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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 HIV/AIDS Reports Aug 2007Highly active antiretroviral regimens are recommended for use in pregnancy to prevent vertical transmission of HIV, and many women enter pregnancy already on these... (Review)
Review
Highly active antiretroviral regimens are recommended for use in pregnancy to prevent vertical transmission of HIV, and many women enter pregnancy already on these regimens for their own health. Sources of data on the potential teratogenicity of antiretroviral drugs include animal studies, cohort studies, the Antiretroviral Pregnancy Registry, and case reports, but data on newly approved drugs are often limited. Thus far, concerns have been identified regarding a potential association between first trimester efavirenz exposure and neural tube defects based on a study in monkeys and case reports in humans, a possible association between first trimester exposure to zidovudine and an increased risk of hypospadias based on one cohort study, and an increased risk of septal heart defects in animals with delavirdine. Additional data on risks of antiretrovirals during pregnancy are needed. Providers should report cases of antiretroviral drug exposures during pregnancy to the Antiretroviral Pregnancy Registry.
Topics: Abnormalities, Drug-Induced; Animals; Anti-Retroviral Agents; Female; HIV Infections; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Pregnancy; Risk Factors; Teratogens
PubMed: 17883999
DOI: 10.1007/s11904-007-0020-y -
Clinical Infectious Diseases : An... Jul 2021
Topics: Anti-Retroviral Agents; Continuity of Patient Care; HIV; HIV Infections; Healthcare Disparities; Humans; Time-to-Treatment; Treatment Outcome
PubMed: 32449902
DOI: 10.1093/cid/ciaa618 -
AIDS (London, England) Jun 2017: It is estimated that by 2030 nearly three-quarters of persons living with HIV will be 50 years and older. The aging HIV population presents a new clinical concern for... (Review)
Review
: It is estimated that by 2030 nearly three-quarters of persons living with HIV will be 50 years and older. The aging HIV population presents a new clinical concern for HIV providers: adverse effects from polypharmacy. An aging population means more comorbidities and potentially more drug-drug interactions for providers to manage. This review discusses major comorbidities including cardiovascular disease, anticoagulation, hypertension, diabetes mellitus and malignancy and considerations for drug-interactions with antiretrovirals.
Topics: Aging; Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; Comorbidity; Drug Interactions; HIV Infections; Humans; Polypharmacy
PubMed: 28471948
DOI: 10.1097/QAD.0000000000001401 -
Clinical Journal of the American... Jan 2006Highly active antiretroviral therapy has dramatically altered the treatment and life expectancy of individuals who are infected with HIV. More than 20 antiretroviral... (Review)
Review
Highly active antiretroviral therapy has dramatically altered the treatment and life expectancy of individuals who are infected with HIV. More than 20 antiretroviral drugs and drug combinations now are available in the United States. Nephrologists need to have an understanding of the pharmacokinetics of antiretroviral medications and the proper dosing of these medications in patients with impaired kidney function. It is also important for nephrologists to be aware of drug-drug interactions that can occur between antiretroviral medications and other medications that they may prescribe, including immunosuppressive medications that are used for renal transplantation, as this becomes more common in HIV-infected patients. Adverse reactions that affect the kidneys and cause fluid-electrolyte complications occur with certain antiretroviral agents, although most are relatively free of nephrotoxicity. This article reviews the clinical pharmacology and dosing modifications of the newer antiretroviral medications in patients with reduced kidney function; important drug-drug interactions involving these medications, particularly with other medications that are likely to be prescribed by nephrologists; and renal toxicities of antiretroviral agents.
Topics: Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; Drug Interactions; Humans; Kidney; Kidney Diseases; Nephrology
PubMed: 17699198
DOI: 10.2215/CJN.00370705 -
Clinical Infectious Diseases : An... Feb 2016
Topics: Africa; Anti-Retroviral Agents; Antiretroviral Therapy, Highly Active; HIV Infections; Humans
PubMed: 26561533
DOI: 10.1093/cid/civ931 -
Current Drug Metabolism 2015For healthcare professionals, the volume of literature available on herb-drug interactions often makes it difficult to separate experimental/potential interactions from... (Review)
Review
For healthcare professionals, the volume of literature available on herb-drug interactions often makes it difficult to separate experimental/potential interactions from those deemed clinically relevant. There is a need for concise and conclusive information to guide pharmacotherapy in HIV/AIDS. In this review, the bases for potential interaction of medicinal herbs with specific antiretroviral drugs are presented, and several botanicals are discussed for which clinically relevant interactions in humans are established. Such studies have provided, in most cases, sufficient ground to warrant the avoidance of concurrent administration of antiretroviral (ARVs) drugs with St John's wort (Hypericum perforatum), black pepper (Piper species) and grapefruit juice. Other botanicals that require caution in the use with antiretrovirals include African potato (Hypoxis hemerocallidea), ginkgo (Ginkgo biloba), ginseng (Panax species), garlic (Allium sativum), goldenseal (Hydrastis canadensis) and kava kava (Piper methysticum). The knowledge of clinically significant herb-drug interaction will be important in order to avoid herb-induced risk of sub-therapeutic exposure to ARVs (which can lead to viral resistance) or the precipitation of toxicity (which may lead to poor compliance and/or discontinuation of antiretroviral therapy).
Topics: Animals; Anti-Retroviral Agents; Citrus paradisi; Garlic; Ginkgo biloba; Herb-Drug Interactions; Humans; Hypericum; Panax; Plants, Medicinal
PubMed: 26526838
DOI: 10.2174/1389200216666151103115053 -
Dermatologic Clinics Oct 2006Combination antiretroviral therapy (ART) has transformed the care of individuals who have HIV infection. Effective ART has resulted in dramatic reductions in mortality,... (Review)
Review
Combination antiretroviral therapy (ART) has transformed the care of individuals who have HIV infection. Effective ART has resulted in dramatic reductions in mortality, hospitalization rates, and the development of AIDS-defining illnesses. This article discusses the variety of agents that can comprise an effective ART regimen, focusing on the basic principles of ART, the indications for initiating ART in treatment-naive individuals who have established HIV infection, and the challenges associated with the use of antiretroviral medications.
Topics: Anti-Retroviral Agents; Dermatology; Drug Resistance, Viral; Drug Therapy, Combination; HIV; HIV Infections; Humans
PubMed: 17010782
DOI: 10.1016/j.det.2006.06.012 -
Clinical Pharmacology in Drug... Mar 2017There are many factors that can affect the pharmacokinetics (PK) of drugs. Pathophysiological changes from disease states can alter the mechanisms that control the PK of... (Review)
Review
There are many factors that can affect the pharmacokinetics (PK) of drugs. Pathophysiological changes from disease states can alter the mechanisms that control the PK of antiretrovirals (ARVs), direct-acting antivirals (DAAs), and addiction treatment medications. Drug-drug interaction pathways of certain ARVs and DAAs can be very complex, with agents being substrates, inhibitors, or inducers of multiple metabolic and transporter pathways. Buprenorphine and methadone may be used in HIV- and hepatitis C virus (HCV)-infected patients and may also be affected by drug interactions. Current research is focused on novel PK analyses, which aim to describe the PK of agents within organs that host the infection of interest, such as within hepatocytes during treatment for HCV. Modeling techniques allow for the prediction of drug PK in specific organs and the plasma compartment. This review will provide a summary of these areas while exploring PK considerations for ARVs, DAAs, and addiction treatment medications.
Topics: Anti-Retroviral Agents; Drug Interactions; Drug Therapy, Combination; Hepatitis C; Humans; Liver; Substance-Related Disorders
PubMed: 28263465
DOI: 10.1002/cpdd.313 -
Journal of the American Geriatrics... Apr 2020Our aim was to clarify if persons living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have adequate economic access to antiretroviral...
OBJECTIVES
Our aim was to clarify if persons living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have adequate economic access to antiretroviral therapy (ART) when admitted to nursing homes (NHs). Medicare Part A pays NHs a bundled skilled nursing rate that includes prescription drugs for up to 100 days, after which individuals are responsible for the costs.
DESIGN
A cross-sectional study.
SETTING
NHs.
PARTICIPANTS
A total of 694 newly admitted long-stay (>100 d) NH residents with HIV.
MEASUREMENTS
We used Minimum Dataset v.3.0, pharmacy dispensing data, NH provider surveys, and Medicare claims from 2011 to 2013. We assessed receipt of any HIV antiretrovirals or recommended combinations (ART), as defined by national care guidelines, and the source of payment. We identified predictors of antiretroviral use with risk-adjusted generalized estimating equation logistic models.
RESULTS
All study persons living with HIV/AIDS in NHs had prescription drug coverage through Medicare's Part D program, and ART was 100% covered. However, only 63.9% received recommended ART, and 15.2% never received any antiretrovirals during their NH stay. The strongest predictor of not receiving antiretrovirals was the first 100 days of a long NH stay (odds ratio [OR] = .44; 95% confidence interval [CI] = .24-.80). The strongest predictor of receiving recommended ART was health acuity (OR = 1.51; 95% CI = 1.20-1.88).
CONCLUSION
People living with HIV in NHs do not always receive lifesaving ART, but the reasons are unclear and appear unrelated to economic barriers. J Am Geriatr Soc 68:777-782, 2020.
Topics: Aged; Anti-Retroviral Agents; Cross-Sectional Studies; Databases, Factual; Female; HIV Infections; Homes for the Aged; Humans; Male; Medicare Part D; Nursing Homes; United States
PubMed: 31829445
DOI: 10.1111/jgs.16288