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What's New in HIV Prevention?
Slide Presentation
October 5, 2016
Susan Buchbinder, MD

Click on slide thumbnails to view full-size image.

Slide 1.
What's New in HIV Prevention?
Slide 1.
Financial Relationships With Commercial Entities
Slide 2.
Will Our Prevention Tools Stop New HIV Infections?
Slide 3.
HIV Epidemiology: Populations at HIV Risk
Slide 4.
Diagnoses of HIV Infection among Adult and Adolescent Males, by Transmission Category, 2010-2014 United States and 6 Dependent Areas
Slide 5.
Diagnoses of HIV Infection among Men Who Have Sex with Men, by Age Group, 2010-2014-United States and 6 Dependent Areas
Slide 6.
Diagnoses of HIV Infection among Men Who Have Sex with Men Aged 13-24 Years, by Race/Ethnicity, 2010-2014 United States and 6 Dependent Areas
Slide 7.
New HIV Diagnoses per 100,000 population by race/ethnicity
Slide 8.
In 2013, who had a greater number of new HIV diagnoses, the young or the old(er!)?
Slide 9.
The Aging HIV Epidemic in the US, 2013
Slide 10.
Number of New HIV Diagnoses by Age
Slide 11.
Where are new infections coming from?
Slide 12.
HIV in Heterosexuals in the US
Slide 13.
Poverty may explain some racial/ethnic differences
Slide 14.
Summary of Epidemiology
Slide 15.
Effectiveness of ARVs for Prevention
Slide 16.
Treatment as Prevention: HPTN 052
Slide 17.
Potential transmission among treated patients
Slide 18.
Serodiscordant Couples
Slide 19.
Clinical Trial Evidence for HIV Prevention Options (February 2016)
Slide 20.
PrEP Works if You Take It - Effectiveness and Adherence in Trials of Oral and Topical Tenofovir-Based Prevention
Slide 21.
Vaginal microbial dysbiosis
Slide 22.
Tenofovir gel effective against HIV with Lactobacillus dominance
Slide 23.
Tenofovir is rapidly depleted by Gardnerella but not Lactobacillus
Slide 24.
Need high levels of adherence to protect against injection exposure? Bangkok TDF Study in PWID
Slide 25.
TDF/FTC PrEP Effectiveness for MSM
Slide 26.
PrEP as a bridge to ART
Slide 27.
HIV incidence
Slide 28.
How would you advise an HIV "sero-different" couple about condom use?
Slide 29.
Condom Effectiveness
Slide 30.
Summary of Effectiveness
Slide 31.
Coverage of ART and PrEP
Slide 32.
Persons Living with Diagnosed or Undiagnosed HIV Infection HIV Care Continuum Outcomes, 2009, 2010, 2011 and 2012
Slide 33.
Unique Individuals Starting FTC/TDF for PrEP in US, 2012 to 2015 (by quarter) from pharmacy database
Slide 34.
Age of Individuals Starting FTC/TDF for PrEP in US 2012-2015
Slide 35.
BUT: Not reaching disproportionately affected populations in US
Slide 36.
Top 20 US Cities with FTC/TDF for PrEP Use in 2015 (January to December)
Slide 37.
PrEP use among HIV-negative MSM at SF City Clinic (SFCC) and city-wide estimates
Slide 38.
Racial disparities in PrEP use among MSM, SF 2014 and 2016
Slide 39.
Crude, preliminary PrEP cascade for MSM in SF
Slide 40.
Summary of Coverage
Slide 41.
Adherence, Persistence
Slide 42.
Adherence and persistence are poor for many meds
Slide 43.
PrEP Use Over Time in the SF Demo Project
Slide 44.
PrEP Persistence, SF COPC clinics
Slide 45.
HPTN 073 Study Design
Slide 46.
HIV Seroconversions
Slide 47.
SATN 113: Daily Oral TDF/FTC as PrEP for Adolescent MSM in US
Slide 48.
Adherence: TFV-DP (fmol/punch) via DBS w/Dosing Estimates
Slide 49.
A Lexicon of Intermittent PrEP J. McConnell/AVAC
Slide 50.
Have you prescribed PrEP, and if so, how do you prescribe it? (Choose highest one)
Slide 51.
Seasons of Risk: MSM in MACS over 8 Years
Slide 52.
IPERGAY : Sex-Driven iPrEP
Slide 53.
HIV Incidence (mITT Analysis)
Slide 54.
PK/PD Simulation of PrEP Efficacy in Rectal Tissue Using the IPERGAY Dosing Regimen
Slide 55.
Proportion of population achieving EC90 level of protection# doses per week
Slide 56.
When are MSM protected from HIV with TDF/FTC?
Slide 57.
Planning for the pre-event dose US online survey, 1013 MSM
Slide 58.
MSM Behavior: Intermittent PrEP is not for everyone
Slide 59.
Problems: Cost
Slide 60.
Impact on Proportion of Infections Averted PrEP Coverage vs. Adherence
Slide 61.
Adherence is Most Important for NNT
Slide 62.
Testing the hypothesis that treatment can eliminate HIV: a nationwide, population-based study of the Danish HIV epidemic in men who have sex with men
Slide 63.
Comparing Denmark and SF
Slide 64.
The Future
Slide 65.
MTN-020/ASPIRE: Dapivirine Vaginal Ring for HIV Prevention in Women
Slide 66.
MTN-020/ASPIRE Subcohort: Adherence vs HIV Protection 3 Mos Before Detection
Slide 67.
The Pharmacokinetic (PK) Tail
Slide 68.
Resistance after Single 300mg Dose of RPV LA
Slide 69.
Persistence of RPV
Slide 70.
CABOTEGRAVIR: GSK126744 Long Acting (744LA)
Slide 71.
HPTN 083: Efficacy of injectable cabotegravir (CAB) for PrEP in MSM and transgender women
Slide 72.
HIV Vaccines
Slide 73.
The impact of vaccination on the health of the world's peoples is hard to exaggerate. With the exception of safe water, no other modality has had such a major effect on mortality reduction and population growth
Slide 74.
Evidence of an early protective effect
Slide 75.
Antibodies Teach Us About HIV Vaccine Development
Slide 76.
Neutralizing Ab to HIV-1
Slide 77.
VRC01 Blocks Attachment to CD4
Slide 78.
VRC01 Protects Against Mucosal SHIV-Challenge in Non-Human Primates
Slide 79.
The AMP Studies: Highlights
Slide 80.
New PrEP Agents: Summary
Slide 81.
Medical progress
Slide 82.
10 years before the licensed, highly effective polio vaccine
Slide 83.
Acknowledgments
Slide 84.

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