Optimising treatment for life-long management of HIVregist2.virology-education.com/presentations/2019/13... · 2019-05-29 · | 2 Introduction Kwasi Torpey School of Public Health,

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Optimising treatment for life-long management of HIV

Symposium at the 2019 INTEREST Congress Accra, Ghana

Artwork Credit: Martin Freeman, Universal

Diagnosed with AIDS in 1990, Martin lives in

San Francisco where he continues to create new pieces.

PHGH/HIV/0519/106

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Introduction

Kwasi TorpeySchool of Public Health, University of Ghana, Accra, Ghana





PHGH/HIV/0519/106

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Faculty and disclosures

Michelle MoorhouseWits Reproductive Health and HIV InstituteJohannesburg, South Africa• Speaker fees and honoraria from Gilead Sciences,

AbbVie, Cipla and Janssen, and has received

conference sponsorship from BD, Gilead, Merck,

Cipla and Mylan

• Part of ART optimisation collaborations

• Funding from USAID, UNITAID and study drug

donations from ViiV and Gilead

Kwasi TorpeySchool of Public Health, University of Ghana, Accra, Ghana• Johnson & Johnson – Speakers Bureau

and Scientific Advisory Board

Lloyd MulengaUniversity of Zambia, Lusaka, Zambia• Johnson & Johnson – Scientific Advisory

Board and honoraria

Serge Paul EholieUniversity Felix Houphuet-Boigny, Abidjan, Ivory Coast• No reported conflict of interest

PHGH/HIV/0519/106

Fafa Addo BoatengJohnson & Johnson Global Public Health• Johnson & Johnson employee

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Learning outcomes

After completing the session, delegates will be able to:

• Review the main challenges around long-term management of HIV adult and

pediatric patients throughout Africa (SOLO3)

‒ Discuss the issues relating specifically to long-term use of PIs in HIV

management

• Describe the latest developments around antiretroviral therapy (ART) and how this

affects local clinical management (SOLO3)

‒ Discuss management options in managing second- and third-line treatment

• Apply the latest clinical data and HIV treatment guidelines to clinical practice in their

own countries (SOLO4)

‒ Discuss optimal treatment strategies available in West Africa

PHGH/HIV/0519/106

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Program overview

PHGH/HIV/0519/106

Time Topic Speaker

13:30 Welcome, introduction and objectives followed by

WHO technical update and 2018 guidelinesKwasi Torpey (Ghana) (Chair)

13:40

Faculty discussion: Understanding the role of PIs in antiretroviral

treatment in Africa

• Describe optimizing best practice with PIs around second- and third-

line treatment in Africa as part of long-term strategic anti-HIV therapy in

adult and paediatric patients

All faculty

(led by Kwasi Torpey)

14:10 Case study 1: Second-line treatment

• Selecting a PI in second line in clinical practice in AfricaLloyd Mulenga (Zambia)

14:25 Case study 2: Third-line treatment

• Switching to a PI in third line in clinical practice in Africa

Michelle Moorhouse

(South Africa)

14:40 New Horizons Advancing Pediatric HIV Care initiative

followed by

Discussion: Implementing New Horizons in Africa

Fafa Addo Boateng

(J&J Global Public Health)

Led by Lloyd Mulenga

15:00 Close Kwasi Torpey

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Keypad voting

• Please make your selection (s)

• Then press OK

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Which of the following colours are in the Ghanaian flag? (select three)

1. Blue

2. Yellow

3. Red

4. Orange

5. Green

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Ghanaian flag

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Disclaimer

• The meeting is organized and supported by Janssen Pharmaceutical

Companies of Johnson & Johnson

• The views expressed in these slides are those of the individual

faculty members and do not necessarily reflect the views of Janssen

Pharmaceutical Companies of Johnson & Johnson

• The program and the content of the presentations is owned by the

Scientific Third Party Committee and the respective faculty members

and may include discussions on off-label data of products and

therapies

PHGH/HIV/0519/106

Confidential | 10

World Health Organization; 2018.

https://www.who.int/hiv/pub/guidelines/ARV2018update/en/

WHO technical update and 2018 guidelines

Kwasi TorpeySchool of Public Health, University of Ghana,

Accra, Ghana

Confidential | 11

WHO ARV guideline development

Recommendations are formulated following WHO standards

for guideline development and based on:

• Supporting evidence

– Up-to-date systematic reviews of the evidence

– Information regarding values and preferences

• Cost and cost-effectiveness

• Simplicity



Confidential | 12

WHO ARV guidelines – timelines

2016 Dec 2018

Updated

consolidated

guidelines on

use of ARV

drugs for

treating and

preventing

HIV infection

Latest guidelines

provide updated

recommendations

May 2018

Drug safety alert

indicating that to

consider avoiding

DTG use during the

peri-conception

period until more

evidence is

available

/

World Health Organization; 2016. http://www.who.int/hiv/pub/arv/arv-2016/en

World Health Organization; 2018. https://www.who.int/hiv/pub/guidelines/ARV2018update/en/

Confidential | 13

Recommendations on choice of first- and second-line ART

First-line

• Preferred: EFV (600 mg)-based regimen

• Alternative: DTG- or EFV (400 mg)-based regimen

• Limited efficacy and safety data in pregnancy

• Limited data with concomitant TB treatment

• TAF was not recommended because of unclear efficacy or safety benefits

over TDF, and concerns over limited clinical experience when used in

pregnancy or with rifampicin-based TB treatment

• ART recommendations for children were unchanged in 2016 from 2013

because of lack of approved DTG dosing for use in children

WHO ARV 2016 guidelines –Considerations at the time

2016

World Health Organization; 2016. http://www.who.int/hiv/pub/arv/arv-2016/en


Confidential | 14

WHO technical update and 2018 ARV guidelines

• Updated findings have shown DTG can be

more effective than EFV-based regimens in

treatment-naïve adults

‒ Higher viral suppression and CD4 cell count

recovery rates

• DTG also has a lower potential for drug-drug

interactions than EFV, and is protective against HIV-2

‒ Some concerns exist surrounding the use of DTG

in women and girls

World Health Organization. HIV treatment interim guidance. Accessed August 2018


Confidential | 15

WHO ARV 2018 guidelines – first line

Populations Preferred Alternative Special

situations

Adult men and adolescent boys

TDF + 3TC

(or FTC) +

DTG

TDF + 3TC

(or FTC) +

EFV 600mg

TDF + 3TC

(or FTC) +

EFV 400mg

AZT + 3TC +

EFV 600mg

TDF + 3TC (or

FTC) + PI/rAdult

women

and

adolescent

girls

Pregnant or breastfeedinga

Not of childbearing potential

Of

childbearing

potential

Offered and using effective

contraception

Offered but not

using effective

contraception

OR

without access to

contraception

OR

want to become

pregnant

Choose to use

DTG after

informed

choice

Choose to use

EFV after

informed

choice

TDF + 3TC

(or FTC) +

EFV 600mg

TDF + 3TC

(or FTC) +

EFV 400mg

TDF + 3TC (or

FTC) + ATV/rb

AZT + 3TC +

EFV 600mg

TDF + 3TC (or

FTC) + RAL

a) Based on programmatic practicality and uncertainty surrounding possible DTG effects after the neural tube closes at 28 days of gestation as noted by the originator and FDA, previous

safe period after 8 weeks is now extended to after the first trimester. In practice, the majority of women will not yet know that they are pregnant during the first 8‒12 weeks of pregnancy

b) If the national prevalence of pre-treatment resistance to EFV or NVP is 10% or higher or if no other alternatives are available


Confidential | 16

Population Preferred Alternative Special situations

Children ABC + 3TC + DTGa

ABC + 3TC + LPV/r

ABC + 3TC + RALb

ABC + 3TC +

EFVc (or NVP)

AZT + 3TC +

EFVc (or NVP)

AZT + 3TC +

LPV/r (or RAL)

Neonates AZT + 3TC + RAL AZT + 3TC + NVP AZT + 3TC + LPV/rd

http://www.who.int/hiv/pub/arv/arv-2016/en/

WHO ARV 2018 guidelines – first line (cont’d)

a) For age and weight groups with approved DTG dosing

b) RAL can be used as an alternative regimen if LPV/r solid formulations are not available

c) EFV should not be used for children younger than three years of age

d) If starting after 2 weeks of age


Confidential | 17

Population Failing first-line

regimen

Preferred second-line

regimenb

Alternative second-line

regimens

Adults and

adolescents

(incl. women and

adolescent girls who

are of childbearing

potential or are

pregnant)a

2 NRTIs + DTGb 2 NRTIs + ATV/r

or LPV/r

DRV/rg,h ± DTGi b +

1–2 NRTIs

(if possible, consider

optimization

using genotyping)

2 NRTIs + EFVc 2 NRTIs + DTGb

Children

2 NRTIs + DTG2 NRTIs + ATV/rd

or LPV/r

2 NRTIs + LPV/r 2 NRTIs + DTGe

2 NRTIs + NNRTI 2 NRTIs + DTGf

a) An optimized NRTI backbone should be used such as AZT following TDF or ABC failure and vice versa

b) Women and adolescent girls of childbearing potential with consistent and effective contraception and who are fully informed of the benefits and risks can use DTG

c) If population-level pretreatment resistance to EFV or NVP is ≥10%, the choice of alternative options to EFV needs to be made weighing the drug availability and toxicity profile

d) ATV/r can be used as an alternative to LPV/r among children older than 3 months

e) This applies to children for whom approved DTG dosing is available. RAL should remain preferred second-line regimen for the children for whom approved DTG dosing is not available

f) ATV/r or LPV/r should remain the preferred second-line treatment for the children for whom approved DTG dosing is not available

g) For PI-experienced people, the recommended DRV/r dose should be 600 mg/100 mg bd

h) Children <3 years should not use DRV/r

i) DTG-based third-line ART following the use of integrase inhibitors must be administered with DTG twice daily

WHO ARV 2018 guidelines – second line



Confidential | 18

• WHO will also incorporate these guidelines into the next full

update of the WHO consolidated ARV guidelines planned

for 2019

‒ WHO will closely monitor data on the potential

association between DTG and neural tube defects and

regularly review emerging data

‒ WHO will update recommendations related to DTG

use as soon as relevant evidence becomes available

• Uptake of the recommendations in national guidelines will

be assessed in 2020

WHO ARV guidelines – next update


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Symposium at the 2019 INTEREST CongressAccra, Ghana

PHEM/HIV/0818/0004c




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Faculty discussion: Understanding the role of PIs in antiretroviral treatment in Africa

PHEM/HIV/0818/0004c




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Which guidelines do you most closely follow when prescribing ART? (select one)

1. WHO

2. National guidelines

3. Local hospital guidelines

4. Other

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When would you consider a PI as part of ART? (select up to three)

1. When initiating treatment – first line

2. At second line

3. At third line

4. I never use PIs

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Which WHO-recommended PIs do you have available to prescribe? (select up to three)

1. ATV/r

2. DRV/r

3. LPV/r

4. I have none of these PIs available

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Symposium at the 2019 INTEREST Congress, Accra, Ghana




PHGH/HIV/0519/106

CASE PRESENTATIONSwitching patient to an effective 2nd line

Lloyd Mulenga, MD

Associate Professor of Infectious Diseases

University of Zambia, School of Medicine, Lusaka, Zambia

Vanderbilt University, Nashville, USA

History• Male, 16 years old

• HIV diagnosis• November 2012 at age of 9 years

• Stays with mother who is on second-line ART• Mother reportedly doing well, although VL and CD4 are unknown• Mother denies taking ART or sdNVP prior to or during pregnancy • She was only tested for HIV after husband died

• Father died when he was 5 years old

• Has 3 older siblings all HIV negative

sdNVP = single-dose nevirapine

ART history and rationale Date Regimen Rationale Comments

15/12/2012 AZT/3TC/NVP Initial • Mother assured HCW of good adherence• Boy stayed with grandmother

15/08/2015 TDF/3TC/EFV Transition to adult regimen at age 12

• No clinical failure• No immunological failure• VL = not available

15/12/2018 TDF/3TC/EFV Routine VL done during VL scale up

• VL = 99,968 copies/mL• No clinical failure• No immunological failure• Enhanced adherence counselling

25/02/2019 TDF/3TC/EFV Repeat VL done • VL = 117,092 copies/mL• No clinical failure• No immunological failure

Reported good adherence

Available resultsDate Hb (g/dL) CD4 cell count/µL (CD4 %) Viral load (copies/mL)

Nov 2012 10.2 167 (13%) ‒

Jun 2013 11.2 360 (24%) ‒

May 2014 11.6 323 (25%) ‒

Feb 2015 10.3 300 (24%) ‒

Aug 2015 10.8 314 (22%) ‒

Aug 2016 11.4 398 (25%)

Aug 2017 11.0 402 (22%)

Dec 2018 10.8 368 (19%) 99,968

Feb 2019 11.8 117,019

Sputum GeneXpert-Rif negative

ALT: 32.9 mmol/L

CREAT: 38 µmol/L

NOTE: Collected samples for resistance test (genotype) in Feb 2019

What is most likely to be the issue?(select one)

1. Resistance to NNRTIs

2. Resistance to NRTI backbone regimen

3. Resistance to both NRTIs and NNRTIs

4. Sub-optimal adherence

What could you have done differently in transitioning this patient from AZT/3TC/NVP to TDF/3TC/EFV? (select as many answers as you wish)

1. Switch to a PI rather than continue an NNRTI

2. Viral load testing before switching

3. Switch away from 3TC

4. Have adherence counselling earlier

5. Other

How would you construct the second-line in this patient in the absence of genotyping?(select one)

Switch from TDF/3TC/EFV to:

1. TDF/3TC + bPI

2. AZT/3TC + bPI

3. DTG/3TC+ bPI

4. AZT/3TC + DTG

5. TDF/3TC/DTG

6. Other regimen

Follow-up

• Switched to • DTG 50mg OD + 3TC 300mg OD + ATV/r 300/100 OD

• April 2019• VL: <20 copies/mL

GENOTYPE RESULT

ADULT INFECT DISEASE CENTER

Referred by MWALE

UNIVERSITY TEACHING HOSPITALPRIVATE BAG RW 1XLUSAKA

Tests ordered: HIV V/load, Drug Resist

DRUG RESISTANCE TESTING

Protease inhibitors

Nucleoside RTI

Non-nucleoside RTI

PI resistance mutations

NRTI resistance mutations

NNRTI resistance mutations

HIV VIRAL LOAD

HIV Viral Load 117092 copies/mL

Atazanavir/r (ATV/r) SusceptibleDarunavir/r (DRV/r) SusceptibleFosamprenavir/r (FPV/r) SusceptibleIndinavir/r (IDV/r) SusceptibleLopinavir/r (LPV/r) SusceptibleNelfinavir (NFV) SusceptibleSaquinavir/r (SQV/r) SusceptibleTipravavir (TPV/r) Susceptible

Abacavir (ABC) High-level resistanceZidovudine (AZT) SusceptibleStavudine (D4T) High-level resistanceDidanosine (DDI) High-level resistance Emtricitabine (FTC) High-level resistanceLamivudine (3TC) High-level resistance Tenofovir (TDF) High-level resistance

Doravirine (DOR) High-level resistanceEfavirenz (EFV) High-level resistance Etravirine (ETR) High-level resistanceNevirapine (NVP) High-level resistance Rilpivirine (RPV) High-level resistance

K65R, D67HN, T69D, Y115F, M184V, K219KE

A98G, K103KN, V106VM, Y181C, G190A

Lab No. ZUA0062809Reference5040-024028955-9Specimen BloodReceived 25/02/2019 09:48

NONE

Our question…

• How do you interpret the above results in view of this history?

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PHGH/HIV/0519/106

Michelle Moorhouse

15 May 2019

Clinical case:

Switching to a PI in third-line in clinical practice in Africa

3TC

Three lines of treatment in most LMICs

XTCTDF EFV

XTC, other nukes

PI/r(LPV/r or ATV/r)ZDV

Darunavir Etravirine

Failure

Failure: genotype

Dolutegravir

WHO technical update and 2018 guidelines

Population First-line regimens Second-line regimens Third-line regimens

Adults and adolescents (incl. women ofchildbearing potential and pregnant women)

2NRTIs + DTG 2NRTIs + (ATV/r or LPV/r)

DRV/r + DTG + 1–2 NRTIs (if possible, consider optimisation using

genotyping)

2NRTIs + EFV 2NRTIs + DTG

Children (0–10 years)

2NRTIs + DTG 2NRTIs + (ATV/r or LPV/r)

2NRTIs + LPV/r 2NRTIs + DTG

2NRTIs + NNRTI 2NRTIs + DTG



Let’s meet our patient… back in 2006

• Mr D, 45 years old

• Newly diagnosed with HIV

• Works as a security guard, occasional shift work

• Tested during hospital admission for AGE with ARF

Test Result Unit

CD4 count 108 cells/µL

Viral load 563,798 copies/mL

ALT 32 IU/L

So when to start (in 2006)?

World Health Organization. 2006. Archive of guidelines on ARVs. https://www.who.int/hiv/topics/treatment/technical/en/

And what to start (in 2006)?

Regimen Drugs Monitoring tests Frequency

1a d4T / 3TC / efavirenz ❑CD4

❑VL

❑ALT

❑Staging, 6 monthly

❑Baseline, 6 monthly

❑Symptomatic

1b d4T / 3TC / NVP ❑CD4

❑VL

❑ALT

❑Staging, 6 monthly

❑Baseline, 6 monthly

❑Baseline, week 2, 4 and 8,

thereafter 6 monthly


And so he starts treatment…

Three weeks later

• Itchy maculopapular rash involving limbs and trunk

• No mucosal lesions noted

• Felt slightly unwell

• Physical exam: NCS (URTI)

Test Result Unit

Temperature 37.1 ∘C

ALT 173 IU/L

Viral hepatitis studies Negative

Was it NVP hypersensitivity?

• All ARVs and co-trimoxazole interrupted

• ALT settled quickly

• Re-started on slightly different regimen: d4T + 3TC + EFV

• Tolerated regimen well

• Adherence not always optimal on account of periods of shift work

Mr D’s progress…

Date BL Mar 07 Sep 07 Jun 08 Feb 09 Aug 09 Apr 10

CD4 count(cells/µL)

108 356 294 388 401 394 153

VL(copies/mL)

563,798 LDL 3572 LDL 4461 360,237 1,134,591

PTB

PTB = pulmonary tuberculosis

What second-line regimen would you choose?(select one)

1. DTG + TDF/FTC

2. DTG + RPV

3. DRV/r + TDF/FTC

4. ATV/r + ZDV/3TC

5. LPV/r + TDF/FTC

So what to switch to (2010)?

• Starts second-line ART regimen: LPV/r + TDF/FTC


Mr D responds well to second-line initially


Oct 10 Apr 11 Oct 11 May 12 Nov 13 May 14 Aug 14

VL(copies/mL)

389 475 498 527 506 364 332


LDL LDL LDL LDL 87,772 35,626 44,620

Re-starts ARVs

Defining second-line failure

VL >1000 copies/mL on second-line >1 year

Repeat VL in 6 months

VL ≤1000 copies/mL

Continue second-line

VL >1000 copies/mL

GENOTYPE

Adherence; compliance; tolerability; drug interactions; psychological

https://sahivsoc.org/Files/ART%20Guidelines%2015052015.pdf

Mr D’s resistance scores using StanfordPI ATV/r DRV/r LPV/r

NRTI ABC AZT FTC 3TC TDF

EFV ETR NVP RPVNNRTI

What third-line regimen would you select? (select one)

1. DTG + TDF/FTC

2. ZDV + 3TC + ABC

3. DRV/r + TDF/FTC + RAL

4. DRV/r + TDF/FTC + DTG

5. DTG + TDF/FTC + ETR

So what third-line regimen in 2014?

• Mr D was started on a third-line regimen of: DRV/r + TDF/FTC + RAL*

• He tolerated the regimen well

• Despite the challenges it presented: twice-daily dosing and pill burden

*DTG not available at the time

What I didn’t tell you about Mr D…

• Mr D, now 54 years old, is hypertensive and has type 2 diabetes

• Metformin, insulin, ACE-I with diuretic, statin

• So his ART regimen was modified: DRV/r + ABC/3TC + RAL

Date Oct 14 Dec 14 Feb 15 May 15 Aug 15 Nov 15

Creatinine clearance(mL/min)

55 52 48 46 44 41

And this is not the end of his problems…

• So another genotype was done, including the integrase genes

Date Jul 16 Jan 17 Mar 17

Viral load (copies/mL)

7340 9294 2546

Mr D’s genotypePI ATV/r DRV/r LPV/r

RALEVGDTGINSTI

0.3% of adults on ART (n=37,087)

0

5

10

15

20

25

30

35

40

45

50

RAL +DRV/r

TDF +FTC +DRV/r

ETR +RAL +DRV

TDF +3TC +RAL +LPV/r

ETR +RAL +DRV/r

TDF +3TC +RAL

TDF +FTC +RAL

TDF +FTC +DRV/r

TDF +FTC +RAL +DRV/r

ZDV +3TC +ABC

ARV regimens

% o

f p

eo

ple

on

th

ird

-lin

e A

RT

Third-line in LMIC (end 2016)

Personal communication to Dr Moorhouse from World Health Organization, 2019

0.3% of adults on ART (n=37,087)

Third-line in LMIC (end 2016)

Projected to end 2019:Adult: 310,000

Paediatric: 24,000

World Health Organization projection, 2016

3TC

XTC, other nukes



Failure: genotype

Dolutegravir

Moorhouse et al, 26th IWHDRTS; Personal communication

250,000

1800Since 2013

SA has largest ARV programme: >5 million

3TC

SA has largest ARV programme: >5 million

XTC, other nukes



Failure: genotype

Dolutegravir*

Moorhouse et al, 26th IWHDRTS; Personal communication

250,000

1800Since 2013

3TC

Failure: genotype

Dolutegravir*

So how many adults failing PI/r-based ART are accessing third-line ART?

Moorhouse et al, 27th IWHDRTS; SAHCS 2018

Adults on third-line ART

1400

1200

1000

800

600

400

200

02013 2014 2015 2016 2017 2018

Adult patients per year Cumulative

Third-line ART algorithm

Eligible for third-line ARTPI score ≥15

TDF/ZDV 30‒59 OR DRV ≥15

TDF/ZDV >29 AND DRV ≥15 AND ETR ≤29

Add ETR

DRV + 3TC/FTC + ZDV/TDF (lowest score)

Add InSTI

Moorhouse et al, 27th IWHDRTS; SAHCS 2018

Good virologic outcomes despite high levels of PI resistance

Moorhouse M et al, J Acquir Immune Defic Syndr. 2019;80:73-78

Good virologic outcomes despite high levels of PI resistance

Moorhouse M et al, J Acquir Immune Defic Syndr. 2019;80:73-78

VL < 1000 copies/mL: 83%

VL < 400 copies/mL: 79%

Mr D’s dilemma

• Co-morbidities• DM, hypertension with end organ damage

• Polypharmacy

• Resistant virus• High-level resistance against all InSTIs

• Intermediate resistance against DRV/r and NRTIs

• No further lines of treatment available in SA public sector

Thanks

• South Africa NDoH Third-line ART Committee

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PHGH/HIV/0519/106

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Fafa Addo BoatengJohnson & Johnson Global Public HealthAfrica




PHGH/HIV/0519/106

70

Contribute to UNAIDS 90-90-90 target

Ensure that global HIV

response addresses the

critical unmet needs of

children and adolescents

Promote treatment

equity between adults

and children

Link 5,000 pediatric patients to 2nd- and 3rd-line care,

and access to J&J treatment by 2020

Our goals

ADVANCING PEDIATRIC HIV CARE

www.newhorizonshiv.com

71

Objectives

Focus areas

Enabling

platforms

and outputs

Partners and Collaborators

Donation program: In collaboration

with country Ministries of Health

Health system strengthening: Improving care and treatment through public

health approach

Drug access Capacity building

Drug delivery – Donation, operations and formulations

Healthcare worker capacity – Tools, training, technical assistance

Operational research, cohort analysis, publications and information sharing

HIV+ youth/patient engagement

Meeting the Needs of Young People Living with HIV



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Donations should benefit the recipient and be based

on an expressed need

Donation process should involve effective collaboration

and coordination between donor and recipient

Quality standards should be consistent across donor

and recipient countries, with no double standards


World Health Organization. Interagency Guidelines for Medicine Donations, 2010

Aligned to WHO donation guidelines

WHO core principles Johnson & Johnson donation

Countries must submit Expression of Interest

Donation process utilizes the same distribution

mechanism used for PEPFAR-funded ARVs

Donated product is the same as the product

procured by country tenders

Operating Principles


73

Drugs to be donated: DARUNAVIR (and/or) ETRAVIRINE1

Managed by national HIV program

Ends when patient reaches 24 years2 of age or experiences treatment failure

Patients transition to adult care to continue treatment

Patient enrollment

Product donationSept.

2014

31 Dec.

202031 Dec.

2039Enrollment

1. Formulations: PREZISTA® 600mg, PREZISTA® 150mg, PREZISTA® 75 mg, PREZISTA® 100mg/ml,

INTELENCE® 100mg, INTELENCE® 25mg

2. Specific “aging out” requirements vary by country

Product Donation Program



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Where do we operate?


• The program operates in many countries across Africa

• Current participating countries:


| 75

Resources

✓ Pediatric HIV online training module

(PaedsHIVLearning.com)

✓ Resistance training workshops

✓ PENTA training workshops

✓ Data harmonization and capacity building

✓ Second- and third-line dosing cards

✓ Management of treatment failure algorithm

✓ Disclosure toolkit

✓ Transition and adherence tools (upcoming)



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Implementing Partners



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PHGH/HIV/0519/106

| 78

Thank you

• Please leave your completed evaluation form and

keypad on your chair at the end of the meeting

• If you require an attendance certificate, please

collect one at the back as you leave

Documents

Optimising treatment for life-long management of HIVregist2.virology-education.com/presentations/2019/13... · 2019-05-29 · | 2 Introduction Kwasi Torpey School of Public Health,