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AIDS (London, England) Aug 2014Adolescent and young adult (AYA) populations (12-24 years) represent over 40% of new HIV infections globally. Adolescence is sometimes characterized by high-risk sexual... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Adolescent and young adult (AYA) populations (12-24 years) represent over 40% of new HIV infections globally. Adolescence is sometimes characterized by high-risk sexual behaviour and a lack of engagement with healthcare services that can affect adherence to antiretroviral therapy (ART). Despite adherence to ART being critical in controlling viral replication, maintaining health and reducing onward viral transmission, there are limited data on ART adherence amongst AYA globally. We undertook a systematic review and meta-analysis of published studies reporting adherence to ART for AYA living with HIV.
DESIGN AND METHODS
Searches included Embase, Medline and PsychINFO databases up to 14 August 2013. Eligible studies defined adequate adherence as at least 85% on self-report or undetectable blood plasma virus levels. A random effects meta-analysis was performed and heterogeneity examined using meta-regression.
RESULTS
We identified 50 eligible articles reporting data from 53 countries and 10,725 patients. Using a pooled analysis of all eligible studies, 62.3% [95% confidence interval (CI) 57.1-67.6; I:97.2%] of the AYA population were adherent to therapy. The lowest average ART adherence was in North America [53% (95% CI 46-59; I:91%)], Europe [62% (95% CI 51-73; I:97%)] and South America [63% (95% CI 47-77; I:85%] and, with higher levels in Africa [84% (95% CI 79-89; I:93%)] and Asia [84% (95% CI 77-91; I:0%].
CONCLUSION
Review of published literature from Africa and Asia indicate more than 70% of HIV-positive AYA populations receiving ART are adherent to therapy and lower rates of adherence were shown in Europe and North America at 50-60%. The global discrepancy is probably multifactorial reflecting differences between focused and generalised epidemics, access to healthcare and funding.
Topics: Adolescent; Africa; Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; Asia; Child; Europe; HIV Infections; Humans; Medication Adherence; North America; Young Adult
PubMed: 24845154
DOI: 10.1097/QAD.0000000000000316 -
Topics in Antiviral Medicine 2015There is general consistency among US and European guidelines regarding the initiation of antiretroviral therapy for HIV-infected individuals. Recent and ongoing trials... (Review)
Review
There is general consistency among US and European guidelines regarding the initiation of antiretroviral therapy for HIV-infected individuals. Recent and ongoing trials comparing regimens may lead to reevaluation of initial treatment choices. The choice of antiretroviral regimen will also likely be affected by development, evaluation, and availability of newer drugs. This article reviews currently recommended regimens and characteristics of selected current investigational drugs, including the nucleotide analogue reverse transcriptase inhibitor tenofovir alafenamide, the nonnucleoside reverse transcriptase inhibitor doravirine, the integrase strand transfer inhibitor cabotegravir, the HIV entry inhibitor BMS-663068, and the HIV maturation inhibitor BMS-955176. This article summarizes a presentation by Roy M. Gulick, MD, MPH, at the IAS-USA continuing education program, Improving the Management of HIV Disease, held in New York, New York, in March 2015 and September 2015.
Topics: Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; Europe; HIV Infections; Humans; Treatment Outcome; United States
PubMed: 26713502
DOI: No ID Found -
Current Opinion in HIV and AIDS Jan 2015HIV genetic diversity poses major challenges for the prevention, control, and cure of infection. Characterizing the diversity and evolution of HIV populations within the... (Review)
Review
PURPOSE OF REVIEW
HIV genetic diversity poses major challenges for the prevention, control, and cure of infection. Characterizing the diversity and evolution of HIV populations within the host provides insights into the mechanisms of HIV persistence during antiretroviral therapy (ART). This review describes the HIV diversity within patients, how it is affected by suppressive ART, and makes a case for early treatment after HIV infection.
RECENT FINDINGS
HIV evolution is effectively halted by ART. However, cells that were infected prior to initiating therapy can proliferate to very high numbers both before and during treatment. Such clonal expansions result in the persistence of integrated proviruses despite therapy. These expanding proviruses have been shown to be a source for residual viremia during ART, and they may be a source for viral rebound after interrupting ART.
SUMMARY
Plasma HIV RNA shows no evidence for evolution during ART, suggesting that HIV persistence is not driven by low-level, ongoing replication. The emergence of identical viral sequences observed in both HIV RNA and DNA is likely due to proliferation of infected cells. Early treatment restricts the viral population and reduces the number of variants that must be targeted for future therapeutic strategies.
Topics: Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; HIV Infections; HIV-1; Humans; Virus Replication
PubMed: 25389802
DOI: 10.1097/COH.0000000000000120 -
South African Medical Journal =... Aug 2022
Topics: Anti-HIV Agents; Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; HIV Infections; Humans; South Africa; Treatment Outcome; Viral Load
PubMed: 36214399
DOI: 10.7196/SAMJ.2022.v112i8.16695 -
AIDS (London, England) Jan 2016International tourism continues to increase worldwide, and people living with HIV and their clinicians are increasingly confronted with the problem of how to dose... (Review)
Review
International tourism continues to increase worldwide, and people living with HIV and their clinicians are increasingly confronted with the problem of how to dose antiretroviral therapy during transmeridian air travel across time zones. No guidance on this topic currently exists. This review is a response to requests from patient groups for clear, practical and evidence-based guidance for travelling on antiretroviral therapy; we present currently available data on the pharmacokinetic forgiveness and toxicity of various antiretroviral regimens, and synthesize this data to provide guidelines on how to safely dose antiretrovirals when travelling across time zones.
Topics: Anti-Retroviral Agents; HIV Infections; Humans; Travel
PubMed: 26684823
DOI: 10.1097/QAD.0000000000000920 -
International Journal of Antimicrobial... Jan 2024Patients living with multidrug-resistant (MDR) HIV have limited antiretroviral regimen options that provide durable viral suppression. Lenacapavir is a novel... (Review)
Review
Patients living with multidrug-resistant (MDR) HIV have limited antiretroviral regimen options that provide durable viral suppression. Lenacapavir is a novel first-in-class inhibitor of HIV-1 capsid function with efficacy at various stages of the viral life cycle, and it is indicated for the treatment of MDR HIV-1 infection in combination with optimized background antiretroviral therapy. The favourable pharmacokinetic profile supports an every sixth month dosing interval of subcutaneous lenacapavir after an initial oral loading dose, which may advocate for continued adherence to antiretroviral therapy (ART) through the reduction of daily pill burden. The role of lenacapavir in promoting virologic suppression has been studied in patients with MDR HIV-1 on failing ART at baseline. Lenacapavir was well tolerated in clinical trials with the most common adverse effects including mild to moderate injection site reactions, gastrointestinal symptoms, and headache. Substitutions on the capsid molecule may confer resistance to lenacapavir by changing the binding potential. Cross-resistance to other antiretrovirals has not been observed. The unique mechanism of action, pharmacokinetics, and safety and efficacy of lenacapavir support its use for the management of MDR HIV-1 infection. Current studies are ongoing to evaluate the potential use of subcutaneous lenacapavir for pre-exposure prophylaxis (PrEP). Future studies will confirm the long-term clinical safety, efficacy, and resistance data for lenacapavir.
Topics: Humans; HIV-1; Capsid; Anti-HIV Agents; HIV Infections; Anti-Retroviral Agents; Capsid Proteins
PubMed: 37844807
DOI: 10.1016/j.ijantimicag.2023.107009 -
Journal of Acquired Immune Deficiency... Jun 2021Before the introduction of highly active antiretroviral therapy, patients infected with HIV experienced poor prognosis including high rates of opportunistic infections,... (Review)
Review
Before the introduction of highly active antiretroviral therapy, patients infected with HIV experienced poor prognosis including high rates of opportunistic infections, rapid progression to AIDS, and significant mortality. Increased life expectancy after therapeutic improvements has led to an increase in other chronic diseases for these patients, including cardiovascular disease and, in particular, end-stage heart failure. Historically, HIV infection was deemed an absolute contraindication for transplantation. Since the development of highly active antiretroviral therapy, however, life expectancy for HIV-positive patients has significantly improved. In addition, there is a low incidence of opportunistic infections and the current antiretrovirals have an improved toxicity profile. Despite this, the current status of cardiac transplants in HIV-positive patients remains unclear. With this in mind, we conducted a narrative review on cardiac transplantation in patients with HIV.
Topics: Adult; Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; Female; Graft Rejection; HIV Infections; Heart Failure; Heart Transplantation; Humans; Immunosuppressive Agents; Integrase Inhibitors; Life Expectancy; Male; Middle Aged; Protease Inhibitors
PubMed: 33534274
DOI: 10.1097/QAI.0000000000002647 -
International Journal of STD & AIDS Jan 2017Many patients who take antiretroviral drugs also take alternative therapies including dietary supplements. Some drug-supplement combinations may result in clinically... (Review)
Review
Many patients who take antiretroviral drugs also take alternative therapies including dietary supplements. Some drug-supplement combinations may result in clinically meaningful interactions. We aimed to investigate the evidence for dietary supplement interactions with antiretrovirals. A systematic review was conducted using multiple resources including PubMed, Natural Medicine Comprehensive Database, The Review of Natural Products, and Google Scholar. All human studies or case reports evaluating an interaction between a dietary supplement and an antiretroviral were selected for inclusion. Twenty-eight pharmacokinetic studies and case-series/case reports were selected for inclusion. Calcium carbonate, ferrous fumarate, some forms of ginkgo, some forms of garlic, some forms of milk thistle, St. John's wort, vitamin C, zinc sulfate, and multivitamins were all found to significantly decrease the levels of selected antiretrovirals and should be avoided in patients taking these antiretrovirals. Cat's claw and evening primrose oil were found to significantly increase the levels of antiretrovirals and patients should be monitored for adverse effects while taking these dietary supplements with antiretrovirals. This systematic review shows the importance of screening all human immunodeficiency virus patients for dietary supplement use to prevent treatment failure or adverse effects related to an interaction.
Topics: Anti-Retroviral Agents; Complementary Therapies; Dietary Supplements; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; HIV Infections; Humans; Male
PubMed: 27655839
DOI: 10.1177/0956462416671087 -
Journal of the International... 2019The benefits of "early" antiretroviral therapy (ART; ie, initiation when CD4 ≥500 cells/mm) are now well accepted as reflected in the removal of the CD4-based...
The benefits of "early" antiretroviral therapy (ART; ie, initiation when CD4 ≥500 cells/mm) are now well accepted as reflected in the removal of the CD4-based eligibility from new ART guidelines by the World Health Organization (WHO). However, neither the "treat-all" strategy recommendations presented in the guidelines nor the HIV care cascade goals in the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets adequately address the issue of ART timing. Our recent study on "immediate" ART (ie, ≤30 days after HIV diagnosis) adds important evidence demonstrating the real and meaningful benefits of rapid ART initiation even among those who have CD4 ≥500 cells/mm. We call on WHO and UNAIDS to consider this research and encourage a shift from the treat-all strategy to an "immediately-treat-all" strategy, and from a slow, fragmented, complicated, multistep HIV care cascade to a fast, easy, and simple cascade with effectiveness measures that incorporate the important aspect of time.
Topics: Anti-Retroviral Agents; CD4 Lymphocyte Count; HIV Infections; Humans; Practice Guidelines as Topic; Time-to-Treatment; United Nations; World Health Organization
PubMed: 30832530
DOI: 10.1177/2325958219831714 -
Expert Opinion on Biological Therapy Sep 2016Knowledge of IFN-antiviral activity against HIV infection dates from the first years of the AIDS epidemic. Recombinant IFN had an inhibitory effect on HIV and was not... (Review)
Review
INTRODUCTION
Knowledge of IFN-antiviral activity against HIV infection dates from the first years of the AIDS epidemic. Recombinant IFN had an inhibitory effect on HIV and was not toxic to peripheral blood mononuclear cells (PBMC), and this finding was the basis for the design of clinical trials that evaluated the potential role of IFN-alpha as an inhibitor of HIV replication.
AREAS COVERED
This review summarizes the history of IFN-alpha in the treatment of HIV infection with reviews of studies performed in different clinical settings; in the pre-highly active antiretroviral therapy (HAART) era, as part of a structured treatment interruption (STI) strategy, in acute HIV infection, as part of salvage therapy, and eliminating the HIV reservoir.
EXPERT OPINION
The role of IFN-alpha has been dismissed in the area of HIV therapy. For this reason, with the advent of HAART, which substantially reduced mortality and the appearance of AIDS, IFN-alpha ceased to be used as an antiretroviral agent in different strategies. In contrast, because of the promising results achieved with IFN-alpha therapy in eliminating the HIV viral reservoir, this may constitute the main research field for IFN-alpha in the HIV setting.
Topics: Animals; Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; Clinical Trials as Topic; HIV Infections; HIV-1; Humans; Immunotherapy; Interferon-alpha; Leukocytes, Mononuclear
PubMed: 27283040
DOI: 10.1080/14712598.2016.1196180