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ARV Resistance PowerPoint Presentation

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Description : This medical presentation titled ""ARV Resistance"" define drug resistance, identifies factors that influence drug resistance and strategies for minimizing development of drug resistance. It also identifies strategies for responding to detection of moderate to high levels of drug resistant HIV.

Tags : ARV Resistance, Human Immunodeficiency Virus, HIV, infection, cells, immune system, AIDS, Acquired Immune Deficiency Syndrome, HIV Positive, Anti-HIV Drug, antiretroviral drugs, AIDS drugs, mutations

Published on : Apr 23, 2021 | Views : 2006 | Downloads : 2

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Slide 1-

ARV Resistance 1
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Learning Objectives Define drug resistance Identify factors that influence drug resistance. Identify strategies for minimizing development of drug resistance. Identify strategies for responding to detection of moderate to high levels of drug resistant HIV.
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Impact of drug resistance Why is it important to measure drug resistance? How does it impact the success of large-scale treatment programs?
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What is ARV drug resistance? Drugs no longer block virus replication Cause: Mutations in the viral genome One or more: Specific for an antiviral drug OR Affecting related drugs (cross-resistance) How much resistance? Which drugs? Depends on type and number of mutations
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Types of drug resistance Acquired drug resistance Develops when patients interrupt their treatment, do not take it according to prescription, or the drugs are not absorbed properly Transmitted drug resistance People are infected from others who had HIV drug resistance and that carry resistant
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HIV Drug Resistance - unavoidable HIV DR is an inevitable consequence of ART, influenced by: Ability of regimens to suppress replication completely Adherence and tolerability of regimens "Genetic barrier" to resistance Relative fitness of resistant variant(s) Pharmacokinetics (IQ) Availability/continuity of drug supply Removal of barriers to access to care Therefore, efforts to minimize HIV DR should be focused on these factors
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Need for population-based therapies
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Need to maintain effectiveness
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Drug resistance and HIV HIV… evolves rapidly within human body has a high replication rate has a high mutation rate  Resistant strains can emerge within days if drug pressure is not sufficient to suppress replication. Resistant strains persist indefinitely and can re-emerge if same drugs are stopped and restarted.
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Review Why is it important to measure drug resistance? How does it impact the success of large-scale treatment programs?
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Factors that influence development of drug resistance What regimens influence drug resistance? What patient factors influence drug resistance? What public health approaches influence drug resistance?
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In which conditions is DR more likely? Treatment with <3 drugs Inappropriate selection of drugs Adding one drug to a failing regimen Interruption of treatment (even for a few days) Prolonging a failing regimen
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Virus related factors influencing resistance High replication rate of HIV Turnover of 10 billion virions daily Frequent errors made during replication High mutation rate 20 million mutations daily Latent reservoirs of HIV Enable drug resistant HIV to hide for 20-30 years
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Resistance can develop quickly, depending on the viral load Siliciano, 2002
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Drug related factors influencing resistance Inadequate potency (strength) Drug interactions leading to suboptimal drug levels Inadequate durability of drug potency (e.g., dual therapy) Poor tolerability Inconvenience of regimen
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Adequate Drug Levels are Crucial to Control HIV Replication High drug levels delay or prevent development of resistance. Low drug levels encourage viral replication, ARV resistance, viral rebound and ultimate clinical deterioration.
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Mutations and Resistance For certain ARVs, only one mutation is needed to stop the drug from working. For other ARVs, multiple, step-wise mutations must occur before the drug loses affect.
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In which conditions is DR less likely? Medication Factors: All patients treated with 3 or more drugs Use of appropriate drug regimens Can reliably suppress HIV replication to levels of <50 copies/ml Use of fixed-dose combinations to support adherence
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In which conditions is DR less likely? Systems Factors: Limited number of regimens Trained personnel, low turnover Supervision and monitoring Adequate lab services Drug supply and delivery systems
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In which conditions is DR less likely? Patient Factors: Adherence to treatment regimen Avoiding interruption of treatment, even if only a few days Regular follow-up (going to clinic) Staying on uninterrupted first-line ART as long as possible
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Programmatic factors affecting patient adherence Cost of treatment to patient (not only money, but time) Distance patient must travel to get treatment Supply interruptions Availability of second-line regimens for patients whose first-line regimens fail Timing of use of second-line regimens
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Discussion What regimens influence drug resistance? What patient factors influence drug resistance? What public health approaches influence drug resistance?
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Reflection What regimens do we use in our country? What systematic and programmatic challenges do we face?
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Minimizing drug resistance What can countries do to minimize or suppress drug resistance?
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Strengthen existing programmes that minimize HIV DR Support for adherence and follow-up  THIS IS YOU! Removal of barriers to ART access Drug supply continuity at the individual, ART site, and national levels
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Monitor early warning indicators Routine collection of medical and pharmacy records Monitor for factors associated with HIV DR prevention or emergence Extent to which prescribing practices meet national and international guidelines % of patients still on first-line; % lost to follow-up % patients with timely medication pick up and clinical follow-up Drug supply continuity at site Adherence and viral load  THIS IS YOU!
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HIV DR Early Warning Indicators (EWIs) Prescribing practices Proportion lost to follow-up during the first 12 months of ART Patient retention on first-line ART On-time ARV drug pick up ART appointment-keeping Drug supply continuity Site-level ART Program Function Viral load suppression @ 6 months Pill count/ adherence
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Key Messages Impact of HIV Drug Resistance Factors that Influence Development of Drug Resistance How to Minimize Drug Resistance