Consistency of Initial Antiretroviral Therapy With HIV Treatment Guidelines in a US Cohort of HIV-Infected Women

2008 ◽  
Vol 47 (3) ◽  
pp. 377-383 ◽  
Author(s):  
Jennifer Cocohoba ◽  
Qiong J Wang ◽  
Christopher Cox ◽  
Stephen J Gange ◽  
Mardge Cohen ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Treatment Guidelines ◽  
Hiv Treatment

scholarly journals Adherence to HIV treatment guidelines for initiation of antiretroviral therapy in Australia

2010 ◽  
Vol 13 (Suppl 4) ◽  
pp. P172 ◽  
Author(s):  
M Bloch ◽  
J Hoy ◽  
N Cunningham ◽  
N Roth ◽  
N Andrianopoulos ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Treatment Guidelines ◽  
Hiv Treatment

scholarly journals Systemic Delays in the Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients in Houston, Texas

2018 ◽  
Vol 17 ◽  
pp. 232595821877404 ◽  
Author(s):  
Osaro Mgbere ◽  
Maria Rodriguez-Barradas ◽  
Karen Joan Vigil ◽  
Melanie McNeese ◽  
Fazal Tabassam ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Medical Care ◽  
Treatment Guidelines ◽  
Health Benefits ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Medical Decision ◽  
Care Providers ◽  
Harris County ◽  
Starting Point

Background: The current US HIV treatment guidelines support initiation of antiretroviral therapy (ART) for persons with HIV for personal health benefits and prevention of HIV transmission. However, high levels of adherence to ART are critical to maximize individual and public health benefits. We examined the nonclinical barriers to ART initiation for clinically eligible individuals and the provider- and patient-related factors associated with these barriers among HIV-infected patients in Houston/Harris County, Texas. Methods: We analyzed data obtained from a probability sample of HIV medical care providers (HMCPs) in 13 outpatient facilities in Houston/Harris County, Texas surveyed between June and September 2009. We used an inductive thematic approach to code HMCP responses to an open-ended question that asked the main reasons why providers may delay initiating ART for clinically eligible patients. Results: The reasons cited by providers for delaying ART for clinically eligible patients were adherence (42.5%; 95% confidence interval [CI]: 28.5-57.8), acceptance (30%; 95% CI: 18.1-45.4), and structural concerns (27.5%; 95% CI: 16.1-42.8), with significant variations ( P < .0001) noted across patients’ race/ethnicity and transmission category. HIV medical care providers with 6 to 10 years’ experience in HIV care and those providing medical care for more than 100 patients monthly were about 4 times (adjusted odds ratio [aOR]: 3.80; 95% CI: 1.20-5.92; P = .039) and 10 times (aOR: 10.36; 95% CI: 1.42-22.70; P = .019) more likely to state adherence and acceptance concerns, respectively, as reasons for delaying ART for clinically eligible patients. Conclusion: Our findings highlight the fact that clinical guidelines are only a starting point for medical decision-making process and that patients themselves play an important role. HMCP access to referrals for other medical issues, support services, and treatment education may help improve adherence and patient readiness for ART, thereby avoiding systemic delays.

scholarly journals Changing Clinician Practices and Attitudes Regarding the Use of Antiretroviral Therapy for HIV Treatment and Prevention

2016 ◽  
Vol 16 (1) ◽  
pp. 81-90 ◽  
Author(s):  
Kate Buchacz ◽  
Jennifer Farrior ◽  
Geetha Beauchamp ◽  
Laura McKinstry ◽  
Ann E. Kurth ◽  
...  
Keyword(s):  
New York ◽  
Antiretroviral Therapy ◽  
Treatment Guidelines ◽  
Hiv Treatment ◽  
Unprotected Sex ◽  
Hiv Care ◽  
Web Based ◽  
Treatment And Prevention ◽  
Clinician Practices

As part of the HPTN 065 study in the Bronx, New York and Washington, the authors, we surveyed clinicians to assess for shifts in their practices and attitudes around HIV treatment and prevention. Antiretroviral therapy (ART)-prescribing clinicians at 39 HIV care sites were offered an anonymous Web-based survey at baseline (2010-2011) and at follow-up (2013). The 165 respondents at baseline and 141 respondents at follow-up had similar characteristics—almost 60% were female, median age was 47 years, two-thirds were physicians, and nearly 80% were HIV specialists. The percentage who reported recommending ART irrespective of CD4 count was higher at follow-up (15% versus 68%), as was the percentage who would initiate ART earlier for patients having unprotected sex with partners of unknown HIV status (64% versus 82%), and for those in HIV-discordant partnerships (75% versus 87%). In line with changing HIV treatment guidelines during 2010 to 2013, clinicians increasingly supported early ART for treatment and prevention.

scholarly journals Dual Antiretroviral Therapy—All Quiet Beneath the Surface?

2021 ◽  
Vol 12 ◽  
Author(s):  
Berend J. van Welzen ◽  
Patrick G. A. Oomen ◽  
Andy I. M. Hoepelman
Keyword(s):  
Antiretroviral Therapy ◽  
Bone Disease ◽  
Immune Activation ◽  
Opportunistic Infections ◽  
Treatment Guidelines ◽  
Dual Therapy ◽  
Antiretroviral Drugs ◽  
Hiv Treatment ◽  
Drug Induced ◽  
Virological Outcomes

Infection with the human immunodeficiency virus (HIV) is characterized by progressive depletion of CD4+ lymphocytes cells as a result of chronic immune activation. Next to the decreases in the number of CD4+ cells which leads to opportunistic infections, HIV-related immune activation is associated with several prevalent comorbidities in the HIV-positive population such as cardiovascular and bone disease. Traditionally, combination antiretroviral therapy (cART) consists of three drugs with activity against HIV and is highly effective in diminishing the degree of immune activation. Over the years, questions were raised whether virological suppression could also be achieved with fewer antiretroviral drugs, i.e., dual- or even monotherapy. This is an intriguing question considering the fact that antiretroviral drugs should be used lifelong and their use could also induce cardiovascular and bone disease. Therefore, the equilibrium between drug-induced toxicity and immune activation related comorbidity is delicate. Recently, two large clinical trials evaluating two-drug cART showed non-inferiority with respect to virological outcomes when compared to triple-drug regimens. This led to adoption of dual antiretroviral therapy in current HIV treatment guidelines. However, it is largely unknown whether dual therapy is also able to suppress immune activation to the same degree as triple therapy. This poses a risk for an imbalance in the delicate equilibrium. This mini review gives an overview of the current available evidence concerning immune activation in the setting of cART with less than three antiretroviral drugs.

Adherence to HIV Treatment Guidelines for Comorbid Disease Assessment and Initiation of Antiretroviral Therapy

2012 ◽  
Vol 59 (5) ◽  
pp. 478-488 ◽  
Author(s):  
Mark Bloch ◽  
Jennifer Hoy ◽  
Nicola Cunningham ◽  
Norman Roth ◽  
Michael Bailey ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Treatment Guidelines ◽  
Hiv Treatment ◽  
Disease Assessment ◽  
Comorbid Disease

scholarly journals Long Term Exposure to Tenofovir Disoproxil Fumarate-Containing Antiretroviral Therapy Is Associated with Renal Impairment in an African Cohort of HIV-Infected Adults

2019 ◽  
Vol 18 ◽  
pp. 232595821882196
Author(s):  
Oche O. Agbaji ◽  
Isaac O. Abah ◽  
Augustine O. Ebonyi ◽  
Zumnan M. Gimba ◽  
Esla E. Abene ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Renal Impairment ◽  
Tenofovir Disoproxil Fumarate ◽  
Treatment Guidelines ◽  
Hiv Treatment ◽  
Resource Limited ◽  
Continued Use ◽  
Tenofovir Alafenamide ◽  
Hiv 1

Objectives and Method: There are growing concerns of tenofovir disoproxil fumarate (TDF)–associated renal toxicity. We evaluated the effect of long-term TDF exposure on renal function in a cohort of HIV-1-infected Nigerians between 2006 and 2015. Multivariate logistic regression was used to identify predictors of renal impairment at different time over 144 weeks of antiretroviral therapy (ART). Results: Data of 4897 patients, median age 42 years (interquartile range: 36-49), and 61% females were analyzed. The prevalence of renal impairment increased from 10% at week 24 to 45% at 144 weeks in TDF-exposed participants compared to an increase from 8% at 24 weeks to 14% at 144 weeks in TDF-unexposed participants. Tenofovir disoproxil fumarate exposure predicted the risk of renal impairment at 144 weeks of ART (odds ratio: 2.36; 95% confidence interval: 1.28-4.34). Conclusion: Long-term exposure to TDF-based ART significantly increases the likelihood of renal impairment. The continued use of TDF-based regimen in our setting should be reviewed. We recommend the urgent introduction of tenofovir alafenamide–based regimen in the HIV treatment guidelines of Nigeria and other resource-limited countries.

scholarly journals Efavirenz Conceptions and Regimen Management in a Prospective Cohort of Women on Antiretroviral Therapy

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Sheree Schwartz ◽  
Taha E. Taha ◽  
Willem Daniel Francois Venter ◽  
Shruti Mehta ◽  
Helen Rees ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Prospective Cohort ◽  
Treatment Guidelines ◽  
First Trimester ◽  
Incidence Rates ◽  
Hiv Treatment ◽  
Pregnancy Intentions ◽  
Kaplan Meier ◽  
First Trimester Of Pregnancy ◽  
Public Clinics

Use of the antiretroviral drug efavirenz (EFV) is not recommended by the WHO or South African HIV treatment guidelines during the first trimester of pregnancy due to potential fetal teratogenicity; there is little evidence of how clinicians manage EFV-related fertility concerns. Women on antiretroviral therapy (ART) were enrolled into a prospective cohort in four public clinics in Johannesburg, South Africa. Fertility intentions, ART regimens, and pregnancy testing were routinely assessed during visits. Women reporting that they were trying to conceive while on EFV were referred for regimen changes. Kaplan-Meier estimators were used to assess incidence across ART regimens. From the 822 women with followup visits between August 2009–March 2011, 170 pregnancies were detected during study followup, including 56 EFV conceptions. Pregnancy incidence rates were comparable across EFV, nevirapine, and lopinavir/ritonavir person-years (95% 100/users (P=0.25)); incidence rates on EFV were 18.6 Confidence Interval: 14.2–24.2). Treatment substitution from EFV was made for 57 women, due to pregnancy intentions or actual pregnancy; however, regimen changes were not systematically applied across women. High rates of pregnancy on EFV and inconsistencies in treatment management suggest that clearer guidelines are needed regarding how to manage fertility-related issues in. women on EFV-based regimens.

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