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19th CROI, Seattle, WA, 2012.La Pedrera, Barcelona – March 13th 201219th CROI, Seattle, WA, 2012.
La Pedrera, Barcelona – March 13th 2012
Dr. José M. MiróInfectious Diseases Service - ICMiD
Hospital Clinic - IDIBAPS University of Barcelona
Barcelona (Spain)
Dr. José M. MiróInfectious Diseases Service - ICMiD
Hospital Clinic - IDIBAPS University of Barcelona
Barcelona (Spain)
Summary I: Opportunistic Infections HCV/HBV Co-Infections & Tumors
Summary I: Opportunistic Infections HCV/HBV Co-Infections & Tumors
E-mail address: [email protected] address: [email protected]
Egger, #100
Egger, #100
Egger, #100
Egger, #100
Tuberculosis TB-IRIS Opportunistic infections Hepatitis co-infections Tumors
Tuberculosis TB-IRIS Opportunistic infections Hepatitis co-infections Tumors
OIs, Hepatitis Coinfections & Tumors
OIs, Hepatitis Coinfections & Tumors
A5221/STRIDE A5221/STRIDE CAMELIA CAMELIA SAPITSAPIT
EndpointsEndpoints
SitesSites
No. No.
ArmsArms
800/800800/800
Africa, Asia, SA, NAAfrica, Asia, SA, NA
215/215215/215660/660660/660
CambodiaCambodia South AfricaSouth Africa
Imm vs. 8-24 wkImm vs. 8-24 wkImm vs. 8 wkImm vs. 8 wkImm vs. 8-12 wkImm vs. 8-12 wk
Death, AIDSDeath, AIDS DeathDeath Death, AIDSDeath, AIDS
When to Start cART During TB Treatment (N Engl J Med, October 20th, 2011)
When to Start cART During TB Treatment (N Engl J Med, October 20th, 2011)
Immediate = First 2 weeks.Immediate = First 2 weeks.
Effects of ART timing on outcomes in CAMELIA and patients with CD4 < 50 in STRIDE and SAPIT
0
5
10
15
20
25
30
CAMELIA STRIDE SAPIT
Immediate Early
34% ↓ p=0.004
42% ↓ p=0.02
68% ↓ p=0.06
NEJM, 2011
AIDS or death
0
2
4
6
8
10
12
14
STRIDE SAPIT
AID
S o
r death
Immediate Early
p=0.67
p=0.34
NEJM, 2011.
Effects of ART timing on outcomes in CAMELIA and patients with CD4 > 50 in STRIDE and SAPIT
Day 0
TB treatment
2RHZE/4RH
Week8 Week 4
Week 2
Rd
Anti TB week 8 (arm 3)
week 1(arm 1)
Week12 Week 20 Week 24
Between arm transfers
cART d4T/AZT/TDF-3TC-EFV
week 4(arm 2)
Wondwossen Amogne Degu , #144
Study Design
RCT to Determine Efficacy and Safety of cART 1 Week after TB Therapy in Patients with CD4 <200 Cells/µL - Ethiopia
Wondwossen Amogne Degu #144Wondwossen Amogne Degu #144
RCT to Determine Efficacy and Safety of cART 1 Week after TB Therapy in Patients with CD4 <200 Cells/µL - Ethiopia
P=0.4
RCT to Determine Efficacy and Safety of cART 1 Week after TB Therapy in Patients with CD4 <200 Cells/µL - Ethiopia
Degu#144Degu#144
RCT to Determine Efficacy and Safety of cART 1 Week after TB Therapy in Patients with CD4 <200 Cells/µL - Ethiopia
Degu#144Degu#144
Degu#144Degu#144
RCT to Determine Efficacy and Safety of cART 1 Week after TB Therapy in Patients with CD4 <200 Cells/µL - Ethiopia
95% CI
0.5-2.9
0.8-7.7
1.1-15.2
TB Incidence Increase after Cessation of 36 Months’ Isoniazid Prophylaxis (IPT) in HIV+ Adults: Botswana
Samandari#147
Samandari#147
Samandari#147
Post-trial (no IPT) n=1678
6H36H
Cumulative TB incidence in the in-trial & post-trial period by study arm for all participants
Cum
ulati
ve T
B in
cide
nce
P=0.04P=0.52
6H 36H
In trial n=1995
6H36H
Nuermberger #127
Nuermberger #127
Nuermberger #127
Nuermberger #127
OIs, Hepatitis Coinfections & Tumors
OIs, Hepatitis Coinfections & Tumors
Tuberculosis TB-IRIS Opportunistic infections Hepatitis co-infections Tumors
Tuberculosis TB-IRIS Opportunistic infections Hepatitis co-infections Tumors
Effects of ART timing on TB-IRIS among patients in STRIDE, SAPIT and CAMELIA trials
0
5
10
15
20
25
30
35
STRIDE SAPIT CAMELIA
IRD
Immediate Early
P<0.01
P<0.01
NEJM; 2011
P<0.05
Severity and Timing of Paradoxical TB-IRIS
• TB IRIS occurred 7.6% (61/806)
* Significant interaction between CD4 + and arm, p =0.014
CD4+ < 50 n= 285
CD4+ ≥ 50 n=521
11.5% (33/285)
5.4% (28/521)
Earlier ART(n=405)
10.4% (42/405)
18.8% (27/ 144)
5.5% (15/261)
Later ART(n=401)
4.7% (19/401)
4.3% (6/141)
5.0% (13/260 )
Luetkemeyer#145
Luetkemeyer#145
Luetkemeyer#145
Management of TB IRIS
• 31% required hospitalization for TB IRIS • No deaths attributed to TB IRIS • 54% received corticosteroids, median treatment 15
days (IQR 7,32) • Infrequent interruption of TB treatment (3) or ART(3)• 34% of those diagnosed with IRIS underwent ≥ 1
invasive procedure: • Lumbar puncture (2)• Thoracentesis (1)• Liver biopsy (1)• Surgical pleural drainage (2)
• FNA (10)• Outpatient abscess drainage (3)• Surgical abscess drainage (1)• Lymph node biopsy (5)
• CRP rapidly decreased on prednisone
Meintjes #146
Research questions
1. What is the effect of prednisone on mycobacterial-specific T-cells and cytokine/chemokine concentrations in TB-IRIS?
2. What is the cellular source of pro-inflammatory cytokines in TB-IRIS?
Meintjes #146
Meintjes #146
Meintjes #146
Neutrophils and monocytes an important source of TNF, IL-6 and IL-12p40 in HIV-TB with higher production of
IL12p40 and TNF by neutrophils in TB-IRIS (preliminary)
OIs, Hepatitis Coinfections & Tumors
OIs, Hepatitis Coinfections & Tumors
Tuberculosis TB-IRIS Opportunistic infections Hepatitis co-infections Tumors
Tuberculosis TB-IRIS Opportunistic infections Hepatitis co-infections Tumors
• Early vs. Deferred (10 weeks) cART in Cryptococcal Meningitis (N=54)– Rx: Fluconazole 800 mg daily and
d4T/3TC/NVP– No use of amphotericin or management of
raised intracranial pressure
• Mortality: 87% early vs. 37% delayed (P=0.002)– Most deaths in immediate ART group occurred
within the first month, possibly due to IRIS– Fluconazole-NVP drug interaction postulated
• Early vs. Deferred (10 weeks) cART in Cryptococcal Meningitis (N=54)– Rx: Fluconazole 800 mg daily and
d4T/3TC/NVP– No use of amphotericin or management of
raised intracranial pressure
• Mortality: 87% early vs. 37% delayed (P=0.002)– Most deaths in immediate ART group occurred
within the first month, possibly due to IRIS– Fluconazole-NVP drug interaction postulated
HIV-associated Cryptococcal Meningitis (Uganda):Immediate vs. Deferred cART
Makadzange A, et al. Clin Infect Dis. 2010; 50(11):1532-8.
Comparison of Kaplan-Meier Survival Estimatesby Treatment Group
Comparison of Kaplan-Meier Survival Estimatesby Treatment Group
1.00
1.00
0.75
0.75
0.00
0.00
0.25
0.25
00 200200 400400 600600 800800
Time to Death (in days)Time to Death (in days)
0.50
0.50
Time to Death (days)Time to Death (days)
P=0.028P=0.028Deferred
Early
Su
rviv
alS
urv
ival
Immediate vs. Deferred cART in Fungal OIs (ACTG A5164) Zolopa AR, et al. PLoS ONE. 2009;4(5):e5575. Epub 2009.
Immediate cART is beneficial
in the ACTG trial !
Chang#955
Chang#955
Chang#955
Chang#955
Benson#96
Benson#96
ZOSTAVAX Is Generally Safe and Immunogenic in HIV+ Adults Virologically Suppressed on ART: Results of a Phase 2, Randomized,
Doubleblind, Placebo-controlled (3:1) Trial
Risk of recurrent/severe herpes zoster (HZ) is increased in HIV+ patients. ZOSTAVAX® (ZV; zoster vaccine live) is generally safe and effective in reducing HZ incidence/severity in HIV– adults ≥50 years old, but has not been evaluated in HIV+ adults. Two doses (day 0, week 6)
Risk of recurrent/severe herpes zoster (HZ) is increased in HIV+ patients. ZOSTAVAX® (ZV; zoster vaccine live) is generally safe and effective in reducing HZ incidence/severity in HIV– adults ≥50 years old, but has not been evaluated in HIV+ adults. Two doses (day 0, week 6)
Conclusions: Administration of 2 doses of ZV in HIV+ adults (CD4 ≥200 copies/μL) virologically suppressed on ART was generally safe (HZ 2 ZV vs. 2 PBO), and immunogenic (mainly CD4>350). Conclusions: Administration of 2 doses of ZV in HIV+ adults (CD4 ≥200 copies/μL) virologically suppressed on ART was generally safe (HZ 2 ZV vs. 2 PBO), and immunogenic (mainly CD4>350).
Tebas#97
Tebas#97
Improved Immunogenicity with High-dose Seasonal Influenza Vaccine in HIV+ Individuals: A Double-blinded, Randomized Trial Comparing
Fluzone High-Dose with Fluzone
HIV (+) Individuals
D0
Immunogenecity evaluations
Vaccine dosing
Fluzone-HD (180µg) (n=97)
Fluzone-SD (45µg) (n=93)
D21-28
Fluzone-HD was approved by the FDA in December of 2009 for adults 65 years and older.
Tebas#97
Tebas#97
Improved Immunogenicity with High-dose Seasonal Influenza Vaccine in HIV+ Individuals: A Double-blinded, Randomized Trial Comparing
Fluzone High-Dose with Fluzone
Standard Dose High Dose P(n = 93), (n = 97),
% subjects (95% CI) % subjects (95% CI)*Seroprotection H1N1 87(80-94) 96(92-100) 0.029 H3N2 92(87-98) 96(92-100) 0.315 B 80(71-88) 91(85-97) 0.03
Seroconversion H1N1 59 (49-69) 75(67-84) 0.018 H3N2 74(65-83) 78(70-87) 0.5 B 34(25-44) 56(46-66) 0.003
*Seroprotection defined as antibody titers ≥ 1:40.Seroconversion defined as a four-fold increase in antibody titers from baseline.
Tebas#97
Tebas#97
Improved Immunogenicity with High-dose Seasonal Influenza Vaccine in HIV+ Individuals: A Double-blinded, Randomized Trial Comparing
Fluzone High-Dose with Fluzone
0 21
Med
ian
GM
T T
iter
(95
% C
I)
0
200
400
600
800
1000
Fluzone SDFluzone HD
0 21
0
200
400
600
800
1000
1200
0 21
0
20
40
60
80
100
120
140
160
180
200
H1N1 H3N2 FluB
*p=0.008 p=0.001 P<0.001
* Comparison between arms at day 21
Tebas#97
Tebas#97
Standard Dose High Dose (n = 8), (n = 14),
% subjects % subjects*Seroprotection H1N1 75 93 H3N2 50 79 B 36 64
Seroconversion H1N1 50 79 H3N2 50 71 B 25 36*Seroprotection defined as antibody titers ≥ 1:40.Seroconversion defined as a four-fold increase in antibody titers from baseline.
• Overall response is lower, but HD also superior• Overall response is lower, but HD also superior
Maldarelli#375
Maldarelli#375
No Effect of Influenza Vaccination on Levels of Persistent Viremia in Individuals on Suppressive cART
OIs, Hepatitis Coinfections & Tumors
OIs, Hepatitis Coinfections & Tumors
Tuberculosis TB-IRIS Opportunistic infections Hepatitis co-infections Tumors
Tuberculosis TB-IRIS Opportunistic infections Hepatitis co-infections Tumors
Boesecke,#133
pegIFN + RBV in Acute HCV:EVR & SVR all GT
284 HIV-infected male patients from 4
European countries (UK, France,
Germany, Austria) with diagnosed
acute HCV infection were treated early
with pegylated interferon and ribavirin
(n=254) or pegylated interferon alone
(n=30). In 88% of cases weight-adapted
dosage of ribavirin (wt ≤75kg: 1000mg;
wt >75kg: 1200mg/d) was used.
Boesecke,#133
pegIFN + RBV in Acute HCV:EVR & SVR only GT 1/4
85,7
707166,5
0
10
20
30
40
50
60
70
80
90
EVR SVR
% pegIFN mono
pegIFN/ RBV
p=0,236
p=0,751
174/22114/2012/14 137/193
Boesecke,#133
pegIFN + RBV in Acute HCV:EVR & SVR only GT 2/3
66,760
96
0
10
20
30
40
50
60
70
80
90
100
EVR SVR
% pegIFN mono
pegIFN/ RBV
94
p=0,029 p=0,007
4/6 24/25 6/10 31/33
Boesecke,#133
pegIFN + RBV in Acute HCVSummary
For GT 2/3 infections addition of Ribavirin shows
beneficial effect on cure rates.
For GT 1/4 infections the role of RBV needs further
evaluation.
In addition the role of DAAs in treatment of AHC needs
to be explored.
Ingiliz#752
Hepatitis C Reinfection in HIV+ MSM
45 HIV+ MSM with acute HCV infection
40 SVR5 SCEpisode 1
16 SVR3 SCEpisode 2(8 pending)
4 SC2 SVR
Episode 3(1 pending)
1SC
Episode 4 1SCSC=spontaneous clearance, SVR=sustained virological response, C=chronification
Ingiliz#752
Hepatitis C Reinfection in HIV+ MSM
Genotype distribution at first and second HCV episode (n=45) and genotype switches (n=26)
1 3 1
1 4 1
1a 4, 4d 6
1a 3a 1
1a 1b 1
1b 1a 1
1b 4, 4d 2
3 1a 4
3 4 1
3a 1 1
4 1a,b 6
4d 1b 1
26 (58%)
Hepatitis C Reinfection in HIV+ MSM
Ingiliz, CROI 2012, Abstract # Q-1004
Switcher Non-Switcher Clearer Non-Clearer
Median HCV-RNA [IU/mL] 310000 360000 n.s. 210200 507400 n.s.
Median ALT [U/L] 301 463 n.s. 498 306 n.s.
Median AST [U/L] 138 203 n.s. 296 139 n.s.
Median GGT [U/L] 194 179 n.s. 268 180 n.s.
Median CD4 cells [/mm3] 498 492 n.s. 681 472 p=0.03
ART [n] (%) 19 (73) 11 (61) n.s. 4 (57) 26 (68) n.s.
IL28B C/C [n] (%) 5 (33) 5 (38) n.s. 4 (80) 7 (29) p=0.05
Patients with or without genotype switch and with or without viral clearance at second HCV episode
Ingiliz#752
Virion assembly
Translation and polyproteinprocessing
RNA replication
Receptor bindingand endocytosis
Fusion anduncoating
(+) RNA
Transport and release
Treatment Targets against HCV
Protease Inhibitors
Boceprevir*
Telaprevir* *NS3/4A PIs
Study 110: Telaprevir in HIV/HCV
co-infected patientsPart A: no ARTPart A: no ART
240 48 72Weeks 12 36
PR PR
PR PR
T/PR TVR + PR Follow-upSVR
Follow-upPR48
(control)
SVRPbo + PR
PR PR
PR PR
Follow-upPR48
(control)
SVRPbo + PR
T/PR TVR + PR Follow-upSVR
Part B: ART (EFV/TDF/FTC or ATV/r + TDF + FTC or 3TC)Part B: ART (EFV/TDF/FTC or ATV/r + TDF + FTC or 3TC)
PR – Pegylated interferon/ribavirin, TVR – Telaprevir,SVR – Sustained virologic responseDieterich D
#46
Dieterich D#46
71
33
69
50
80
50
74
45
0
10
20
30
40
50
60
70
80
90
100
Pat
ient
s w
ith
Und
etec
tabl
e H
CV
RN
A (
%)
No ART EFV/TDF/FTC ATV/r/TDF/FTC Total
n/N =n/N = 5/75/7 11/1611/16 12/1512/15 28/3828/38
T/PRT/PR PRPR2/62/6 4/84/8 4/84/8 10/2210/22
Study 110: SVR Rates 12 Weeks Post-Treatment (SVR12)
*Patient was defined as SVR12 if HCV RNA was < LLOQ in the visit window*Patient was defined as SVR12 if HCV RNA was < LLOQ in the visit window
Sulkowski #47
Study Design: BOC + PEG/RBV for HCV/HIV co-infection (SVR12 results)
• Two-arm study, double-blinded for BOC, open-label for PEG2b/RBV– 2:1 randomization (experimental: control)– Boceprevir dose 800 mg TID
• 4-week lead-in with PEG2b/RBV for all patients– PEG-2b 1.5 µg/kg QW; RBV 600-1400 mg/day divided BID
• Control arm patients with HCV-RNA ≥ LLOQ at TW 24 were offered open-label PEG2b/RBV+BOC via a crossover arm
Weeks 12 24 28 48 72
PEG2b+RBV 4 wk
Placebo + PEG2b + RBV44 wk
Boceprevir + PEG2b + RBV44 wk
Follow-upSVR-24 wk
Follow-upSVR-24 wk
PEG2b+RBV 4 wk
Arm 1
Arm 2
Futility Rules
Sulkowski #47
8.814.7
23.532.4 29.4 26.5
4.7
42.2
59.4
73.465.6
60.7
0
20
40
60
80
100
4 8 12 24 EOT SVR12
Treatment Week
PR B/PR
%
HC
V R
NA
Un
det
ecta
ble
3/34 3/64 5/34 27/64 8/34 38/64 11/34 47/64
Virologic Response Over Time†
10/34 9/3442/64 37/61
† Three patients undetectable at FW4 have not yet reached FW12 and were not included in SVR12 analysis.
Tolerability and safety: first signals from pilot trials
• 34% and 23% of T/PR and PR patients, respectively had rash; no severe rashes were reported in either group
• Preliminary safety data of B/PR in co-infected patients showed a profile consistent with that observed in mono-infected patients (anemia 41% vs. 26%)
• HIV Breakthroughs were observed in 3/64 patients in the B/PR group and 4/34 patients in the control group
Dieterich, # 46Sulkowski # 47
Management Issues with Co-medicationshttp://www.interaccionesVIH.com
Resumen VII – Interacciones farmacológicas y farmacocinética
Dr. Esteve Ribera
Dieterich, # 46Sulkowski # 47
Futility rules
W4 W12 W24W4 W12 W24 W48
HCV -RNA>1000 IU/ml
PEG -IFN+RBV
Stop
Telaprevir
HCV - RNA>1000 IU/ml
Stop
HCV -RNA>20 IU/ml
Stop
PEG -IFN+RBV
Boceprevir
HCV -RNA>100 IU/ml
Stop
HCV -RNA>20 IU/ml
Stop
Initial HCV RNA decline provides information on treatment prediction outcome
HCV GT-1 SVR Rates Over Time According to the Type of anti-HCV Therapies
IFN
IFN + RBV
Peg-IFN + RBV
Peg-IFN+ RBV + Boceprevir/Telaprevir
15-20%
35-40%
45-50%
70-75%
-
-
17-35%
61-74%
1990
1998
2001
2011
HCV HCV/HIV
*Monitor fibrosis stage annually, preferably with two established methods. Treat with triple therapy, if rapid progression.
Management of HCV/HIV Coinfected GT-1 Patients According to Fibrosis Stage & Prior Rx Outcome
Rockstroh#72
• INX-184 (Inhibitex)
DAA in the Pipeline (2012-20)phase 1 phase 3phase 2
NS3protease inhibitors
NS5B polymeraseinhibitors
•Telaprevir (Vertex/Johnson& Johnson)
•Boceprevir (MSD)
NS5Ainhibitors
• ACH-1625 (Achillion)• BMS-650032 (BMS)• PHX1766 (Phenomix)• VX-813 (Vertex)• GS-9256 (Gilead)• GS-9451 (Gilead)
• MK-0608 (Merck)• VCH-222, -759, 916
(ViroChem)
• ABT-450 (Abbott/Enanta)• BI 201335 (Boehringer)• CTS1027 (Conatus)• ITMN-191-Danoprevir-R7227
(InterMune/Roche)• MK-7009-Vaniprevir (MSD)• Narlaprevir (MSD)• TMC435 (Medivir/J&J)
• ABT-333 (Abbott)• ANA598 (Anadys)• BI 207127 (Boehringer)• Filibuvir (Pfizer) • GS 9190 (Gilead)
• BMS-790052 (BMS)• PPI-461 (Presidio)• GS-5885 (Gilead)
Nucleos/tide • IDX184 (Idenix)• PSI-7851/7977 (Pharmasset)• R7128 (Pharmasset/Roche)• GS7977 (Gilead)
Non-nucleoside
• GS-7977 is a potent, specific HCV nucleotide analog
• Safe and well-tolerated in clinical studies
• Once daily, with or without food• Potent antiviral activity• High barrier to resistance
– No virologic breakthrough to date
O
C H
FHO
ON
NH
O
O
PO
O
NH
O
O C H3
GS-7977 Background
Lawitz E, et al. J Lawitz E, et al. J Hepatol 2011; 54: S543. 2011; 54: S543. Lawitz E, et al. J Lawitz E, et al. J Hepatol 2011; 54: S543. 2011; 54: S543.
• To evaluate the antiviral activity of 12 weeks GS-7977 + RBV in genotype 1 patients who were either:
– Prior null responders (<2 log10 reduction in HCV RNA at Week 12 of a Peg/RBV regimen)
– Treatment-naïve
• RBV dosing in all arms, independent of HCV genotype, was 1000 mg for patients <75 kg and 1200 mg for those ≥75 kg
ELECTRON Study Design for HCV Genotype 1 - Interferon-Free/-Sparing Regimens
Genotype 1 Treatment-naïve (GS-7977 + RBV)Genotype 1 Treatment-naïve (GS-7977 + RBV)
Genotype 1 Null Responders (GS-7977 + RBV) Genotype 1 Null Responders (GS-7977 + RBV)
n=25
SVR12
SVR12
n=10
4 8Wk 0 12 24
Gane#54LB
Time (Weeks)
0 1 2 3 4
HC
V R
NA
(lo
g 10I
U/m
l)
0
1
2
3
4
5
6
7
GS-7977/RBV GT-1 Null Responders GS-7977/RBV GT-1 Treatment NaiveGS-7977/RBV GT2/3 Treatment Naive
Assay LLOD 15 IU/mLAssay LLOD 15 IU/mL
Rapid Rapid Viral Suppression in Prior Null and Treatment-Naïve Genotype 1 Patients
Genotype 1 null respondersGenotype 1 treatment-naïveGenotype 2/3 treatment-naïve
Gane#54LB
Gane#54LB
100% Genotype 1 Prior Null RespondersHad HCV RNA <LOD at End of Treatment
Genotype 1
Null Responders
(N=10)
Genotype 1
Treatment-naïve
(N=25)
Genotype 2/3 Treatment-naïve
(N=10)
n/N % <LOD n/N % <LOD n/N % <LOD
Week 1 1/10 10 7/25 28 2/10 20
Week 2 7/10 70 17/24 71 10/10 80
Week 4 10/10 100 25/25 100 10/10 100
Week 10 9/9 100 25/25 100 10/10 100
Week 11 9/9 100 16/16 100 10/10 100
Week 12 9/9 100 6/6 100 10/10 100
SVR 4 1/9 11 -- -- 10/10 100
OIs, Hepatitis Coinfections & Tumors
OIs, Hepatitis Coinfections & Tumors
Tuberculosis TB-IRIS Opportunistic infections Hepatitis co-infections Tumors
Tuberculosis TB-IRIS Opportunistic infections Hepatitis co-infections Tumors
Cancer Stage, Age at Diagnosis, and Survival Comparing HIV+ vs. HIV- Individuals with Common Non-AIDS-Cancers
Silverberg, #903
Silverberg, #903
Source population: 22,081 HIV(+) and 230,069 HIV(‐) individuals matched by age, sex, clinic, and initial year of follow‐up.Source population: 22,081 HIV(+) and 230,069 HIV(‐) individuals matched by age, sex, clinic, and initial year of follow‐up.
Objective: To compare age at diagnosis, stage at diagnosis and 5‐year survival for HIV(+) and HIV(‐) individuals diagnosed with prostate, anal, lung and colorectal cancers, and Hodgkin lymphoma.
Objective: To compare age at diagnosis, stage at diagnosis and 5‐year survival for HIV(+) and HIV(‐) individuals diagnosed with prostate, anal, lung and colorectal cancers, and Hodgkin lymphoma.
Cancer Stage, Age at Diagnosis, and Survival Comparing HIV+ vs. HIV- Individuals with Common Non-AIDS-Cancers
Silverberg, #903
Silverberg, #903
Cancer Stage, Age at Diagnosis, and Survival Comparing HIV+ vs. HIV- Individuals with Common Non-AIDS-Cancers
Silverberg, #903
Silverberg, #903
Incidence and Predictors of Non-Hodgkin Lymphoma Among HIV-Infected Persons on Suppressive ART
Achenbach, #131
Achenbach, #131
• HIV-infected persons continue to have high incidence of NHL despite suppressive ART– Our study: 15 cases per 10k py– U.S. SEER rate (2004-2008): 2 per 10k py– Kaiser Permanente HIV-negative: 1.7 per 10k py
• Level of immune suppression continues to be an independent predictor of NHL after controlling for age, race, and sex.
• HIV viremia, even low level, also likely contributes to NHL risk.
• HIV-infected persons continue to have high incidence of NHL despite suppressive ART– Our study: 15 cases per 10k py– U.S. SEER rate (2004-2008): 2 per 10k py– Kaiser Permanente HIV-negative: 1.7 per 10k py
• Level of immune suppression continues to be an independent predictor of NHL after controlling for age, race, and sex.
• HIV viremia, even low level, also likely contributes to NHL risk.
AIDS-PCNSL Treated with HAART and Radiation-Sparing Therapy: Rituximab, Methotrexate and
Leucovorin [NCT00267865]
Uldrick #911
Uldrick #911
Median (range) follow-up 42 months (7 months ‐ 7 years)
78% (60 to 90%)
Treatment of Anal Intraepithelial Neoplasia in 148 HIV+ MSM: A Triple-arm RCT of Imiquimod, Topical
5-Fluoruracil (5FC), and Electrocautery
Richel#135LBRichel
#135LB
ImiquimodImiquimod 5FC5FC ElectrocauteryElectrocautery P valueP value
Complete response
Recurrence at 6 months
Severe Side Effects
Complete response
Recurrence at 6 months
Severe Side Effects
26%
25%
43%
26%
25%
43%
17%
57%
27%
17%
57%
27%
41%
17%
18%
41%
17%
18%
=0.03
-
=0.02
=0.03
-
=0.02
Imiquimod, 3 times weekely; 5-fluoruracil (5FC), twice a week; Electrocautery, monthlyDuration of the treatment: 4 months.
Evaluation: high-resolution anoscopy with biopsies 4 weeks and 6 months after treatment.
Imiquimod, 3 times weekely; 5-fluoruracil (5FC), twice a week; Electrocautery, monthlyDuration of the treatment: 4 months.
Evaluation: high-resolution anoscopy with biopsies 4 weeks and 6 months after treatment.
CJ AchenbachC. Boesecke
C. ChangK. DooleyM. EggerX. Forns
CJ AchenbachC. Boesecke
C. ChangK. DooleyM. EggerX. Forns
AcknowledgementsAcknowledgements
http://retroconference.orghttp://retroconference.org
A. LuetkemeyerG. Meintjes
E. NuermbergerJ. RockstrohW. SimonsP. Tebas
A. LuetkemeyerG. Meintjes
E. NuermbergerJ. RockstrohW. SimonsP. Tebas