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Rapporteur Session Summary - Track B Marco Vitoria Chris Duncombe Francois Venter Omar Sued

Rapporteur Session Summary - Track B Marco Vitoria Chris Duncombe Francois Venter Omar Sued Polly Clayden Valeria Saraceni. Track B: Important Messages. Treatment works as long patients have access and can stay on it. Retention & loss to follow up are major challenges to reach UA.

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Rapporteur Session Summary - Track B Marco Vitoria Chris Duncombe Francois Venter Omar Sued

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  1. Rapporteur Session Summary - Track B Marco Vitoria Chris Duncombe Francois Venter Omar Sued Polly Clayden Valeria Saraceni

  2. Track B: Important Messages Treatment works as long patients have access and can stay on it. Retention & loss to follow up are major challenges to reach UA. Accelerating access to ART is the most effective way of reduce the early HIV mortality. Task shifting and mentoring are successful strategies to improve access in RLS. Lack of infrastructure and diagnostics continue to be important barriers to scale up ART in children. Being simple (and not "simplistic") seems to be the best way to continue to scale up prevention, treatment and care. The unified strategy: HIV prevention must marry treatment with involvement of the community.

  3. Selected Topics • Treatment Outcomes in RLS • Task shifting Experiences • New Drugs • ABC controversies • TB/HIV • ART in Children • Early ART initiation • Immune Activation and CV risk

  4. Outcomes of ART 5 year survival on HAART in Botswana LTF and mortality rates in the first year of HAART in Latin America and the Caribean 88.6% (88.1 – 89.2) Puvimanasinghe JPA et al. IAC 2008 (MOAB0204) Jacobs-Jokhan et al IAC 2008 (TUPDB205)

  5. More health workers needed to fight AIDS Traditional model Task shifting model Ivers LC et al (IAC 2008, WEAXO103)

  6. Tecnicos de Medicina in Mozambique Majority of NPC trainings completed Gimbel-Sherr K et al (IAC 2008, WEAX0105

  7. Roll Up to National Level 150 150 78% ↓ in physician demand for HIV 183% ↑ in physician capacity for non-HIV 77 51% 17 11% 7

  8. Naive-patients PrEP New indications for “New drugs”? Markowitz, IAC 2008 (TUAB0102) Cohen, IAC 2008 (TUPL0101)

  9. Who is still taking d4T? Marlink R et al , IAC 2008 (WEAXO106) Hosseinipour M et al, IAC 2008 (TUAB0105)

  10. ABC and MI Risk

  11. HIV/TB Issues X/MDR TB emphasizes importance of infection control for TB Ten key TB infection control actions should be implemented TB/HIV is critical issue for drug users The newly released WHO guidelines on TB/HIV and drug use require urgent implementation

  12. Survival After a TB diagnosis, by exposure to HAART, in the THRio Cohort, Rio de Janeiro, Brazil Log-rank test – p<.001 Saraceni V et al, IAC 2008, MOAB0305

  13. TB/HIV – What about TB Prevention? Vitoria M et al, IAC 2008 (WEPE0140) Pushing IPT ahead

  14. ART outcomes - more good news National programmes reporting good outcomes 1 year survival estimated as 93-95% 2 year survival 91%

  15. ART in Children • More children are receiving ART • Increased from 75,000 in 2005 to almost 200,000 in 2007 • 19 of 20 countries with highest PMTCT burden are in sub-Saharan Africa • 90% of burden is in 20 countries Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector, WHO/UNAIDS/UNICEF 2008

  16. Therapy for Early HIV Infection Clinical Symptoms Symptomatic (Stages 3 & 4) Asymptomatic (Stages 1 & 2) < 200 500 200 350 CD4 Count (cell/mm3)

  17. Effectsof HIV, Host and ART (Currier,WHEAX0102 ) HIV Replication ART Effects Immune Activation Inflammation Altered Lipid Effects Endothelial Function Macrophage recruitment Insulin Resistance HIV Diabetes Smoking Hypertension Genetics

  18. The scale up of AIDS treatment is the most ambitious public health undertaking of our lifetimes--it is the first attempt to treat a chronic disease among millions of poor people in the developing world. • The future success of ART scale up depends on strengthening primary care worldwide. • The struggle for AIDS treatment can be a catalyst for strengthening health systems in low and middle income countries. Gregg Gonsalves, ART Scale Up (THPL0103)

  19. What can be expected in 2010 Vienna … UA Report - achievements and way forward More on ART, non-AIDS events & inflammatory markers POC for diagnosis and ART monitoring More on Operational Research More "one pill-once daily" options More conclusive data on TDF safety profile in specific populations More conclusive studies on ABC safety and efficacy Role of new classes in initial therapy and MDR management (NRTI sparing regimens ?) When to Start debate probably will continue…

  20. Thanks

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