Articles tagged as "HIV Treatment"

Care and Support (Anxiety and Depression pre- ARV Initiation)

Nogueira Campos L, De Fatima Bonolo P, et al. Anxiety and depression assessment prior to initiating antiretroviral treatment in Brazil. AIDS Care 2006;18:529-36

Nogueira Campos carried out a cross-sectional study with 386 patients who received their first anti-retroviral prescription between May 2001 and May 2002 in public AIDS referral centers in Belo Horizonte, Brazil. The main objective was to assess the prevalence and factors associated with anxiety and depression among HIV-infected patients initiating ART using the Hospital Anxiety and Depression Scale. The authors collected clinical, behavioural and demographic data from interviews and medical charts, and conducted multivariate analysis by logistic regression. Prevalence of moderate to severe anxiety and depression were 35.8% and 21.8%, respectively. Female gender, low schooling, lack of health insurance, attendance to psychotherapy, difficulty in accessing health services and exposure category were independently associated with anxiety. On the other hand, female gender, lack of health insurance, low income, living alone, and lacking a sexual partner in the last month were independently associated with depression. The authors conclude that this study highlights the importance of detecting psychological distress by simple screening methods in the HIV setting, where the prevalence of anxiety and depression is considerably high, so proper intervention can be established soon in the treatment course.

Comorbidity, HIV Treatment
  • share
0 comments.

Nutrition

Humphrey JH, Hargrove JW, et al. HIV incidence among post-partum women in Zimbabwe: risk factors and the effect of vitamin A supplementation. AIDS 2006;20:1437-46. http://gateway.ut.ovid.com/gw2/ovidweb.cgi

Between November 1997 and January 2001, Humphrey and colleagues randomly administered 400,000 IU vitamin A or placebo to 14,110 women within 96 hours post-partum, and monitored incidence among 9562 HIV-negative women. The authors found the cumulative incidence to be 3.4% (95% CI 3.0-3.8) and 6.5% (95% CI 5.7-7.4) over 12 and 24 months after delivery, respectively. Vitamin A supplementation had no impact on incidence [hazard ratio (HR) 1.08; 95% CI, 0.85-1.38]. However, among 398 women for whom baseline serum retinol was measured, those with levels indicative of deficiency (9.2% of those measured) were 10.4 (95% CI 3.0-36.3) times more likely to seroconvert than women with higher concentrations. Severe anaemia was associated with a 2.7-fold increase in the rate of new infections. Younger women were at higher risk of HIV infection: incidence declined by 5.7% (2.8-8.6) with each additional year of age. Humphrey and colleagues conclude that among post-partum women, a single large-dose vitamin A supplementation had no effect on incidence, and recommend that further investigations be carried out to determine whether vitamin A supplementation of vitamin-A-deficient women or treatment of anaemic women can reduce HIV incidence in women.

HIV Treatment
  • share
0 comments.

Treatment

 

Walensky RP, Paltiel AD, et al. The survival benefits of AIDS treatment in the United States. J Infect Dis 2006;194:11-9. http://www.journals.uchicago.edu/JID/journal/issues/v194n1/35845/35845.html

 

 

As widespread adoption of potent combination ART reaches its tenth year, the authors used mathematical modelling to quantify the cumulative survival benefits of AIDS care in the US. They found that, compared with survival associated with untreated HIV disease, per-person survival increased 0.26 years with Pneumocystis jiroveci pneumonia prophylaxis alone. Four eras of increasingly effective ART in addition to prophylaxis resulted in per-person survival increases of 7.8, 11.1, 11.6 and 13.3 years compared to the absence of treatment. Treatment for patients with AIDS in care in the US since 1989 yielded a total survival benefit of 2.8 million years. Prevention of mother-to-child transmission of HIV averted nearly 2900 infant infections, equivalent to 137,000 additional years of survival benefit. They conclude that at least 3.0 million years of life have been saved in the US as a direct result of care of patients with AIDS, highlighting the significant advances made in HIV disease treatment.

 

HIV Treatment
  • share
0 comments.

Treatment

Lynen L, Thai S, et al. The added value of a CD4 count to identify patients eligible for highly active antiretroviral therapy among HIV-positive adults in Cambodia. J Acquir Immune Defic Syndr. 2006 May 8; [Epub ahead of print]. http://gateway.ut.ovid.com/gw2/ovidweb.cgi

In a retrospective study of 648 persons with HIV infection in Cambodia, Lynen and colleagues determined the validity of the 2003 WHO criteria to start HAART based on clinical criteria alone or based on a combination of clinical symptoms and the total lymphocyte count. As a reference test, the authors used the 2003 WHO criteria, including the CD4 count. The 2003 WHO clinical criteria had a sensitivity of 96%, a specificity of 57%, and an accuracy of 89% in identifying patients in need of HAART. In their clinic, with a predominance of patients with advanced disease, the 2003 WHO clinical criteria alone were a good predictor of patients needing HAART. A total lymphocyte count as an extra criterion did not improve the accuracy. Nine percent of patients were wrongly identified to be in need of HAART. Among them, almost 50% had a CD4 count of more than 500 cells/ml, and 73% had weight loss of more than 10% as a stage-defining condition. The authors conclude that (according to their data), in settings with limited access to CD4 count testing, it might be useful to target this test to patients in WHO stage 3 whose staging is based on weight loss alone, to avoid unnecessary treatment.

HIV Treatment
  • share
0 comments.

Child Health

Menson EN, Walker AS, et al. Underdosing of antiretrovirals in UK and Irish children with HIV as an example of problems in prescribing medicines to children, 1997-2005: cohort study. BMJ 2006;332:1183-87. http://bmj.bmjjournals.com/cgi/content/full/332/7551/1183

The evidence base for prescribing drugs to children lacks sufficient pharmacokinetic and pharmacodynamic data. As such, adult doses are often extrapolated to children without taking account of potential differences in drug handling with age or dose requirements for effectiveness. Menson and colleagues looked at doses of antiretroviral drugs for 615 HIV infected children aged 2-12 years in the United Kingdom and Ireland from January 1997 and March 2005. They found that actual doses standardised to weight or surface area varied widely across individual drugs, antiretroviral class, and calendar time. The proportion of time when children were underdosed (prescribed less than 90% of currently recommended doses) varied from 6% to 62%. The authors attributed this suboptimal ARV dosing to three serious issues, which may be relevant to other paediatric prescribing, including poor pharmacokinetic data at licensing, guidelines stating alternative dosage strategies, and failure to adjust for children's growth.

HIV Treatment
  • share
0 comments.

Treatment

Zuniga JM. State of HIV Treatment: Results of the International Association of Physicians in AIDS Care Surveys of HIV-Positive Patients and HIV-Treating Physicians in the United States. J Int Assoc Physicians AIDS Care 2006;5:51-56. http://jia.sagepub.com/cgi/reprint/5/2/51

There are few reports about physician and patient attitudes about antiretroviral therapy. The author conducted surveys of HIV-treating physicians (online questionnaire), and a separate set of HIV-positive patients (written questionnaire). The results show that physicians and patients agreed on several issues, including the priority of viral suppression when making treatment decisions and the treatment-limiting impact of side effects. However, they had diverging treatment goals in mind and differing impressions of the type and incidence of side effects. There were also sharp differences in physicians' estimates of how well patients understand HIV disease and its treatment. The author concludes that the differences revealed through these surveys underline the need to conduct a systematic study of physician and patient attitudes about antiretroviral therapy, as well as physician-patient communication.


Kremer H, Ironson G, et al. To Take or Not to Take: Decision-Making About Antiretroviral Treatment in People Living with HIV/AIDS. AIDS Patient Care STDS 2006;20:335-49. http://www.liebertonline.com/doi/abs/10.1089/apc.2006.20.335

Knowledge is limited regarding decision-making about ART from the patient's perspective. In this study, Kremer and colleagues compared the rationales of HIV-positive individuals (n = 79) deciding to take or not to take ART in Miami. Inclusion criteria were HIV-related symptoms, or CD4 less than 350, or viral load greater than 55,000. Diagnosis was on average 11 years ago; 36% were female, 42% African American, 28% Latino, 24% white, and 6% other. Qualitative content analysis of semi-structured interviews identified 10 criteria for the decision to take or not to take ART: CD4/viral load counts (87%), quality of life (85%), knowledge/beliefs about resistance (66%), mind-body beliefs (65%), adverse effects of ART (59%), easy-to-take regimen (58%), spirituality/worldview (58%), drug resistance (41%), experience of HIV/AIDS symptoms (39%), and preference for complementary/alternative medicine (17%). Participants choosing not to take ART (27%) preferred complementary/alternative medicine (p=0.001), perceived a better quality of life without ART (p<0.004), and weighted avoidance of adverse effects of ART more heavily (p<0.030) than participants taking ART (73%). Demographic characteristics related to taking ART were having a partner (p<0.008) and having health insurance (p<0.040). The authors conclude that decisions to take or not to take ART depend not only on patient medical characteristics, but also on individual beliefs about ART, complementary/alternative medicine, spirituality, and mind-body connection. HIV-positive individuals declining treatment place more weight on alternative medicine, avoiding adverse effects and perceiving a better quality of life through not taking ART.

HIV Treatment
  • share
0 comments.

Treatment

Sanchez R, Portilla J, Gimeno A, Boix V, et al. Immunovirologic consequences and safety of short, non-structured interruptions of successful antiretroviral treatment. J Infect 2006 May 8; [Epub ahead of print].

Sanchez et al evaluated the safety of short ART interruptions and their virologic and immunologic consequences in HIV-infected adults in Spain on HAART with suppressed viral replication. They prospectively followed 20 patients with undetectable viral load while on HAART to detect any treatment interruption, and analysed viral and cellular kinetics, incidence of resistance mutations, clinical outcome and results after therapy resumption. The mean time since HIV diagnosis was 95 months and time with undetectable viral load 16 months. Treatment was interrupted because of adverse effects, cancer, tuberculosis or patient will, and reintroduced after 4 weeks using, if possible, the same combination. HIV viral load was detectable on day 28 after interruption in 18 (90%) patients. There was a non-significant decrease in median CD4 count from 478/mm3 to 257/mm3. Resistance mutations were found in 9 (45%) patients after interruptions, and treatment was reintroduced in 14 patients; all of whom achieved viral suppression. The authors conclude that in patients on HAART who have undetectable viral load, an interruption no longer than 4 weeks due to any intercurrent problem seems to be safe. However, due to the frequent development of resistance, a genotypic test during interruption might be helpful.


Etard JF, Ndiaye I, Thierry-Mieg M, et al. Mortality and causes of death in adults receiving highly active antiretroviral therapy in Senegal: a 7-year cohort study. AIDS 2006;20: 1181-89

The authors evaluated survival and ascertained causes of death among the first HIV-1 infected adults patients of the Senegalese Antiretroviral Drug Access Initiative (enrolled between 08/1998 and 04/2002). The first-line regimen for these patients consisted of two NRTI and either a NNRTI or PI. Cause of death was ascertained through medical records or verbal autopsy. A total of 404 patients (54.7% women; median age 37 years, CD4 128 cells/μl, viral load 5.2 log cp/ml) were enrolled and followed for a median of 46 months after initiating HAART. At baseline, 5% were ART-experienced, and 39% and 55% were respectively at CDC stage B and C. 93 patients died during follow-up giving an overall death rate of 6.3/100 person-years. The death rate, which was highest during the first year after HAART initiation, decreased with time yielding a cumulative probability of dying of 17.4% at 2 years and 24.6% 5 years. The most frequent causes of death were mycobacterial infections, neurotropic infections and septicaemia.


Crabb C. Testing a CCR5 drug? Avoid mosquito bites. AIDS 2006; 28:N3-N4.

‘Sleep under netting, wear long sleeves and pants, and use mosquito repellent’, may be sage advice for HIV patients taking experimental CCR5-blocking drugs. Researchers at theNational Institutes of Allergy and Infectious Diseases in Bethesda, Maryland, have discovered that the genetic mutation of the CCR5 surface protein that makes individuals highly resistant to HIV infection also leaves them more susceptible to potentially fatal infection of the mosquito-borne West Nile virus.

HIV Treatment
  • share
0 comments.