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Antimicrobials during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
This drug is a non-nucleoside reverse transcriptase inhibitor that is indicated for the treatment of HIV-1 infection in combination with at least two other active antiretroviral agents. Delavirdine lowers viral titer in an attempt to minimize HIV comorbidities (e.g., Kaposi’s sarcoma). It is an FDA pregnancy category C drug in the old system. The registry is actively collecting patients exposed to this drug during pregnancy. Currently, only 10 infants have been born following first trimester exposure, one of whom had a birth defect that was corrected surgically.
Aids and Hepatitis
Published in T.M. Craft, P.M. Upton, Key Topics In Anaesthesia, 2021
Patients. HIV positive patients may require surgery for tumour excision, diagnostic biopsy, drainage of foci of infection or for non-related disease, for example trauma. Preoperative assessment should seek respiratory, neurological, gastrointestinal and haematological complications as well as secondary infections. Drug therapy such as protease inhibitors, nucleoside and non-nucleoside reverse transcriptase inhibitors are often used in combination. Side effects such as neutropenia, anaemia, diarrhoea, and abnormal hepatic, glucose and lipid metabolism are common. Aseptic techniques are vital, and the risks of sepsis from invasive monitoring should be balanced against the potential benefits. The psychological implications of HIV infection must not be forgotten.
Antiviral Agents and Rational Drug Design
Published in Nathan Keighley, Miraculous Medicines and the Chemistry of Drug Design, 2020
Non-nucleoside reverse transcriptase inhibitors have a different mode of action. The molecules are generally hydrophobic and bind to a hydrophobic allosteric binding site; a binding site on the enzyme that is different to that used by the normal substrate, namely the active site. The physical effect of binding to a protein changes its shape, therefore deforms the active site, rendering it unusable by the normal substrate. NNRTIs are referred to as non-competitive reversible inhibitors because they are not in conflict with the normal substrate for access to the active site and their binding to the reverse transcriptase is not permanent. These two binding sites are distinct, so NNRTIs can be used in combination with NRTIs, which is advantageous because mutation can rapidly change the allosteric binding site and without a multidrug approach would result in the preservation of resistant viruses.
Influence of HIV on in-hospital outcomes in patients with atrial fibrillation
Published in Acta Cardiologica, 2023
Daniel Antwi-Amoabeng, Joban Ghuman, Sunil Sathappan, Bryce D. Beutler, Mark B. Ulanja, Mihir Dave, Omar Canaday
In the early years of the epidemic, HIV/AIDS was considered a death sentence; the median life expectancy for an individual diagnosed with AIDS was 1–2 years [13]. Fortunately, progress in HIV/AIDS management since the early 1980s has been nothing short of astounding. The first antiretroviral agent, zidovudine (AZT)—a nucleoside reverse transcriptase inhibitor—was approved by the Food and Drug Administration in 1987 and represented a quantum leap forward in HIV treatment, marking a transition from supportive care to targeted therapy [14]. Protease and non-nucleoside reverse transcriptase inhibitors were approved in 1995 and 1996, respectively, and significantly prolonged the lives of affected individuals [15]. Further progress was achieved with the introduction of entry and integrase inhibitors in the first decade of the 2000s. As of this writing, the projected life expectancy for a young adult diagnosed with HIV who receives highly-active antiretroviral therapy (HAART) is ∼53 years—less than a decade shorter than the average life expectancy of the general population[16].
Prediction and prevention of preterm birth in pregnant women living with HIV on antiretroviral therapy
Published in Expert Review of Anti-infective Therapy, 2022
Amanda J. Jones, Uzoamaka A. Eke, Ahizechukwu C. Eke
The beneficial effects of ART for preventing perinatal transmission are indisputable. However, the literature contains conflicting findings on the association between ART exposure and preterm birth. Combination ART exposure in utero has been associated with an increased rate of preterm delivery, particularly with regimens that contain protease inhibitors (PI) [15,16]. The European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) Study Group reported no association between nucleoside reverse transcriptase inhibitor (NRTI) therapy and preterm birth [17]. However, a 2006 prospective cohort study (n = 999) found that combination ART with a PI was associated with an increased risk of preterm birth (OR 1.9, 95% confidence interval [CI] 1.1–3.0) [15]. In a retrospective analysis of the Mma Bana Study, randomized clinical trial (RCT) [18], Powis et al. found that PI-based combination ART initiated in the third trimester of pregnancy was associated with a two-fold higher odds of a preterm delivery compared with triple NRTI-based combination ART [19]. In France, combination ART compared with zidovudine monotherapy was significantly associated with prematurity (adjusted odds ratio [aOR] 1.69, 95% CI 1.38–2.07; P < 0.01), and the prematurity rate was higher with ritonavir-boosted PI therapy than with non-boosted PI therapy started during pregnancy (14.4% vs 9.1% P = 0.05; adjusted hazard ratio [aHR] 2.03, 95% CI 1.06–3.89) [20].
HIV TB coinfection - perspectives from India
Published in Expert Review of Respiratory Medicine, 2021
Bharat Bhushan Rewari, Amitabh Kumar, Partha Pratim Mandal, Anoop Kumar Puri
Zidovudine was the first drug shown to be effective against HIV in 1985 but the virus developed resistance quickly with single drug. By 1995, many studies demonstrated the benefit of using a two-drug combination in preventing progression of disease and reduction in mortality as well-opportunistic infections. The year 1996 was a turning point in the treatment options when results of using a triple drug combination using new very potent agents, protease inhibitors, became available. But these were associated with issue of multiple pills, high costs, and toxicity issues. Discovery of non-nucleoside reverse transcriptase inhibitors (Nevirapine and later Efavirenz) made the therapy simpler and soon became standard of care along with two nucleoside reverse transcriptase inhibitors. The availability of different drugs in fixed dose combination (FDC) by Indian pharmaceutical companies in generic forms made therapy simpler, reduced the number of tablets to be taken daily thereby increasing adherence potential. The offer of ART at ‘a dollar a day’ by an Indian pharmaceutical company was clearly the game changer in increasing access to antiretroviral (ARV) drugs globally. The annual cost of treatment has come down significantly from USD$ 10,000 in late nineties to around USD$ 60 presently.