Initiation of Antiretroviral Therapy

2017 ◽  
Author(s):  
Saira Ajmal ◽  
Zelalem Temesgen
Keyword(s):  
Immune Deficiency ◽  
Cardiovascular Disease ◽  
Antiretroviral Therapy ◽  
Cumulative Exposure ◽  
Neurologic Complications ◽  
Combination Antiretroviral Therapy ◽  
Hiv Replication ◽  
Dramatic Decline ◽  
Independent Association ◽  
Over Time

The primary goal of therapy is to prevent HIV-associated morbidity and mortality. In addition to the dramatic decline in HIV-related illness and death that has been observed as a result of the introduction and expansion of combination antiretroviral therapy, evidence is emerging that uncontrolled HIV replication also has a deleterious impact on conditions that are not conventionally associated with immune deficiency. These conditions include cardiovascular disease, kidney disease, liver disease, neurologic complications, and malignancy. Studies have found an independent association between cumulative exposure to replicating virus over time and mortality. Emerging data also increasingly support the earlier use of ART.

HIV-Associated Neurocognitive Disorder

2018 ◽  
pp. 171-205
Author(s):  
Ahmed Abd Elkader Elrashedy
Keyword(s):  
Antiretroviral Therapy ◽  
Neurocognitive Disorder ◽  
Combination Antiretroviral Therapy ◽  
Hiv Replication ◽  
Everyday Functioning ◽  
Cns Inflammation ◽  
Neurocognitive Dysfunction ◽  
Dramatic Decline ◽  
Hiv Associated Neurocognitive Disorder

In the last two decades, several advancement studies have increased the care of HIV-infected individuals. Specifically, the development for preparation of combination antiretroviral therapy has resulted in a dramatic decline in the rate of deaths from AIDS. The term “HIV-associated neurocognitive disorder” (HAND) has been used to distinguish the spectrum of neurocognitive dysfunction associated with HIV infection. HIV can pass to the CNS during the early stages of infection and last in the CNS. CNS inflammation and infection lead to the development of HAND. The brain can serve as a sanctuary for ongoing HIV replication, even when the systemic viral suppression has been achieved. HAND can remain in patients treated with combination antiretroviral therapy, and its effect on survival, quality of life, and everyday functioning make it a significant unresolved problem. This chapter discusses details of the computational modeling studies on mechanisms and structures of human dopamine transporter (hDAT) and its interaction with HIV-1 trans activator of transcription (Tat).

scholarly journals Changes Over Time in Risk of Initial Virological Failure of Combination Antiretroviral Therapy

2006 ◽  
Vol 166 (5) ◽  
pp. 521 ◽  
Author(s):  
Fiona C. Lampe ◽  
Jose M. Gatell ◽  
Schlomo Staszewski ◽  
Margaret A. Johnson ◽  
Christian Pradier ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Virological Failure ◽  
Combination Antiretroviral Therapy ◽  
Changes Over Time ◽  
Over Time

scholarly journals No evidence of ongoing HIV replication or compartmentalization in tissues during combination antiretroviral therapy: Implications for HIV eradication

2019 ◽  
Vol 5 (9) ◽  
pp. eaav2045 ◽  
Author(s):  
G. Bozzi ◽  
F. R. Simonetti ◽  
S. A. Watters ◽  
E. M. Anderson ◽  
M. Gouzoulis ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Clonal Expansion ◽  
Combination Antiretroviral Therapy ◽  
Hiv Replication ◽  
Hiv Persistence ◽  
Hiv Eradication ◽  
Infected Cells ◽  
Anatomic Locations

HIV persistence during combination antiretroviral therapy (cART) is the principal obstacle to cure. Mechanisms responsible for persistence remain uncertain; infections may be maintained by persistence and clonal expansion of infected cells or by ongoing replication in anatomic locations with poor antiretroviral penetration. These mechanisms require different strategies for eradication, and determining their contributions to HIV persistence is essential. We used phylogenetic approaches to investigate, at the DNA level, HIV populations in blood, lymphoid, and other infected tissues obtained at colonoscopy or autopsy in individuals who were on cART for 8 to 16 years. We found no evidence of ongoing replication or compartmentalization of HIV; we did detect clonal expansion of infected cells that were present before cART. Long-term persistence, and not ongoing replication, is primarily responsible for maintaining HIV. HIV-infected cells present when cART is initiated represent the only identifiable source of persistence and is the appropriate focus for eradication.

scholarly journals Human Immunodeficiency Virus Type-1 (HIV-1) Transcriptional Regulation, Latency and Therapy in the Central Nervous System

Vaccines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1272
Author(s):  
Joseph Hokello ◽  
Adhikarimayum Lakhikumar Sharma ◽  
Priya Tyagi ◽  
Alok Bhushan ◽  
Mudit Tyagi
Keyword(s):  
Central Nervous System ◽  
Human Immunodeficiency Virus ◽  
Nervous System ◽  
Transcriptional Regulation ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Combination Antiretroviral Therapy ◽  
Hiv Replication ◽  
Immunodeficiency Virus ◽  
The Central Nervous System

The central nervous system (CNS) is highly compartmentalized and serves as a specific site of human immunodeficiency virus (HIV) infection. Therefore, an understanding of the cellular populations that are infected by HIV or that harbor latent HIV proviruses is imperative in the attempts to address cure strategies, taking into account that HIV infection and latency in the CNS may differ considerably from those in the periphery. HIV replication in the CNS is reported to persist despite prolonged combination antiretroviral therapy due to the inability of the current antiretroviral drugs to penetrate and cross the blood–brain barrier. Consequently, as a result of sustained HIV replication in the CNS even in the face of combination antiretroviral therapy, there is a high incidence of HIV-associated neurocognitive disorders (HAND). This article, therefore, provides a comprehensive review of HIV transcriptional regulation, latency, and therapy in the CNS.

scholarly journals Hypertriglyceridemia, Metabolic Syndrome, and Cardiovascular Disease in HIV-Infected Patients: Effects of Antiretroviral Therapy and Adipose Tissue Distribution

2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
Jeroen P. H. van Wijk ◽  
Manuel Castro Cabezas
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Antiretroviral Therapy ◽  
Hdl Cholesterol ◽  
Postprandial Hyperlipidemia ◽  
Dramatic Decline ◽  
Low Hdl ◽  
Related Mortality

The use of combination antiretroviral therapy (CART) in HIV-infected patients has resulted in a dramatic decline in AIDS-related mortality. However, mortality due to non-AIDS conditions, particularly cardiovascular disease (CVD) seems to increase in this population. CART has been associated with several metabolic risk factors, including insulin resistance, low HDL-cholesterol, hypertriglyceridemia and postprandial hyperlipidemia. In addition, HIV itself, as well as specific antiretroviral agents, may further increase cardiovascular risk by interfering with endothelial function. As the HIV population is aging, CVD may become an increasingly growing health problem in the future. Therefore, early diagnosis and treatment of cardiovascular risk factors is warranted in this population. This paper reviews the contribution of both, HIV infection and CART, to insulin resistance, postprandial hyperlipidemia and cardiovascular risk in HIV-infected patients. Strategies to reduce cardiovascular risk are also discussed.

scholarly journals Gender inequalities in the response to combination antiretroviral therapy over time: the Swiss HIV Cohort Study

HIV Medicine ◽  
2014 ◽  
Vol 16 (5) ◽  
pp. 319-325 ◽  
Author(s):  
C Rosin ◽  
L Elzi ◽  
C Thurnheer ◽  
J Fehr ◽  
M Cavassini ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Gender Inequalities ◽  
Combination Antiretroviral Therapy ◽  
Over Time

scholarly journals Association of HIV Infection and Antiretroviral Therapy With Arterial Stiffness: A Systematic Review and Meta-Analysis

Hypertension ◽  
2021 ◽  
Author(s):  
Alvin Kuate Defo ◽  
Mhd Diaa Chalati ◽  
Christopher Labos ◽  
Lesley K. Fellows ◽  
Nancy E. Mayo ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Antiretroviral Therapy ◽  
Arterial Stiffness ◽  
Disease Risk ◽  
Mean Difference ◽  
Cumulative Exposure ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Standardized Mean Difference ◽  
Meta Analyses

Incidence of cardiovascular disease in people living with HIV has increased as overall survival has improved because of combination antiretroviral therapy (cART). Arterial stiffness is a composite indicator of cardiovascular disease risk independent of traditional risk factors. We aimed to synthesize the evidence on the relation of HIV and of cART to arterial stiffness. Medline, Embase, CINAHL, PubMed, and Cochrane Libraries were systematically searched for studies relating HIV/cART to arterial stiffness until June 2019. A standardized extraction form was used to collect data from published reports. Random-effects meta-analyses were performed to produce standardized mean differences and 95% CIs from studies reporting carotid-femoral pulse wave velocity. We retrieved 995 citations. Seventy-four studies (N=18 711 participants/13 119 with HIV) were included: 59 cross-sectional, 9 cohort, and 6 randomized trials. In meta-analyses of 17 studies, arterial stiffness was found to be elevated overall in individuals with HIV relative to controls (standardized mean difference, 0.44 m/s [95% CI, 0.25–0.63]) and in cART-treated versus untreated individuals with HIV (standardized mean difference, 0.35 m/s [95% CI, 0.13–0.57]). Several studies suggested that cumulative exposure to cART is associated with a continual increase in arterial stiffness. However, early initiation of treatment might improve arterial stiffness later in life. The results highlight the need for monitoring of cardiovascular risk in this population. The cross-sectional nature of most studies (59/74) mainly allowed for the exploration of associations; large longitudinal studies are needed to confirm the observed associations and establish causality between HIV/cART and arterial stiffness.

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