HIV Drug Resistance Update 2007

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HIV Drug Resistance Update 2007

Slide Presentation
February 21, 2007
Harry Lampiris, MD

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Slide 1.

HIV Drug Resistance Update 2007

Slide 1.

Overview of Talk

Slide 2.

When to Use Resistance Testing

Slide 3.

Case 1: Resistance Testing in Treatment-Naive Patients

Slide 4.

Case 1: A Genotype Is Obtained

Slide 5.

Prevalence of Drug Resistance in Recently Infected ART-Naive Persons

Slide 6.

The SPREAD Study: Transmitted HIV-1 Drug Resistance in Europe

Slide 7.

Resistance in Naive Patients: A Global Study

Slide 8.

Effects of Selected Nucleoside Mutations on Viral Fitness

Slide 9.

Case 2: Salvaging K65R

Slide 10.

In This Patient, The Nucs Chosen for His Next Regimen Were Combivir and Tenofovir. Reasonable Choices for Non-Nucleoside Agents in the Patient's Backbone in Next Regimen Include:

Slide 11.

Impact of K65R on Treatment Response

Slide 12.

Response to Etravirine in Patients with NNRTI and PI Resistance (ITT:NC=F)

Slide 13.

Effect of 103N and 181C on Virologic Response to Etravirine (TMC125)

Slide 14.

Effect of Baseline Resistance on Response to Etravirine

Slide 15.

Case 3: High Level Three Class Resistance in Advanced Disease

Slide 16.

Case 3: Antiretroviral History

Slide 17.

Case 3: Prior Genotype

Slide 18.

Now what?

Slide 19.

Considerations for When to Switch HAART

Slide 20.

Table 1

Slide 21.

Table 2

Slide 22.

Next Salvage Regimen?

Slide 23.

Effect of T-20 Plus An Active PI

Slide 24.

Clinical Cut-Offs for Genotypic Scores

Slide 25.

New r/PI Monogram Phenotype Clinical Cutoffs

Slide 26.

Baseline Characteristics of RESIST Patients

Slide 27.

RESIST: Week 96 Results - Overall Results

Slide 28.

TPV Mutations Associated with Virologic Failure in RESIST Studies

Slide 29.

Important Tipranavir Drug Interactions with Newer Agents

Slide 30.

Darunavir: POWER 1 and 2 Combined 48 Week Analysis (2006 IAC, #TUAB0104)

Slide 31.

Phenotypic and Genotypic Determinants of Darunavir Resistance

Slide 32.

Weighing the Mutations Associated with A Diminished Response to Darunavir

Slide 33.

Mutations Selected in the Clinical Setting or Associated with Reduced Virological Response

Slide 34.

Individual Mutations Associated with Increased Susceptibility to TPV and Darunavir (Vircotype Analysis)

Slide 35.

Susceptibility to TPV or DRV after Failure of the Alternative Agent

Slide 36.

I50V and Clinical Response in the RESIST Studies

Slide 37.

Summary: Tipranavir vs Darunavir I

Slide 38.

Summary: Tipranavir vs Darunavir II

Slide 39.

Summary: Tipranavir vs Darunavir III

Slide 40.

Case 4: MDR HIV: Biding Your Time

Slide 41.

3TC Alone vs Treatment Interruption in Patients Failing 3TC-Based Therapy

Slide 42.

Change in HIV RNA after 3TC Withdrawal

Slide 43.

Risk of Delayed Switch on Stable ART

Slide 44.

Studies of Enfuvirtide Resistance and Effects of Discontinuation

Slide 45.

Guidelines for Choosing A Partially Suppressive ART Regimen

Slide 46.

New ARV Choices: Resisting the Temptation to Use Them Too Soon

Slide 47.