Welcome to the BC-CfE Special Webinar COVID-19, the BC-CfE Response
Acknowledgements We acknowledge with gratitude that our place of work is within the unceded traditional home lands of the Musqueam, Squamish, and Tsleil-Waututh Nations.
Webinar Main Objectives • An update on BC-CfE’s position regarding the COVID-19 pandemic • An overview of the COVID-19 pandemic, clinical presentations and prevention • Update on the BC-CfE’s precision medicine testing services in view of the COVID-19 pandemic • Information on what the BC-CfE is doing to facilitate access to ART in view of the COVID-19 pandemic
Presenters Dr. Julio Montaner Executive Director & Physician-in-Chief BC Centre for Excellence in HIV/AIDS Dr. Peter Phillips Clinical Professor Division of Infectious Diseases, University of British Columbia Dr. Zabrina Brumme Laboratory Director, BC Centre for Excellence in HIV/AIDS Professor, Faculty of Health Sciences, Simon Fraser University Scholar, Michael Smith Foundation for Health Research Junine Toy, Pharm D Senior Manager, BC Centre for Excellence in HIV/AIDS Drug Treatment Program Clinical Pharmacy Specialist, St. Paul’s Hospital
A Brief Update on the BC-CfE’s activities during the COVID-19 Pandemic Julio Montaner, OC, OBC, MD Executive Director & Physician-in-Chief, BC-CfE March 25, 2020
Slides and related information are available at: http://cfenet.ubc.ca/ March 20 th 2020 DHHS - Interim Guidance for COVID-19 and Persons with HIV https://aidsinfo.nih.gov/guidelines/html/8/covid-19- and-persons-with-hiv--interim-guidance- /0?utm_source=AIDSinfo&utm_medium=email&utm_cam paign=3-20-20-COVID19_Guidance The following is a summary of the key messages, which are in keeping with the BC-CfE guidance
General Guidance * PLWH >60 y.o. and those with DM, hypertension, CVD, or lung disease (incl’ chronic smoking) are at high risk of severe/life-threatening COVID-19 * Limited data available do not suggest HIV under effective ART changes the course of COVID-19 * However, until more is known, additional caution for all PLWH, especially those with advanced or poorly controlled disease , is warranted.
General Prevention * PLWH should follow all applicable recommendations to prevent COVID-19, such as social distancing and proper hand hygiene * Influenza and pneumococcal vaccinations should be kept up to date
Antiretroviral Therapy * Maintain ≥ 90-day supply of ARVs and other medications * Defer any elective ART changes until close follow-up and monitoring are reliably available * LPV/r has not been shown effective as treatment for COVID-19 and further RCTs are underway, globally - In an open-label trial, 199 hospitalized pts with COVID-19 were randomized to 14 days of LPV/r plus SoC or SoC alone. There was no statistically significant difference re: time to clinical improvement or mortality. NEJM March 19 th 2020 * Effective ART should not be switched to a PI based regimen to prevent/treat COVID-19
Clinic or Laboratory Monitoring Visits * Encourage telephone or virtual visits for routine or non- urgent care and adherence counseling * PLWH on ART, with a consistently undetectable plasma HIV viral load and in stable health, should be encouraged to defer routine medical and laboratory visits
Pre-Exposure Prophylaxis (PrEP) * Maintain ≥ 90-day supply * Encourage telephone or virtual visits * Defer routine medical and laboratory visits Note: PrEP is not anticipated to have an impact on COVID-19
COVID-19 Clinical Prevention, Presentation and Management Peter Phillips, MD, FRCPC Division of Infectious Diseases, St Paul’s Hospital March 25, 2020
COVID-19 Prevention 1. Vaccine (none) 2. Antiviral prophylaxis (none) 3. Public Health Interventions Containment & Mitigation – case finding isolation – contact tracing quarantine – high risk travel quarantine – social distancing, school closures etc. – mass quarantine (“lockdown”)
Mitigation: – flattening the Curve
Total Coronavirus Cases in Canada
Daily New Cases in Canada
COVID-19 Clinical presentation Fever 94% Cough 79% Sputum 23% Diarrhea 5% Nausea /vomit 4% (URTI symptoms ?) Zhou F et al. Lancet March 9 th 2020
COVID-19 mortality rate by age
COVID-19 Management 1. Supportive • oxygen • ICU, +/- ventilator, +/- ECMO 2. Investigational • antiviral therapy – remdesivir – hydroxychloroquine +/- azithromycin – lopinavir-ritonavir – tocilizumab (IL-6 inhibitor) • immunotherapy – convalescent plasma
Update on the BC-CfE’s precision medicine testing services during COVID-19 Zabrina Brumme, PhD Director, BC-CfE Laboratories March 25, 2020
Key information in today’s presentation is available at: http://cfenet.ubc.ca/ Key information has also been emailed to provincial labs and mailed to all HIV care providers in British Columbia
The BCCfE’s HIV precision medicine testing service IS OPERATIONAL, however: 1. We request that health care providers limit test requests to only those urgently needed to guide clinical care. Please defer non-essential requests to a later date. 2. The BC-CfE Laboratory will be temporarily reducing the routine availability of some of our Precision Medicine tests. 3. We aim to maintain our standard turnaround times, but delays in reporting may occur.
The BC-CfE will continue to routinely perform the following essential precision medicine tests: • Genotypic testing for resistance to HIV Protease Inhibitors, NRTI and NNRTI • Genotypic testing for resistance to HIV Integrase Inhibitors • HLA-B*57:01 genotyping for abacavir hypersensitivty reaction
The following tests will not be routinely available, but will be performed if urgently needed • HIV gp41 resistance testing for enfuvirtide (T20) • RNA and proviral DNA-based HIV genotypic co-receptor tropism testing for maraviroc • Therapeutic Drug Level Monitoring and Untimed Drug Level testing of HIV antiretrovirals • HCV genotypic drug resistance testing Please contact the BC-CfE lab at 1-800-517-1119 if you urgently require any of the above tests
Scenarios where tests should still be ordered Tests required to make critical treatment decisions should be ordered. These include, but are not limited to: • Resistance testing of a patient's first positive pVL sample to decide an initial regimen • Resistance testing in patients failing therapy with pVL > 250 copies/ml • Resistance testing required to support treatment switches in patients experiencing toxicity or other adverse events • Any test required to support treatment decisions in hospitalized patients. Contact us if necessary.
Scenarios where testing could be deferred These may include, but are not limited to: • Tests in samples with low-level viremia (including transient "blips" or persistent low-level viremia below 250 copies/mL) • Retrospective testing of archived specimens to support treatment change decisions in patients with suppressed viremia who are not experiencing adverse events ( i.e. "elective" therapy changes or treatment simplification)
A request RE: specimen courier deliveries to BC-CfE The BCCfE requests that clinics and labs sending specimens by courier alert us to incoming shipments. Please provide the courier name and tracking number to: lab@cfenet.ubc.ca
Requests from labs doing COVID-19 testing in BC: 1. Please limit routine viral load testing for these viruses: HIV EBV BK HBV HCV Routine CMV viral load testing should proceed as normal. This is to reserve instrument/reagent capacity for COVID-19 testing 2. Please defer all non-essential serology. Note: BCCDC has temporarily halted routine HCV antibody, RNA and genotyping. HCV antibody and RNA will continue to be performed for those hospitalized and those requiring organ donor testing 3. Please do not phone COVID-19 testing labs for results. Outpatients can access COVID-19 results through my ehealth
HIV Treatment and Prevention Programs Access to Antiretrovirals Junine Toy, Pharm D Senior Manager, BC-CfE Drug Treatment Program March 25, 2020
Objectives 1. An update on BC-CfE’s position regarding the COVID- 19 pandemic 2. An overview of the COVID-19 pandemic, clinical presentation and prevention 3. Update on the BC-CfE’s precision medicine testing services in view of the COVID-19 pandemic 4. Information on what the BC-CfE is doing to facilitate access to ARVs in view of the COVID-19 pandemic
BC-CfE HIV treatment and prevention programs Central program operations as per usual … HIV HIV PrEP PEP treatment prevention BC-CfE Drug Treatment Program St. Paul’s Hospital Ambulatory Pharmacy
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