la pedrera, barcelona march th13 2018 summary i: tb ... · la pedrera, barcelona march th13 2018...
TRANSCRIPT
![Page 1: La Pedrera, Barcelona March th13 2018 Summary I: TB ... · La Pedrera, Barcelona March th13 2018 Dr. José M. Miró Infectious Diseases Service Hospital Clinic - IDIBAPS University](https://reader031.vdocuments.pub/reader031/viewer/2022022615/5ba286cb09d3f2b25b8bf85a/html5/thumbnails/1.jpg)
La Pedrera, Barcelona
March 13th 2018
Dr. José M. Miró Infectious Diseases Service
Hospital Clinic - IDIBAPS University of Barcelona
Barcelona (Spain)
Summary I:
TB, Opportunistic Infections, HCV/HBV
Co-Infections, HPV, STI & Tumors
E-mail address: [email protected]
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Accepted, 1105 (51%)
- Oral, 114 (10%)
- Poster, 991 (90%) Hepatitis, 91 (8%)
Tuberculosis, 46 (4%)
Cryptococcal meningitis + OIs 51 (5%)
STI / HPV, 43 (4%)
Cancer, 68 (6%)
Abstracts - CROI 2018
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TB/OIs, HCV/HBV, STI/HPV & Tumors
Tuberculosis
Cryptococcal meningitis
Other Infections
IRIS
HCV/HBV coinfection
HPV/STI
Cancer
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JoAnne L. Flynn, CROI 2018
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JoAnne L. Flynn, CROI 2018
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RCT ONE MONTH OF RIFAPENTINE/ISONIAZID TO PREVENT
TB IN PEOPLE WITH HIV: BRIEF-TB/A5279 RCT (#37LB)
Rifapentine + Isoniazid, 1 month
=
Isoniazid, 9 months
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ONE MONTH OF RIFAPENTINE/ISONIAZID TO PREVENT TB IN
PEOPLE WITH HIV: BRIEF-TB/A5279 RCT (#37LB)
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ONE MONTH OF RIFAPENTINE/ISONIAZID TO PREVENT TB IN
PEOPLE WITH HIV: BRIEF-TB/A5279 RCT (#37LB)
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First RCT to focus on IPT in
HIV-infected pregnant and
postpartum women at high
risk of developing TB
RCT OF SAFETY OF ISONIAZID PREVENTIVE
THERAPY DURING OR AFTER PREGNANCY (#142LB)
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RCT OF SAFETY OF ISONIAZID PREVENTIVE
THERAPY DURING OR AFTER PREGNANCY (#142LB)
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RCT OF SAFETY OF ISONIAZID PREVENTIVE
THERAPY DURING OR AFTER PREGNANCY (#142LB)
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RCT OF SAFETY OF ISONIAZID PREVENTIVE
THERAPY DURING OR AFTER PREGNANCY (#142LB)
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RCT OF SAFETY OF ISONIAZID PREVENTIVE
THERAPY DURING OR AFTER PREGNANCY (#142LB)
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RCT OF SAFETY OF ISONIAZID PREVENTIVE
THERAPY DURING OR AFTER PREGNANCY (#142LB)
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RCT OF SAFETY OF ISONIAZID PREVENTIVE
THERAPY DURING OR AFTER PREGNANCY (#142LB)
!
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URINE-BASED SCREENING FOR TUBERCULOSIS:
A RCT IN HIV-POSITIVE INPATIENTS (#38LB)
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URINE-BASED SCREENING FOR TUBERCULOSIS:
A RCT IN HIV-POSITIVE INPATIENTS (#38LB)
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URINE-BASED SCREENING FOR TUBERCULOSIS:
A RCT IN HIV-POSITIVE INPATIENTS (#38LB)
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STATIS RCT: SYSTEMATIC vs. TEST-GUIDED
TUBERCULOSIS TREATMENT (#29LB)
• The trial was conducted in Côte d'Ivoire, Uganda, Cambodia and Vietnam
(African and Asian countries).
• ART-naïve HIV-1 infected adults with CD4<100 cells/µl ready to start ART
were randomly assigned to either ART + extensive TB screening using
Xpert MTB/RIF and urine LAM (arm 1) or ART + systematic empirical
TB treatment (4HRZE/2HR) (arm 2).
• 1047 participants were included (arm 1: 525; arm 2: 522; 56% from Africa;
44% from South-East Asia).
• The W24 hazard ratio of events between arm 2 vs. arm 1 was 0.93 (95%
CI 0.61-1.42) for death or IBD, 0.92 (0.57-1.48) for death alone, 1.14
(0.54-2.40) for IBD alone and 2.70 (1.80-4.04) for grade 3-4 drug-related
toxicity.
→ Systematic TB treatment is not superior to extensive TB
screening in ART-naïve adults ready to start ART with CD4<100/µl.
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SAFETY AND EFFICACY OF DOLUTEGRAVIR-BASED ART IN
TB/HIV COINFECTED ADULTS AT WEEK 24 (#33)
DTG-based ART =
EFV-based ART
TB Disease
RIF-based TB treatment
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SAFETY AND EFFICACY OF DOLUTEGRAVIR-BASED ART IN
TB/HIV COINFECTED ADULTS AT WEEK 24 (#33)
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SAFETY AND EFFICACY OF DOLUTEGRAVIR-BASED ART IN
TB/HIV COINFECTED ADULTS AT WEEK 24 (#33)
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SAFETY AND EFFICACY OF DOLUTEGRAVIR-BASED ART IN
TB/HIV COINFECTED ADULTS AT WEEK 24 (#33)
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Tuberculosis “Pearls”
#767 IMPROVED SENSITIVITY OF A NOVEL RECOMBINANT
PROTEIN SKIN TEST FOR THE DIAGNOSIS OF TB.
#772 C-REACTIVE PROTEIN (CRP) TO SCREEN FOR HIV-
ASSOCIATED TUBERCULOSIS IN SOUTH AFRICA.
#773 PLASMA INDOLEAMINE 2, 3-DIOXYGENASE (IDO)*, A
BIOMARKER FOR TUBERCULOSIS DISEASE IN HIV
INFECTION
* IDO is an immunoregulatory enzyme that breaks down tryptophan (Trp) to metabolites known as kynurenines (Kyns) and the ratio
of Kyn to Trp is very useful for TB diagnosis: PPV 89% & NPV 100%. Adu-Gyamfi CG ET AL. Clin Infect Dis. 2017; 65:1356-58.
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TB/OIs, HCV/HBV, STI/HPV & Tumors
Tuberculosis
Cryptococcal meningitis
Other Infections
IRIS
HCV/HBV coinfection
HPV/STI
Cancer
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RCT HIGHER HIGH DOSE FLUCONAZOLE FOR THE
TREATMENT OF CRYPTOCOCCAL MENINGITIS (#35)
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RCT HIGHER DOSE FLUCONAZOLE FOR THE
TREATMENT OF CRYPTOCOCCAL MENINGITIS (#35)
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RCT HIGHER DOSES FLUCONAZOLE FOR THE
TREATMENT OF CRYPTOCOCCAL MENINGITIS (#35)
1,600 mg oral FLU is the most effective
dose and safer than 2,000 mg,
although less effective than AMB !!!
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ASTRO-CM RCT ADJUNCTIVE SERTRALINE IN HIV-
ASSOCIATED CRYPTOCOCCAL MENINGITIS (#36)
• Amphotericin B 7-14 days
plus fluconazole starting at
800 mg daily.
• Sertraline: 400 mg/day for 2
weeks, followed by 200
mg/day for 10 weeks.
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ASTRO-CM RCT ADJUNCTIVE SERTRALINE IN HIV-
ASSOCIATED CRYPTOCOCCAL MENINGITIS (#36)
Sertraline did not reduce mortality
among patients with HIV-associated
cryptococcal meningitis
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TB/OIs, HCV/HBV, STI/HPV & Tumors
Tuberculosis
Cryptococcal meningitis
Other Infections
IRIS
HCV/HBV coinfection
HPV/STI
Cancer
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CMV VIREMIA AND DISEASE IN PATIENTS WITH ADVANCED
HIV INFECTION: A PROSPECTIVE STUDY (N=49) (#801)
Prevalence CMV viremia ↑
CMV EOD ↓ (only 1 case)
→ CMV Rx is not necessary
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TB/OIs, HCV/HBV, STI/HPV & Tumors
Tuberculosis
Cryptococcal meningitis
Other Infections
IRIS
HCV/HBV coinfection
HPV/STI
Cancer
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Integrase Inhibitor-based ART regimens
are a Risk Factor for IRIS in CROI 2017
Dutch cohort*
French cohort**
OR (95%CI)
3.25 (1.83 - 5.80)
1.99 (1.09 - 3.47)
*CROI 2017 # 731 (ATHENA) & **CROI 2017 # 732 (Dat’AIDS Study Group)
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IMPACT OF RALTEGRAVIR INTENSIFICATION OF
FIRST-LINE ART ON IRIS IN THE REALITY TRIAL (#23)
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IMPACT OF RALTEGRAVIR INTENSIFICATION OF
FIRST-LINE ART ON IRIS IN THE REALITY TRIAL (#23)
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IMPACT OF RALTEGRAVIR INTENSIFICATION OF
FIRST-LINE ART ON IRIS IN THE REALITY TRIAL (#23)
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IMPACT OF RALTEGRAVIR INTENSIFICATION OF
FIRST-LINE ART ON IRIS IN THE REALITY TRIAL (#23)
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IMPACT OF RALTEGRAVIR INTENSIFICATION OF
FIRST-LINE ART ON IRIS IN THE REALITY TRIAL (#23)
RALTEGRAVIR intensification did
not increase IRIS incidence
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TB-IRIS: INSPIRING Trial (#33)
DOLUTEGRAVIR ART did not
increase TB-IRIS incidence
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IRIS: OPTIMAL Trial (#495)
INSTI based ART did not increase
IRIS incidence in OPTIMAL RCT
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PCP-IRIS RISK FACTORS (#795)
IRIS occurred in 12 of 97 German patients (12.4%)
There were no significant differences regarding other parameters including death, initial
CD4 count or time between start of PCP therapy and ART.
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KS-IRIS (#133)
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KS-IRIS (#133)
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KS-IRIS (#133)
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TB/OIs, HCV/HBV, STI/HPV & Tumors
Tuberculosis
Cryptococcal meningitis
Other Infections
IRIS
HCV/HBV coinfection
HPV/STI
Cancer
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TasP in Switzerland: The Swiss HCVree Trial (#81LB)
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INTERNATIONAL vs. DOMESTIC
HCV TRANSMISSION IN MSM (#130)
Foreing-to-Swiss transmission was
estimated to range between 24% and 62%
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LOW RATES OF SPONTANEOUS CLEARANCE
OF ACUTE HCV COINFECTION (#129)
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8 WEEKS OF GRAZOPREVIR/ELBASVIR FOR ACUTE
HCV: A MULTICENTER RCT (DAHHS 2) (#128)
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8 WEEKS OF GRAZOPREVIR/ELBASVIR FOR ACUTE
HCV: A MULTICENTER RCT (DAHHS 2) (#128)
94%-98%
SVR12
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RETREATMENT OF HEPATITIS C INFECTION IN PATIENTS
WHO FAILED GLECAPREVIR/PIBRENTASVIR (#128)
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RETREATMENT OF HEPATITIS C INFECTION IN PATIENTS
WHO FAILED GLECAPREVIR/PIBRENTASVIR (#128)
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RETREATMENT OF HEPATITIS C INFECTION IN PATIENTS
WHO FAILED GLECAPREVIR/PIBRENTASVIR (#128)
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HIGH INCIDENCE OF HCV REINFECTION IN
MSM IN THE GECCO COHORT (#128)
Out of 2,074 patients, 41(1.97%) were identified with an HCV reinfection.
Reinfection occurred within a median of 63 weeks (range16-180) after end-of-treatment response.
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Hepatitis “Pearls”
#637 POTENTIAL FOR SERUM MICRO-RNAs TO PREDICT
FIBROSIS REGRESSION DURING HBV TREATMENT.
#639 CIRCULATING MICRO-RNAs IN HIV PATIENTS REVEAL
SPECIFIC SIGNATURES FOR LIVER DAMAGE
#640 MICRO-RNA PROFILE OF HCV SPONTANEOUS
CLEARANCE INDIVIDUALS SHOW PREVIOUS HCV
INFECTION
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Hepatitis “Pearls”: “EXPANDING HOPE”
HIV D+/R+ Transplants (HOPE action)
• N = 24, KT 14, LT 10
• All patients survived with good graft function
HCV D+/R- Kidney transplantation (EXPANDER Trial)
• N=10 cases
• All cases received DAA: GZR/EBR±SOF
• SVR 100%, HCV Ab + 50% (SC)
• Safe 100% (No D/C) Christine Durand, CROI 2018
*Durand C et al. Ann Intern Med. 2018 Mar 6. doi: 10.7326/M17-2871.
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TB/OIs, HCV/HBV, STI/HPV & Tumors
Tuberculosis
Cryptococcal meningitis
Other Infections
IRIS
HCV/HBV coinfection
HPV/STI
Cancer
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2014 WHO Guidelines
69
Single visit screen-and-treat using cryotherapy.
Loop electrosurgical excision procedure (LEEP) is an alterative for women not eligible for cryotherapy.
Conditional recommendations for the optimal treatment to prevent cancer.
1. Santesso N, et al. International Journal of Gynecology and Obstetrics World Health Organization Guidelines for
treatment of cervical intraepithelial neoplasia 2 – 3 and screen-and-treat strategies to prevent cervical cancer the Guideline Support Group : Int J Gynecol Obstet 2016.
2014
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ACTG 5282: HPV TEST & TREAT vs. CYTOLOGY-BASED
CERVICAL CANCER PREVENTION IN HIV+ WOMEN (#134)
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ACTG 5282: HPV TEST & TREAT vs. CYTOLOGY-BASED
CERVICAL CANCER PREVENTION IN HIV+ WOMEN (#134)
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ACTG 5282: HPV TEST & TREAT vs. CYTOLOGY-BASED
CERVICAL CANCER PREVENTION IN HIV+ WOMEN (#134)
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ACTG 5282: HPV TEST & TREAT vs. CYTOLOGY-BASED
CERVICAL CANCER PREVENTION IN HIV+ WOMEN (#134)
HPV test-and-treat was not
associated with better outcomes
as compared to a single round of
cytology-based screening
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INCIDENT HIV, HEPATITIS C AND OTHER STI IN
DAILY vs. EVENT-DRIVEN PrEP USERS (#1026)
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PRIOR SYPHILIS PROTECTS AGAINST T. PALLIDUM
DISSEMINATION IN REPEAT INFECTION (#798)
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SYPHILIS TREATMENT WITH DOXYCYCLINE IN
HIV-INFECTED PATIENTS (#796)
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TB/OIs, HCV/HBV, STI/HPV & Tumors
Tuberculosis
Cryptococcal meningitis
Other Infections
IRIS
HCV/HBV coinfection
HPV/STI
Cancer
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STATIN EXPOSURE IS ASSOCIATED WITH DECREASED
RISK OF CANCER (#132)
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STATIN EXPOSURE IS ASSOCIATED WITH DECREASED
RISK OF CANCER (#132)
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STATIN EXPOSURE IS ASSOCIATED WITH DECREASED
RISK OF CANCER (#132)
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STATIN EXPOSURE IS ASSOCIATED WITH DECREASED
RISK OF CANCER (#132)
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STATIN EXPOSURE IS ASSOCIATED WITH DECREASED
RISK OF CANCER (#132)
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STATIN EXPOSURE IS ASSOCIATED WITH DECREASED
RISK OF CANCER (#132)
Statin exposure is associated
with lower risk of cancer
independent of HIV status.
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Cancer “Pearls”
#651 STILL HIGH RISK OF VIRUS-RELATED CANCER
DESPITE 20 YEARS OF cART IN ICONA COHORT
#644 FAILURE RATE OF ULTRASOUND SURVEILLANCE
OF HEPATOCELLULAR CARCINOMA IN HIV+ PATIENTS
#669 PRESENTATION AND OUTCOME OF BIOPSY-
PROVEN HEPATOCELLULAR CARCINOMA BY HIV
STATUS
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J. Baker C. Boesecke D.A. Braun R. Chaisson M. Colombo K. Dooley C. Durand
Acknowledgements
http://www.croiconference.org
J.L. Flynn A. Gupta S.P. Koenig J.M. Llibre N. Merchante J. Schillinger T. Sterling