scholarly journals 838. A Multidisciplinary Approach to the Management of Renal Disease in Patients with HIV

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S511-S511
Author(s):  
Yussef Bennani ◽  
Annalisa Perez ◽  
Hira Hasan ◽  
Lauren Richey
Keyword(s):  
Renal Function ◽  
Kidney Disease ◽  
Renal Disease ◽  
Creatinine Clearance ◽  
Research Study ◽  
Scientific Research ◽  
Study Investigator ◽  
Ckd Stage ◽  
Stage Renal Disease ◽  
Multidisciplinary Model

Abstract Background Chronic kidney disease (CKD) remains an important complication of HIV infection, with up to 30% of people with HIV (PWH) having abnormal renal function. Those with HIV and CKD are reported to have higher mortality than those with either alone. As survival of PWH continues to improve with antiretroviral therapy, additional risk factors for CKD become more prevalent with advancing age. Optimizing management of renal disease in this population to reduce mortality and progression to ESRD has become a more pressing need. Our study describes the implementation of a multidisciplinary HIV/nephrology clinic nested within a Ryan White HIV/AIDS Program-funded clinic on the progression of renal disease in PWH in New Orleans. Methods Clinic patients with HIV with at least CKD stage 3 (excluding those with end-stage renal disease) or significant proteinuria were eligible to be referred. Both an HIV primary care provider and a nephrologist evaluated patients at their initial visit, and the subspecialists jointly developed treatment plans. Patients included in the initial analysis were evaluated between January and May 2021. Baseline renal function and proteinuria were obtained, as well as additional studies as appropriate. Results A total of 1,968 patients were seen in the HIV clinic during the 18 months prior to the referral period. 305 (15.5%) had an ICD-10 diagnosis code for either CKD or proteinuria. During January – May 2021, 15 patients were referred and 13 evaluated in the multidisciplinary clinic, including 10 men and 3 women. Patients were seen an average of 1.3 times during this time. 8 patients were African-American, and 4 where white. Median age was 59. Median creatinine clearance at baseline was 45 mL/minute. Among those with proteinuria, median proteinuria was 891 mg/g. 8 patients had a diagnosis of hypertension, while 2 had diabetes mellitus. Initial data show a mean improvement in creatinine clearance of 4.2 mL/minute over a mean of 105 days of observation in those with repeat measurements. Conclusion There continues to be a high prevalence of CKD in PWH in the era of ART. Given the natural history of kidney disease, an improvement in creatinine clearance is promising. Aggressive co-management of HIV and CKD using a multidisciplinary model may limit progression of CKD and mortality. Disclosures Yussef Bennani, MD, MPH, Gilead Sciences (Scientific Research Study Investigator)ViiV Healthcare (Scientific Research Study Investigator)

scholarly journals 1157. Clinical Safety, Efficacy, and Pharmacokinetics of Fosmanogepix, a Novel First-in-class Antifungal, in Patients with Renal Insufficiency: Subset Analysis from a Phase 2 Candidemia Trial

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S605-S605
Author(s):  
Pierre Bulpa ◽  
Galia Rahav ◽  
Ilana Oren ◽  
Mickaël Aoun ◽  
George R Thompson ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Insufficiency ◽  
Antifungal Agents ◽  
Research Study ◽  
Scientific Research ◽  
Panel Member ◽  
Antifungal Treatment ◽  
Successful Outcome ◽  
Review Panel ◽  
Study Investigator

Abstract Background Fosmanogepix (FMGX) is a first-in-class antifungal agent, with a unique MOA targeting the fungal enzyme Gwt1, and broad-spectrum activity against yeasts and molds, including fungi resistant to other antifungal agents. Patients with candidemia often have underlying renal insufficiency or are receiving medications that affect renal function. This analysis evaluated outcomes in patients with varying degrees of renal insufficiency. Methods This global, multicenter, open-label, non-comparative study evaluated the safety and efficacy of FMGX for first-line treatment of candidemia. Patients with a recent diagnosis of candidemia defined as positive blood culture for Candida spp within 96 hrs prior to study entry with ≤ 2 days of prior antifungal treatment were eligible, including those with renal insufficiency. Patients with neutropenia, C. krusei infection, deep-seated Candida infections or receiving hemodialysis were excluded. Subjects were treated with FMGX for up to 14 days: 1000 mg IV BID for 1 day, then 600 mg IV QD for at least 2 days, followed by either 600 mg IV QD or 700 mg PO QD. Patients requiring antifungal treatment beyond 14 days received fluconazole. The primary efficacy endpoint was outcome at end of study treatment (EOST) as determined by an independent data review committee. Successful outcome was defined as survival with clearance of Candida from blood cultures with no additional antifungal treatment. Results 14/21 (66%) subjects had some degree of renal insufficiency: 7 had mild renal insufficiency (GFR:60-89), 5 had moderate renal insufficiency (GFR:30-59), and 2 had severe renal insufficiency (GFR:15-29). 12/14 (86%) completed study treatment, and treatment was successful at EOST in 12/14 (86%) subjects. Decline in renal function was not observed at EOST. 4 had worsening of renal function during the follow-up period; none required dialysis. Renal impairment did not increase exposure of FMGX. There were no treatment-related adverse events. Conclusion FMGX demonstrated high level treatment success with no evidence of drug-related nephrotoxicity, with no dose adjustments required. These preliminary data support the continued evaluation of FMGX in patients with candidemia and renal dysfunction as an alternative to potentially nephrotoxic antifungal agents. Disclosures Pierre Bulpa, MD, Amplyx Pharmaceuticals (Scientific Research Study Investigator) Galia Rahav, MD, AstraZeneca (Scientific Research Study Investigator) Mickaël Aoun, MD, Amplyx Pharmaceuticals (Scientific Research Study Investigator) Peter Pappas, MD, SCYNEXIS, Inc. (Consultant, Advisor or Review Panel member, Research Grant or Support) Bart Jan Kullberg, MD, FRCP, FIDSA, Amplyx (Advisor or Review Panel member) Sara Barbat, BSN, RN, Amplyx Pharmaceuticals (Employee) Pamela Wedel, BSc, Amplyx Pharmaceuticals (Employee) Haran T. Schlamm, MD, Amplyx (Consultant) Michael Hodges, BSc. MD, Amplyx Pharmaceuticals Inc. (Employee)

Rapid Decline of Residual Renal Function in Patients on Automated Peritoneal Dialysis

1996 ◽  
Vol 16 (3) ◽  
pp. 307-315 ◽  
Author(s):  
Kinya Hiroshige ◽  
Kougi Yuu ◽  
Masasuke Soejima ◽  
Masayuki Takasugi ◽  
Akio Kuroiwa
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Creatinine Clearance ◽  
Experimental Period ◽  
Residual Renal Function ◽  
University Hospital ◽  
Rapid Decline ◽  
Automated Peritoneal Dialysis ◽  
Stage Renal Disease

Objective To determine the effect of peritoneal dialysis modalities such as nightly intermittent peritoneal dialysis (NIPD), continuous cyclic peritoneal dialysis (CCPD), and continuous ambulatory peritoneal dialysis (CAPD) on residual renal function. Design A six-month prospective, nonrandomized comparison study. Setting Outpatient CAPD unit of a university hospital. Participants Eighteen end-stage renal disease patients treated by peritoneal dialysis (8 by NIPD, 5 by CCPD, and 5 by CAPD). Interventions Samples from the total dialysate, blood, and 24hour urine collection were obtained monthly. Measurements Urea, creatinine, and beta2-microglobulin concentrations were measured. Renal and peritoneal clearances of each substance and KT/V urea were calculated. Residual renal function (RRF) was estimated by renal creatinine clearance (RCcr). Results No significant differences in age, sex, and primary renal disease among the three groups were noted. In all groups, anemic and hypertensive states were controlled identically, and mean weekly total (renal + peritoneal) KT/V urea (over 2.1/wk) and total creatinine clearance (over 60 L/wk/1.73 m2) were maintained during the whole experimental period. Starting mean RCcr was near 4.0 mL/min/1.73 m2 in all groups. Thereafter, a rapid and significant decline in RRF was demonstrated on NIPD and CCPD. The declining rates of RCcr values at 6 months after starting NIPD and CCPD were -0.29 and -0.34 mL/min/month, respectively, which were much greater than those of CAPD (+0.01 mL/min/month). Conclusion Because of a possibly characteristic progressive loss of RRF in automated peritoneal dialysis (APD), strict regular assessment of RRF should be performed from the start of APD.

scholarly journals Impact of Left Ventricular End-Diastolic Wall Stress on Plasma B-Type Natriuretic Peptide in Heart Failure with Chronic Kidney Disease and End-Stage Renal Disease

2009 ◽  
Vol 55 (7) ◽  
pp. 1347-1353 ◽  
Author(s):  
Shinichiro Niizuma ◽  
Yoshitaka Iwanaga ◽  
Takaharu Yahata ◽  
Yodo Tamaki ◽  
Yoichi Goto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Disease ◽  
Natriuretic Peptide ◽  
End Stage Renal Disease ◽  
Wall Stress ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background: Plasma B-type natriuretic peptide (BNP) is a diagnostic and prognostic marker in heart failure (HF). Although renal function is reported as an important clinical determinant, precise evaluations of the relationships of renal function with hemodynamic factors in determining BNP have not been performed. Therefore, we evaluated the association of plasma BNP concentrations with LV end-diastolic wall stress (EDWS) in a broad range of HF patients including those with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Methods: In 156 consecutive HF patients including those with CKD and ESRD, we measured plasma BNP and performed echocardiography and cardiac catheterization. LV EDWS was calculated as a crucial hemodynamic determinant of BNP. Results: Plasma BNP concentrations increased progressively with decreasing renal function across the groups (P < 0.01) and were correlated with LV EDWS (r = 0.47) in the HF patients overall. This relationship was also present when patients were subdivided into systolic and diastolic HF (P < 0.01). In multivariable analysis, higher EDWS was associated with increased BNP concentration independently of renal dysfunction (P < 0.01). Anemia, systolic HF, and decreased BMI also contributed to increased BNP concentrations. Conclusions: These results suggest that LV EDWS is a strong determinant of BNP even in patients with CKD and ESRD. Anemia, obesity, and HF type (systolic or diastolic) should also be considered in interpreting plasma BNP concentrations in HF patients. These findings may contribute to the clinical management of HF patients, especially those complicated with CKD and ESRD.

scholarly journals 702. Risk Factors for Acute Gastroenteritis Among Patients Hospitalized in 5 Veterans Affairs Medical Centers, 2016–19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S451-S451
Author(s):  
Neha Balachandran ◽  
Jordan Cates ◽  
Anita Kambhampati ◽  
Vincent Marconi ◽  
Sheldon T Brown ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Disease ◽  
Research Study ◽  
Scientific Research ◽  
Veterans Affairs ◽  
The Past ◽  
Medical Centers ◽  
Study Investigator ◽  
Severe Renal Disease ◽  
Veterans Affairs Medical Centers

Abstract Background In the United States, an estimated 179 million acute gastroenteritis (AGE) episodes occur each year. Identifying factors contributing to AGE susceptibility and severity is important to address the high disease burden of AGE among adults. The primary objective of this analysis was to identify risk factors for all-cause AGE, norovirus-associated AGE and severe AGE among hospitalized adults. Methods We analyzed data from 1029 inpatient AGE cases and 624 non-AGE controls enrolled prospectively from December 1, 2016 – November 30, 2019 from 5 Veterans Affairs Medical Centers (Atlanta, Bronx, Houston, Los Angeles, Palo Alto). Standardized patient interviews and medical chart abstractions were conducted to collect demographics, exposure history, and underlying medical conditions. Stool samples from participants were tested for 22 pathogens using the BioFire Gastrointestinal Panel. Severity of AGE was determined using a 20-point modified Vesikari score (MVS) and severe AGE was defined as a MVS score of ≥ 11. Multivariate logistic regression was performed to assess associations between potential risk factors and outcomes. Results Of the total AGE cases, 551 (54%) had severe AGE; 44 (4%) were norovirus positive. Risk factors for all-cause AGE vs. non-AGE controls included household contact with a person with AGE in the past 7 days (aOR=2.9, 95% CI:1.3-6.7), severe renal disease (aOR=3.1, 95% CI:1.8-5.2), human immunodeficiency virus (HIV) (aOR=3.9, 95% CI:1.8-8.5), and immunosuppressive therapy (aOR=5.6, 95% CI:2.7-11.7). Factors associated with norovirus positivity by univariate analysis were contact with a person with AGE outside (OR=4.4, 95% CI:1.6-12.0) and within (OR=5.0, 95% CI:2.2-11.5) the household in the past 7 days. Detection of any viral pathogen (aOR=4.0, 95% CI:1.7-9.5) was a risk factor for severe AGE. Conclusion Our findings suggest that inpatients with HIV or severe renal disease, on immunosuppressive therapy, or in contact with a person with AGE within household are at higher risk for all-cause AGE. Patients with these medical conditions should be monitored for AGE related hospitalizations and may benefit from targeted AGE prevention messaging. Disclosures Vincent Marconi, MD, Bayer (Consultant, Scientific Research Study Investigator)Eli Lilly (Consultant, Scientific Research Study Investigator)Gilead Sciences (Consultant, Scientific Research Study Investigator)ViiV (Consultant, Scientific Research Study Investigator)

Abstract 49: The Effect of Gender, Obesity, and Chronic Kidney Disease on Cardiovascular Events

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Paul Kolm ◽  
Zugui Zhang ◽  
James Bowen ◽  
Rubeen Israni ◽  
William S Weintraub ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Black Females ◽  
Ckd Stage ◽  
Stage Renal Disease ◽  
End Stage ◽  
Event Rates

Background: Obesity and chronic kidney disease (CKD) are well known risk factors for cardiovascular (CV) events. Studies have shown that in patients with end-stage renal disease, the rate of CV events decreases as body mass index (BMI) increases. These studies, however, used only one measurement of BMI to predict CV events. The objective of this study was to assess whether rates of CV events changed according to variations in BMI and glomerular filtration rate (GFR) over time. Methods: A retrospective cohort of patients followed in outpatient practices from 1995 to 2010 was evaluated. Adult patients with at least 2 records of serum creatinine were included. The practices’ electronic health records (EHRs) were linked to the hospital EHR to assess CV events. GFR (mL/min/1.73m 2 ) was calculated using the Modification of Diet in Renal Disease equation and stratified according to the Kidney Disease Outcomes Quality Initiative guidelines as Normal (≥ 60), CKD stage 3 (30-59) and stage 4-5 (< 30) at each patient’s encounter. Outcomes were identified using ICD9 codes for myocardial infarction, congestive heart failure, coronary heart disease, dysrhythmia, stroke and peripheral vascular disease. The data spanned up to 10 years from a patient’s index to last visit. CV events were modeled as a function of age, gender, race, BMI and CKD status by negative binomial regression for count data. The model included interactions of age, gender, race, BMI and CKD. Results: Over the 10-year period, there were a total of 1,024,891 observations from 39,605 patients with 8,901 CV events. There was a significant age by gender by race by BMI interaction as well as a significant CKD main effect (p < 0.01). Increasing age, being male, black, overweight and having CKD, were associated with higher event rates. However, this association between BMI and event rates was not present for black females over 70, thus the 4-way sex by race by age by BMI interaction (Figure). Conclusion: These results support the hypothesis that overweight / obesity is not protective of CV events in CKD patients.

scholarly journals Predictive performance of the estimating equations of renal function in Sri Lankan subjects

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Ranga Migara Weerakkody ◽  
Mohammed Hussain Rezvi Sheriff
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Disease ◽  
Creatinine Clearance ◽  
Sri Lankan ◽  
Predictive Equations ◽  
Disease Epidemiology ◽  
Renal Functions ◽  
Significant Difference

Abstract Objectives This study validates two popular predictive equations of renal function firstly, Modifications of Diet in Renal Disease and secondly, Chronic Kidney Disease Epidemiology Collaboration equations for Sri Lankan cohort. We used data of the patients referred to Renal Research lab of University of Colombo for creatinine clearance measurement. Results Predictive performances varied with the gender. Creatinine clearance and predicted renal functions were compared. Both fared unsatisfactorily with R2 ranging from 0.632 to 0.652, and overestimated renal function by 6–15%. The proportion chronic kidney disease staging 1 and 2 returned by Chronic Kidney Disease Epidemiology Collaboration equation showed significant difference, in females. Modifications of Diet in Renal Disease equation significantly under-estimated advanced chronic kidney disease in females. Chronic Kidney Disease Epidemiology Collaboration equation had better accuracy. The study sample had more females, Asian and lower body size and better renal functions than historic cohorts. Thai and Pakistani studies show both equations and their Asian adaptations fare poorly. Chronic kidney disease stages differ significantly with the equation used. Predictive equations have fared unsatisfactorily by overestimating renal functions. We recommend further studies using gold standards of measuring renal function.

scholarly journals Comparison of Lipid Profile Among the Different Stages of Chronic Kidney Disease in Children

KYAMC Journal ◽  
2019 ◽  
Vol 10 (3) ◽  
pp. 137-142
Author(s):  
Muhammad Mozammel Haque ◽  
Mosammat Afroza Jinnat ◽  
Shafi Ahmed ◽  
Ranjit Ranjan Roy ◽  
Mohammad Akteruzzaman ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Lipid Profile ◽  
End Stage Renal Disease ◽  
Obstructive Uropathy ◽  
Group I ◽  
Ckd Stage ◽  
Stage Renal Disease ◽  
End Stage

Background: Chronic Kidney Disease (CKD) is associated with significantly increased morbidity and mortality. Children with (CKD)/End stage renal disease (ESRD) exhibit various co-morbidities, including dyslipidemia. Hypertriglyceridemia is inversely correlated with renal function. Children with advanced chronic kidney disease or end stage renal disease developed atherosclerosis and cardiovascular disease. Objectives: To measure the lipid profile in kidney disease and comparison of lipid profile among the different stages of CKD. Materials and Methods: A cross sectional analytic study to measure and compare lipid profile in fifty children with different stages of chronic kidney disease during January 2016 to June 2016 by purposive sampling technique and divided into two groups, Children with CKD stage iii and iv included in Group I and CKD stage V and V(D) included in Group II. Results: Out of Fifty children with CKD, 28(56%) were male and 22 (44%) male, 30(60%) were of11-15 year age group and 32(64%) were from rural area and 18(36%) from urban area. The etiology of CKD in two groups glomerulonephritis were 14(28%), obstructive uropathy 15 (30%), hypoplasia/dysplasia 9(18%), polycystic kidney disease 9(18%) and acute kidney injury 3(6%). All the cases were anemic, 26(52%) were hypertensive and 20(40%) had osteodystrophy. Conclusion: Dyslipidemia specially hypertriglyceridemia is common in children with CKD. Hypertriglyceridemia is inversely related to severity of CKD stages. KYAMC Journal Vol. 10, No.-3, October 2019, Page 137-142

scholarly journals 1002. A Daily Single Tablet Regimen (STR) of Bictegravir/Emtricitabine/Tenofovir Alafenamide (B/F/TAF) in Virologically-Suppressed Adults Living with HIV and End Stage Renal Disease on Chronic Hemodialysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S529-S530
Author(s):  
Joseph J Eron ◽  
Aimee Wilkin ◽  
Moti Ramgopal ◽  
Olayemi Osiyemi ◽  
Mehri McKellar ◽  
...  
Keyword(s):  
Research Study ◽  
Scientific Research ◽  
Panel Member ◽  
Study Drug ◽  
Virologic Suppression ◽  
Research Support ◽  
Review Panel ◽  
Study Investigator ◽  
Stage Renal Disease ◽  
Research Grant

Abstract Background Treatment for people living with HIV (PLWH) and end stage renal disease (ESRD) on hemodialysis (HD) has previously required complex dose-adjusted regimens. We evaluated a daily regimen of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) and established this treatment as effective and safe, showing that daily TAF resulted in lower plasma tenofovir exposure than a historical comparison of once weekly tenofovir disoproxil fumarate in patients with ESRD on HD. After week (W) 96, participants transitioned to daily B/F/TAF to assess whether efficacy and safety would be maintained on this STR that is guidelines-recommended for PLWH with eGFR &gt; 30 mL/min. Methods Virologically suppressed adult PLWH with ESRD on chronic HD who completed W96 on E/C/F/TAF enrolled in the B/F/TAF extension for 48 weeks. Efficacy was assessed as the proportion of participants with virologic suppression (HIV RNA &lt; 50 copies/mL). Safety was assessed throughout the study, PK was assessed using sparse sampling at W4, 24 and 48. Results 55 enrolled, 36 completed E/C/F/TAF, 10 entered the B/F/TAF extension. The median age was 55 yrs (range 34-63); median time on HD was 4 yrs (range 2-16). All ten participants on B/F/TAF had HIV-1 RNA &lt; 50 c/mL (95% CI 69%, 100%) at W48. All participants had at least 1 adverse event (AE); most were grade 1 or 2 in severity. One participant had a grade 3 AE and 3 had serious AEs; none were considered related to study drug by the investigator. One participant had AEs attributed to study drug (malaise grade 1 and nausea grade 2), which resolved and did not lead to discontinuation of study drug. There were no clinically relevant changes in fasting lipids. In participants with evaluable data (n=2-5 per timepoint), mean bictegravir trough concentrations were lower compared to PLWH not on HD but remained 4- to 7-fold higher than the established protein-adjusted 95% effective concentration (paEC95) of 162 ng/mL against wild-type virus. Conclusion A once daily regimen of B/F/TAF maintained virologic suppression in PLWH on chronic HD. B/F/TAF was well-tolerated with no discontinuations. B/F/TAF may be an effective, safe and convenient once daily STR and ameliorate the need for dose adjustment in appropriate PLWH who require chronic HD. Disclosures Joseph J. Eron, MD, Gilead Sciences (Consultant, Research Grant or Support)Janssen (Consultant, Research Grant or Support)Merck (Consultant)ViiV Healthcare (Consultant, Research Grant or Support) Aimee Wilkin, MD, MPH, Gilead Sciences Inc. (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member)GlaxoSmithKline (Grant/Research Support)Janssen (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member)Pfizer (Grant/Research Support) Moti Ramgopal, MD FACP FIDSA, AbbVie (Speaker’s Bureau)Allergan (Speaker’s Bureau)Gilead Sciences Inc. (Consultant, Scientific Research Study Investigator, Speaker’s Bureau)Janssen (Speaker’s Bureau)Merck (Consultant)Viiv Healthcare (Consultant) Olayemi Osiyemi, M.D, GlaxoSmithKline (Advisor or Review Panel member, Speaker’s Bureau)ViiV Healthcare (Advisor or Review Panel member, Speaker’s Bureau) Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau) David Asmuth, MD, Gilead Sciences Inc. (Scientific Research Study Investigator) Edwin DeJesus, MD, Gilead Sciences (Advisor or Review Panel member) Polina German, PharmD, Gilead Sciences (Employee) Christiana Blair, MS, Gilead Sciences (Employee, Shareholder) Christoph C. Carter, MD, Gilead Sciences Inc. (Employee, Shareholder) Diana M. Brainard, MD, Gilead Sciences (Employee) Sean E. Collins, MD, MS, Gilead Sciences (Employee) Hal Martin, MD, MPH, Gilead Sciences Inc. (Employee, Shareholder)

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