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.

scholarly journals Antiretroviral drugs and acute pancreatitis in HIV/AIDS patients: is there any association? A literature review

2014 ◽  
Vol 12 (1) ◽  
pp. 112-119 ◽  
Author(s):  
Natalia Mejias Oliveira ◽  
Felipe Augusto Yamauti Ferreira ◽  
Raquel Yumi Yonamine ◽  
Ethel Zimberg Chehter
Keyword(s):  
Acute Pancreatitis ◽  
Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
Case Reports ◽  
Case Series ◽  
Antiretroviral Drugs ◽  
Pancreatic Involvement ◽  
Frequent Event ◽  
Hiv Seropositive ◽  
Hiv Aids

In HIV-seropositive individuals, the incidence of acute pancreatitis may achieve 40% per year, higher than the 2% found in the general population. Since 1996, when combined antiretroviral therapy, known as HAART (highly active antiretroviral therapy), was introduced, a broad spectrum of harmful factors to the pancreas, such as opportunistic infections and drugs used for chemoprophylaxis, dropped considerably. Nucleotide analogues and metabolic abnormalities, hepatic steatosis and lactic acidosis have emerged as new conditions that can affect the pancreas. To evaluate the role of antiretroviral drugs to treat HIV/AIDS in a scenario of high incidence of acute pancreatitis in this population, a systematic review was performed, including original articles, case reports and case series studies, whose targets were HIV-seropositive patients that developed acute pancreatitis after exposure to any antiretroviral drugs. This association was confirmed after exclusion of other possible etiologies and/or a recurrent episode of acute pancreatitis after re-exposure to the suspected drug. Zidovudine, efavirenz, and protease inhibitors are thought to lead to acute pancreatitis secondary to hyperlipidemia. Nucleotide reverse transcriptase inhibitors, despite being powerful inhibitors of viral replication, induce a wide spectrum of side effects, including myelotoxicity and acute pancreatitis. Didanosine, zalcitabine and stavudine have been reported as causes of acute and chronic pancreatitis. They pose a high risk with cumulative doses. Didanosine with hydroxyurea, alcohol or pentamidine are additional risk factors, leading to lethal pancreatitis, which is not a frequent event. In addition, other drugs used for prophylaxis of AIDS-related opportunistic diseases, such as sulfamethoxazole-trimethoprim and pentamidine, can produce necrotizing pancreatitis. Despite comorbidities that can lead to pancreatic involvement in the HIV/AIDS population, antiretroviral drug-induced pancreatitis should always be considered in the diagnosis of patients with abdominal pain and elevated pancreatic enzymes.

scholarly journals Changes to the ART guidelines – an overview

2010 ◽  
Vol 11 (1) ◽  
Author(s):  
Celicia Serenata
Keyword(s):  
Antiretroviral Therapy ◽  
South African ◽  
Standard Treatment ◽  
Treatment Guidelines ◽  
Dual Therapy ◽  
National Standard ◽  
Child Transmission ◽  
Task Team ◽  
Standard Treatment Guidelines ◽  
Mother To Child

In 2009 the South African National AIDS Council (SANAC) Treatment Technical Task Team (TTT) finalised recommendations for changes to the national standard treatment guidelines for adult and paediatric management and treatment, as well as changes in the prevention of mother-to-child transmission of HIV (PMTCT) guidelines, moving away from monotherapy to dual therapy. President Zuma announced changes in the national antiretroviral therapy (ART) programme on World AIDS Day 2009. Subsequently additional changes were made to the treatment guidelines to be in line with these new Presidential mandates, which came into effect on 1 April 2010.

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 HIV as a Cause of Immune Activation and Immunosenescence

2017 ◽  
Vol 2017 ◽  
pp. 1-16 ◽  
Author(s):  
T. Sokoya ◽  
H. C. Steel ◽  
M. Nieuwoudt ◽  
T. M. Rossouw
Keyword(s):  
Immune Activation ◽  
Large Scale ◽  
Antiretroviral Treatment ◽  
Treatment Guidelines ◽  
Hiv Treatment ◽  
Therapeutic Interventions ◽  
Adjunctive Treatment ◽  
Systemic Immune Activation ◽  
Proinflammatory Mediators ◽  
Age Related

Systemic immune activation has emerged as an essential component of the immunopathogenesis of HIV. It not only leads to faster disease progression, but also to accelerated decline of overall immune competence. HIV-associated immune activation is characterized by an increase in proinflammatory mediators, dysfunctional T regulatory cells, and a pattern of T-cell-senescent phenotypes similar to those seen in the elderly. These changes predispose HIV-infected persons to comorbid conditions that have been linked to immunosenescence and inflamm-ageing, such as atherosclerosis and cardiovascular disease, neurodegeneration, and cancer. In the antiretroviral treatment era, development of such non-AIDS-defining, age-related comorbidities is a major cause of morbidity and mortality. Treatment strategies aimed at curtailing persistent immune activation and inflammation may help prevent the development of these conditions. At present, the most effective strategy appears to be early antiretroviral treatment initiation. No other treatment interventions have been found effective in large-scale clinical trials, and no adjunctive treatment is currently recommended in international HIV treatment guidelines. This article reviews the role of systemic immune activation in the immunopathogenesis of HIV infection, its causes and the clinical implications linked to immunosenescence in adults, and the therapeutic interventions that have been investigated.

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

Optimal antiretroviral therapy for aging

Sexual Health ◽  
2011 ◽  
Vol 8 (4) ◽  
pp. 534 ◽  
Author(s):  
Damien V. Cordery ◽  
David A. Cooper
Keyword(s):  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Treatment Guidelines ◽  
Age Groups ◽  
Developed Countries ◽  
Neurological Complications ◽  
Antiretroviral Drugs ◽  
People Living With Hiv ◽  
Metabolic Complications ◽  
Long Term Treatment

The introduction of highly active antiretroviral therapy (HAART) has irrevocably changed the nature of the HIV epidemic in developed countries. Although the use of HAART does not completely restore health in HIV-infected individuals, it has dramatically reduced morbidity and mortality. Increases in life expectancy resulting from effective long-term treatment mean that the proportion of older people living with HIV has increased substantially in the past 15 years. Increasing age is associated with many complications including cardiovascular disease, neurological complications, kidney and liver dysfunction, and metabolic complications such as dyslipidaemia and diabetes. HIV infection and antiretroviral drugs have also been associated with similar complications to those seen with increasing age. The increase in HIV prevalence in older age groups has not been accompanied by the development of treatment guidelines or recommendations for appropriate antiretroviral therapy or clinical management in these patients.

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.

Neuropsychiatric adverse effects of HIV antiviral medication

2017 ◽  
Vol 41 (S1) ◽  
pp. S697-S698
Author(s):  
S. Nascimento ◽  
M. Mendes ◽  
C. Solana ◽  
M. Croca ◽  
J. Reis
Keyword(s):  
Antiretroviral Therapy ◽  
Adverse Effects ◽  
Reverse Transcriptase ◽  
Opportunistic Infections ◽  
Antiretroviral Drugs ◽  
Reverse Transcriptase Inhibitors ◽  
Nucleoside Reverse Transcriptase Inhibitors ◽  
Neuropsychiatric Complications ◽  
Competing Interest ◽  
Neuropsychiatric Adverse Effects

IntroductionHIV (human immunodeficiency virus) infection is related to several neuropsychiatric complications, such as dementia, encephalopathy, psychosis, as well as, opportunistic infections of the central nervous system (CNS). The discovery of antiretroviral therapy (ART) has limited these conditions and extended the life span of infected patients into a chronic illness, but it is also associated with neuropsychiatric adverse effects.ObjectivesTo review the literature on the most common neuropsychiatric complications of the ART, since it can be difficult to distinguish drugs toxicity, the effects of the virus, immune system and psycho-social events.MethodsThe authors have conducted an online search in PubMed with the terms: “Psychiatry”, “HIV”, “adverse effects” and “antiretroviral drugs” from 2011 until 2016. From the outcome were collected, analyzed and summarized the articles considered to be relevant.ResultsThe antiretroviral therapy (ART) are associated with a numerous adverse effects on the central and peripheral nervous systems, as well as, metabolic, gastrointestinal, cardiac, and other toxicities. The neuropsychiatric effects are common and highly variable, including depression, cognitive impairment and sleep disturbance. The nucleoside reverse transcriptase inhibitors and the non-nucleoside reverse transcriptase inhibitors are one of the two classes of antiviral drugs most frequently associated with neuropsychiatric complications.ConclusionsThe occurrence of new-onset conditions related to ART makes it difficult to determine the association between psychiatric disorders and ART adverse effects, and given the fact that patients commit to lifelong therapy, as well as, they can diminish quality of life; it makes these assessment important in treating these conditions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals KIDNEY DISEASE IN THE SETTING OF HIV INFECTION: CONCLUSIONS FROM A KIDNEY DISEASE: IMPROVING GLOBAL OUTCOMES (KDIGO) CONTROVERSIES CONFERENCE

2018 ◽  
Vol 22 (6) ◽  
pp. 84-100 ◽  
Author(s):  
C. R. Swanepoel ◽  
M. G. Atta ◽  
V. D. D’Agati ◽  
M. M. Estrella ◽  
A. B. Fogo ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Kidney Disease ◽  
Hiv Infection ◽  
Prolonged Exposure ◽  
Opportunistic Infections ◽  
Kidney Injury ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Treatment And Prevention ◽  
Increased Risk

HIV-positive individuals are at increased risk for kidney disease, including HIV-associated nephropathy, noncollapsing focal segmental glomerulosclerosis, immune-complex kidney disease, and comorbid kidney disease, as well as kidney injury resulting from prolonged exposure to antiretroviral therapy or from opportunistic infections. Clinical guidelines for kidney disease prevention and treatment in HIV-positive individuals are largely extrapolated from studies in the general population, and do not fully incorporate existing knowledge o f the unique HIV-related pathways and genetic factors that contribute to the risk of kidney disease in this population. We convened an international panel of experts in nephrology, renal pathology, and infectious diseases to define the pathology of kidney disease in the setting of HIV infection; describe the role of genetics in the natural history, diagnosis, and treatment of kidney disease in HIV-positive individuals; characterize the renal risk-benefit of antiretroviral therapy for HIV treatment and prevention; and define best practices for the prevention and management of kidney disease in HIV-positive individuals.

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