早期治疗获益与风险的平衡英文.pptx

;Reality of current status of the global HIV epidemic;International HIV management guidelines based on scientific evidence;Why treating earlier benefits patients;Increased healthful survival ;6;Risk of death and certain complications“not thought to be HIV-associated”: D.A.D.;;Why start early?:Population health benefits ;;Those who went before…;Granich R, et al. Lancet 2010;Breakthrough of the year 2011;Transmission during therapy;Heterosexual HIV transmission after initiation of antiretroviral therapy (Donnell D et al. Lancet 2010);; TasP: is it going to be easy?NO;Gardner EM et al. Clin Infect Dis 2011;52:793-800.; TasP: is it going to be enough?;It is clear that TasP should be scaled up in conjunction with other effective HIV prevention interventions .But it is also clear that TasP is an essential component of the prevention package and should be rolled out as expeditiously as possible.;The truth of the matter is that virtually all HIV-infected individuals need to be treated anyhow for their own health.It is best to do this in a way that maximizes both individual and public health benefits: - which means as early as possible!;Earlier treatment?;Earlier treatment?;Objective;Drug resistance;Drug resistance;Drug resistance;AIDS (2013, 27: ) ;Mathematical modelling;Kampala, Uganda;Kampala, Uganda;Drug use;Classification of resistance;Transmitted Drug Resistance Prevalence;Transmitted drug resistance by drug class or mutation;So resistance increases…;Prevention versus Resistance;Strategies to reduce drug resistance;Can we limit drug resistance?;1. Viral load monitoring;Viral load monitoring;Viral load;2.Increasing access to 2nd line;Increase second-line;Increasing access to second-line;3. Baseline genotyping;Drug resistance;Baseline genotyping;But which strategy is the best?;But which strategy is the best?;Strategy;Is resistance unavoidable?;Conclusion;Erasmus Medical Centre