HIV & TB : THE ODD COUPLE Felipe Gutierrez MD, MPH Infectious - - PowerPoint PPT Presentation

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HIV & TB : THE ODD COUPLE Felipe Gutierrez MD, MPH Infectious - - PowerPoint PPT Presentation

Jul 01, 2023 216 likes •384 views

HIV & TB : THE ODD COUPLE Felipe Gutierrez MD, MPH Infectious Diseases Section Chief Phoenix VA Health System HIV/TB SYNDEMIC Urbanization Poverty Migration Increased susceptibility Reported TB Cases US 1982-2013 30,000

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SLIDE 1

HIV & TB : THE ODD COUPLE

Felipe Gutierrez MD, MPH Infectious Diseases Section Chief Phoenix VA Health System

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SLIDE 2
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SLIDE 3

HIV/TB SYNDEMIC

  • Urbanization
  • Poverty
  • Migration
  • Increased susceptibility
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SLIDE 4

Reported TB Cases US 1982-2013

CDC National TB Surveillance 2013

5,000 10,000 15,000 20,000 25,000 30,000

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SLIDE 5

Increase in Rates of TB US 1985-1992

Data from Kwan & Ernst.Clin Micro Rev.Apr 2011.351-376

0% 50% 100% TR RATE INCREASE Urban Areas California New York

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SLIDE 6

Estimated % HIV/TB Coinfection US 1993-2013

10 20 30 40 50 60 70

All Ages Aged 25 - 44

CDC National TB Surveillance 2013

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SLIDE 7

GLOBAL EPIDEMIOLOGY

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SLIDE 8

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Afghanistan Bangladesh Brazil Cambodia China DR of the Congo Ethiopia India Indonesia Kenya Mozambique Myanmar Nigeria Pakistan Phillipines Russian Federation South Africa Thailand Uganda Tanzania Viet Nam Zimbabwe TB CASES WORLDWIDE

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SLIDE 9

HIV Prevalence Among New TB Cases

WHO Global Tuberculosis Control Report 2014

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SLIDE 10

Global Impact of HIV/TB

WHO Global Tuberculosis Control Report 2014

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SLIDE 11

PATH TO SUCCESS

  • HIV TESTING
  • ACCESS TO INH
  • ACCESS TO ART
  • IDENTIFICATION OF CASES
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SLIDE 12

TREATMENT CHALLENGES FOR THE CLINICIAN

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SLIDE 13

Immune Reconstitution Inflammatory Syndrome (IRIS)

  • Paradoxical excacerbation of infectious process after

initiation of antiretroviral therapy (ART)

  • Immune mediated process
  • Timing of ART
  • Management options
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SLIDE 14

TB-ART DRUG INTERACTIONS

  • Theoretical vs Practical
  • Rifamycins

– Cytochrome P450 induction

  • Resources

– Local TB Program – CDC 2013 Publication

  • “Managing Drug Interactions in The Treatment of HIV-Related Tuberculosis”

– TB Referal Centers

  • Heartland National TB Center
  • National Jewish
  • Curry International TB Center
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SLIDE 15

QUESTIONS?