Providing Care for HIV-infected Woman Amneris E. Luque, MD SMH AIDS Center Medical Director 2002/07/01

Providing Care for HIV-infected Woman Amneris E. Luque, MD SMH AIDS Center Medical Director 2002/07/01

8000 6000 4000 2000 0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 30 25 20 15 10 5 0

/ (%) 100,000 1924 (18) 2 6784 (63) 49 1948 (18) 15 63 (1) 1 / 40 (<1) 5 * 10,780 (100) 9.3 *

: 9.3 N=10,780 10+ 5 9.9 _ <5 /100,000 <5 cases * 3.0 2.1 2.5 1.9 1.6 1.7 1.2 3.6 1.3 2.0 2.0 2.7 2.1 1.8 1.2 2.5 2.1 0.9 3.4 9.1 11.0 5.9 30.0 15.0 13.4 23.2 6.3 6.7 7.4 5.5 1.8 9.2 7.4 0.9 1.5 4.7 4.6 5.2 1.6 PR 21.3 VI 30.1 14.8 21.0 1.2 7.2 13.0 19.6 14.1 93.4 MA NH RI CT NJ DE MD DC * * * *

1991 1995

HIV

HIV HIV

HIV HIV

15-44 64% 10,000 23% 2% 1%

HIV HIV

CD4

(37%) (15%) (13%)

HIV

(d4t) (ddi)

HIV EE AUC 19% EE AUC 37% EE) EE EE

:

40-60%

Amneris E. Luque, Lisa M. Demeter, Heng Li and Richard C. Reichman

HIV HIV HPV HIV 204

(n=16) :

: : Cervex-Brush HPV DNA

HIV-1 RNA HPV DNA DIGENE : (LR HPV): HPV 6, 11, 42, 43, 44 : (HR HPV): HPV 16, 18, 31, 33, 35, 45, 51, 52, 57 HPV : VLP ELISA

HIV-1 RNA 10,000 HPV Luque AE, Demeter LM and Reichman RC. JID 179:1405-9, 1999

HIV-1 RNA > 10,000 copies/ml (P = 0.0016) HPV (P = < 0.001) Luque AE, Demeter LM and Reichman RC. JID 179:1405-9, 1999

(Pap smear) (n=191) 123 (64%) normal 31 (16%) ASCUS 25 (13%) LGSIL 7 (4%) HGSIL 3 (2%) dysplasia nos

HIV : 104 (51%) HIV 37 (18%) NRTI 2 61 (30%) NRTI 2 + PI 6 (3%) NRTI 2 + NNRTI

Median CD4 count (cells/ml) Median HIV-1 RNA (copies/ml) 357 422 429 270 1,056 11,968 572 33,667 Normal Pap smear 50 (69%) 22 (31%) 58 (76%) * 18 (24%) Abnormal Pap smear 18 (51%) 17 (49%) 16 (53%) 14 (47%) HPV DNA - 42 (63%) 25 (37%) 46 (77%) ** 14 (23%) HPV DNA + 24 (62%) 15 (38%) 16 (50%) 16 (50%)

100 80 87% P<.03 60 40 53% 47% HIV HIV 20 0 13% l Luque. 8th CROI; 2001; Chicago. Abstract 724.

80 78% 80% P<.01 60 40 20 0 22% HPV DNA+ 20% HPV DNA Luque. 8th CROI; 2001; Chicago. Abstract 724.

HIV HIV (P = 0.03, OR: 0.17, 95% CI: 0.03-0.97)

HIV HPV DNA P = <0.01, OR: 0.07, 95% CI; 0.013-0.416 HIV RNA CD4

32 (SHCS) 416 Weisser M, Rudin C, et al. J Acqu Imm Def Hum Ret 1998;17:404-410

( )

PCR HIV 10 HIV

HIV HIV

HIV

14-34 AZT 500 mg/ 1 AZT 2mg/Kg 1mg/Kg 8-12 AZT 2 mg/kg 6

HIV ACTG 076 HIV 14 AZT

AZT AZT

ZDV PCR N (%) 95% CI 423(45) 26 (6) 4.1-8.9 0.23 (0.16-0.34) 50(5.3) 5 (10) 3.3-21.8 0.38 (0.18-0.81) 48 86 (9.2) 8 (9.3) 4.1-17.5 0.35 (0.19-0.65) 3 38 (4) 7 (18.40 7.7-34.3 0.69 (0.35-1.36) 237 (25) 63 (26.6) 21-32.7 1 Wade N, Birkhead G et al NEJM 1998: 339-1409-14

AZT AZT 48 HIV

PACTG 076 1994 HIV HIV-1 14-36 ZDV 2 mg /Kg ZDV 2 mg/kg ZDV 8.3% ZDV 500mg/ 5 6 25% 1mg/kg/hr 6 ( 67.5%) 1999 1999 36 ZDV 300 mg 2 / 36 ZDV 300 mg / ZDV 300 mg ZDV 9.2% 18.6% ( 51%) ZDV 300 mg ( ) ZDV 15.7% / 25% ( 37%) 1999 ZDV 300 mg ZDV 4 mg/kg / / x 7 NVP 2 mg/kg NVP 200 mg ZDV 25% NVP 13% ( 47%NVP)

HIVNET-012 311 NVP 200 mg 72 NVP ZDV NVP ZDV 47% Guay LA, Musoke P, Fleming T et al Lancet 199;354:795-802

NVP 6-8 19% 46% K103 Y181C Eshelman S, et al Abstract 516. 8th CROI Feb 4-8, 2001. Chicago

PACTG 316 3 NVP 200 mg + 72 2 mg/kg HIV 41% 3 28% ZDV + 3TC 21-24% ZDV 2% NVP

PACTG 316 HIV (1.5%) HIV (50% ) Dorenbaum A, et al Abstract LB7. 8th CROI Feb 4-8, 2001.. Chicago

PACTG 316 NVP ZDV 23% ZDV + 3TC 28% PI 41% Dorenbaum A, et al Abstract LB7. 8th CROI Feb 4-8, 2001.. Chicago

HIV ( )

(< 2 ) CD4 < 200 ( ) John GC et al. JID 2001: 183: 206-12

( 2 ) HIV RNA > 43,000 John GC et al. JID 2001: 183: 206-12

15 (5 1 ) 8,533 HIV 4,675 ZDV 7,840 The International Perinatal HIV group.nejm 1999: 340:977-87

HIV

HIV

HIV -AETC NRC