HIV Infection in Women in Vinnitsia Oblast€¦ · • The patient’s examination at each visit did not show any objectively positive changes; breast is deformed, nipple is inverted,

КЗ «Вінницький обласний клінічний Центр профілактики та боротьби зі СНІДом»

WAVE Workshop «On track to improve health of women living with HIV – Ukraine»Kyiv, Ukraine, July 5-6, 2019

HIV Infection in Women in Vinnitsia Oblast Clinical and Epidemiological Situation

Ihor MatkovskyChief Physician

HIV Dynamics in the Region(Vinnitsia Oblast)

Official Statistical data of Vinnitsia Oblast Clinical AIDS Prevention Centre and CPH of MoH of Ukraine, 2019

75

190

339

0

100

200

300

40019

88 -1

995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Died of AIDS Developed AIDS Officially Registered

Registered Patients with HIV in the Region, by Sex and Age (Vinnitsia Oblast, 1988 – 2018)

73 3 32

1 302

151

0-14 15-17 18-24 25-49 старше 50

menwomen


ART Coverage – 82% of Active Follow-up Group

(Vinnitsia Oblast)

12 12 12 13 17 19 21

290378 452 510

657750

849755

9701 146

1 277

1 5681 721

1 899

2012 2013 2014 2015 2016 2017 2018

GirlsWomenTotal


1986 Patients Have Been Continuously on ART as of 01.06.2019 (Vinnitsia Oblast)

89445%

105053%

171%

251%

Women

Men

Girls

Boys

•Official Statistical data of Vinnitsia Oblast Clinical AIDS Prevention Centre and CPH of MoH of Ukraine, 2019

Age Distribution of Women on ART as of01.06.2019

(Vinnitsia Oblast)


DTG and Women• As of 01.06.19 ARV therapy was provided to 1,986 patients including 959 patients on

DTG-based regimens, which is 48.29% of the total number of people on ART, 543 of whom were women, i.e. 56.62%.

• Three pregnancies on DTG-based regimen:- First pregnancy (the woman presented after 12 weeks) ended in childbirt in February

2019; the follow-up of a child continues; - Second pregnancy (the woman presented at 17 weeks) - follow-up and lab

monitoring are performed in accordance with the current clinical protocol; - Third pregnancy (the woman presented at 12 weeks): HIV/TB coinfection; the patient

receives TBC maintenance treatment (Izoniazid, Rifampicin); her ART regimen:TDF/FTC+ DTG was changed to TDF/FTC/EFV (to avoid unwanted interaction between DTG and Rifampicin) (could we have possible doubled DTG dosage during pregnancy?) and the woman is followed up.


Distribution of ART Regimens


1 986

0

543416959

patients on DTG

Total on ART

Women on DTG

Men on DTG48,29 56,62%43,38%

HIV Prevalence among Pregnant Women


0,45

0,52 0,520,55 0,55

0,48 0,47 0,45

0,390,36

0,320,3

0,33

0,180,23

0,27 0,27 0,280,25

0,16

0,24 0,260,22 0,24

0,15

0,220,25

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Ukraine Vinnitsia obl.

Correlation between women who became pregnang and gave birth knowing their HIV+ status, and women who learned their HIV+ status during their current pregnancy (Vinnitsia Oblast)

4

26 2732

3746

35 35

21

3742 38

31 33 36 33 33 3441

68 65 6370

82

68 68

55

2006 2008 2010 2012 2014 2015 2016 2017 2018

Під меднаглядом Вперше взяті під МН Всього народили


In care First time linked to care

Total deliveries

Children Born to HIV+ Mothers(Vinnitsia Oblast)


Cancer Manifestations in HIV+ Women(Vinnitsia Oblast, 2018)

HIV related 241. Lymphoma in the brain 8 (33%)2. B-cell non-Hodgkin lymphoma 4 (17%)3. Kaposi sarcoma 4 (17%)4. iInvasive cervical cancer 8 (33%)

Not related to HIV 71. Cutaneous neoplasms 42. Breast carcinoma 13. Hepatic haemangioma 2


Clinical Case(Breast Carcinoma)

Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019

Clinical Case

• Patient V, born in 1972

• HIV antibodies detected on 21.06.2018 (code 113.2)• She first presented at the Centre on 10.07.2018, when she was

examined and treated at PROC (Podil Regional Oncology Centre) and was tested for HIV antibodies.

• Diagnosis: В 22.2, clinical stage IV. Body weight loss over 10% in 6 months. Recurrent oropharingeal candidiasis. Са in lower outer quadrant of left breast - ІІb stage, ІІ clinical group (T2 N1 M0)


Са Diagnosis Verification

• 21.05.2018 – cytology – Adenocarcinoma

• 22.05.2018 – histology – Infiltrating carcinoma

• 25.05.2018 – IHC, cancer-specific marker – HER2 neu expression +++, PR – negative, 0%, ER – weak positive reaction, 14%


Additional Examinations 1

• Blood chemistry (31.05.2018):

– AST – 1027,9 U/L, ALT – 903,6 U/L.

–CBC (30.05.2018): leucocytes – 5,8*109/L, red blood cells –4,01*10’12/L, haemoglobin 96 g/L, platelets - 390*10’9/L.

–HBsAg – 13.07.2018 – negative

–Anti-HCV – 13.07.2018 – positive


• Mammography (17.04.2018) – the picture is typical for Ca of left breast

• Breast sonography (17.05.2018) – neoplasm in left breast (size126*155) with the signs of infiltraing growth. Mts in the left axillary lymph node

• CT of thoracic spine (15.05.2018) – Scoliosis. Degenerative changes of thoracic spine, more expressed in Т4-Т8, complicated with spondylarthrosis deformans (Т3-Т10)



Sonography (17.05.2018)


Axillary lymph nodeBreast



• Helical computed tomography (30.05.2018р) of brain, chest CT, abdominal CT, pelvic examination with IV contrast “Tomohexol 350”. Scan slice thickness 5 mm. CT for the signs of additional growth in left breast. Hepatomegalia, hepatosteatosis.

• TB doctor consultation (11.07.2018):

no data on pulmonnary TB identified

• Consultation with TB specialist – orthopedist (06.08.2018): no data on thoracic spine TB identified. Disseminated thoracic spine ostechondrosis with pain syndrome.


Additional Consultations

Treatment

• Consultation with oncologist – chemotherapist on 09.07.2018

• Pain control if needed (Nalbuphine 10mg i/m in case of pain)

• Chemoreduction: Docetaxel 128mg + Herzeptin 496 mg(thereafter - 372 mg), 4 cycles in case ALT and AST activity normalizes


ART

On 06.08.2018 ART regimen ABC/3TC/DTG is prescribed(3 months after the confirmation of Са!)


Chemotherapy


• 06.11.2018р – 07.11.2018: – Herceptin 496mg– Docet. 126 mg

• 21.12.2018р – 22.12.2018: – Herceptin 544 mg– Docet. 134 mg



• 20.05.2019р – 22.05.2019: – Herceptin 552 mg– Mesna 600 mg– Cyclophosphamidum 1 079 mg– Epirubicin 162 mg

• 21.06.2019р – 22.06.2019: – Herceptin 420 mg– Doxorubicin 109 mg– Cyclophosphamidum 1 086 mg

Treatment Dynamics

• The patient’s examination at each visit did not show any objectively positive changes; breast is deformed, nipple is inverted, the structure is bulging and dense.

• Left axillary lymph node is elevated and painful• Oncologists plan to intensify the chemotherapy protocol


Sonography (21.06.2019)


Axillary lymph nodeBreast

Breast - general appearance


Conclusions• If it does not disturb you – it does not mean that it is ‘absent’

• Breast cancer affects the female body irrespective of age and HIV status

• After 40 years of age women should examine their breaststhemselves and see a doctor every year, and have mammography every 1-2 years

• A woman abuses herself if she delays a visit to a doctor for months, if she feels stress and permanent fear


THANK YOU FOR ATTENTION!

Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019

QUESTIONS

Documents

HIV Infection in Women in Vinnitsia Oblast€¦ · • The patient’s examination at each visit did not show any objectively positive changes; breast is deformed, nipple is inverted,