Antiretroviral therapies and corticosteroids

Abstract Introduction: Patient preferences for long-acting antiretroviral therapies (LA-ART) should inform development of regimens with optimal adherence and acceptability. We describe a systematic process used to identify attributes and levels for a discrete choice experiment (DCE) designed to elicit preferences for potential LA-ART options in the US. Methods: Our approach was conducted in four stages: data collection, data reduction, removing inappropriate attributes, and optimizing wording. We started with 8 attributes defining potential LA-ART products based on existing literature and knowledge of products in development. We conducted 12 key informant interviews with experts in HIV treatment. The list of attributes, the set of plausible levels for each attribute, and restrictions on combinations of attribute levels were updated iteratively.Results: Despite uncertainty about which products will become available, key informant discussions converged on 4 delivery modes (infusions and patches were not considered immediately feasible) and 6 additional attributes. Treatment effectiveness and frequency of clinical monitoring were dropped. Oral lead-in therapy was split into two attributes: pre-treatment time undetectable and pre-treatment negative reaction testing. We omitted product-specific systemic and local side effects. In addition to mode, the final set of attributes included: frequency of dosing; location of treatment; pain; pre-treatment time undetectable; pre-treatment negative reaction testing; and late-dose leeway.Conclusions: A systematic process successfully captured elements that are both feasible and relevant to evaluating the acceptability of potential LA-ART alternatives to patients.

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Who Wants to Switch? Gauging Patient Interest in Novel Antiretroviral Therapies

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy247 ◽

2018 ◽

Vol 5 (10) ◽

Cited By ~ 3

Author(s):

Caroline B Derrick ◽

Jan Ostermann ◽

Sharon B Weissman ◽

Amy Hobbie ◽

Noor Alshareef ◽

...

Keyword(s):

Drug Delivery ◽

Drug Delivery Systems ◽

Delivery Systems ◽

Antiretroviral Therapies ◽

Oral Regimen ◽

Dosing Frequency ◽

Study Participants ◽

Novel Drug

Abstract Study participants were asked about their interest in switching to novel drug delivery systems that reduce the dosing frequency of antiretroviral regimens. Across a diverse, treatment-experienced cohort, we describe greatest interest in switching to an oral regimen taken once weekly, followed by injections taken every other month and twice-annual implants.

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Iatrogenic Cushing's Syndrome in a Small Case Series of HIV Patients on Steroid Inhalation and Antiretroviral Therapies

Canadian Journal of Diabetes ◽

10.1016/j.jcjd.2016.08.091 ◽

2016 ◽

Vol 40 (5) ◽

pp. S31-S32

Author(s):

Allison Martin ◽

Ali Mooshekhian

Keyword(s):

Cushing’S Syndrome ◽

Case Series ◽

Cushing's Syndrome ◽

Hiv Patients ◽

Small Case Series ◽

Antiretroviral Therapies ◽

Iatrogenic Cushing’S Syndrome

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Quadruple versus triple combination antiretroviral therapies for treatment naive people with HIV: systematic review and meta-analysis of randomised controlled trials

BMJ ◽

10.1136/bmj.l4179 ◽

2019 ◽

pp. l4179 ◽

Cited By ~ 4

Author(s):

Qi Feng ◽

Aoshuang Zhou ◽

Huachun Zou ◽

Suzanne Ingle ◽

Margaret T May ◽

...

Keyword(s):

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Triple Combination ◽

Antiretroviral Therapies ◽

Treatment Naïve ◽

Randomised Controlled ◽

Hiv 1 ◽

Cd4 T Cell Count ◽

Better Than

AbstractObjectiveTo evaluate the effects of four drug (quadruple) versus three drug (triple) combination antiretroviral therapies in treatment naive people with HIV, and explore the implications of existing trials for clinical practice and research.DesignSystematic review and meta-analysis of randomised controlled trials.Data sourcesPubMed, EMBASE, CENTRAL, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature from March 2001 to December 2016 (updated search in PubMed and EMBASE up to June 2018); and reference lists of eligible studies and related reviews.Study selectionRandomised controlled trials comparing quadruple with triple combination antiretroviral therapies in treatment naive people with HIV and evaluating at least one effectiveness or safety outcome.Review methodsOutcomes of interest included undetectable HIV-1 RNA, CD4 T cell count, virological failure, new AIDS defining events, death, and severe adverse effects. Random effects meta-analyses were conducted.ResultsTwelve trials (including 4251 people with HIV) were eligible. Quadruple and triple combination antiretroviral therapies had similar effects on all relevant effectiveness and safety outcomes, with no point estimates favouring quadruple therapy. With the triple therapy as the reference group, the risk ratio was 0.99 (95% confidence interval 0.93 to 1.05) for undetectable HIV-1 RNA, 1.00 (0.90 to 1.11) for virological failure, 1.17 (0.84 to 1.63) for new AIDS defining events, 1.23 (0.74 to 2.05) for death, and 1.09 (0.89 to 1.33) for severe adverse effects. The mean difference in CD4 T cell count increase between the two groups was −19.55 cells/μL (−43.02 to 3.92). In general, the results were similar, regardless of the specific regimens of combination antiretroviral therapies, and were robust in all subgroup and sensitivity analyses.ConclusionIn this study, effects of quadruple combination antiretroviral therapy were not better than triple combination antiretroviral therapy in treatment naive people with HIV. This finding lends support to current guidelines recommending the triple regimen as first line treatment. Further trials on this topic should be conducted only when new research is justified by adequate systematic reviews of the existing evidence. However, this study cannot exclude the possibility that quadruple cART would be better than triple cART when new classes of antiretroviral drugs are made available.

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The Continuing Evolution of HIV-1 Therapy: Identification and Development of Novel Antiretroviral Agents Targeting Viral and Cellular Targets

Molecular Biology International ◽

10.1155/2012/401965 ◽

2012 ◽

Vol 2012 ◽

pp. 1-17 ◽

Cited By ~ 21

Author(s):

Tracy L. Hartman ◽

Robert W. Buckheit

Keyword(s):

Cellular Targets ◽

Treatment Regimens ◽

Highly Active ◽

Antiretroviral Therapies ◽

Pediatric Populations ◽

Developed World ◽

Anti Hiv ◽

Virus Isolates ◽

Hiv 1 ◽

Drug Resistant Virus

During the past three decades, over thirty-five anti-HIV-1 therapies have been developed for use in humans and the progression from monotherapeutic treatment regimens to today’s highly active combination antiretroviral therapies has had a dramatic impact on disease progression in HIV-1-infected individuals. In spite of the success of AIDS therapies and the existence of inhibitors of HIV-1 reverse transcriptase, protease, entry and fusion, and integrase, HIV-1 therapies still have a variety of problems which require continued development efforts to improve efficacy and reduce toxicity, while making drugs that can be used throughout both the developed and developing world, in pediatric populations, and in pregnant women. Highly active antiretroviral therapies (HAARTs) have significantly delayed the progression to AIDS, and in the developed world HIV-1-infected individuals might be expected to live normal life spans while on lifelong therapies. However, the difficult treatment regimens, the presence of class-specific drug toxicities, and the emergence of drug-resistant virus isolates highlight the fact that improvements in our therapeutic regimens and the identification of new and novel viral and cellular targets for therapy are still necessary. Antiretroviral therapeutic strategies and targets continue to be explored, and the development of increasingly potent molecules within existing classes of drugs and the development of novel strategies are ongoing.

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