Maybe the End of HIV

Pained ◽  
2020 ◽  
pp. 167-170
Author(s):  
Michael D. Stein ◽  
Sandro Galea
Keyword(s):  
Social Stigma ◽  
Hiv Care ◽  
Rural Poor ◽  
Delivery Of Care ◽  
Privacy Concerns ◽  
Down Low ◽  
Lack Of Information ◽  
Aids Clinical Trials ◽  
Long Acting ◽  
Hiv Drugs

This chapter focuses on HIV, which has been our most politically charged illness and a defining health challenge of our time. The world of HIV care over the last two decades has seen a great, almost miraculous, revolution. Today, a 35-year-old who was HIV-infected in 2018 and takes her daily medication adherently has the life expectancy of a 35-year-old without HIV infection. Monthly injections of long-acting HIV drugs look to be as good as daily pills at suppressing the virus, creating easier treatment. Despite these stunning advances, disparities in detection and care characterize the disease. The epidemic has shifted to groups that are hard to test, hard to get started on preventive care, and hard to keep on daily medication—persons who inject stimulants, men on the down-low, the mentally ill, the homeless, and the rural poor with no health insurance. Lack of information, lack of trust of providers, unfamiliarity with services, and refusals of testing and treatment due to social rejection and privacy concerns make the delivery of care more challenging for these groups. Even among persons enrolled in AIDS clinical trials who have found their way to cutting-edge medical treatment, blacks and Hispanics have poorer outcomes. As such, reaching an end to HIV will require new attention to health systems and social stigma, to geography, to housing and outreach, to the long work of public health.

scholarly journals A New Approach to Developing Long-Acting Injectable Formulations of Anti-HIV Drugs: Poly(Ethylene Phosphoric Acid) Block Copolymers Increase the Efficiency of Tenofovir against HIV-1 in MT-4 Cells

2020 ◽  
Vol 22 (1) ◽  
pp. 340
Author(s):  
Ilya Nifant’ev ◽  
Andrei Siniavin ◽  
Eduard Karamov ◽  
Maxim Kosarev ◽  
Sergey Kovalchuk ◽  
...  
Keyword(s):  
Controlled Release ◽  
Block Copolymers ◽  
Phosphoric Acid ◽  
Hiv Infection ◽  
Targeted Delivery ◽  
Release Formulation ◽  
Poly Ethylene ◽  
Long Acting ◽  
Hiv Drugs ◽  
Anti Hiv

Despite the world’s combined efforts, human immunodeficiency virus (HIV), the causative agent of AIDS, remains one of the world’s most serious public health challenges. High genetic variability of HIV complicates the development of anti-HIV vaccine, and there is an actual clinical need for increasing the efficiency of anti-HIV drugs in terms of targeted delivery and controlled release. Tenofovir (TFV), a nucleotide-analog reverse transcriptase inhibitor, has gained wide acceptance as a drug for pre-exposure prophylaxis or treatment of HIV infection. In our study, we explored the potential of tenofovir disoproxil (TFD) adducts with block copolymers of poly(ethylene glycol) monomethyl ether and poly(ethylene phosphoric acid) (mPEG-b-PEPA) as candidates for developing a long-acting/controlled-release formulation of TFV. Two types of mPEG-b-PEPA with numbers of ethylene phosphoric acid (EPA) fragments of 13 and 49 were synthesized by catalytic ring-opening polymerization, and used for preparing four types of adducts with TFD. Antiviral activity of [mPEG-b-PEPA]TFD or tenofovir disoproxil fumarate (TDF) was evaluated using the model of experimental HIV infection in vitro (MT-4/HIV-1IIIB). Judging by the values of the selectivity index (SI), TFD exhibited an up to 14-fold higher anti-HIV activity in the form of mPEG-b-PEPA adducts, thus demonstrating significant promise for further development of long-acting/controlled-release injectable TFV formulations.

Ethical impact of suboptimal referrals on delivery of care in radiology department

2021 ◽  
pp. medethics-2021-107335
Author(s):  
Catherine Chilute Chilanga ◽  
Kristin Bakke Lysdahl
Keyword(s):  
Imaging Modality ◽  
Well Being ◽  
Good Health ◽  
Correct Choice ◽  
Radiology Department ◽  
Ethical Challenges ◽  
Patient Anxiety ◽  
Missed Opportunities ◽  
Delivery Of Care ◽  
Lack Of Information

The referral is the key source of information that enables radiologists and radiographers to provide quality services. However, the frequency of suboptimal referrals is widely reported. This research reviews the literature to illuminate the challenges suboptimal referrals present to the delivery of care in radiology departments. The concept of suboptimal referral includes information, that is; missing, insufficient, inconsistent, misleading, hard to interpret or wrong. The research uses the four ethical principles of non-maleficence, beneficence, Autonomy and Justice as an analytic framework.Suboptimal referrals can cause harm by hindering safe contrast-media administration, proper radiation protection by justification of procedures, and compassionate patient care. Suboptimal referrals also hinder promoting patient benefits from the correct choice of imaging modality and protocol, an optimal performed examination, and an accurate radiology report. Additionally, patient autonomy is compromised from the lack of information needed to facilitate benefit–risk communication. Finally, suboptimal referrals challenge justice based on lack of reasonable patient prioritising and the unfairness caused by unnecessary examinations.These findings illuminate how suboptimal referrals can inhibit good health and well-being for patients in relation to safety, missed opportunities, patient anxiety and dissatisfaction. The ethical challenges identified calls for solutions. Referral-decision support tools and artificial intelligence may improve referral quality, when implemented. Strategies addressing efforts of radiology professionals are inevitable, including gatekeeping, shared decision-making and inter-professional communication; thereby raising awareness of the importance of good referral quality and promoting commitment to ethical professional conduct.

Factors associated with interest in a long-acting HIV regimen: perspectives of people living with HIV and healthcare providers in four European countries

2021 ◽  
pp. sextrans-2020-054648
Author(s):  
Babatunde Akinwunmi ◽  
Daniel Buchenberger ◽  
Jenny Scherzer ◽  
Martina Bode ◽  
Paolo Rizzini ◽  
...  
Keyword(s):  
Unmet Needs ◽  
Resource Constraints ◽  
Hiv Treatment ◽  
Transmission Risk ◽  
People Living With Hiv ◽  
Privacy Concerns ◽  
Medical Needs ◽  
Suboptimal Adherence ◽  
Long Acting ◽  
Living With Hiv

ObjectivesA novel long-acting regimen (LAR) of cabotegravir and rilpivirine for HIV treatment requires dosing every 2 months instead of daily. We assessed what proportion of people living with HIV and physicians would be interested in trying and offering LAR respectively and why.Methods688 people living with HIV on treatment, and 120 HIV physicians completed web-based surveys in Germany, Italy, the UK and France during 2019. Balanced description of a hypothetical LAR regarding efficacy, administration and possible side effects were provided. The hypothetical long-acting injections were assumed to be cost-neutral to current daily oral antiretrovirals. Interest of people living with HIV in trying (‘very’/’highly’) and physicians’ willingness to offer (‘definitely’/’probably’) this LAR in different situations, with perceived benefits/concerns was measured.ResultsOf people living with HIV, 65.8% were interested in trying LAR. The majority (~80%–90%) of those with unmet needs felt LAR would help, including those with strong medical needs (malabsorption and interfering gastrointestinal conditions), suboptimal adherence, confidentiality/privacy concerns and emotional burden of daily dosing. Of physicians, percentage willing to offer LAR varied situationally: strong medical need (dysphagia, 93.3%; malabsorption, 91.6%; interfering gastrointestinal issues, 90.0%; central nervous system disorders, 87.5%); suboptimal adherence (84.2%); confidentiality/privacy concerns (hiding medications, 86.6%) and convenience/lifestyle (84.2%). People living with HIV liked LAR for not having to carry pills when travelling (56.3%); physicians liked the increased patient contact (54.2%). Furthermore, 50.0% of people living with HIV perceived LAR would minimise transmission risk and improve their sexual health. The most disliked attribute was scheduling appointments (37.2%) and resource constraints (57.5%) for people living with HIV and physicians, respectively. Physicians estimated 25.7% of their patients would actually switch.ConclusionProviders and people living with HIV viewed the described LAR as addressing several unmet needs. Alternative treatment routes and especially LAR may improve adherence and quality of life.

scholarly journals Recent Advances in HIV-1 Gag Inhibitor Design and Development

Molecules ◽  
2020 ◽  
Vol 25 (7) ◽  
pp. 1687
Author(s):  
Alexej Dick ◽  
Simon Cocklin
Keyword(s):  
Matrix Protein ◽  
Life Quality ◽  
Immune Deficiency Syndrome ◽  
Deficiency Syndrome ◽  
Inhibitor Design ◽  
Resistance Mutations ◽  
Long Acting ◽  
The Individual ◽  
Hiv Drugs ◽  
Hiv 1

Acquired Immune Deficiency Syndrome (AIDS) treatment with combination antiretroviral therapy (cART) has improved the life quality of many patients since its implementation. However, resistance mutations and the accumulation of severe side effects associated with cART remain enormous challenges that need to be addressed with the continual design and redesign of anti-HIV drugs. In this review, we focus on the importance of the HIV-1 Gag polyprotein as the master coordinator of HIV-1 assembly and maturation and as an emerging drug target. Due to its multiple roles in the HIV-1 life cycle, the individual Gag domains are attractive but also challenging targets for inhibitor design. However, recent encouraging developments in targeting the Gag domains such as the capsid protein with highly potent and potentially long-acting inhibitors, as well as the exploration and successful targeting of challenging HIV-1 proteins such as the matrix protein, have demonstrated the therapeutic viability of this important protein. Such Gag-directed inhibitors have great potential for combating the AIDS pandemic and to be useful tools to dissect HIV-1 biology.

scholarly journals Three HIV Drugs, Atazanavir, Ritonavir, and Tenofovir, Coformulated in Drug-Combination Nanoparticles Exhibit Long-Acting and Lymphocyte-Targeting Properties in Nonhuman Primates

2018 ◽  
Vol 107 (12) ◽  
pp. 3153-3162 ◽  
Author(s):  
Simone Perazzolo ◽  
Laura M. Shireman ◽  
Josefin Koehn ◽  
Lisa A. McConnachie ◽  
John C. Kraft ◽  
...  
Keyword(s):  
Drug Combination ◽  
Nonhuman Primates ◽  
Long Acting ◽  
Hiv Drugs

54 Altrenogest supplementation during early pregnancy improves swine embryonic development

2019 ◽  
Vol 31 (1) ◽  
pp. 152
Author(s):  
B. Muro ◽  
R. Carnevale ◽  
M. Mendonça ◽  
D. Leal ◽  
M. Torres ◽  
...  
Keyword(s):  
Embryonic Development ◽  
Pregnancy Rate ◽  
Embryo Development ◽  
Early Pregnancy ◽  
Early Embryo ◽  
Maternal Serum ◽  
Interferon Tau ◽  
Lack Of Information ◽  
Long Acting ◽  
Implantation Period

Progesterone (P4) is of paramount importance in the establishment and maintenance of pregnancy for mammals. Progesterone stimulates the endometrial secretion of several molecules involved in conceptus growth and development during the peri-implantation period. Indeed, several studies involving ruminants have reported that exogenous P4 supplementation is related to increased early embryo development, higher levels of interferon tau, and improved pregnancy rate. However, there is a lack of information about P4 supplementation during early pregnancy regarding swine embryonic development. Additionally, some of the few studies involving pigs have shown an impaired pregnancy rate when supplementation was performed before Day 6 of pregnancy. Thus, the objective of this study was to evaluate the effects of progesterone/progestin supplementation from Day 6 of pregnancy on total number of embryos (TE), pregnancy rate (PR), embryo development, and maternal serum 17β-oestradiol concentration (17β-E). A total of 31 crossbred, 2 to 6 parity sows were used. All sows were inseminated every 24h through the first oestrus following a 21-day lactation, and ovulation was detected by transrectal real-time ultrasound to determine Day 0 of pregnancy. On Day 6 of pregnancy, animals were randomly allocated to one of the following groups: CON (n=11), non-supplemented sows; RU (n=11), sows supplemented daily with 20mg of Altrenogest-Regumate® from Day 6 to 12 of pregnancy; and PG (n=9), sows supplemented with 2.15 mg/kg of long-acting P4 IM on Day 6 of pregnancy. Sows were treated with altrenogest p.o. as a top dressing over a small portion of feed. Blood samples were collected from 12 sows (4 per group) on Day 12 of pregnancy to measure the level of plasma 17β-E by radioimmunoassay. Sows were slaughtered on Day 28 of pregnancy. The uterus from each sow was collected and embryos were counted to determine TE. Embryos were individually separated from their placentas, weighed, and crown-to-rump length was determined. Data were analysed by the SAS program. All variables were analysed by PROC-MIXED t-test. Statistical difference was considered when P<0.05. The PR did not differ among groups (91, 90, and 88%, for CON, RU, and PG, respectively; P>0.05). No difference was observed among groups for TE and 17β-E level (P>0.05). However, embryonic weight and crown-to-rump length differed among the 3 groups (P<0.001). The RU-treated sows had heavier and bigger embryos when compared with the other groups. In contrast, PG-treated sows had the lowest averages for the same variables (weight: 1.39±0.01, 1.46±0.02, and 1.22±0.01; crown-to-rump: 21.07±0.08, 21.61±0.11, and 20.66±0.11; for CON, RU, and PG, respectively). In conclusion, altrenogest supplementation from Day 6 to 12 of pregnancy increases size and weight of porcine embryos, whereas 2.15mg kg−1 of long-acting P4 on Day 6 of pregnancy decreased these variables when compared with non-supplemented sows. Research was supported by FAPESP Grant 2017/00290-0.

How social stigma sustains the HIV treatment gap for MSM in Mpumalanga, South Africa

2017 ◽  
Vol 26 (4) ◽  
pp. 6-13 ◽  
Author(s):  
Kabelo Maleke ◽  
Joseph Daniels ◽  
Tim Lane ◽  
Helen Struthers ◽  
James McIntyre ◽  
...  
Keyword(s):  
South Africa ◽  
Social Stigma ◽  
Clinical Care ◽  
Traditional Healers ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Care Seeking ◽  
Mpumalanga Province ◽  
Sex With Men ◽  
The Impact

There are gaps in HIV care for men who have sex with men (MSM) in African settings, and HIV social stigma plays a significant role in sustaining these gaps. We conducted a three-year research project with 49 HIV-positive MSM in two districts in Mpumalanga Province, South Africa, to understand the factors that inform HIV care seeking behaviors. Semi-structured focus group discussions and interviews were conducted in IsiZulu, SiSwati, and some code-switching into English, and these were audio-recorded, transcribed, and translated into English. We used a constant comparison approach to analyze these data. HIV social stigma centered around gossip that sustained self-diagnosis and delayed clinical care with decisions to use traditional healers to mitigate the impact of gossip on their lives. More collaboration models are needed between traditional healers and health professionals to support the global goals for HIV testing and treatment.

scholarly journals Long-Acting Anti-HIV Drugs Targeting HIV-1 Reverse Transcriptase and Integrase

2019 ◽  
Vol 12 (2) ◽  
pp. 62 ◽  
Author(s):  
Kamal Singh ◽  
Stefan G. Sarafianos ◽  
Anders Sönnerborg
Keyword(s):  
Drug Resistance ◽  
Clinical Trials ◽  
Reverse Transcriptase ◽  
Treatment Regimens ◽  
Drug Concentrations ◽  
The Status ◽  
Long Acting ◽  
Major Factors ◽  
Hiv Drugs ◽  
Hiv 1

One of the major factors contributing to HIV-1 drug resistance is suboptimal adherence to combination antiretroviral therapy (cART). Currently, recommended cART for HIV-1 treatment is a three-drug combination, whereas the pre-exposure prophylaxis (PrEP) regimens consist of one or two antivirals. Treatment regimens require adherence to a once or twice (in a subset of patients) daily dose. Long-acting formulations such as injections administered monthly could improve adherence and convenience, and thereby have potential to enhance the chances of expected outcomes, although long-lasting drug concentrations can also contribute to clinical issues like adverse events and development of drug resistance. Globally, two long-acting antivirals have been approved, and fifteen are in clinical trials. More than half of investigational long-acting antivirals target HIV-1 reverse transcriptase (HIV-1 RT) and/or integrase (HIV-1 IN). Here, we discuss the status and potential of long-acting inhibitors, including rilpivirine (RPV), dapivirine (DPV), and 4-ethynyl-2-fluoro-2-deoxyadenosine (EFdA; also known as MK-8591), which target RT, and cabotegravir (CAB), which targets IN. The outcomes of various clinical trials appear quite satisfactory, and the future of long-acting HIV-1 regimens appears bright.

Adherence, Attitudes and Beliefs of Growth Hormone Deficient Patients – A Questionnaire-based Cohort Study

2019 ◽  
Author(s):  
Felix Amereller ◽  
Katharina Schilbach ◽  
Jochen Schopohl ◽  
Sylvère Störmann
Keyword(s):  
Growth Hormone ◽  
Systemic Disease ◽  
Treatment Options ◽  
Hormone Deficiency ◽  
Attitudes And Beliefs ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Lack Of Information ◽  
Custom Made ◽  
Long Acting

Abstract Introduction GHD is a chronic and systemic disease requiring daily replacement of growth hormone (GHRT). Adherence and attitudes of adult GHD patients are not well known. We sought to assess patients’ knowledge of growth hormone deficiency (GHD) in association with treatment adherence and attitudes regarding available and upcoming treatment options. Methods We performed a cross-sectional survey with a custom-made questionnaire at a single centre assessing data on demographics, knowledge of GHD, adherence and attitudes towards GHRT. Results Of 106 eligible patients actively followed for GHD 70 returned the completed survey (return-rate 66%, 34 m/36 f; age 56±14 years). 46 patients were actively treated, but almost one third (n=24) refused GHRT. 12 patients had participated in clinical trials with LAGH (long-acting growth hormone). Overall, patients with GHRT showed good adherence. Patients refusing GHRT mostly feared side effects and/or had a lack of information/perceived effect. Disease knowledge and level of education were higher in treated than untreated patients (p=0.023/0.017). Only 36% of respondents would initiate treatment with LAGH. Patients with prior LAGH experience and patients with childhood-onset GHD were more likely to adopt LAGH (p=0.048/0.031). Discussion Most often, misinformation causes patients to refuse GHRT. Possibly the understanding of their condition and consequences of non-treatment is limited. To improve adherence more focused educational and behavioural strategies may be needed. Willingness to begin a therapy with LAGH was lower than expected (36%). The reasons for reluctance against LAGH need to be elucidated.

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