HIVAIDS Treatment Adult

1
HIV/AIDS Treatment- Adult Pediatric
Similarities and Differences

• Global Health Mini-University
• September 12, 2008

2
Objectives

• Define Antiretroviral (ARV) Treatment
• Understand underlying precepts to multi-drug ARV
  treatment
• Name the different classes of ARV medications
• Identify challenges in resource poor settings
• Differences between adult and pediatric ARV
  treatment

3
Similarities

• Retrovirus
• Lifecycle of HIV
• Target points in lifecycle
• Classes of medications
• Challenges
• Public Health Approach

4
Differences

• Diagnosis
• Disease progression
• Signs and symptoms
• Cost and availability of medications
• Administration of medications
• Caretaker
• Expertise

5
What is Antiretroviral Treatment?

• Retrovirus

6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
Life cycle
19
Main classes of ARVs

• Nucleoside/tide Reverse Transcriptase Inhibitors
  (NRTIs and NtRTIs)
• Non Nucleside Reverse Transcriptase Inhibitors
  (NNRTI)
• Protease Inhibitors (PIs)
• Fusion Inhibitors co-receptor antagonists
• Integrase Inhibitors

20
Fusion Inhibitors
21
NRTIs
22
NNRTIs
23
PIs
24
(No Transcript)
25
Multiple Drug Approach
26
Goals of Therapy and Tools to Achieve Goals

• Prevention of vertical transmission
• Prevention of transmissionto sexual partners
• Selection of ARV regimen
• Preservation of future treatment options
• Maximizing adherence
• Use of resistance testing

• Improved quality of life
• Reduction of HIV-related morbidity and mortality
• Restoration and/or preservation of immunologic
  function
• Maximal and durable suppression of viralload

27
Adult Resource Poor Settings
http//www.who.int/hiv/pub/guidelines/WHO20Adult
20ART20Guidelines.pdf
28
Pediatric Resource Poor Settings
http//www.who.int/hiv/pub/guidelines/WHOpaediatri
c.pdf
29
(No Transcript)
30
Public Health Approach
31
Challenges Human Resources
32
Infrastructure
33
Supplies
34
Transport
35
Pediatric Challenges
36
Diagnosis

• lt 18 months
• Persistence of maternal antibody
• No EIA, Western Blot
• Tests for viral components
• HIV DNA or RNA PCR,
• Immune Complex Dissociated (ICD) p24 antigen
• Dried Blood Spots (DBS)
• gt 18 months
• Can use EIA, Western Blot

37
Natural Progression of HIV in Children

• If undiagnosed/untreated
• 35 mortality by 1 year
• 50 mortality by age 2
• 60 mortality by age 3

WHO World Health Report 2005
38
Signs Symptoms

• Often non-specific
• Respiratory distress
• Poor weight gain weight or abnormal growth
• Missed milestones in development
• crawling, walking and speaking
• Poor school performance, seizures, and other
  symptoms of HIV encephalopathy

39
Challenges

• Pediatric expertise and experience
• Misperceptions that all infected children will
  die early in childhood
• Caretaker dependence
• Drug availability, appropriate formulations at
  affordable prices

http//www.who.int/3by5/en/finalreport.pdf
40
Children and ARV Medications

• Delivery
• Liquid v. solid
• Whole, split, crushed, dispensed in water
• With or without food
• Multiple times per day
• Fixed Dose Combinations (FDC)

41
Children and ARV Medications

• Syrups, solutions, or dissolvable formulations
• zidovudine(AZT), abacavir (ABC), lamivudine(3TC)
• nevirapine(NVP)
• lopinavir/ritonavir (LPV/r)
• Not as ideal
• stavudine (d4T) liquid
• didanosine(ddi) sachets
• nelfinavir powders

http//www.who.int/3by5/en/finalreport.pdf
42
Children and ARV Medications

• Taste
• Palatable?
• Dosage
• Growth
• Pharmacokinetics
• Mg/kg, mg/m2 (BSA), weight bands

43
From Abrams, El-Sadr and Rabkin The ICAP
Pediatric Clinical Manual, September 2004
44
Children and ARV Medications

• Other
• Cold chain storage
• Toxicities
• Adverse reactions
• Dependence on a caretaker

45
(No Transcript)
46
Objectives

• Define Antiretroviral (ARV) Treatment
• Understand underlying precepts to multi-drug ARV
  treatment
• Name the different classes of ARV medications
• Identify challenges in resource poor settings
• Differences between adult and pediatric ARV
  treatment
• Similarities/Differences

47
Discussion

• www.usaid.gov
• www.pepfar.gov
• www.globalhealthlearning.org
• http//depts.washington.edu/hivaids/index.html
• www.who.int/hiv/pub/guidelines/en/

48
Pearls

• Many similar challenges faced in both adult and
  pediatric HIV treatment.
• We can overcome the major challenges in pediatric
  HIV treatment with better pediatric case finding
  as well increased drug availability in
  appropriate formulations at affordable prices.
• Children are not small adults.