to Episode Eight of Multiple Sclerosis Discovery, the podcast of the MS Discovery Forum. I’m your host, Dan Keller. This week’s podcast features an interview with researcher, Wendy Macklin, whose team studies myelination and demyelination in zebrafish and mouse animal models. But to begin, here is a brief summary of some of the topics we’ve been covering on the MS Discovery Forum at msdiscovery.org. As listeners may already be aware, a new study suggested that infection with HIV is associated with a lower risk of developing MS. Researchers looked at a large sample of hospital records and found that individuals infected with HIV had a 62% lower risk of MS than HIV-negative individuals who were matched for age, gender, region, and socioeconomic status. The researchers think that antiretroviral drugs might be causing the protective effect, though it’s possible the infection with HIV itself somehow protects against developing MS. Antiretroviral drugs may attack some ancient viral genes thought to trigger MS and other autoimmune diseases. Science journalist, Ricki Lewis, covered a study of patients with a rare mitochondrial eye disease that may be entwined with MS. The disease called Leber hereditary optic neuropathy, LHON, is a degenerative eye disease that causes progressive loss of vision. But in some patients, the disease can also cause MS-like symptoms. Researchers performed MRIs on patients with LHON and found that their white matter lesions resembled MS, possibly providing an early snapshot of MS. The similarity of the diseases has also led some researchers to question whether they share a pathogenesis, but the rarity of LHON and MS developing in the same person is shifting the opinion towards calling any comorbidity of the diseases just a coincidence. In a recent post in MS Patient, Ph.D., blogger Griselda Zuccarino-Catania followed up her feature on DMTs in pregnancy with her own personal debate on whether to continue her DMT while breastfeeding. In her post, she profiles researcher Thomas Hale, who studies drug concentrations in breast milk. He’s found that concentrations in a woman’s blood plasma are associated with the concentrations in her breast milk. These levels can be used to assess the risk any drug might have to infants. [transition music] Now for the interview. Science journalist, Carol Morton, met with Wendy Macklin at the Glia Meeting in Cold Spring Harbor, New York. She and Dr. Macklin discussed new research in myelination using the mTOR cell apoptosis pathway, the feasibility of a remyelinating drug, and her work with an unusual animal model for modeling MS – the zebrafish. [Note: the word "apoptosis" is incorrect and should not have appeared in the introduction to Dr. Macklin's interview. While it's impractical to remove it from the already-released audio podcast, we are correcting the error here, in this transcript.--Editor] Interviewer – Carol Morton There are not that many MS researchers who work with that. Interviewee – Wendy Macklin No, and there are times when you have to suggest that there is relevance to multiple sclerosis for looking at little two-inch fish. But they do. They provide really important information because you're not even looking at the two-inch fish; you're looking at the little, teeny tiny larva and embryos, but they are optically clear. So some of the new technologies use these green fluorescent proteins that originally were identified in jellyfish that make the jellyfish fluoresce at night. If you shine a certain wavelength of light, they turn green. And so, you can do that in a live animal, in a live fish; and in fact, some of the stuff that we were hearing today was even doing it in the mouse, but there you have to actually be able to get the microscope so you can actually see into the mouse brain. But in the fish, everything is transparent; so you can see it no matter what. So you just put the fish in a microscope environment, and you can watch cells, and you can take movies of cells moving, cells trying to make new processes, and cells wrapping around axons. And so you can watch this in realtime. MSDF You recently had a really interesting paper. Do you want to talk about...? Dr. Macklin So that paper came out of a project that we'd started a long time ago that was focused on understanding how one particular protein, Akt – which does many, many things in cells – regulates oligodendrocytes, which are the cells that make myelin. And it does many things; we thought it was involving in a survival element; and so we thought maybe we could find things that would help the oligodendrocytes survive immune attacks, survive things better and not die. And so we created a mouse where we overexpressed that protein in the oligodendrocyte. And instead, actually, what happened it did not change the survival of the cells at all; it changed how much myelin they made. And in fact, it drove the cells to make too much myelin. And in fact, if that becomes pathologic, the animals actually die when they're about a year old because they have too much myelin, and it's filling up their brain. So it's a dramatic change. And so, then we began to drill down to see well what is it about that molecule because it does many things? This particular hypermyelination syndrome was really feeding down through the mTOR pathway. And so, if you knockout parts of the mTOR pathway in the oligodendrocytes, the spinal cord is far worse and makes much less myelin and does not really generate the right kind of myelin. Whereas other parts of the brain are doing just fine or seem to be doing just fine. So one of the questions is why is this anymore damaged by this change in the cell? So the oligodendrocyte is identifying an axon and then wrapping around and making myelin, and that's what's the key question in MS is how to make sure that cell continues to make myelin. And we now have a system where we have changed the axons in some way – using again this mTOR pathway – and those axons don't encourage the oligodendrocyte to make myelin. So now we have a system where we can go in and try and figure out well what's fundamentally changed about those axons that they say don't myelinate me; whereas the oligodendrocytes in other parts of the nervous system are doing just fine making myelin. MSDF Now after the session this morning, I'm actually wondering if myelin making is now the goal, or has the goal…is the goal changing as people find out more for for therapeutic? Dr. Macklin I would say we don't know. So if you look in MS tissue, you see that where there's demyelination there still are oligodendrocyte progenitor cells, and there still are the cells that are trying to make myelin, the premyelinating cells. There's small numbers relative to the normal tissue, and they don't make myelin. So is that because we don't have enough cells? Is that because they have an inhibitor that's preventing them in that environment, or because they're not getting some positive signal? So I would still say the question of understanding how myelination is regulated has huge clinical relevance. MSDF Recently you went to another meeting that was really focused on myelination as a therapeutic problem, a therapeutic target. Dr. Macklin Right. MSDF In addition to knowing what's happening with the cells and the molecules in the environment in the brain, there's some other issues in getting myelin-making drugs through clinical testing. Dr. Macklin Yeah. In contrast to many of the other neurologic diseases, there are disease-modifying drugs out there for MS, but they almost all – at the current time – hit the immune component, which is absolutely essential and is definitely important. But even if you got rid of 100% of the immune component of MS, you still would have damage in the brain. And there is a good deal of evidence that the myelin not only does it allow better conduction of these axons, but it also provides all sorts of support. Metabolic it's providing energy to the axons; it provides a great many things to the axons that help the axons survive, which are part of the neurons. So if there is really still serious damage, you want to figure out some way to repair that. And so there are a couple of clinical trials actually going on right now that are looking at drugs that might enhance the remyelination in patients. And so, some of the things that we're doing – looking both in the fish as well as in the mouse – are pathways that could be targeted for therapeutics that might help you to enhance myelination. One of the big themes that came out of that meeting last month was that if you had the perfect therapy for remyelination – you know that it works well in the zebrafish; you know it works well in the mouse – you can get other models that allow you to look at remyelination in a number of different contexts. You have to get those to patients and see if they actually do create new myelin. In patients, the problem is that the current imaging modalities for patients, MRI, is measuring water. And where you have myelin there is less water because of the way myelin works. It's hard to know exactly why there's less water where you're looking in MRI. So there's a variety of different approaches. There's new techniques with MRI. There's even some new PET techniques – which are clearly experimental at this stage – to try to really be able to show new myelin. And part of that meeting was really if we had the perfect therapy how would we prove it in a clinical trial? You can show clinical improvement, which is great, but is that because of you've changed the immune system, because you've changed other aspects of the patient, or you really have new myelin? That's currently still a really hard problem in terms of the the clinical end of things to really be able to prove that. Nevertheless, people are developing these kinds of drugs, and as I said a couple of them are in clinical trial right now. MSDF Looking at your animal models, the ways that you have evaluating more or less myelin are ways are ways that can't be translated to people… Dr. Macklin Well some of them are. I mean that's really where some of this work is going is trying to figure out how to use either MRI or PET imaging of live animals, and then you can go and test. And you think you have a signal that tells you you have increased myelin then you can actually go in and check and see – at the tissue level – is there really new myelin? So you can validate some of these imaging modalities that way. But you you will always have to go eventually to the patients and be able to really demonstrate that that particular way of imaging the tissue proved in in an animal model really does mean something in the patient as well. MSDF I've seen those little mouse MRIs. Dr. Macklin They're so adorable. MSDF They are. Dr. Macklin And they definitely show you something. They definitely show you something. And some of the PET work…the PET work is more specifically directed to myelin so you can have a PET ligand, which shows up in PET imaging, that just literally binds only to myelin or binds predominantly to myelin, and it will go into the tissue, and it will bind there. And that actually gives you some fairly discrete imaging that because you know it's a molecule that only binds to myelin when you see that signal in a particular place you know that that is myelin. And if you see more of a signal, then you know that that's more myelin. So those are really interesting approaches, and they're very much more directed to being able to specifically say that's myelin that you're seeing. But in the clinical context, those kinds of approaches are being worked on, but they're still very early stages. In terms of trying to set up a clinical trial, those kinds of approaches may be the way you'll go eventually, but today you couldn't do it that way. MSDF Anything else that I should be asking, or that you wanted to add that would in in this context that would be interesting? Dr. Macklin Well I mean I think at this stage there are other issues of the question of so much of the work is done on myelination, which is crucial during development, and it's absolutely essential. And problems with normal myelination during development result in really serious brain problems. There are ways to study developmental myelination: in the fish, in the mouse, in a variety of different ways. And then there's a series of adult ways of getting rid of myelin to look at remyelination. And so, the overwhelming perspective has always been well whatever you learn from the myelination during development would be exactly what you would need to know about for the remyelination in the adult. And much of that's true. I mean you have to get the cells, you have to get the cells to proliferate, you have to get them to the right place. But there are now data that suggest that there are definite differences in the way the adult cells are responding to their overall environment, which is totally different than from the developmental environment. The cells may be very similar, but in the developing environment the many things are changing all of the time – the nerve cells, all of the different cells are changing, the brain is getting bigger – there's all sorts of changes. And in a damaged adult brain, you see certain differences that do seem to be real in terms of the way the signaling pathways are that would regulate how the myelin is generated in the remyelinating context versus in the developmental context. So we do need to go back and forth even the ones of us who work on the fish. We need to be able to look and see some adult context that's a demyelination/remyelination context that those same things that you're seeing developmentally are important in the adult. MSDF That is interesting because I have heard people say well you recapitulate, you want to recapitulate the… Dr. Macklin Yes, and it does. It… MSDF …the developmental pattern. Dr. Macklin Right. MSDF So that's interesting in that. Okay, well that's fabulous. Well, thank you for taking the time to do this. Dr. Macklin Okay. Certainly. MSDF It was wonderful. Dr. Macklin I hope it's useful for you. MSDF Okay, great. [transition music] Thank you for listening to Episode Eight of Multiple Sclerosis Discovery. This podcast was produced by the MS Discovery Forum, MSDF, the premier source of independent news and information on MS research. MSDF’s executive editor is Robert Finn. Msdiscovery.org is part of the non-profit Accelerated Cure Project for Multiple Sclerosis. Robert McBurney is our President and CEO, and Hollie Schmidt is vice president of scientific operations. Msdiscovery.org aims to focus attention on what is known and not yet known about the causes of MS and related conditions, their pathological mechanisms, and potential ways to intervene. By communicating this information in a way that builds bridges among different disciplines, we hope to open new routes toward significant clinical advances. We’re interested in your opinions. Please join the discussion on one of our online forums or send comments, criticisms, and suggestions to editor@msdiscovery.org. [outro music]

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Effect of Micronutrient Supplementation on Disease Progression in Asymptomatic, Antiretroviral-Naive, HIV-Infected Adults in Botswana

JAMA Author Interviews: Covering research in medicine, science, & clinical practice. For physicians, researchers, & clinician

Play Episode Listen Later Nov 26, 2013 4:44

Interview with Marianna K Baum, PhD, author of Effect of Micronutrient Supplementation on Disease Progression in Asymptomatic, Antiretroviral-Naive, HIV-Infected Adults in Botswana

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How can we live with HIV?

Translational Medicine

Play Episode Listen Later Jan 10, 2012 3:39

Dr Lucy Dorrell tells us how our immune system controls HIV and how we can live with this virus. The aim of Dr Lucy Dorrells' research is to develop immunotherapy to reduce the dependence of those infected with HIV-1 on their current treatment - antiretroviral therapy (ART). This is because 9 million of the estimated 33 million people living with HIV/AIDS today are not able to access the ARTs which they are in immediate need of.

art arts vaccines hiv hiv aids clinical trials t cells antiretroviral viral vector

How can we live with HIV?

HIV

Play Episode Listen Later Jan 10, 2012 3:39

Dr Lucy Dorrell tells us how our immune system controls HIV and how we can live with this virus. There are currently around 91,000 people in the UK living with HIV/AIDS. HIV is a challenging target for a vaccine because it can mutate its genetic makeup. Dr Lucy Dorrell aims to develop immunotherapy to reduce dependence on antiretroviral therapy (ART), the current standard treatment for those infected with HIV-1. Worldwide, 9 million of the estimated 33 million people living with HIV/AIDS today are not able to access the ARTs which they are in immediate need of.

art uk arts vaccines hiv worldwide hiv aids clinical trials antiretroviral viral vector

How can we live with HIV?

HIV

Play Episode Listen Later Jan 10, 2012 3:39

Dr Lucy Dorrell tells us how our immune system controls HIV and how we can live with this virus. There are currently around 91,000 people in the UK living with HIV/AIDS. HIV is a challenging target for a vaccine because it can mutate its genetic makeup. Dr Lucy Dorrell aims to develop immunotherapy to reduce dependence on antiretroviral therapy (ART), the current standard treatment for those infected with HIV-1. Worldwide, 9 million of the estimated 33 million people living with HIV/AIDS today are not able to access the ARTs which they are in immediate need of.

art uk arts vaccines hiv worldwide hiv aids clinical trials t cells antiretroviral viral vector

How can we live with HIV?

Translational Medicine

Play Episode Listen Later Jan 10, 2012 3:39

Dr Lucy Dorrell tells us how our immune system controls HIV and how we can live with this virus. The aim of Dr Lucy Dorrells' research is to develop immunotherapy to reduce the dependence of those infected with HIV-1 on their current treatment - antiretroviral therapy (ART). This is because 9 million of the estimated 33 million people living with HIV/AIDS today are not able to access the ARTs which they are in immediate need of.

art arts vaccines hiv hiv aids clinical trials t cells antiretroviral viral vector

The Evolution of Drug Resistance Interpretation Algorithms: ANRS, REGA and Extension of Resistance Analysis to HIV-1 Group O and HIV-2

Medizin - Open Access LMU - Teil 19/22

Play Episode Listen Later Jan 1, 2012

Antiretroviral drug resistance is mostly linked to a complex interaction of several amino acids with variable importance or a single amino acid. To facilitate the interpretation of observed mutation patterns, hospital university centers have developed several interpretation systems. All the currently available interpretation algorithms evolved, are being continuously updated and have been improved during the last decade. Some discrepancies are still evident that are partially smoothened by link of the individual programs with other systems. After the interpretation of HIV-1 group M subtype B mutations, a refined algorithm for the other group M sub-types was developed followed by the interpretation of HIV-1 group O and HIV-2 mutations. The process of improvement is ongoing, due to the better understanding and interpretation of single and cluster mutations and the availability of new antiretroviral substances. The knowledge gained from the experience of HIV drug resistance testing has been used to establish the interpretation of HBV polymerase mutations and will be extended for the treatment of HCV infected with protease inhibitors. Copyright (C) 2012 S. Karger AG, Basel

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The Newest Antiretroviral Agents: Their Role in Therapy

MedicalMissions.com Podcast

Play Episode Listen Later Nov 1, 2011 58:54

Twenty-five antiretroviral agents have been marketed in the United States for the treatment of human immunodeficiency virus (HIV) infection/AIDS. The classification of these agents is reviewed and the properties of the five newest antiretroviral agents are discussed in detail. The specific indications for which the use of the new agents is recommended are identified, as are the risks and limitations of their use. The advantages and disadvantages of the new agents are considered in the context of comparisons with previously marketed antiretroviral agents. A rating (on a scale of 1 to 5) for each of the new drugs is provided based on an evaluation of their advantages and disadvantages

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Access to Antiretroviral AIDS Drugs Worldwide

HIV / AIDS at 30

Play Episode Listen Later Jun 30, 2011 1:40

drugs aids worldwide antiretroviral

Calculation of direct antiretroviral treatment costs and potential cost savings by using generics in the German HIV ClinSurv cohort.

Medizin - Open Access LMU - Teil 17/22

Play Episode Listen Later Jan 1, 2011

BACKGROUND/AIM OF THE STUDY: The study aimed to determine the cost impacts of antiretroviral drugs by analysing a long-term follow-up of direct costs for combined antiretroviral therapy, cART, -regimens in the nationwide long-term observational multi-centre German HIV ClinSurv Cohort. The second aim was to develop potential cost saving strategies by modelling different treatment scenarios. Antiretroviral regimens (ART) from 10,190 HIV-infected patients from 11 participating ClinSurv study centres have been investigated since 1996. Biannual data cART-initiation, cART-changes, surrogate markers, clinical events and the Centre of Disease Control- (CDC)-stage of HIV disease are reported. Treatment duration was calculated on a daily basis via the documented dates for the beginning and end of each antiretroviral drug treatment. Prices were calculated for each individual regimen based on actual office sales prices of the branded pharmaceuticals distributed by the license holder including German taxes. During the 13-year follow-up period, 21,387,427 treatment days were covered. Cumulative direct costs for antiretroviral drugs of €812,877,356 were determined according to an average of €42.08 per day (€7.52 to € 217.70). Since cART is widely used in Germany, the costs for an entire regimen increased by 13.5%. Regimens are more expensive in the advanced stages of HIV disease. The potential for cost savings was calculated using non-nucleotide-reverse-transcriptase-inhibitor, NNRTI, more frequently instead of ritonavir-boosted protease inhibitor, PI/r, in first line therapy. This calculation revealed cumulative savings of 10.9% to 19.8% of daily treatment costs (50% and 90% substitution of PI/r, respectively). Substituting certain branded drugs by generic drugs showed potential cost savings of between 1.6% and 31.8%. Analysis of the data of this nationwide study reflects disease-specific health services research and will give insights into the cost impacts of antiretroviral therapy, and might allow a more rational allocation of resources within the German health care system.

Untersuchung des mitochondrialen Membranpotentials und der Apoptoserate peripherer mononukleärer Blutzellen HIV-positiver, bisher nicht antiretroviral behandelter Patienten

Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 09/19

Play Episode Listen Later Dec 11, 2008

Thu, 11 Dec 2008 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/9505/ https://edoc.ub.uni-muenchen.de/9505/1/Tischleder_Annette.pdf Tischleder, Annette

patienten bisher untersuchung positiver antiretroviral blutzellen ddc:600 apoptoserate membranpotentials

Update to the U.S. DHHS Antiretroviral Treatment Guidelines for Adults and Adolescents

HIV News & Views

Play Episode Listen Later Dec 1, 2008 21:35

On Nov. 3, 2008, the U.S. government updated its Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. These guidelines were last updated on Jan. 29, 2008. We asked Joel Gallant, M.D., M.P.H., to provide a summary of the changes. Dr. Gallant is not only one of the top clinicians and researchers in the United States, he's also a guidelines panel member.

united states hiv adults guidelines adolescents gallant dhhs treatment guidelines antiretroviral

The Lancet: April 04, 2008

The Lancet

Play Episode Listen Later Apr 4, 2008 9:31

Doubts over the long-term safety of the HIV nucleoside reverse transcriptase inhibitor abacavir and the less commonly used antiretroviral drug didanosine are raised in a research Article. Both drugs were found to be associated with an increased risk of myocardial infarction. Jens Lundgren (University of Copenhagen, Denmark) discusses the study in this week's podcast.

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GENERAL MEDICINE: Starting Antiretroviral Therapy Can Trigger Leprosy

Play Episode Listen Later Sep 20, 2007 5:34

Audio Journal of Medicine, September 18th, 2007 Reporting from: 47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Chicago, 2007 Starting Antiretroviral Therapy Can Trigger Leprosy DIANA LOCKWOOD, London School of Hygiene and Tropical Medicine REFERENCE: Interscience Conference on Antimicrobial Agents and Chemotherapy, 17 – 20 September 2007, Chicago ICAAC delegates heard that ‘hidden’ leprosy can be triggered in some patients who are receiving HIV antiretroviral therapy. So what might this mean for the countries that are rolling out this therapy to large numbers of people? Derek Thorne discussed the issue with Diana Lockwood of the London School of Hygiene and Tropical Medicine.

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HIV/AIDS, Big Pharma, and Food

Deconstructing Dinner

Play Episode Listen Later May 25, 2007 59:08

This broadcast attempts to tie together some of the most pressing global issues and observe just how interconnected our food choices are to the world around us, and just how significant of an impact our food choices can have on the shape and future of this planet and its inhabitants. The connections between the global pharmaceutical industry and global food may not be so apparent, but the most startling example is the push to begin growing genetically modified crops to provide ingredients to the pharmaceutical industry. But as such technology is not yet approved for commercial use, we travel to Africa, where the connection between Big Pharma and Food exists today. In brief, the connections appear as such; pharmaceutical companies profit off of an industrial food system that in turn contributes to poverty and food shortages, which in turn contributes to the spread of HIV/AIDS, and then, the pharmaceutical companies profit from the drugs they produce to treat the virus. Helping to make the connections, Deconstructing Dinner uses audio productions from InterWorld Radio (IWR), a part of the UK-based Panos Institute, an international media organization which produces news, features and analysis about the most critical global issues of today. Featured Audio "Malawi: Toxic Hunger" - Around one million people in Malawi live with HIV and AIDS. Many people who fall ill find it hard to farm, and struggle to get enough to eat. Antiretroviral drugs which help boost the immune system can help people regain their strength. But taking such potentially toxic treatment without food can be dangerous. Research by the UK's Overseas Development Institute argues food security is essential to break this vicious cycle. In Malawi, the charity Care International supports vulnerable households by running communal vegetable gardens. Hilary Mbobe visited Steria, who is living with HIV, in the village of Matapila. 01/02/2007 "The Food On Your Plate" - More and more countries are producing food they don't eat and eating food they don't produce but is this a good thing? Do the big supermarkets have too much power? Is the organic movement and local production and consumption a sensible way forward? 15/10/2003 "Ghana: Foreign Flavours" - Rice and chicken is a signature dish in Ghana and there's plenty of demand for the raw ingredients. But only if the price is right. Ghana's farmers find they can't compete with cheap cuts of meat from the European Union or subsidized rice from the US, and it's fueling hardship. Isaac Tetteh reports. 16/02/2006 "Zambia: Buying Your Way Out of Hunger" - Each year wealthy nations donate more than five million tonnes of food aid to poorer countries. But some aid professionals think giving food should be a last resort. They say many people facing food shortages would be better off with cash or vouchers to spend in local shops. Researchers who looked into a scheme in Zambia's western province in which aid workers gave out cash instead of food aid say the results are promising. Pamela Mnyantha reports. 01/02/2007 "Zambia: GM Under the Microscope" - Genetic modification or GM is one of the most hotly contested technologies of today. Embraced in the US and shunned in Europe it affects the food we eat, our environment and the livelihoods of farmers. Genetic modification involves altering the genes of plants and animals in an attempt to produce crops more efficiently. But questions over its safety and whether it is in fact superior to other farming methods have divided consumers and scientists.Zambia was catapulted into the heart of the controversy three years ago when it famously refused American food aid during a famine because it contained GM maize. The government still maintains its ban today - not least, some say, because it wants to hold onto its European market. But farmers in Zambia are divided about the issue. IWR reporter Pamela Mnyantha found out what's happening in Zambia now. 07/04/2005

GLOBAL HEALTH: Maraviroc: New Antiretroviral Drug Shows Efficacy and Safety

Play Episode Listen Later Mar 13, 2007 5:57

Audio Journal of Global Health Issues Maraviroc: New Antiretroviral Drug Shows Efficacy and Safety REFERENCE: Abstract Number: 104aLB, 104bLB, 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles February 25-28, 2007 HOWARD MAYER, Pfizer Global Research, New London CT MARK WAINBERG, McGill University, Montreal In a population of treatment-experienced HIV-infected subjects, maraviroc plus optimised background antiretroviral therapy provided significantly superior virologic control and increases in CD4 cell counts compared with placebo plus optimized background therapy. There were no clinically relevant differences in the safety profiles between the maraviroc and the placebo treatment groups. These drugs do not attack the virus itself but rather block host cells’ CCR5 cell surface cytokine receptors that HIV interacts with to gain entry into the cell.

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GLOBAL HEALTH: Entecavir Shows Activity Against HIV But Also Selects for an Antiretroviral Drug Resistance Mutation

Play Episode Listen Later Mar 5, 2007 4:22

Audio Journal of Global Health Issues Entecavir Shows Activity Against HIV But Also Selects for an Antiretroviral Drug Resistance Mutation REFERENCE: Abstract: 136LB, 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles February 25-29, 2007 CHLOE THIO, Johns Hopkins University School of Medicine Entecavir, used to treat hepatitis B virus infections, can lower levels of HIV in co-infected patients but also selects for a mutation that makes HIV resistant to entecavir as well as the antiretroviral drugs lamivudine and emtracitabine. These findings, derived from three case reports and associated laboratory studies, have important implications for the treatment of HBV in HIV-infected patients. Current guidelines, issued in October 2006 and which recommend entecavir as a first-line treatment of HBV in co-infected individuals who do not require anti-HIV therapy, need to be reconsidered. Chloe Thio discussed her study results and their implications with Dan Keller at the 14th Conference on Retroviruses and Opportunistic Infections in Los Angeles.

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GLOBAL HEALTH: Growth Hormone Releasing Factor Analog: Slimming Aid for Patients Receiving HAART?

Play Episode Listen Later Feb 28, 2007 5:15

Audio Journal of Global Health Issues Growth Hormone Releasing Factor Analog: Slimming Aid for Patients Receiving HAART? REFERENCE: 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles February 25-29, 2007 STEVEN GRINSPOON, Massachusetts General Hospital, Boston COMMENT: JUDITH CURRIER, University of California, Los Angeles Daily administration of an analog of growth hormone releasing factor to HIV patients receiving highly active antiretroviral therapy significantly decreased visceral fat and improved their lipid profiles. This development-stage drug, TH9507, was well tolerated and may help patients reduce central fat accumulation and abnormal lipid profiles, both of which are know cardiovascular risk factors. In addition, decreases in central fat may have a positive effect on patients' self-image. Steven Grinspoon gave Dan Keller details during the 14th Conference on Retroviruses and Opportunistic Infections in Los Angeles.

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GLOBAL HEALTH: Three-Class Antiretroviral Therapy for HIV Not Appropriate: Results from the FIRST Study