hiv infection in women in vinnitsia oblast€¦ · • the patient’s examination at each visit...
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КЗ «Вінницький обласний клінічний Центр профілактики та боротьби зі СНІДом»
WAVE Workshop «On track to improve health of women living with HIV – Ukraine»Kyiv, Ukraine, July 5-6, 2019
HIV Infection in Women in Vinnitsia Oblast Clinical and Epidemiological Situation
Ihor MatkovskyChief Physician
HIV Dynamics in the Region(Vinnitsia Oblast)
Official Statistical data of Vinnitsia Oblast Clinical AIDS Prevention Centre and CPH of MoH of Ukraine, 2019
75
190
339
0
100
200
300
40019
88 -1
995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Died of AIDS Developed AIDS Officially Registered
Registered Patients with HIV in the Region, by Sex and Age (Vinnitsia Oblast, 1988 – 2018)
73 3 32
1 302
151
0-14 15-17 18-24 25-49 старше 50
menwomen
Official Statistical data of Vinnitsia Oblast Clinical AIDS Prevention Centre and CPH of MoH of Ukraine, 2019
ART Coverage – 82% of Active Follow-up Group
(Vinnitsia Oblast)
12 12 12 13 17 19 21
290378 452 510
657750
849755
9701 146
1 277
1 5681 721
1 899
2012 2013 2014 2015 2016 2017 2018
GirlsWomenTotal
Official Statistical data of Vinnitsia Oblast Clinical AIDS Prevention Centre and CPH of MoH of Ukraine, 2019
1986 Patients Have Been Continuously on ART as of 01.06.2019 (Vinnitsia Oblast)
89445%
105053%
171%
251%
Women
Men
Girls
Boys
•Official Statistical data of Vinnitsia Oblast Clinical AIDS Prevention Centre and CPH of MoH of Ukraine, 2019
Age Distribution of Women on ART as of01.06.2019
(Vinnitsia Oblast)
•Official Statistical data of Vinnitsia Oblast Clinical AIDS Prevention Centre and CPH of MoH of Ukraine, 2019
DTG and Women• As of 01.06.19 ARV therapy was provided to 1,986 patients including 959 patients on
DTG-based regimens, which is 48.29% of the total number of people on ART, 543 of whom were women, i.e. 56.62%.
• Three pregnancies on DTG-based regimen:- First pregnancy (the woman presented after 12 weeks) ended in childbirt in February
2019; the follow-up of a child continues; - Second pregnancy (the woman presented at 17 weeks) - follow-up and lab
monitoring are performed in accordance with the current clinical protocol; - Third pregnancy (the woman presented at 12 weeks): HIV/TB coinfection; the patient
receives TBC maintenance treatment (Izoniazid, Rifampicin); her ART regimen:TDF/FTC+ DTG was changed to TDF/FTC/EFV (to avoid unwanted interaction between DTG and Rifampicin) (could we have possible doubled DTG dosage during pregnancy?) and the woman is followed up.
•Official Statistical data of Vinnitsia Oblast Clinical AIDS Prevention Centre and CPH of MoH of Ukraine, 2019
Distribution of ART Regimens
•Official Statistical data of Vinnitsia Oblast Clinical AIDS Prevention Centre and CPH of MoH of Ukraine, 2019
1 986
0
543416959
patients on DTG
Total on ART
Women on DTG
Men on DTG48,29 56,62%43,38%
HIV Prevalence among Pregnant Women
•Official Statistical data of Vinnitsia Oblast Clinical AIDS Prevention Centre and CPH of MoH of Ukraine, 2019
0,45
0,52 0,520,55 0,55
0,48 0,47 0,45
0,390,36
0,320,3
0,33
0,180,23
0,27 0,27 0,280,25
0,16
0,24 0,260,22 0,24
0,15
0,220,25
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Ukraine Vinnitsia obl.
Correlation between women who became pregnang and gave birth knowing their HIV+ status, and women who learned their HIV+ status during their current pregnancy (Vinnitsia Oblast)
4
26 2732
3746
35 35
21
3742 38
31 33 36 33 33 3441
68 65 6370
82
68 68
55
2006 2008 2010 2012 2014 2015 2016 2017 2018
Під меднаглядом Вперше взяті під МН Всього народили
•Official Statistical data of Vinnitsia Oblast Clinical AIDS Prevention Centre and CPH of MoH of Ukraine, 2019
In care First time linked to care
Total deliveries
Children Born to HIV+ Mothers(Vinnitsia Oblast)
•Official Statistical data of Vinnitsia Oblast Clinical AIDS Prevention Centre and CPH of MoH of Ukraine, 2019
Cancer Manifestations in HIV+ Women(Vinnitsia Oblast, 2018)
HIV related 241. Lymphoma in the brain 8 (33%)2. B-cell non-Hodgkin lymphoma 4 (17%)3. Kaposi sarcoma 4 (17%)4. iInvasive cervical cancer 8 (33%)
Not related to HIV 71. Cutaneous neoplasms 42. Breast carcinoma 13. Hepatic haemangioma 2
•Official Statistical data of Vinnitsia Oblast Clinical AIDS Prevention Centre and CPH of MoH of Ukraine, 2019
Clinical Case(Breast Carcinoma)
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
Clinical Case
• Patient V, born in 1972
• HIV antibodies detected on 21.06.2018 (code 113.2)• She first presented at the Centre on 10.07.2018, when she was
examined and treated at PROC (Podil Regional Oncology Centre) and was tested for HIV antibodies.
• Diagnosis: В 22.2, clinical stage IV. Body weight loss over 10% in 6 months. Recurrent oropharingeal candidiasis. Са in lower outer quadrant of left breast - ІІb stage, ІІ clinical group (T2 N1 M0)
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
Са Diagnosis Verification
• 21.05.2018 – cytology – Adenocarcinoma
• 22.05.2018 – histology – Infiltrating carcinoma
• 25.05.2018 – IHC, cancer-specific marker – HER2 neu expression +++, PR – negative, 0%, ER – weak positive reaction, 14%
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
Additional Examinations 1
• Blood chemistry (31.05.2018):
– AST – 1027,9 U/L, ALT – 903,6 U/L.
–CBC (30.05.2018): leucocytes – 5,8*109/L, red blood cells –4,01*10’12/L, haemoglobin 96 g/L, platelets - 390*10’9/L.
–HBsAg – 13.07.2018 – negative
–Anti-HCV – 13.07.2018 – positive
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
• Mammography (17.04.2018) – the picture is typical for Ca of left breast
• Breast sonography (17.05.2018) – neoplasm in left breast (size126*155) with the signs of infiltraing growth. Mts in the left axillary lymph node
• CT of thoracic spine (15.05.2018) – Scoliosis. Degenerative changes of thoracic spine, more expressed in Т4-Т8, complicated with spondylarthrosis deformans (Т3-Т10)
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
Additional Examinations 2
Sonography (17.05.2018)
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
Axillary lymph nodeBreast
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
Additional Examinations 3
• Helical computed tomography (30.05.2018р) of brain, chest CT, abdominal CT, pelvic examination with IV contrast “Tomohexol 350”. Scan slice thickness 5 mm. CT for the signs of additional growth in left breast. Hepatomegalia, hepatosteatosis.
• TB doctor consultation (11.07.2018):
no data on pulmonnary TB identified
• Consultation with TB specialist – orthopedist (06.08.2018): no data on thoracic spine TB identified. Disseminated thoracic spine ostechondrosis with pain syndrome.
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
Additional Consultations
Treatment
• Consultation with oncologist – chemotherapist on 09.07.2018
• Pain control if needed (Nalbuphine 10mg i/m in case of pain)
• Chemoreduction: Docetaxel 128mg + Herzeptin 496 mg(thereafter - 372 mg), 4 cycles in case ALT and AST activity normalizes
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
ART
On 06.08.2018 ART regimen ABC/3TC/DTG is prescribed(3 months after the confirmation of Са!)
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
Chemotherapy
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
• 06.11.2018р – 07.11.2018: – Herceptin 496mg– Docet. 126 mg
• 21.12.2018р – 22.12.2018: – Herceptin 544 mg– Docet. 134 mg
• 01.04.2019р – 02.04.2019: – Herceptin 552 mg– Docet. 135 mg
• 24.04.2019р – 25.04.2019: – Herceptin 552 mg– Docet. 135 mg
• 20.05.2019р – 22.05.2019: – Herceptin 552 mg– Mesna 600 mg– Cyclophosphamidum 1 079 mg– Epirubicin 162 mg
• 21.06.2019р – 22.06.2019: – Herceptin 420 mg– Doxorubicin 109 mg– Cyclophosphamidum 1 086 mg
Treatment Dynamics
• The patient’s examination at each visit did not show any objectively positive changes; breast is deformed, nipple is inverted, the structure is bulging and dense.
• Left axillary lymph node is elevated and painful• Oncologists plan to intensify the chemotherapy protocol
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
Sonography (21.06.2019)
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
Axillary lymph nodeBreast
Breast - general appearance
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
Conclusions• If it does not disturb you – it does not mean that it is ‘absent’
• Breast cancer affects the female body irrespective of age and HIV status
• After 40 years of age women should examine their breaststhemselves and see a doctor every year, and have mammography every 1-2 years
• A woman abuses herself if she delays a visit to a doctor for months, if she feels stress and permanent fear
Clinical Case, Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
THANK YOU FOR ATTENTION!
Vinnitsia Oblast Clinical AIDS Prevention Centre, 2019
QUESTIONS