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Roy M. Gulick, MD, MPH
Every 2 years, the International AIDS Society (IAS) holds its Conference on HIV Science, and this time it was in Mexico City, with nearly 6000 people from 130 countries attended IAS 2019. With multiple tracks, over 90 sessions and 1300 abstracts, it is impossible to cover all the information presented, but in this program, Trip Gulick highlights new data from research pertinent to treatment initiation, maintenance therapy, switch studies, and new drugs in development, as well as prevention efforts including pre-exposure prophylaxis and vaccine development. So, if you want to stay up to date and know what is in the horizon, do not miss this important program.
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David J. Back, PhD
Are drug interactions still an HIV treatment issue in 2019? You bet they are, but how can we differentiate ARVs in terms of their mechanisms of action and interaction potential? And what commonly co-administered drugs, such as statins, psychotropics, proton pump inhibitors, steroids, and gender affirming hormones do we need to be on high-alert for? All this, plus interactions with recreational drugs, especially those used in chem-sex, are discussed. Don’t miss this important presentation by David Back, internationally recognized for his groundbreaking work in online interactive drug-drug interaction awareness. Your patients will thank you.
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Anna Huang, MD
The kinds of sexually transmitted infections as well as their optimal treatments, in our patient with or at risk for HIV, are evolving and increasingly problematic. Recently, there was another cluster of sexually transmitted cases of hepatitis A in NYC, multi-drug-resistant GC remains a threat, lymphogranuloma venereum is a treatment problem especially when it is rectal, and mycoplasma genitalium (MGen) is on the rise. Being up to date on the diagnosis and treatment of STIs, and what do do when treatment fails, is important not just for your patients’ well-being but for their partners as well. Don’t miss this important update by Anna Huang on the other STIs we are presently seeing in the era of U = U and PrEP, and what you need to know to more effectively interrupt their chains of transmission.
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Bernard M. Branson, MD
When you write an order for an HIV test, do you know what assay your facility or reference lab is using? And depending on what assay is being used, and whether the specimen is whole blood or plasma, how soon after exposure can HIV infection be detected? And how does this window of time to detection change in patients who do not take PrEP as prescribed, for one reason or another? Yes, it gets complicated. You probably ask yourself these questions every time you see somebody requesting PEP or PrEP, or struggling to answer these questions as accurately as you can when your patients ask you for your expert opinion. This presentation by Bernard Branson will help you understand the limitations and advantages of the various HIV tests currently available as well as new assays in the testing pipeline, so that you can answer all of these questions better, no matter who is asking.
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Sapna A. Mehta, MD
With the success of antiretroviral therapy, our patients are approaching near-normal life-expectancy. But we are also seeing a higher risk for end-organ disease in our aging HIV patients, and greater need for organ transplants. Even with the addition of HIV-positive organ donors, what is the wait time for recipients most in need? If the organ donor also has hepatitis C, can transplantation to an HCV-negative donor still be safe? And the outcomes-- how are HIV-positive recipients of liver, kidney, heart and lung transplants doing, as compared to the general population? For answers to these questions and much more about HIV-positive transplant recipients and donors, do not miss this exciting and informative program by Sapna Mehta.
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Christina M. Wyatt, MD
Whether we are initiating antiretroviral therapy for HIV infection or pre-exposure prophylaxis to prevent it, we must not forget to screen for underlying kidney disease, and to establish baselines from which nephrotoxicity secondary to treatment can be detected and managed. This presentation by Christina Wyatt is packed with clinical pearls that will help you screen and evaluate kidney disease in your patients, including changes secondary to ARV toxicities and comorbid conditions such as diabetes and/or hypertension, strategies to maintain kidney health, as well as management of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD).
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Craig W. Hendrix, MD
At the most recent HIV Research for Prevention (HIVR4P) convention in Madrid, advocates from around the world were marching and chanting in support for more choices in HIV prevention modalities. And the prevention pipeline is very interesting! This presentation by Craig Hendrix targets the drugs, delivery systems, safety and efficacy of agents currently used for PrEP in diverse populations, including cisgender and transgender women, as well as the many agents in development that will help you in your next conversation with a patient wishing or waiting for more prevention choices.
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Rajesh T. Gandhi, MD
We are fortunate in HIV medicine to have robust treatment and prevention guidelines, but there is always room for improvement. The advances we continue to see are driven, in part, by the controversies surrounding optimal prevention, treatment and cure strategies as evidence-based outcomes are continually reassessed. So, don’t miss this up-to-date review of current controversies by Raj Gandhi, focusing on prevention, treatment, complications of treatment, and efforts to find a cure.
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Roy M. Gulick, MD, MPH
Every year the Conference on Retrovirology and Opportunistic Infections (CROI) is packed with important new information and this program focuses on the advances in antiretroviral therapy to improve standards of care and point the way to future advances through emerging research and drug development. Don’t miss this engaging review by Trip Gulick on CROI 2019 highlights in HIV cure, treatment strategies and drug resistance, new drugs and mechanisms of action, HIV prevention, and TB coinfection.
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Thomas J. Hope, PhD
What happens after genital or anal exposure to HIV, and how fast can infection take hold? When and where can this infection be stopped after exposure and what is the virus doing during the eclipse and window periods before it can be detected in blood? In this thought-provoking program, Tom Hope will sharpen your view of pathogenesis with his research into the earliest events of HIV transmission and dissemination utilizing non-human primate mucosal-challenge models, human tissue explant cultures, whole animal PET/CT and PET/MRI imaging, and electron microscopy.
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Vaty M. Poitevien, MD and Pierre R. Arty, MD
Internet hook-up trends for gay men, in combination with recreational drugs, including crystal meth, to decrease inhibitions and increase sexual pleasure, are the drivers of what has become known as chemsex. This phenomenon is not limited to the UK and Europe, where the term was first used—it is international in scope, including New York City, and can lead to substance use disorders and mental illness. Chemsex also greatly increases the risk for non-adherence to HIV medication, PrEP, and condom use, while elevating the risk for transmission of HIV and other sexually transmitted diseases. How can we understand and help in a non-judgmental way? This program by Drs. Vaty Poitevien and Pierre Arty tackles this important and too-often overlooked problem.
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Demetre C. Daskalakis, MD, MPH
We are making great strides in New York to end the HIV epidemic, as this presention by Demetre Daskalakis demonstrates. But how are the demographics changing? What are the emerging disparities? And how can we address the evolving needs of New Yorkers who are newly infected or at ongoing risk for transmission in all of our diverse communities? Don’t miss this important presentation on where we stand and the problems we currently face in the struggle to end the HIV epidemic once and for ALL by the end of 2020.
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Tae-Wook Chun, PhD
Achieving a scalable and broad-based cure for HIV-infected individuals is a daunting challenge, but Cure research is ongoing, including immune-based strategies that boost the host immune response against the virus. Clinical trials aimed at achieving ART-free HIV-remission will need to include placebo groups and analytical treatment interruption and plasma viremia as an end point. Don’t miss this important presentation on current Cure research and ways that you and your eligible patients may be able to contribute to the science by which research outcomes can be effectively measured.
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Kristen Marks, MD
The newer drugs we now have to treat Hepatitis C have never been more tolerable, efficacious, or easier to use. And better yet, they can be used safely in acute HCV, people who continue to inject drugs, and even in people with end-stage liver disease and cirrhosis. If you are not already treating your patients with HCV, now is the time to watch this exciting program by Kristen Marks, and consider expanding your practice to treat and cure your patients with hepatitis C. Yes, its curable, and you can do this!
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Todd T. Brown, MD, PhD
You may not be seeing facial lipoatrophy or buffalo humps like we did in the early years of HAART, but body fat changes persist now, even with newer regimens. In this program, Todd Brown discusses the past and present body fat changes in the long-term management of HIV disease, the critical importance of lifestyle changes for the management of liopohypertrophy and obesity in HIV, the risk and benefits of pharmacologic approaches to treatment, and research strategies to guide treatment in the future.
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W. David Hardy, MD
The treatment and prevention of HIV disease, Hepatitis C and their myriad complications are constantly changing—and the evolution of state-of-the-art management is almost always forecasted by research presented at major scientific meetings both nationally and internationally. In this program, David Hardy targets some of the highlights from AIDS 2018, the International AIDS Society’s conference in Amsterdam, and IDWeek 2018, the Infectious Diseases Society of America’s annual conference. Don’t miss this important review on diverse topics of interest to our primary care audience.
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Peter W. Hunt, MD
Even with early initiation of combination antiretroviral therapy, there is still a gap in life expectancy between our HIV-positive and HIV-negative patients, and age-associated morbidities and multimorbidities are more common in people aging with HIV. Don’t miss this fascinating and clinically important presentation by Peter Hunt on the effects of immune activation in our patients aging with HIV, what life-style changes and anti-inflammatory drugs may be helpful, and research strategies targeting root causes of chronic inflammation that may help our patients age more normally with fewer complications in the future.
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Susan E. Krown, MD
In the days before combination antiretroviral therapy, one of the most stigmatizing AIDS-defining complications of HIV disease was Kaposi Sarcoma (KS), caused by coinfection with Kaposi Sarcoma-associated Herpes Virus (KSHV), also known as Human Herpesvirus-8 (HHV-8). Thankfully, we see KS infrequently now, but still need to keep it in the back of our minds. KSHV infection is life-long, similar to other herpesviruses, and even though overall KSHV seroprevalence in the USA is less than 10%, it is much higher in HIV-negative MSM (20-30%) and even higher in HIV-positive MSM (30-60%). So what are the implications for these patient populations as they age? Don’t miss this important review by Susan Krown, a leader in KS diagnosis and treatment from the earliest days of the AIDS epidemic in NYC, who is still involved in the fight against KS internationally.
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Stephen E. Goldstone, MD, and Peter S. Kozuch, MD
When anal cancer prevention efforts fail, or when initial physical exam and screening lead to the diagnosis of malignancy, what next? This presentation by Stephen Goldstone, a surgeon, and Peter Kozuck, an oncologist, will walk you through the typical and atypical presentations of anal cancer, standard approaches to therapy, post-treatment follow-up, and consequent morbidities that that your patients may face.
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Joel M. Palefsky, MD, FRCP(C)
Current data shows that anal cancer is increasing in general population and will remain the most common preventable cancer in our HIV-positive patients. So, what can we do to help prevent HPV-associated anal cancer? The preventive HPV vaccine is safe and highly efficacious, but what about anal cancer prevention in our patients already infected with oncogenic strains of HPV? This presentation by Joel Palefsky will bring you up-to-date on all current prevention modalities, how to evaluate your patients at risk, efforts to block progression to cancer, and scientific advances that may help us improve screening and prevention moving forward.
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Roy M. Gulick, MD, MPH
In this program Trip Gulick discusses important events leading up to the International AIDS Society conference - AIDS 2018 - including the 2018 UNAIDS data report on the global AIDS response, the FDA approval of the first PI-based single-tablet regimen for HIV, and the publication in JAMA of the IAS-USA 2018 recommendations for antiretroviral treatment and prevention of HIV infection. With this background, Dr. Gulick proceeds to discuss highlights of the AIDS 2018 meeting in Amsterdam, including new research on HIV treatment initiation, HIV and TB coinfection, and HIV switch studies. Due to the length of this program, we have split this into two parts. Be sure to watch both!
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Roy M. Gulick, MD, MPH
In this continuation of highlights from AIDS 2018 in Amsterdam, Dr. Gulick finishes his review of HIV switch studies, and goes on to discuss drug toxicities, ARVs in pregnancy and pediatrics, drug resistance, PrEP, including important information for PrEP in trans women, and further efforts to discover a cure for HIV infection. Don’t miss either of the two parts of this important and exciting program!
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Karen Palmore Beckerman, MD
Efforts to prevent mother-to-child transmission of HIV are the oldest and most successful examples of HIV prophylaxis, and a model for post-exposure prophylaxis and the expanded efforts we now have, such as Treatment as Prevention. But even though it is rare, we still see mother-to-child transmission of HIV, especially when mothers become acutely infected during pregnancy or while nursing. It is important to understand the deficiencies and oversights in routine standards of care, if we hope to finally reduce perinatal HIV infection to zero.
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Elaine J. Abrams, MD
Growing up is always difficult. Remember? But growing up with perinatal HIV infection, adds new dimensions to the physical and psychosocial challenges that children face as they struggle simply to survive, and hopefully thrive. This important presentation by Elaine Abrams will help you identify interventions that may help you improve the outcomes of young people growing up with HIV and care for them with a deeper understanding when they transition to adult medical care.
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Douglas S. Kwon, MD, PhD
We hear more and more about the microbiome these days, but what impact does the microbiome have in people with or at risk for HIV infection? We know the gut lymphoid system is rapidly and permanently impaired by HIV, and chronic use of antiretroviral drugs for HIV and antibiotic prophylaxis against opportunistic infections can affect the gut, but need we be concerned about the microbiome? This fascinating program will help you understand what is presently known about the interplay of the bacterial microbiome and mucosal immunity, the resulting effects on HIV susceptibility and HIV-associated chronic inflammation, and the latest efforts to leverage the microbiome to prevent HIV transmission and improve health for those living with HIV.
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Benjamin J. Eckhardt, MD
Injection drug use is a growing problem across the country, and a well-known risk for transmission of hepatitis C. But can HCV in our patients who continue to inject drugs be successfully be treated? Does HIV/HCV coinfection decrease the odds for success? Can they be re-infected with HCV once cured? Will treatment of HCV in in these patients help stop the HCV epidemic? Unlike HIV, HCV is now curable, but we will never end the HCV epidemic if we cannot adequately serve our most vulnerable populations. This important program grapples with the barriers, both real and imagined, that stand in our way.
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Francine Cournos, MD
As a medical provider, you can have a powerful impact on the behavioral health of your patients living with HIV, but you need to know how to sort out what is required and what is optional, and utilize practical behavioral strategies to evaluate and manage depression, anxiety and stress. This presentation by Dr. Francine Cournos is packed with clinical pearls that will help you serve your patients mental health needs more effectively, while preserving your own sanity.
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Robert H. Remien, PhD
If we do not address mental health issues at the primary care level, we are very unlikely to be able to bring an end to the HIV epidemic. Mental health problems contribute not only to HIV acquisition, but also to poorer outcomes at every step in the HIV treatment cascade. Since people living with HIV disease have significantly higher rates of mental health disorders than that of the general population, in this program, Dr. Robert Remien focuses on strategies we can use to integrate mental health assessment and treatment into routine HIV care. Only then will we be able to achieve our “90-90-90” and “EtE” goals.
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