scholarly journals Recommended First-Line Antiretroviral Therapy Regimens and Risk of Diabetes Mellitus in HIV-Infected Adults in Resource-Limited Settings

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Ninutcha Paengsai ◽  
Gonzague Jourdain ◽  
Nicolas Salvadori ◽  
Apichat Tantraworasin ◽  
Jean Yves Mary ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Antiretroviral Therapy ◽  
Reference Group ◽  
Multivariable Analysis ◽  
Antiretroviral Drugs ◽  
World Health ◽  
First Line ◽  
Resource Limited ◽  
Increased Risk ◽  
Health Organization

Abstract Objective The use of some antiretroviral drugs has been associated with a higher risk of diabetes mellitus (DM) in HIV-infected patients, but the risk associated with antiretroviral drug combinations remains unclear. We investigated the association between first-line antiretroviral therapy (ART) regimens, recommended by the World Health Organization (WHO) in 2016, and the risk of DM in adults. Method We selected all HIV-infected adults within the Thai National AIDS Program who started a first-line ART regimen consisting the following between October 2006 and September 2013: zidovudine+lamivudine+nevirapine; tenofovir disoproxil fumarate (TDF)+lamivudine+nevirapine; zidovudine+lamivudine+efavirenz; TDF+lamivudine/emtricitabine+efavirenz; zidovudine+lamivudine+ritonavir-boosted lopinavir (LPV/r); or TDF+lamivudine+LPV/r. Diagnosis of DM was defined as having at least 2 of the following characteristics: fasting plasma glucose ≥126 mg/dl, 2010 WHO ICD-10 codes E11-E14, or prescription of antidiabetic drugs. To identify ART regimens associated with DM, we used competing risks regression models that considered mortality without DM as a competing event and adjusted for sex, age, pancreas disease, and stratified by groups defined by a score summarizing the propensity to receive a specific first-line ART regimen. Results Data from 35 710 adults (49.1% male; median age, 35.0 years; median follow-up, 2.0 years) were included. In the multivariable analysis with zidovudine+lamivudine+nevirapine as the reference group, a higher risk of DM was observed with TDF+lamivudine/emtricitabine+efavirenz (adjusted sub-distribution hazard ratio [aSHR], 1.6; 95% confidence interval [CI], 1.3–1.9), zidovudine+lamivudine+efavirenz (aSHR, 2.0; 95% CI, 1.7–2.3), and TDF+lamivudine+LPV/r (aSHR, 2.7; 95% CI, 1.9–3.9). Conclusions Several of the WHO recommended ART regimens, particularly tenofovir + lamivudine +LPV/r and regimens containing efavirenz, may be associated with an increased risk of DM.

Polycythaemia vera

2020 ◽  
pp. 113-125
Author(s):  
Tiziano Barbui ◽  
Tariq I. Mughal ◽  
Guido Finazzi
Keyword(s):  
World Health ◽  
Polycythaemia Vera ◽  
First Line ◽  
First Line Therapy ◽  
Increased Risk ◽  
The World ◽  
Recent Phase ◽  
Health Organization ◽  
Cell Disorder ◽  
Acute Myeloid

Polycythaemia vera (PV) is a clonal stem cell disorder characterized by erythrocytosis and associated with burdensome symptoms, risk of thrombohaemorrhagic complications, and transformation to myelofibrosis and acute myeloid leukaemia. Diagnostic criteria are very recently revised by the World Health Organization (WHO) based on haemoglobin and haematocrit levels, bone marrow morphology consistent with trilineage proliferation and presence of the JAK2 V617 mutation. Cytoreductive therapy is indicated in patients at increased risk of thrombosis. Hydroxyurea (HU) remains the most commonly used first-line cytoreductive therapy and interferon (IFN) is used either at failure of HU or in selected patients as first-line therapy. A recent phase 3 trial has shown the superiority of the JAK1/2 inhibitor ruxolitinib in comparison to best available treatment in HU-intolerant or resistant patients.

scholarly journals Prevalence and Clinical Outcomes of Poor Immune Response Despite Virologically Suppressive Antiretroviral Therapy Among Children and Adolescents With Human Immunodeficiency Virus in Europe and Thailand: Cohort Study

2019 ◽  
Author(s):  
◽  
Elizabeth Chappell ◽  
Andrew Riordan ◽  
Gonzague Jourdain ◽  
Antoni Soriano-Arandes ◽  
...  
Keyword(s):  
Immune Response ◽  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Multivariable Analysis ◽  
World Health ◽  
Severe Immunosuppression ◽  
Art Initiation ◽  
Cell Counts ◽  
Increased Risk ◽  
Immunodeficiency Virus

Abstract Background In human immunodeficiency virus (HIV)–positive adults, low CD4 cell counts despite fully suppressed HIV-1 RNA on antiretroviral therapy (ART) have been associated with increased risk of morbidity and mortality. We assessed the prevalence and outcomes of poor immune response (PIR) in children receiving suppressive ART. Methods Sixteen cohorts from the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) contributed data. Children <18 years at ART initiation, with sustained viral suppression (VS) (≤400 copies/mL) for ≥1 year were included. The prevalence of PIR (defined as World Health Organization advanced/severe immunosuppression for age) at 1 year of VS was described. Factors associated with PIR were assessed using logistic regression. Rates of acquired immunodeficiency syndrome (AIDS) or death on suppressive ART were calculated by PIR status. Results Of 2318 children included, median age was 6.4 years and 68% had advanced/severe immunosuppression at ART initiation. At 1 year of VS, 12% had PIR. In multivariable analysis, PIR was associated with older age and worse immunological stage at ART start, hepatitis B coinfection, and residing in Thailand (all P ≤ .03). Rates of AIDS/death (95% confidence interval) per 100 000 person-years were 1052 (547, 2022) among PIR versus 261 (166, 409) among immune responders; rate ratio of 4.04 (1.83, 8.92; P < .001). Conclusions One in eight children in our cohort experienced PIR despite sustained VS. While the overall rate of AIDS/death was low, children with PIR had a 4-fold increase in risk of event as compared with immune responders.

The Political Economy of Antiretroviral Drugs in Zambia

2006 ◽  
Vol 5 (4) ◽  
pp. 385-409 ◽  
Author(s):  
Edgar Bwalya
Keyword(s):  
Antiretroviral Therapy ◽  
Scaling Up ◽  
Antiretroviral Drugs ◽  
World Health ◽  
The Political ◽  
Infection Rates ◽  
The World ◽  
The Government ◽  
Health Organization ◽  
Hiv Aids

AbstractAccording to the 2005 United Nations Programe on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) Report, Zambia has one of the highest rates of HIV/AIDS cases in Southern Africa as well as in the world. However, it is also one of the few countries that have recorded a drop in the infection rates from an estimated 26% of the population in 2000 to just fewer than 16% in 2005. There appears to be a general consensus that the availability and free provision of antiretroviral drugs (ARVs) and treatment have raised hope that the recipients will live a longer, improved, and productive life. This paper will attempt to assess the major challenges to scaling-up antiretroviral therapy in Zambia. It argues that, while the government has made some progress in scaling-up access to ARVs, there is still much to be done.

scholarly journals Efficacy of first-line, WHO recommended generic HAART regimens in Indian children

2010 ◽  
Vol 7 (3) ◽  
pp. 220-225 ◽  
Author(s):  
A Parakh ◽  
AP Dubey ◽  
A Kumar ◽  
A Maheshwari ◽  
R Saxena
Keyword(s):  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Transcriptase Inhibitor ◽  
World Health ◽  
Highly Active ◽  
Resource Limited ◽  
Z Scores ◽  
Nucleotide Reverse Transcriptase Inhibitor ◽  
Health Organization ◽  
Reverse Transcriptase Inhibitor

Background: The clinical efficacy of highly active antiretroviral therapy (HAART) in children has been well documented in the developed countries, although most of the regimens are Protease Inhibitor (PI) based which are too expensive. To circumvent this problem World Health Organization (WHO) has recommended Non- Nucleotide Reverse Transcriptase Inhibitor (NNRTI) based regimen for resource-limited countries. Aim: To assess the long-term efficacy of first line World Health Organization (WHO)-recommended generic highly active antiretroviral therapy (HAART) regimens in treatment -naïve children. Materials and methods: Observational retrospective analysis was done. Thirty patients on HAART for > 6 months were included (27 on Stavudine; three on Zidovudine with Lamivudine/ Nevirapine). No protease inhibitors were used. Results: median age was seven years (Interquartile [IQR]: 5.62-8.50) and median duration on HAART was 18 months (IQR: 6-24). No new staging events were observed after six months of initiation of HAART. The median CD4% increased from 6.0 % at baseline to 15.5% at six months, 21.7% at 12 months, 25.4% at 18 months, 24.6 % at 24 months 25.3% at 30 months and 23.7% at 36 months. There was only one case of immunological failure. Stratified analysis based on baseline CD4 % show that even patients with a baseline CD4 % of <5% achieved percentage of >25% at 18-24 months and maintained it subsequently. Significant increase in the weight and body mass index Z scores was observed but significant fall in the height Z scores were observed. This sub group of patients with poor linear height velocity would require detailed endocrine evaluation after testing for viral loads. Conclusions: Non- Nucleotide Reverse Transcriptase Inhibitor based HAART regimens are feasible and effective in long term in resource-limited setting despite initiation of treatment in advanced stages. These can be continued in NACO/WHO scale up programmes at present for children. Key words: HAART in children; India; NNRTI based HAART; resource limited settings; WHO prequalified Antiretroviral therapy DOI: 10.3126/kumj.v7i3.2727 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 220-225

scholarly journals The utility of a modified W.H.O. TB screening tool among children at a Botswana child welfare clinic

2021 ◽  
Vol 21 (1) ◽  
pp. 64-71
Author(s):  
Wame Dikobe ◽  
Mooketsi Molefi ◽  
Bornapate Nkomo ◽  
Botshelo Kgwaadira ◽  
Boingotlo Gasenelwe ◽  
...  
Keyword(s):  
Screening Tool ◽  
World Health ◽  
Resource Limited ◽  
Increased Risk ◽  
Child Welfare Clinic ◽  
Childhood Tb ◽  
History Of ◽  
Hiv Exposure ◽  
Hiv Exposed ◽  
Health Organization

Background: In high TB/HIV settings, the increased risk for TB amongst children exposed to HIV has been established through biomedical tests. Screening HIV exposed children for TB can improve early childhood TB detection and treatment. Objective: This study assessed the utility of a modified World Health Organization (WHO) tool by including HIV variables, to determine TB exposure amongst HIV exposed children presenting to a “Well Child” Clinic (CWC). Methods: Clinical data were obtained from medical records and/or from the caregivers of children presenting to CWC. Data was analyzed to explore factors associated with positive screening for TB, including being exposed to HIV and current HIV status. Results: Five percent (55/1100) screened reported a close TB contact and 21% (n=231) had positive TB symptom screen. History of close TB contact was a risk factor for positive screening for TB symptoms (OR 1.89 CI 1.05-3.4) while being HIV negative was protective (OR 0.3, Cl 0.19-0.62). HIV exposure was associated with increased risk of TB exposure (OR 2.9 CI 1.61-5.19). Conclusion: Integrating HIV variables in the existing WHO screening tool for childhood TB can be useful in early detec- tion and treatment of TB in HIV exposed children in resource limited settings. Keywords: Childhood TB screening; HIV Exposure screening; TB/HIV integration.

scholarly journals The utility of a modified W.H.O. TB screening tool among children at a Botswana child welfare clinic

2021 ◽  
Vol 21 ◽  
pp. 64-71
Author(s):  
Wame Dikobe ◽  
Mooketsi Molefi ◽  
Bornapate Nkomo ◽  
Botshelo Kgwaadira ◽  
Boingotlo Gasenelwe ◽  
...  
Keyword(s):  
Screening Tool ◽  
World Health ◽  
Resource Limited ◽  
Increased Risk ◽  
Child Welfare Clinic ◽  
Childhood Tb ◽  
History Of ◽  
Hiv Exposure ◽  
Hiv Exposed ◽  
Health Organization

Background: In high TB/HIV settings, the increased risk for TB amongst children exposed to HIV has been established through biomedical tests. Screening HIV exposed children for TB can improve early childhood TB detection and treatment. Objective: This study assessed the utility of a modified World Health Organization (WHO) tool by including HIV variables, to determine TB exposure amongst HIV exposed children presenting to a “Well Child” Clinic (CWC). Methods: Clinical data were obtained from medical records and/or from the caregivers of children presenting to CWC. Data was analyzed to explore factors associated with positive screening for TB, including being exposed to HIV and current HIV status. Results: Five percent (55/1100) screened reported a close TB contact and 21% (n=231) had positive TB symptom screen. History of close TB contact was a risk factor for positive screening for TB symptoms (OR 1.89 CI 1.05-3.4) while being HIV negative was protective (OR 0.3, Cl 0.19-0.62). HIV exposure was associated with increased risk of TB exposure (OR 2.9 CI 1.61-5.19). Conclusion: Integrating HIV variables in the existing WHO screening tool for childhood TB can be useful in early detec- tion and treatment of TB in HIV exposed children in resource limited settings. Keywords: Childhood TB screening; HIV Exposure screening; TB/HIV integration.

Antidiabetics: Structural Diversity of Molecules with a Common Aim

2018 ◽  
Vol 25 (18) ◽  
pp. 2140-2165 ◽  
Author(s):  
Jelena B. Popovic-Djordjevic ◽  
Ivana I. Jevtic ◽  
Tatjana P. Stanojkovic
Keyword(s):  
Structural Diversity ◽  
World Health ◽  
Common Disease ◽  
Peroxisome Proliferator ◽  
Epidemic Disease ◽  
Peroxisome Proliferator Activated Receptor ◽  
Increased Risk ◽  
Dipeptidyl Peptidase Iv Inhibitors ◽  
Glucagon Like Peptide 1 ◽  
Health Organization

Background: Diabetes mellitus type 2 (DMT2) is an endocrine disease of global proportions which is currently affecting 1 in 12 adults in the world, with still increasing prevalence. World Health Organization (WHO) declared this worldwide health problem, as an epidemic disease, to be the only non-infectious disease with such categorization. People with DMT2 are at increased risk of various complications and have shorter life expectancy. The main classes of oral antidiabetic drugs accessible today for DMT2 vary in their chemical composition, modes of action, safety profiles and tolerability. Methods: A systematic search of peer-reviewed scientific literature and public databases has been conducted. We included the most recent relevant research papers and data in respect to the focus of the present review. The quality of retrieved papers was assessed using standard tools. Results: The review highlights the chemical structural diversity of the molecules that have the common target-DMT2. So-called traditional antidiabetics as well as the newest and the least explored drugs include polypeptides and amino acid derivatives (insulin, glucagon-like peptide 1, dipeptidyl peptidase-IV inhibitors, amylin), sulfonylurea derivatives, benzylthiazolidine- 2,4-diones (peroxisome proliferator activated receptor-γ agonists/glitazones), condensed guanido core (metformin) and sugar-like molecules (α-glucosidase and sodium/ glucose co-transporter 2 inhibitors). Conclusion: As diabetes becomes a more common disease, interest in new pharmacological targets is on the rise.

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