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Substance Abuse and Health Services Utilization Among Women in a Comprehensive HIV Program
Published in G. J. Huba, Lisa A. Melchior, Vivian B. Brown, Trudy A. Larson, A. T. Panter, Evaluating HIV/AIDS Treatment Programs: Innovative Methods and Findings, 2020
Karen L. Meredith, Donna B. Jeffe, Victoria J. Fraser, Linda M. Mundy
Utilization of health services utilization in 1997 was based on number of medical (clinic) visits per quarter and number of nursing/social work-case management interventions. Numbers of clinic visits for medical care were obtained from the medical records. Optimal medical care, especially for women taking highly active antiretroviral therapy (HAART), required at least one clinic visit every three months to monitor plasma HIV RNA levels and CD4 cell counts (Carpenter, Fischl, Hammer et al., 1998; Report of the NIH Panel, 1998). Medical care was categorized as a proportion of time enrolled in 1997 for which women had clinic visits: 0 = having no visits during any quarter enrolled in 1997; 1 = having visits less than half the time enrolled; 2 = having visits during only half the time enrolled; 3 = having visits more than half the time enrolled; 4 = having at least one clinic visit during all quarters enrolled at HHSCC in 1997 (optimal). Using this graded coding scheme, we could take into consideration time in which women were either not enrolled at HHSCC or deceased.
Limitations of Current Therapies for HIV-1 Infection
Published in Thomas R. O’Brien, Chemokine Receptors and AIDS, 2019
Studies evaluating combinations of antiretroviral drugs introduced the new treatment paradigm for HIV infection – the suppression of plasma HIV RNA below detectable levels (1,2). This strategy has become the standard for patient management and the criterion by which new drugs and new drug combinations are evaluated (3,4). Moreover the implementation of these potent combination regimens has resulted in a remarkable impact on morbidity and mortality in developed countries in Europe and the Americas (5). However, the use of the term HAART (for highly active antiretroviral therapy) is to be eschewed because it implies both that all regimens are equivalent and that current regimens are sufficiently potent (6). Neither implication can be supported.
Human Immunodeficiency Virus
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Neil Ritchie, Alasdair Robertson
Over the past 15 years significant progress has been made in the treatment of HIV-infected individuals. Highly active antiretroviral therapy (HAART) has transformed the prognosis for people living with HIV, turning the disease from a fatal affliction into a manageable chronic condition. HAART is a treatment consisting of various regimens of multiple pharmaceutical agents. Each drug in a HAART regimen inhibits a different part of the viral lifecycle. By inhibiting the virus at multiple stages effective viral suppression can be obtained. The commonly used drugs inhibit one of the three main viral enzymes for replication: reverse transcriptase, protease and integrase.
Efavirenz-Associated Retinal Toxicity Presenting with Night Vision Defects in Patients with Human Immunodeficiency Virus
Published in Ocular Immunology and Inflammation, 2020
Sridharan Sudharshan, Kolli Dileep Kumar, Muna Bhende, Jyotirmay Biswas, Poongulali Selvamuthu
Ocular lesions in patients with human immunodeficiency virus (HIV) are commonly due to underlying opportunistic infections1 and can rarely be due to malignancies or immune recovery uveitis.1,2 Suppression of HIV replication is an important component in prolonging life as well as in improving the quality of life in patients with HIV infection. Although highly active antiretroviral therapy (HAART)-associated improvement in immune status of the patient has reduced systemic morbidity and mortality due to opportunistic infections, drug-related side effects have been noted systemically.3 Drug-related side effects such as Steven-Johnson-like syndrome due to nevirapine can have manifestations in the eye.4 Drug-associated ocular side effects have been reported,5 including those implicating efavirenz causing retinal toxicity.6,7 We report a series of five patients with possible efavirenz-related retinal toxicity, visual function abnormalities and its management, with reversal of ocular side effects after change in the HAART regime.
‘High’ antiretroviral deintensification strategy and cellular HIV DNA levels
Published in Journal of Chemotherapy, 2020
Massimiliano Lanzafame, Emanuela Lattuada, Marcello Vincenzi, Marta Vecchi, Dora Luise, Erica Diani, Davide Gibellini
HAART (highly active antiretroviral therapy) has dramatically changed the management and evolution of HIV disease, decreasing morbidity and mortality in the HIV-1-infected population. The advent of HAART has also led to an increase in the percentage of older individuals in the HIV-1-infected population, due to the increase in life expectancy, in spite of the adverse effects of some antiretroviral drugs.1,2 Hence, several groups have focussed their efforts on developing antiretroviral-sparing strategies to avoid/prevent these drug-related adverse events, including the development of several comorbidities represented, for example, by renal, cardiovascular and liver diseases or metabolic disorders. In particular, ‘less drug regimens’ have given better results in terms of virological efficacy in suppressed HIV-1-infected patients with respect to naïve subjects.3 Recently, we have published results regarding the virologic safety of a high antiretroviral deintensification strategy in a small cohort of fully adherent patients. They were treated at the beginning with a non-nucleosidic reverse transcriptase inhibitor (NNRTI)-based regimen and then deintensified to lamivudine plus efavirenz or nevirapine at a reduced dose.4
Evaluating the relationship between adherence to Highly Active Antiretroviral Therapy (HAART) and social and clinical characteristics in Chinese patients with HIV
Published in AIDS Care, 2019
Yuan-Yuan Wang, Tang Wang, Hong Yan, Rik Carl D’Amato, Wei Wang, Shi-Yue Li
Human Immunodeficiency Virus (HIV) infection is a significant public health challenge, which may lead to grief, loss, excessive personal suffering, and is a problematic disease worldwide (Maartens, Celum, & Lewin, 2014). According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), there were approximately 36.7 million people living with HIV infection in 2015 (UNAIDS, 2016). In 2014, it was estimated that approximately 501,000 persons lived with HIV or acquired immune deficiency syndrome (AIDS) in China (National Health and Family Planning Commission, 2015). The Highly Active Antiretroviral Therapy (HAART) was introduced in the mid-1990s, which works by suppressing HIV viral load (Bhaskaran et al., 2008). The advent of HAART includes protease inhibitors and/or non-nucleoside reverse transcriptase inhibitors (Sendi, Palmer, Gafni, & Battegay, 2001). The HAART has been proven to be an effective treatment for patients with HIV, which can decrease the morbidity and the mortality. However, a very high level of treatment adherence (>95%) is essential for HAART to work effectively, in order to deal with the rapid replication and mutation rate of HIV (Bangsberg et al., 2000). It is vital to achieve proper adherence, since poor adherence is associated with detrimental outcomes, including treatment failure, development of resistant strains and AIDS (Sabin et al., 2015; Sethi, Celentano, Gange, Moore, & Gallant, 2003).