China
Africa
Explore chapters and articles related to this topic
Human immunodeficiency virus (HIV)
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Richard Basilan, William Salzer
Testing for ARV drug resistance should be done prior to starting ARV therapy (whether for therapy or prophylaxis), as well as when considering modification of a patient’s drug regimen. Assays for HIV drug resistance require that the patient has a detectable viral load, which is usually the case in untreated individuals and patients failing therapy.
Limitations of Current Therapies for HIV-1 Infection
Published in Thomas R. O’Brien, Chemokine Receptors and AIDS, 2019
There are two fundamental approaches to contend with HIV drug resistance - to prevent it and to treat it. Prevention can be accomplished by more intelligent prescribing of antiretroviral drugs by health care providers, by better adherence to regimens by patients and to more effective suppressive drug regimens. Physician education is beyond the scope of this review, but strategies to improve adherence and potency are discussed elsewhere.
The effectiveness evaluation of antiretroviral therapy in Mangusada Hospital Bali
Published in Elida Zairina, Junaidi Khotib, Chrismawan Ardianto, Syed Azhar Syed Sulaiman, Charles D. Sands, Timothy E. Welty, Unity in Diversity and the Standardisation of Clinical Pharmacy Services, 2017
H. Meriyani, N.N.W. Udayani, K.A. Adrianta
According to the WHO European Region (2007) reported, there are 3 different definitions for declaring the failure of antiretroviral therapy, there are: clinical failure, immunological failure, and virological failure. Clinical failure when there is a new or recurrent WHO stage 4 condition. Immunological failure when CD4 falls to the pre-therapy baseline (or below) or there is a 50% fall from the on-treatment peak value (if known) or CD4 levels are persistently < 100 cells/mm3. Virological failure when plasma viral load > 10 000 copies/ml. The failure of antiretroviral therapy in this study included into immunological failure in which 17.3% of patients experienced CD4 falls to the pre-therapy baseline (or below). A systematic review from resource limited settings report HIV drug resistance of 11% in patients on ARV therapy for 12–23 months, 15% at 24–36 months and 21% at >36 months (Stadeli, 2013). A cohort study in Africa shows that among 7975 patients with ARV Therapy, 823 patients (10%) experience virological failure to ARV therapy (Petersen, 2014). This shows that, the failure of ARV therapy is not only happening in Indonesia, but in other countries that may never been reported.
Investigational drugs for HIV: trends, opportunities and key players
Published in Expert Opinion on Investigational Drugs, 2023
Ronald J. Overmars, Zoë Krullaars, Thibault Mesplède
Beyond immunodeficiency, the main concern with missed injections is the possible development of resistance mutations and treatment failure, which is the same as with missed oral daily antiretroviral drugs but for its timing. Indeed, the time scale of transmitted drug resistance development may be skewed when people at risk engage in care less often than yearly, and trends in resistance may be captured late, potentially after several years [76]. There are several circumstances under which we are concerned about HIV drug resistance development under long-acting antiretroviral treatment. Contrary to what we have speculated [92–96], drug resistance is unavoidable. We believe that monotherapy (functional or real) or the combination of two drugs with low barriers to resistance is insufficient to prevent the development of resistance. We believe this statement to be true whether these two drugs are used orally or administered by injection.
Bictegravir in a fixed-dose tablet with emtricitabine and tenofovir alafenamide for the treatment of HIV infection: pharmacology and clinical implications
Published in Expert Opinion on Pharmacotherapy, 2019
Hanh Thi Pham, Thibault Mesplède
According to the Global Health Observatory (GHO) approximately 36.9 million people worldwide were living with HIV (PLWH) in 2017 (https://www.who.int/gho/hiv/en/). Since the discovery of the first antiretroviral drug, zidovudine, significant progress has been made to transform HIV infection from a deadly syndrome into a manageable chronic disease. This has mainly occurred through the development of combination antiretroviral therapy (ART), which prevents progression to AIDS and prolongs the life expectancy of PLWH. However, successful use of ART is dependent on several factors, including medication adherence, efficacy, pharmacological aspects, healthcare access, and patient engagement through longitudinal treatment plans. When one of these factors is suboptimal, patients are at risk of developing HIV drug resistance. In fact, together with the increasing use of ART, there has been a growing risk of HIV drug resistance globally [1,2]. Resistance mutations can emerge against every antiretroviral drug class. This is linked to the extremely high mutation rate of the HIV-reverse transcription enzyme, which is 3 × 10−5 per base per cell in vitro and 4.1 ± 1.7 × 10−3 in patients [3,4]. By progressively reducing treatment options, HIV drug resistance can lead to AIDS [5–8]. In addition, important emergent therapeutic strategies aimed at preventing HIV transmission such as pre-exposure prophylaxis, treatment as prevention and same day treatment initiation, are likely to be facilitated by new safer drugs. As a result, it remains vital to continue developing new antiviral drugs.
“cART intensification by the HIV-1 Tat B clade vaccine: progress to phase III efficacy studies”
Published in Expert Review of Vaccines, 2018
Aurelio Cafaro, Cecilia Sgadari, Orietta Picconi, Antonella Tripiciano, Sonia Moretti, Vittorio Francavilla, Maria Rosaria Pavone Cossut, Stefano Buttò, Giovanni Cozzone, Fabrizio Ensoli, Paolo Monini, Barbara Ensoli
Additionally, about two million HIV-infected children and adolescents [3] face a lifelong drug burden amidst paucity of therapy and no vaccination options. In addition to increased risks of non-AIDS-related comorbidities [9], children and adolescents are more sensitive than adults to drug-induced metabolism changes [10], which increase the long-term risk of CVD. Moreover, lifelong adherence to therapy is hampered by high pre-ART viral loads and sub-therapeutic drug concentrations due to limited pediatric drug formulations, variable pharmacokinetics, side effects, substance use, and continuous bodyweight changes [11,12]. These factors promote the emergence of HIV drug resistance mutations [13]. This and the unknown long-term toxic effects represent major concerns in these age groups [14].