scholarly journals Antiretroviral Drug Treatment of Individuals that Used Preexposure Prophylaxis (PrEP) Before Diagnosis

2021 ◽  
Author(s):  
David A. M. C. van de Vijver ◽  
Shreoshee Mukherjee ◽  
Jeroen J.A. van Kampen
Keyword(s):  
Drug Resistance ◽  
Drug Treatment ◽  
Treatment Options ◽  
Antiretroviral Drugs ◽  
Anecdotal Evidence ◽  
First Line ◽  
Acute Hiv Infection ◽  
Genotypic Resistance ◽  
Preexposure Prophylaxis ◽  
Antiretroviral Drug

Abstract Purpose of review The antiretroviral drugs, tenofovir and emtricitabine used as preexposure prophylaxis (PrEP), are also used in treatment of HIV. Drug resistance due to PrEP can therefore jeopardize future treatment options. This review discusses treatment of individuals that used PrEP in whom viral mutations against tenofovir (K65R) or emtricitabine (M184I/V) are found. Recent findings Although no studies systematically investigated the optimal treatment of individuals who used PrEP before diagnosis, there is anecdotal evidence that HIV including the K65R and/or M184I/V can be successfully treated using recommended first-line regimens. Summary Drug resistance can be ascribed to use of PrEP while having an unrecognized acute HIV infection, partial adherence to PrEP, and transmission of HIV resistant to PrEP drugs. First-line antiretroviral drug treatment in individuals who used PrEP before diagnosis must be optimized based on genotypic resistance test results. Individuals in whom M184I/V and/or K65R is detected can be treated with dolutegravir-based, bictegravir-based, or darunavir-based regimens plus tenofovir plus lamivudine or emtricitabine. Dual therapy using dolutegravir plus lamivudine is not recommended for induction therapy in individuals with viral mutations against the drugs used as PrEP. There is an urgent need to confirm the anecdotal evidence for successful treatment using first-line regimens.

scholarly journals Drug Resistance-Associated Mutations in Antiretroviral Treatment-Experienced Patients in Kuwait

2018 ◽  
Vol 27 (2) ◽  
pp. 152-157
Author(s):  
Wassim Chehadeh ◽  
Osama Albaksami ◽  
Sonia Elezebeth John ◽  
Widad Al-Nakib
Keyword(s):  
Reverse Transcriptase ◽  
Transcriptase Inhibitor ◽  
Antiretroviral Drugs ◽  
First Line ◽  
Genotypic Resistance ◽  
Nonnucleoside Reverse Transcriptase Inhibitor ◽  
High Level ◽  
Interpretation Algorithm ◽  
Hiv 1 ◽  
Level Resistance

Objectives: To investigate the prevalence of nonpolymorphic resistance-associated mutations (RAM) in HIV-1 patients on first-line antiretroviral therapy in Kuwait. Subjects and Methods: Total RNA was isolated from plasma samples of 42 patients who received a first-line nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. HIV-1 protease and reverse transcriptase genetic regions were then amplified by nested reverse transcription-polymerase chain reaction and directly sequenced. The HIV-1 subtype was identified using the Bayesian phylogenetic method, and RAM were identified using the Stanford University genotypic resistance interpretation algorithm. Results: The HIV-1 viral load at sampling ranged from < 20 to 8.25 × 104 copies/ml. CRF01_AE, C, and B were the most predominant HIV-1 subtypes. Nonpolymorphic mutations associated with resistance to antiretroviral drugs were detected in 11 (26.2%) of the 42 patients; 5 (11.9%) patients had mutations associated with a high-level resistance to nucleoside reverse transcriptase inhibitors (NRTI), 4 (9.5%) patients had mutations associated with resistance to NNRTI, 1 (2.4%) patient had mutations associated with resistance to both NRTI and NNRTI, and 1 (2.4%) patient had mutations potentially associated with low-level resistance to both protease inhibitors and NNRTI. All patients with RAM had a detectable plasma HIV-1 RNA level. Conclusion: Our results indicate the development of RAM during an NNRTI-based regimen and highlight the importance of considering other regimens to avoid treatment failure.

Augmentation and combination of antidepressants with each other and with antipsychotics

2011 ◽  
Vol 26 (S2) ◽  
pp. 698-698
Author(s):  
L. Timmerman
Keyword(s):  
Drug Treatment ◽  
Remission Rate ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Augmentation Therapy ◽  
First Line ◽  
Severe Problem ◽  
Medline Search ◽  
New Treatment ◽  
Line Drug

IntroductionNonrespons in first -line drug treatment of patients suffering from depression in psychiatric outpatient populations is a severe problem.The non respons rate is up tot 30% and the non remission rate more than 50% in the first line of treatment with antidepressants in this population.ObjectiveTo devellop more rapid and efficious drug treatment strategies in depression.AimsDuring the last few years several strategies to improve outcome in depression have been under investigation. A few have proven to be valuable.MethodsMedline search 2005–2010 into treatment resistent depression, combination therapy, augmentation therapy, drug therapy.ResultThere is growing evidence for the value of the combination of antidepressants and of combining antidepressants with antipsychotics.Treatment options as pindolol addition to antidepressants, substance P or folic acid addition do not seem of clinical significance yet.The same is true for treatment methods who directly influence the glucocorticoid system such as glucocorticoid receptor antagonists.NMDA antagonists look promising but more research into this option is needed.ConclusionsThere are two outstanding and much promising relatively new treatment options with: Combinations of antidepressants and with combinations of an antidepressant with an antipsychotic.

scholarly journals Antiretroviral Drug Resistance in HIV-1–Infected Patients Experiencing Persistent Low-Level Viremia During First-Line Therapy

2011 ◽  
Vol 204 (4) ◽  
pp. 515-520 ◽  
Author(s):  
Babafemi Taiwo ◽  
Sebastien Gallien ◽  
Evgenia Aga ◽  
Heather Ribaudo ◽  
Richard Haubrich ◽  
...  
Keyword(s):  
Drug Resistance ◽  
First Line ◽  
Low Level ◽  
Antiretroviral Drug Resistance ◽  
First Line Therapy ◽  
Line Therapy ◽  
Antiretroviral Drug ◽  
Hiv 1

scholarly journals A105 Virologic versus immunologic monitoring and the rate of accumulated genotypic resistance to first-line antiretroviral drugs in Uganda

2013 ◽  
Vol 62 ◽  
pp. S33
Author(s):  
Steven J. Reynolds ◽  
Hakim Sendigire ◽  
Kevin Newell ◽  
Barbara Castelnuovo ◽  
Immaculate Nankya ◽  
...  
Keyword(s):  
Antiretroviral Drugs ◽  
First Line ◽  
Genotypic Resistance ◽  
Immunologic Monitoring

scholarly journals Clinically Relevant Transmitted Drug Resistance to First Line Antiretroviral Drugs and Implications for Recommendations

PLoS ONE ◽  
2014 ◽  
Vol 9 (3) ◽  
pp. e90710 ◽  
Author(s):  
Susana Monge ◽  
Vicente Guillot ◽  
Marta Alvarez ◽  
Natalia Chueca ◽  
Natalia Stella ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antiretroviral Drugs ◽  
Transmitted Drug Resistance ◽  
First Line

scholarly journals Transmitted drug resistance in ART-naive persons with acute/ early/ primary HIV infection: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Chun-Xiang GUO ◽  
Ya-Xin WU ◽  
Yang ZHANG ◽  
Xin-Chao LIU ◽  
Ai-Xin LI ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Hiv Infection ◽  
Meta Analysis ◽  
Antiretroviral Drugs ◽  
Cochrane Library ◽  
Resistance Testing ◽  
Transmitted Drug Resistance ◽  
Acute Hiv Infection ◽  
Early Primary ◽  
The Cochrane Library

Abstract Background: In the absence of AIDS vaccine，antiretroviral therapy (ART) was the most effective tool to prevent and control the HIV pandemic. But the widespread use of ART has raised concerns about the emergence of HIV transmitted drug resistance (TDR). Acute HIV infection (AHI) was the most appropriate time to detect the spread of TDR. In this meta-analysis, our purpose was to evaluate the level of TDR in ART-naive patients with acute/ primary/ early HIV infection, and describe the critical drug-resistant mutations. Methods: We systematically reviewed 1192 studies published between January 1, 2008 and December 30, 2019 in PubMed, Web of Science, Embase, and the Cochrane Library, and selected 12 studies that meet our inclusion criteria. To evaluate the overall prevalence of TDR, we extracted raw data and analyzed prevalence estimates using Stata SE. Estimates of mixed-effects were calculated by random-effects meta-analysis, and the I²statistics were used to estimate the heterogeneity of all included studies.Results: The Data of this meta-analysis come from 12 observational studies, covering 3558 ART-naive individuals with PHI, AHI or EHI. The overall prevalence of HIV-TDR is 9.8% (95% confidence interval (CI): 7.2%–12.3%, p<0.001). Prevalence of resistance by drug class is highest for the NNRTIs at 5.9% (95% CI: 3.1%–8.6%, p<0.001), followed by NRTIs 3.4% (95% CI: 1.8%–5.0%, p<0.001) and PIs 3.4% (95% CI: 2.7%–4.0%, p<0.001). The prevalence of TDR to INIs is 0.3% (95% CI: -0.1%-0.7%, p<0.001), which is the lowest among all antiretroviral drugs.Conclusion: The overall prevalence of TDR is high among AHI patients who have never received ART. This emphasizes the importance of baseline drug resistance testing for public health surveillance and guiding the choice of ART. In addition, the prevalence of TDR to NNRTIs is the highest, while the TDR to INIs is the lowest. This may guide the selection of clinical antiretroviral drugs.

scholarly journals Previous antiretroviral drug use compromises standard first-line HIV therapy and is mediated through drug-resistance

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Seth C. Inzaule ◽  
Cissy M. Kityo ◽  
Margaret Siwale ◽  
Alani Sulaimon Akanmu ◽  
Maureen Wellington ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Drug Use ◽  
First Line ◽  
Hiv Therapy ◽  
Antiretroviral Drug
Sign in / Sign up

Export Citation Format

Share Document