POLA PENGGUNAAN OBAT ANTIRETROVIRAL (ARV) PADA RESEP PASIEN RAWAT JALAN DARI KLINIK HIV/AIDS SALAH SATU RUMAH SAKIT SWASTA DI KOTA BANDUNG

2019 ◽  
Vol 1 (1) ◽  
pp. 64-81
Author(s):  
Ani Anggriani ◽  
Ida Lisni ◽  
Olga Susana Liku
Keyword(s):  
Reverse Transcriptase ◽  
Antiretroviral Drugs ◽  
Public Health Issue ◽  
Prescription Data ◽  
Global Public Health ◽  
Human Immune System ◽  
Reverse Transcriptase Inhibitors ◽  
First Line ◽  
Treatment Standards ◽  
Hiv Aids

ABSTRACT The Human Immunodeficiency Virus (HIV) continues to be a major global public health issue, which targets the human immune system. The using of ARVs in the treatment of HIV / AIDS increased life expectancy for PLHIV (People With HIV / AIDS). This study aims to determine the description of the using of ARV drugs in outpatients of the HIV / AIDS Clinic and assessed their suitability with established treatment standards. This research was carried out in a descriptive non-experimental manner, with data collection carried out retrospectively, used patient prescription data from April to December 2017. The results of quantitative studies showed 87% were male patients, and the largest age group was 20-29 years (39%) . Class of antiretroviral drugs used were Nucleoside / Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), and Protease Inhibitors (PI), with a combination of antiretroviral drugs most was the combination of first-line tenofovir + lamivudine + efavirenz (69%) while the second-line drug zidovudine + lamivudine + lopinavir / ritonavir  was 1%. The most commonly used comorbid drug was cotrimoxazole. For qualitative data, the accuracy of combination and dose of ARV drugs was 100% in accordance with Permenkes No. 87/ 2014, with 79% of patients adhered to antiretroviral treatment every month. The potential for most ARV drug interactions with other drugs for the moderate category was zidovudin + cotrimoxazole (11%) which occured pharmacokinetically by decreasing renal clearance of zidovudine and glucuronide metabolites. In conclusion, the pattern of used of ARV drugs had met the standard of Permenkes No.87/2014, with the most used were the first line combination of tenofovir + lamivudine + efavirenz.

scholarly journals Patent Pooling for Promoting Access to Antiretroviral Drugs (ARVs) – A Strategic Option for India

2010 ◽  
Vol 4 (1) ◽  
pp. 41-53
Author(s):  
Kanikaram Satyanarayana ◽  
Sadhana Srivastava
Keyword(s):  
Developing Countries ◽  
Intellectual Property ◽  
Reverse Transcriptase ◽  
Andhra Pradesh ◽  
Antiretroviral Drugs ◽  
People Living With Hiv ◽  
Second Line ◽  
Reverse Transcriptase Inhibitors ◽  
Nucleoside Reverse Transcriptase Inhibitors ◽  
Hiv Aids

The current HIV/AIDS scenario in India is quite grim with an estimated 2.4 million people living with HIV/AIDS (PLHA) in 2008, just behind South Africa and Nigeria. The anti-retroviral drugs (ARVs) remain the main stay of global HIV/AIDS treatment. Over 30 ARVs (single and FDCs) available under six categories viz., NRTIs (nucleoside reverse transcriptase inhibitors), NNRTIs (non-nucleoside reverse transcriptase inhibitors), Protease inhibitors, the new Fusion inhibitors, Entry inhibitors-CCR5 co-receptor antagonists and HIV integrase strand transfer inhibitors. The major originator companies for these ARVs are: Abbott, Boehringer Ingelheim (BI), Bristol-Myers Squibb (BMS), Gilead, GlaxoSmithKline (GSK), Merck, Pfizer, Roche, and Tibotec. Beginning with zidovidine in 1987, all the drugs are available in the developed countries. In India, about 30 ARVs are available as generics manufactured by Aurobindo, Hyderabad, Andhra Pradesh; Cipla Limited, Goa; Emcure Pharmaceuticals, Pune, Maharashtra; Hetero Drugs, Hyderabad, Andhra Pradesh; Macleods Pharmaceuticals, Daman; Matrix Laboratories, Nashik, Maharashtra; Ranbaxy, Sirmour, Himachal Pradesh; and Strides Arcolab, Bangalore, Karnataka. The National AIDS Control Organization (NACO) set up in 1992 by the Govt. of India provides free ARVs to HIV positive patients in India since 2004. The drugs available in India include both single drugs and FDCs covering both first line and second line ARVs. Even while there are claims of stabilization of the disease load, there is still huge gap of those who require ARVs as only about 150,000 PLHA receive the ARVs from the Govt. and other sources. Access to ARVs therefore is still a cause of serious concern ever since India became fully Trade Related Aspects of Intellectual Property Rights (TRIPS)-complaint in 2005. Therefore, the Indian pharmaceutical companies cannot make generics for those for drugs introduced post-2005 due to product patent regime. Other concerns include heat stable, other better formulations and second line ARVs for adults and more drugs and formulations for paediatric groups, that are still to be widely available in India and other developing countries. To examine whether strong intellectual property (IP) protection systems are to be considered important barriers for the limited or lack of access to ARVs, we studied the patent profile of the ARVs of the originator companies within and outside India. We could record 93 patents in the United States Patent & Trademark Office (USPTO). The originator companies have been also aggressively filing and enforcing patents in India. There have been a few efforts by companies like Gilead and GSK to grant licenses to generic manufacturers in developing countries, ostensibly to promote access to ARVs through lower (two-tier) pricing. These steps are considered as too little and too late. There is an urgent need to look for alternative strategies to promote access to ARVs both linked to and independent of IPRs. Patent pooling as a viable strategy mooted by the UNITAID should be seriously explored to promote access to ARVs. India is ideally suited for trying out the patent pool strategy as most of the global requirement of affordable ARV drugs for HIV/AIDS treatment is sourced from Indian generic companies.

scholarly journals Modelling Hepatotoxicity of Antiretroviral Therapy in the Liver during HIV Monoinfection

2014 ◽  
Vol 2014 ◽  
pp. 1-17 ◽  
Author(s):  
Hasifa Nampala ◽  
Livingstone S. Luboobi ◽  
Joseph Y. T. Mugisha ◽  
Celestino Obua
Keyword(s):  
Reverse Transcriptase ◽  
Antiretroviral Drugs ◽  
Response Functions ◽  
Reverse Transcriptase Inhibitors ◽  
First Line ◽  
Nonnucleoside Reverse Transcriptase Inhibitors ◽  
Therapy Efficacy ◽  
Combinational Therapy ◽  
Immunodeficiency Virus ◽  
Parameter Values

Liver related complications are currently the leading cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals. In HIV monoinfected individuals on therapy, liver injury has been associated with the use of antiretroviral agents as most of them exhibit some degree of toxicity. In this study we proposed a mathematical model with the aim of investigating hepatotoxicity of combinational therapy of antiretroviral drugs. Therapy efficacy and toxicity were incorporated in the model as dose-response functions. With the parameter values used in the study, protease inhibitors-based regimens were found to be more toxic than nonnucleoside reverse transcriptase inhibitors-based regimens. In both regimens, the combination of stavudine and zidovudine was the most toxic baseline nucleoside reverse transcriptase inhibitors followed by didanosine with stavudine. However, the least toxic combinations were zidovudine and lamivudine followed by didanosine and lamivudine. The study proposed that, under the same second line regimens, the most toxic first line combination gives the highest viral load and vice versa.

An Overview of Antiretroviral Agents for Treating HIV Infection in Paediatric Population

2020 ◽  
Vol 27 (5) ◽  
pp. 760-794 ◽  
Author(s):  
Rita Melo ◽  
Agostinho Lemos ◽  
António J. Preto ◽  
Beatriz Bueschbell ◽  
Pedro Matos-Filipe ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Reverse Transcriptase ◽  
Targeted Delivery ◽  
Highly Active Antiretroviral Therapy ◽  
Antiretroviral Drugs ◽  
Viral Reservoir ◽  
Reverse Transcriptase Inhibitors ◽  
Replication Process ◽  
Antiretroviral Agents ◽  
Multiple Drugs

Paediatric Acquired ImmunoDeficiency Syndrome (AIDS) is a life-threatening and infectious disease in which the Human Immunodeficiency Virus (HIV) is mainly transmitted through Mother-To- Child Transmission (MTCT) during pregnancy, labour and delivery, or breastfeeding. This review provides an overview of the distinct therapeutic alternatives to abolish the systemic viral replication in paediatric HIV-1 infection. Numerous classes of antiretroviral agents have emerged as therapeutic tools for downregulation of different steps in the HIV replication process. These classes encompass Non- Nucleoside Analogue Reverse Transcriptase Inhibitors (NNRTIs), Nucleoside/Nucleotide Analogue Reverse Transcriptase Inhibitors (NRTIs/NtRTIs), INtegrase Inhibitors (INIs), Protease Inhibitors (PIs), and Entry Inhibitors (EIs). Co-administration of certain antiretroviral drugs with Pharmacokinetic Enhancers (PEs) may boost the effectiveness of the primary therapeutic agent. The combination of multiple antiretroviral drug regimens (Highly Active AntiRetroviral Therapy - HAART) is currently the standard therapeutic approach for HIV infection. So far, the use of HAART offers the best opportunity for prolonged and maximal viral suppression, and preservation of the immune system upon HIV infection. Still, the frequent administration of high doses of multiple drugs, their inefficient ability to reach the viral reservoirs in adequate doses, the development of drug resistance, and the lack of patient compliance compromise the complete HIV elimination. The development of nanotechnology-based drug delivery systems may enable targeted delivery of antiretroviral agents to inaccessible viral reservoir sites at therapeutic concentrations. In addition, the application of Computer-Aided Drug Design (CADD) approaches has provided valuable tools for the development of anti-HIV drug candidates with favourable pharmacodynamics and pharmacokinetic properties.

scholarly journals Drug Resistance-Associated Mutations in Antiretroviral Treatment-Experienced Patients in Kuwait

2018 ◽  
Vol 27 (2) ◽  
pp. 152-157
Author(s):  
Wassim Chehadeh ◽  
Osama Albaksami ◽  
Sonia Elezebeth John ◽  
Widad Al-Nakib
Keyword(s):  
Reverse Transcriptase ◽  
Transcriptase Inhibitor ◽  
Antiretroviral Drugs ◽  
First Line ◽  
Genotypic Resistance ◽  
Nonnucleoside Reverse Transcriptase Inhibitor ◽  
High Level ◽  
Interpretation Algorithm ◽  
Hiv 1 ◽  
Level Resistance

Objectives: To investigate the prevalence of nonpolymorphic resistance-associated mutations (RAM) in HIV-1 patients on first-line antiretroviral therapy in Kuwait. Subjects and Methods: Total RNA was isolated from plasma samples of 42 patients who received a first-line nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. HIV-1 protease and reverse transcriptase genetic regions were then amplified by nested reverse transcription-polymerase chain reaction and directly sequenced. The HIV-1 subtype was identified using the Bayesian phylogenetic method, and RAM were identified using the Stanford University genotypic resistance interpretation algorithm. Results: The HIV-1 viral load at sampling ranged from < 20 to 8.25 × 104 copies/ml. CRF01_AE, C, and B were the most predominant HIV-1 subtypes. Nonpolymorphic mutations associated with resistance to antiretroviral drugs were detected in 11 (26.2%) of the 42 patients; 5 (11.9%) patients had mutations associated with a high-level resistance to nucleoside reverse transcriptase inhibitors (NRTI), 4 (9.5%) patients had mutations associated with resistance to NNRTI, 1 (2.4%) patient had mutations associated with resistance to both NRTI and NNRTI, and 1 (2.4%) patient had mutations potentially associated with low-level resistance to both protease inhibitors and NNRTI. All patients with RAM had a detectable plasma HIV-1 RNA level. Conclusion: Our results indicate the development of RAM during an NNRTI-based regimen and highlight the importance of considering other regimens to avoid treatment failure.

scholarly journals Diabetes and HIV

2019 ◽  
Vol 7 (02) ◽  
pp. 45-49
Author(s):  
Ranabir Salam ◽  
Sarita Bajaj ◽  
Nitin Kapoor ◽  
Banshi Saboo ◽  
Arundhati Dasgupta
Keyword(s):  
Diabetes Mellitus ◽  
Reverse Transcriptase ◽  
People Living With Hiv ◽  
Reverse Transcriptase Inhibitors ◽  
First Line ◽  
Hiv Patients ◽  
Nucleoside Reverse Transcriptase Inhibitors ◽  
Family History Of Diabetes ◽  
Drug Of Choice ◽  
History Of

AbstractIn India, the prevalence of HIV infection among adults (15–49 years) is estimated at 0.26%. The total number of people living with HIV (PLHIV) in India was estimated at 21.17 lakhs in 2015. There has been a declining trend in the mortality rate of HIV-infected patients on antiretroviral therapy (ART). With HIV becoming a chronic manageable disease, metabolic complications like diabetes mellitus (DM) and dyslipidemia are coming to the forefront. Generally, protease inhibitors (PI) are implicated in metabolic derangement; however, nucleoside reverse transcriptase inhibitors (NRTI) like stavudine can also cause diabetes. Among HIV-infected patients, the prevalence of diabetes is reported to range from 2 to 19%, so there is strong case for screening of diabetes among HIV-infected cases. The South Asian Consensus Guidelines recommend that both fasting and postprandial glucose values should be checked at screening and during monitoring of therapy. National AIDS Control Organization (NACO) recommends fasting plasma glucose with value ≥ 126 mg% diagnostic of diabetes mellitus. HbA1c may underestimate the degree of hyperglycemia in HIV-infected individuals and may not be a good diagnostic tool. Lifestyle modification is recommended as part of treatment. Metformin should be used with caution in HIV patients. Concomitant use of metformin with non-nucleoside reverse transcriptase inhibitors (NNRTI) can cause lactic acidosis. Thiazolidinediones should be the drug of choice in HIV, particularly in patients with lipodystrophy. Insulin secretagogues (meglitinides and sulfonylureas) are safe but may not be effective in the presence of severe insulin resistance. There are concerns regarding the use of gliptins in HIV-infected patients as they have molecular targets on immune cells. Insulin should be the drug of choice for HIV-infected patients with marked hyperglycemia (HbA1c > 9%), ketonuria, severe liver disease, or severe kidney disease. SGLT2 inhibitor may increase the risk of urinary tract infection and genital mycotic infections in HIV-infected diabetics. Regarding the use of ART among HIV patients with diabetes, NACO guidelines recommend that Tenofovir, lamivudine, and efavirenz should be used as first-line ART for all new patients, except known cases of severe diabetes, severe hypertension, or renal disease. Tenofovir, lamivudine, and lopinavir/ritonavir should be used as first line in women ever exposed to single dose Nevirapine in the past and also for all confirmed HIV-2 or HIV-1 & 2 coinfected patients. HIV infected with diabetes mellitus and microalbuminuria or proteinuria need Abacavir-based regimen (Abacavir + Lamivudine + Efavirenz). There is some suggestion that PI-based regimes should be avoided in patients at high risk of developing diabetes, for example, those with a history of gestational diabetes, positive family history of diabetes, or impaired glucose tolerance on screening.

Advances in the development of pyridinone derivatives as non-nucleoside reverse transcriptase inhibitors

RSC Advances ◽  
2016 ◽  
Vol 6 (3) ◽  
pp. 2119-2130 ◽  
Author(s):  
Hugo Vite-Caritino ◽  
Oscar Méndez-Lucio ◽  
Héctor Reyes ◽  
Alberto Cabrera ◽  
Daniel Chávez ◽  
...  
Keyword(s):  
Reverse Transcriptase ◽  
Medicinal Chemistry ◽  
Computational Design ◽  
Reverse Transcriptase Inhibitors ◽  
Nucleoside Reverse Transcriptase Inhibitors ◽  
Biological Screening ◽  
Hiv Aids

Medicinal chemistry, computational design and biological screening have advanced pyridin-2(1H)-one derivatives as a promising class of non-nucleoside reverse transcriptase inhibitors for the treatment of HIV/AIDS.

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