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&NA;. "Tipranavir enhances antiretroviral therapy for HIV-1 infections." Inpharma Weekly &NA;, no. 1550 (August 2006): 16. http://dx.doi.org/10.2165/00128413-200615500-00040.
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Kline, Erik R., and Roy L. Sutliff. "The Roles of HIV-1 Proteins and Antiretroviral Drug Therapy in HIV-1-Associated Endothelial Dysfunction." Journal of Investigative Medicine 56, no. 5 (June 1, 2008): 752–69. http://dx.doi.org/10.1097/jim.0b013e3181788d15.
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Since the emergence of highly active antiretroviral therapy (HAART), human immunodeficiency virus-1 (HIV-1)-infected patients have demonstrated dramatic decreases in viral burden and opportunistic infections, and an overall increase in life expectancy. Despite these positive HAART-associated outcomes, it has become increasingly clear that HIV-1 patients have an enhanced risk of developing cardiovascular disease over time. Clinical studies are instrumental in our understanding of vascular dysfunction in the context of HIV-1 infection. However, most clinical studies often do not distinguish whether HIV-1 proteins, HAART, or a combination of these 2 factors cause cardiovascular complications. This review seeks to address the roles of both HIV-1 proteins and antiretroviral drugs in the development of endothelial dysfunction because endothelial dysfunction is the hallmark initial step of many cardiovascular diseases. We analyze recentin vitroandin vivostudies examining endothelial toxicity in response to HIV-1 proteins or in response to the various classes of antiretroviral drugs. Furthermore, we discuss the multiple mechanisms by which HIV-1 proteins and HAART injure the vascular endothelium in HIV-1 patients. By understanding the molecular mechanisms of HIV-1 protein- and antiretroviral-induced cardiovascular disease, we may ultimately improve the quality of life of HIV-1 patients through better drug design and the discovery of new pharmacological targets.
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Concha, Mauricio, and Alejandro Rabinstein. "Central Nervous System Opportunistic Infections in HIV-1 Infection." CNS Spectrums 5, no. 4 (April 2000): 43–60. http://dx.doi.org/10.1017/s1092852900013110.
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AbstractNeurologic disease is commonly encountered in the population infected with human immunodeficiency virus type 1 (HIV-1). Although HIV-1 is responsible for many of these neurologic complications, other organisms will affect the nervous system as the immune deficiency state progresses. With the wide use of potent antiretroviral therapy, the mortality from and incidence of opportunistic infections (OIs) among persons with advanced HIV-1 infection has decreased. Nevertheless, these diseases are still seen frequently, especially among those with limited access to new antiretroviral therapies. Therefore, it remains important to recognize the most common OIs of the central nervous system (CNS) as well as primary CNS lymphoma, which will be the focus of this review.
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Permanyer, Marc, Ester Ballana, Alba Ruiz, Roger Badia, Eva Riveira-Munoz, Encarna Gonzalo, Bonaventura Clotet, and José A. Esté. "Antiretroviral Agents Effectively Block HIV Replication after Cell-to-Cell Transfer." Journal of Virology 86, no. 16 (June 13, 2012): 8773–80. http://dx.doi.org/10.1128/jvi.01044-12.
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Cell-to-cell transmission of HIV has been proposed as a mechanism contributing to virus escape to the action of antiretrovirals and a mode of HIV persistence during antiretroviral therapy. Here, cocultures of infected HIV-1 cells with primary CD4+T cells or lymphoid cells were used to evaluate virus transmission and the effect of known antiretrovirals. Transfer of HIV antigen from infected to uninfected cells was resistant to the reverse transcriptase inhibitors (RTIs) zidovudine (AZT) and tenofovir, but was blocked by the attachment inhibitor IgGb12. However, quantitative measurement of viral DNA production demonstrated that all anti-HIV agents blocked virus replication with similar potency to cell-free virus infections. Cell-free and cell-associated infections were equally sensitive to inhibition of viral replication when HIV-1 long terminal repeat (LTR)-driven green fluorescent protein (GFP) expression in target cells was measured. However, detection of GFP by flow cytometry may incorrectly estimate the efficacy of antiretrovirals in cell-associated virus transmission, due to replication-independent Tat-mediated LTR transactivation as a consequence of cell-to-cell events that did not occur in short-term (48-h) cell-free virus infections. In conclusion, common markers of virus replication may not accurately correlate and measure infectivity or drug efficacy in cell-to-cell virus transmission. When accurately quantified, active drugs blocked proviral DNA and virus replication in cell-to-cell transmission, recapitulating the efficacy of antiretrovirals in cell-free virus infections andin vivo.
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Duffalo, Melody L. "Fungal Opportunistic Infections in HIV Disease." Journal of Pharmacy Practice 19, no. 1 (February 2006): 17–30. http://dx.doi.org/10.1177/0897190005284095.
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Fungal pathogens can lead to many of the complications seen in advanced HIV disease and are commonly identified in HIV-infected populations with decreased immune function. Common fungal organisms affecting individuals with AIDS include Cryptococcus neoformans, various Candida species, and Histoplasma capsulatum. While infection with these organisms can be fatal, appropriate identification and management of the condition can result in reduced mortality and the opportunity for effectivemanagement of HIV disease with highly active antiretroviral therapy. This article describes the clinical presentation and treatment of 3 fungal infections common in the immunocompromised individual with AIDS. Current antifungal therapy for themanagement of these infections is discussed. In addition, the role of newer antifungal agents in the setting of these conditions is reviewed.
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Purdy, Bonnie D. "Management and Prevention of Opportunistic Infections in the HIV-Infected Patient." Journal of Pharmacy Practice 13, no. 6 (December 2000): 475–98. http://dx.doi.org/10.1106/jdyc-jyvc-xjaa-lj1f.
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With the introduction of potent antiretroviral therapy, the incidence of opportunistic infections (OIs) as well as death has dramatically decreased since 1996. Opportunistic infections are seen mainly in three groups: (1) newly diagnosed patients not receiving antiretroviral therapy and presenting with an OI, (2) patients nonadherent to antiretroviral and OI treatment regimens or (3) patients whose antiretroviral therapy has failed. This article will review the most common opportunistic infections (OIs) seen in the HIV-infected individual and their treatment. The current guidelines for the prophylaxis against these OIs will also be discussed.
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Adhikary, Rishi Rajat, Prachi More, and Rinti Banerjee. "Smart nanoparticles as targeting platforms for HIV infections." Nanoscale 7, no. 17 (2015): 7520–34. http://dx.doi.org/10.1039/c5nr01285f.
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Thomas, Dia-Jeanette. "Mycobacterial Diseases in HIV-Positive Patients." Journal of Pharmacy Practice 19, no. 1 (February 2006): 10–16. http://dx.doi.org/10.1177/0897190005284100.
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Mycobacterial infections comprise the largest group of opportunistic infections in the HIV-infected population. The incidence of these and other opportunistic infections has declined significantly since the introduction of highly active antiretroviral therapy. Mortality from these illnesses has decreased as optimal combinations of antibiotics were discovered. Despite these facts, mycobacterial infections still pose a major threat to AIDS patients, particularly in underserved populations. The most common mycobacterial infections found in HIV-infected individuals are Mycobacterium tuberculosis, Mycobacterium avium intracellulare, and Mycobacterium kansasii, although other nontuberculous mycobacteria have been isolated. While established guidelines have made the task of preventing and treating opportunistic infections easier, resistance, toxicity, adherence, and drug interactions remain barriers to providing optimal therapy.
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Zimina, Vera, Svetlana Degtyareva, Elena Beloborodova, Julia Klimova, and Alexey Kravchenko. "Concurrent treatment of HIV, disseminated Mycobacterium avium complex and HCV-infection." Folia Medica 63, no. 4 (August 31, 2021): 586–90. http://dx.doi.org/10.3897/folmed.63.e56124.
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Patients with HIV-infection diagnosed at late stages usually have significant immunosuppression and demand simultaneous antiretroviral therapy and treatment of opportunistic infections. The presence of HCV coinfection makes treatment even more challenging because of possible adverse effects and drug-drug interactions. HCV cure in such clinical situations not only prevents fibrosis progression, but can also enhance virologic and/or immunologic response to antiretrovirals and thus effective treatment of opportunistic infections. Thorough consideration of all existing diseases and drug interactions of the combined therapy makes simultaneous treatment of HIV, chronic hepatitis C, and opportunistic infections not only possible but the best way to improve outcomes in a complex clinical situation.
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Lavender, Kerry J., Kathrin Gibbert, Karin E. Peterson, Erik Van Dis, Sandra Francois, Tyson Woods, Ronald J. Messer, et al. "Interferon Alpha Subtype-Specific Suppression of HIV-1 InfectionIn Vivo." Journal of Virology 90, no. 13 (April 20, 2016): 6001–13. http://dx.doi.org/10.1128/jvi.00451-16.
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ABSTRACTAlthough all 12 subtypes of human interferon alpha (IFN-α) bind the same receptor, recent results have demonstrated that they elicit unique host responses and display distinct efficacies in the control of different viral infections. The IFN-α2 subtype is currently in HIV-1 clinical trials, but it has not consistently reduced viral loads in HIV-1 patients and is not the most effective subtype against HIV-1in vitro. We now demonstrate in humanized mice that, when delivered at the same high clinical dose, the human IFN-α14 subtype has very potent anti-HIV-1 activity whereas IFN-α2 does not. In both postexposure prophylaxis and treatment of acute infections, IFN-α14, but not IFN-α2, significantly suppressed HIV-1 replication and proviral loads. Furthermore, HIV-1-induced immune hyperactivation, which is a prognosticator of disease progression, was reduced by IFN-α14 but not IFN-α2. Whereas ineffective IFN-α2 therapy was associated with CD8+T cell activation, successful IFN-α14 therapy was associated with increased intrinsic and innate immunity, including significantly higher induction of tetherin and MX2, increased APOBEC3G signature mutations in HIV-1 proviral DNA, and higher frequencies of TRAIL+NK cells. These results identify IFN-α14 as a potent new therapeutic that operates via mechanisms distinct from those of antiretroviral drugs. The ability of IFN-α14 to reduce both viremia and proviral loadsin vivosuggests that it has strong potential as a component of a cure strategy for HIV-1 infections. The broad implication of these results is that the antiviral efficacy of each individual IFN-α subtype should be evaluated against the specific virus being treated.IMPORTANCEThe naturally occurring antiviral protein IFN-α2 is used to treat hepatitis viruses but has proven rather ineffective against HIV in comparison to triple therapy with the antiretroviral (ARV) drugs. Although ARVs suppress the replication of HIV, they fail to completely clear infections. Since IFN-α acts by different mechanism than ARVs and has been shown to reduce HIV proviral loads, clinical trials are under way to test whether IFN-α2 combined with ARVs might eradicate HIV-1 infections. IFN-α is actually a family of 12 distinct proteins, and each IFN-α subtype has different efficacies toward different viruses. Here, we use mice that contain a human immune system, so they can be infected with HIV. With this model, we demonstrate that while IFN-α2 is only weakly effective against HIV, IFN-α14 is extremely potent. This discovery identifies IFN-α14 as a more powerful IFN-α subtype for use in combination therapy trials aimed toward an HIV cure.
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Haeri Mazanderani, Ahmad Farid, and Osman Ebrahim. "Progressive HIV infection in the presence of a raised CD4+ count: HIV/HTLV-1 co-infection." Southern African Journal of HIV Medicine 14, no. 2 (June 4, 2013): 92–94. http://dx.doi.org/10.4102/sajhivmed.v14i2.85.
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There are a number of pathophysiological causes for a normal or raised CD4 count in the context of progressive HIV infection. These include various co-infections, previous splenectomy, and lymphoproliferative disorders. Such circumstances can both confound HIV diagnosis and delay initiation of chemoprophylaxis and highly active antiretroviral therapy (HAART). We describe the case of a patient co-infected with HIV and human T-cell lymphotropic virus type 1 (HTLV-1) who, prior to HAART initiation, was found to have progressive immune deficiency associated with a raised CD4 count.
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Peters, B. S., and K. Conway. "Therapy for HIV." Advances in Dental Research 23, no. 1 (March 25, 2011): 23–27. http://dx.doi.org/10.1177/0022034511399082.
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Initial therapies for HIV infection comprised nucleoside analogues, but as single or dual agents, they failed to prevent disease progression. When a new class of drug was introduced, the protease inhibitors, an effective triple therapy became possible—namely, highly active antiretroviral therapy, or HAART. HAART reduced viral replication almost completely and enabled immune system recovery. The probability of classical infections and tumors attributed to HIV were dramatically reduced, and life expectancy correspondingly increased. The initial disadvantages of HAART included the need for strict adherence to prevent drug resistance, the cost that initially precluded their widespread use in the developing world, and the short- and long-term side effects. One of the most disabling long-term complications was HIV lipodystrophy, which in extreme cases lead to severe peripheral fat wasting and central fat gain. In recent years, many of these disadvantages have been addressed: Once-daily drug combinations improve adherence; global access to HAART has been markedly improved; and new drugs enable patients to avoid many of the initial side effects. Future research will determine at what CD4 count HAART should be initiated, and new approaches such as immunotherapeutic HIV vaccines are being tested with the aim to delay or obviate the need for antiretroviral drugs.
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Shenoy, Nandita, John T. Ramapuram, Ashok Shenoy, Junaid Ahmed, and N. Srikant. "Incidence of Opportunistic Infections among HIV-Positive Adults on Highly Active Antiretroviral Therapy in a Teaching Hospital, India: Prospective Study." Journal of the International Association of Providers of AIDS Care (JIAPAC) 16, no. 3 (January 4, 2017): 309–11. http://dx.doi.org/10.1177/2325957416686192.
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Oral manifestations in HIV infections are numerous and some of these are acknowledged as being of great importance in the early diagnosis of the disease. Many HIV-associated oral infections occur early in HIV disease, not infrequently as the presenting sign or symptom. Thus, early detection of the associated oral opportunistic infections should, in many cases, result in earlier diagnosis of HIV infection. Cytology, a simple, painless, and inexpensive method, has become a preferred method and was used in our study for early diagnosis of certain lesions. To determine the effect of highly active antiretroviral therapy on incidence rate of opportunistic infections among HIV-positive adults in a teaching hospital in India, a prospective study was conducted and the required sample size was 40. Study participants were selected randomly from the outpatient department of an HIV clinic who were currently on for antiretroviral therapy (ART). Data on age, gender, form of contagion, antiretroviral therapy at the time of review, number of CD4 lymphocytes per milliliter, and viral load were collected. Oral cytologic investigation was carried out and then stained for histopathological examination. A total of 40 individuals were examined and the incidence of opportunistic infections was 66.7% in individuals with CD4 counts less than 200, 55.6% in individuals with CD4 counts of 200 to 499, and 40.0% in individuals with CD4 counts more than 500. The incidence of opportunistic infection was higher in individuals with low CD4 counts in spite of being on ART.
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Storim, Julian, Jens Verheyen, Eva Wolff, Jeremias Wohlschlaeger, Evelyn Heintschel von Heinegg, Dirk Schadendorf, and Stefan Esser. "Antiretroviral therapy suppresses rectal HIV-RNA shedding despite inflammation in MSM with rectal C. trachomatis and N. gonorrhoeae infections—a cross-sectional, single-center study." Sexually Transmitted Infections 95, no. 2 (February 3, 2018): 95–98. http://dx.doi.org/10.1136/sextrans-2017-053409.
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ObjectivesRectal infections with Chlamydia trachomatis and/or Neisseria gonorrhoeae (CT/NG) are common in men who have sex with men (MSM) and are linked to HIV transmission. However, rectal CT/NG infections are often asymptomatic and it is not known how they contribute to HIV transmission. We assessed clinical and cytological signs of inflammation as well as rectal HIV-RNA in HIV-infected MSM with and without CT/NG infection.Methods112 HIV-positive MSM with or without rectal symptoms and with or without antiretroviral therapy who underwent high-resolution anoscopy (HRA) at the proctological outpatient centre of the University Hospital Essen, Germany, between November 2013 and February 2014 were included in this cross-sectional study. During the examination, rectal swabs for the assessment of CT/NG, HIV-RNA and inflammatory cells (granulocytes, lymphocytes, histiocytes) were collected. 110 patients were assessed according to the study protocol, and no imputation of missing data was performed.ResultsRectal infections with CT or NG were detected in 17 participants, and 4 participants were coinfected. Only symptomatic CT/NG infections (8/17) showed signs of inflammation in HRA. Symptomatic CT/NG infections were also associated with the detection of lymphocytes and histiocytes in rectal cytology (both P<0.001). In contrast, asymptomatic CT/NG infections neither resulted in clinical nor cytological signs of inflammation. Rectal HIV-RNA was undetectable in all participants with rectal CT/NG infections who received combined antiretroviral therapy (ART) when plasma HIV-RNA was below the limit of detection (n=13). Besides rectal CT/NG infections, syphilis (n=4) and HPV-associated lesions (n=37) were frequently detected, and proctological symptoms were associated with simultaneous infection with ≥2 STDs.ConclusionsOnly symptomatic but not asymptomatic rectal infections with CT and/or NG were associated with clinical and cytological signs of inflammation. Rectal HIV shedding was not promoted by CT/NG infections in patients receiving ART with suppressed plasma HIV-RNA.Trial registration numberUTN: U1111-1150-4804. German Clinical Trials Register (DRKS): DRKS00005468.
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Permatasari, Jelly, Indri Meirista, and Hamira Bafadhal. "Relations of Antiretroviral Combinations to CD4 Levels of HIV TB Patiens in RSUD H.Abdul Manap Jambi." Journal of Pharmacy and Science 6, no. 2 (July 17, 2021): 75–79. http://dx.doi.org/10.53342/pharmasci.v6i2.198.
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The cases of Human Immunodeficiency Virus (HIV) infection are increasing every year. This case is a disease that is very rapidly transmitted throughout the world. HIV increases the risk of developing tuberculosis (TB) and conversely TB infection increases HIV progression. In 2017, it is estimated that 10 million people have HIV TB. Combination of antiretrovirals is the basis for the management of antiretroviral therapy for HIV / AIDS patients, because it can reduce resistance, suppress HIV replication effectively so that transmission, opportunistic infections and other complications. The purpose of this study was to determine the relationship between antiretroviral combinations and CD4 levels in outpatient HIV TB patients at RSUD H. Abdul Manap Jambi. This study is a retrospective cohort study using medical records of outpatient HIV TB patients at RSUD H. Abdul Manap Jambi based on inclusion and exclusion criteria. Based on research conducted on outpatient HIV TB patients at Abdul Manap Hospital, Jambi, it was found that there was no relationship between antiretroviral combinations and CD4 levels in HIV TB patients, marked by Asimp.Sig 0.778> 0.05.
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Kuse, Nozomi, Mohammad Arif Rahman, Hayato Murakoshi, Giang Van Tran, Takayuki Chikata, Madoka Koyanagi, Kinh Van Nguyen, Hiroyuki Gatanaga, Shinichi Oka, and Masafumi Takiguchi. "Different Effects of Nonnucleoside Reverse Transcriptase Inhibitor Resistance Mutations on Cytotoxic T Lymphocyte Recognition between HIV-1 Subtype B and Subtype A/E Infections." Journal of Virology 89, no. 14 (May 13, 2015): 7363–72. http://dx.doi.org/10.1128/jvi.00974-15.
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ABSTRACTThe effect of antiretroviral drug resistance mutations on cytotoxic T lymphocyte (CTL) recognition has been analyzed in HIV-1 subtype B infections, but it remains unclear in infections by other HIV-1 subtypes that are epidemic in countries where antiretroviral drugs are not effectively used. We investigated the effect of nonnucleoside reverse transcriptase (RT) inhibitor (NNRTI)-resistance mutations (Y181C, Y181I, and Y181V) on epitope recognition by CTLs specific for 3 different HIV-1 epitopes (HLA-A*02:01-restricted IV10, HLA-B*35:01-restricted NY9, and HLA-C*12:02-restricted KY9) in subtype B and subtype A/E infections and the accumulation of these mutations in treatment-naive Japanese and Vietnamese. These NNRTI-resistance mutations critically affected NY9-specific and KY9-specific T cell responses in the subtype B infections, whereas they showed a different effect on IV10-specific T cell responses among the subtype B-infected individuals. These mutations affected IV10-specific T cell responses but weakly affected NY9-specific T cell responses in the subtype A/E infections. The substitution at position 3 of NY9 epitope which was found in the subtype A/E virus differently influenced the peptide binding to HLA-B*35:01, suggesting that the differences in peptide binding may result in the differences in T cell recognition between the subtype B virus and A/E virus infections. The Y181C mutation was found to be accumulating in treatment-naive Vietnamese infected with the subtype A/E virus. The present study demonstrated different effects of NNRTI-resistance RT181 mutations on CTL responses between the 2 subtype infections. The Y181C mutation may influence HIV-1 control by the CTLs in Vietnam, since this mutation has been accumulating in treatment-naive Vietnamese.IMPORTANCEAntiretroviral therapy leads to the emergence of drug-resistant HIV-1, resulting in virological and clinical failures. Though HIV-1-specific CTLs play a critical role in HIV-1 infection, some of drug resistance mutations located in CTL epitopes are known to affect HIV-1-specific CTL responses. Nonnucleoside reverse transcriptase inhibitor (NNRTI)-resistance RT181 mutations are frequently observed in patients treated with NNRTIs. Such drug resistance mutations may have an influence on immune control by HIV-1-specific CTLs, especially in countries where antiretroviral drugs are not effectively used. We here investigated the effect of three NNRTI-resistance RT181 mutations on immune responses by HIV-1-specific CTLs and the recent accumulation of these mutations in treatment-naive Vietnamese infected with HIV-1 subtype A/E virus. RT181 mutations affected CTL recognition in both subtype A/E and B infections, while the RT Y181C mutation has been accumulating in treatment-naive Vietnamese. The results suggest that the Y181C mutation may influence HIV-1 control by CTLs in Vietnam.
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Ahmad, Ali, Vikram Mehraj, Mohammad-Ali Jenabian, Suzanne Samarani, Cecile Tremblay, and Jean-Pierre Routy. "Combination antiretroviral therapy and indoleamine 2,3-dioxygenase in HIV infections." AIDS 30, no. 11 (July 2016): 1839–41. http://dx.doi.org/10.1097/qad.0000000000001168.
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Putra, Oki Nugraha. "A cross sectional survey of side effects of antiretroviral (ARV) in outpatients HIV by Naranjo Algorithm." Jurnal Ilmiah Farmasi 17, no. 1 (July 31, 2021): 34–45. http://dx.doi.org/10.20885/jif.vol17.iss1.art4.
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Background: The main modality in HIV patients is the administration of long-treatment antiretroviral therapy (ARV). One of the problems from the use of ARV therapy is the side effects that can reduce patient compliance in taking medication, which has the potential to cause treatment failure. Objective: This study aims to examine the side effects and their causality in the use of ARVs in outpatient HIV patients at the VCT Clinic, Bhayangkara H.S. Hospital. Samsoeri Mertojoso Surabaya. Methods: This research was a prospective observational study with a cross-sectional design. Side effect data were taken from HIV patients by interview using the Naranjo algorithm. HIV patients who met the inclusion criteria were included in the study sample using consecutive sampling. This research was conducted from January to March 2020. Results: There were 72 outpatient HIV patients who met the inclusion criteria. The most opportunistic infections found in HIV patients are tuberculosis and Pneumocystis pneumonia. The results showed that the most common side effects experienced by patients were dizziness (43%), nausea and vomiting (31%), and rash (11%) with the highest Naranjo score being in the probable category of 86%. The Naranjo score in HIV patients with opportunistic infections and with comorbidities was significantly smaller than those in HIV patients without opportunistic infections or without comorbidities with independent t-test (P <0.05). Conclusion: The side effects in HIV patients while undergoing treatment with antiretroviral therapy are classified as a minor side effect and the cause of the side effects that occur is thought to be due to the probable category of ARV therapy. Keywords: HIV Patients, Antiretroviral, Side Effects, Naranjo's Algorithm.
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Mocumbi, Ana Olga. "Cardiac Disease and HIV in Africa: A Case for Physical Exercise." Open AIDS Journal 9, no. 1 (October 20, 2015): 62–65. http://dx.doi.org/10.2174/1874613601509010062.
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AIDS-related deaths and new HIV infections have declined globally, but continue to be a major problem in Africa. Prior to the advent of antiretroviral treatment (ART) HIV patients died of immunodeficiency and associated opportunistic infections; Highly Active Antiretroviral Therapy (HAART) has resulted in increased survival of these patients and has transformed this illness into a chronic condition. Cardiovascular, respiratory, neurological and muscular problems interfere with exercise in HIV-infected patients. Particularly cardiovascular disease may be associated with direct damage by the virus, by antiretroviral therapy and by malnutrition and chronic lung disease, resulting in physical and psychological impairment. Recent studies have shown the benefits of exercise training to improvement of physiologic and functional parameters, with the gains being specific to the type of exercise performed. Exercise should be recommended to all HIV patients as an effective prevention and treatment for metabolic and cardiovascular syndromes associated with HIV and HAART exposure in sub-Saharan Africa.
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Figueiredo, Eberval Gadelha, João Paulo Fadil Romão, Leonardo C. Welling, Jefferson Rosi Junior, and Manoel J. Teixeira. "Highly Effective Antiretroviral Therapy and Cerebral Aneurysms." JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA 21, no. 3 (March 19, 2018): 168–71. http://dx.doi.org/10.22290/jbnc.v21i3.849.
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Classically, the death of patients infected with the human immunodeficiencyvirus (HIV) has been due to multiple causes, including incurable systemic infections, neurological disease and multisystem failure. With the advent of the highly effective antiretroviral therapies (HAART), the survival has been longerand processes that have traditionally not had enough time to play a role in the functional decline of HIV-infected patients are appearing. Although vascular complications in HIV-infected patients in use of HAARTs has been addressed in the literature, there has been limited discussions regarding the possiblerelationship between infection with HIV, use of HAART and the development of cerebral aneurysms. The aim of the present study is provide insight into the understanding of cerebrovascular complications, especially cerebral aneurysms, associated with the use of HAARTs in HIV-infected patients.
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Toni, Thomas A., Bluma G. Brenner, Eugene L. Asahchop, Michel Ntemgwa, Daniella Moisi, and Mark A. Wainberg. "Development of an Allele-Specific PCR for Detection of the K65R Resistance Mutation in Patients Infected with Subtype C Human Immunodeficiency Virus Type 1." Antimicrobial Agents and Chemotherapy 54, no. 2 (December 7, 2009): 907–11. http://dx.doi.org/10.1128/aac.01080-09.
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ABSTRACTThe selection of drug-resistant variants of human immunodeficiency virus type 1 (HIV-1) is an impediment to the efficiency of antiretroviral (ARV) therapy. We have developed an allele-specific real-time PCR assay to explore the presence of K65R minority species among treated HIV-1 subtype B and C infections. Thirty HIV-1 subtype C- and 26 subtype B-infected patients lacking K65R as determined by conventional sequencing methods were studied, and viral minority species were found in four HIV-1 subtype C samples.
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Santoro, Maria Mercedes, and Carlo Federico Perno. "HIV-1 Genetic Variability and Clinical Implications." ISRN Microbiology 2013 (June 17, 2013): 1–20. http://dx.doi.org/10.1155/2013/481314.
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Despite advances in antiretroviral therapy that have revolutionized HIV disease management, effective control of the HIV infection pandemic remains elusive. Beyond the classic non-B endemic areas, HIV-1 non-B subtype infections are sharply increasing in previous subtype B homogeneous areas such as Europe and North America. As already known, several studies have shown that, among non-B subtypes, subtypes C and D were found to be more aggressive in terms of disease progression. Luckily, the response to antiretrovirals against HIV-1 seems to be similar among different subtypes, but these results are mainly based on small or poorly designed studies. On the other hand, differences in rates of acquisition of resistance among non-B subtypes are already being observed. This different propensity, beyond the type of treatment regimens used, as well as access to viral load testing in non-B endemic areas seems to be due to HIV-1 clade specific peculiarities. Indeed, some non-B subtypes are proved to be more prone to develop resistance compared to B subtype. This phenomenon can be related to the presence of subtype-specific polymorphisms, different codon usage, and/or subtype-specific RNA templates. This review aims to provide a complete picture of HIV-1 genetic diversity and its implications for HIV-1 disease spread, effectiveness of therapies, and drug resistance development.
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Ailioaie, O., N. Arzouk, MA Valantin, J. Tourret, RO Calin, M. Turinici, G. Mircescu, and B. Barrou. "Infectious complications in HIV-infected kidney transplant recipients." International Journal of STD & AIDS 29, no. 4 (September 1, 2017): 341–49. http://dx.doi.org/10.1177/0956462417726213.
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Renal transplantation is now a viable alternative for dialysis in HIV-infected patients who achieve good immunovirological control with current antiretroviral therapy regimens available. However, there are few studies that analyze the incidence of post-transplant infections in this population. In this study, a retrospective analysis of data files of 24 HIV-infected kidney transplant (KT) recipients was undertaken, matched to 21 non-infected controls. All patients received induction with anti-interleukin-2 antibodies and were followed in the Pitié-Salpêtrière Hospital in Paris, France. The rate of incidence of post-transplant infections was 23.58 and 26.98/100 patient-years, in HIV-infected and HIV-negative groups (relative risk [RR]: 0.90; 95% confidence interval [CI]: 0.58–1.39; p = 0.63). In HIV-infected KT recipients, bacterial infections were the most frequent (67.7%), followed by viral (14.7%) and fungal and parasitic infections (8.8%). Similar trends were seen in the control group. Incidence of opportunistic infections was similar in HIV-infected KT recipients and controls (38.2 vs. 26.5%; p = 0.44). There were three post-transplant HIV reactivations in two patients, secondary to poor adherence to medication. HIV status did not influence survival, but infections increased the risk of unfavorable outcome. Incidence of post-transplant infections was similar in HIV-infected KT recipients and controls. Infections, but not HIV status, had adverse effects on patient and graft survival.
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Sarraf, Deependra Prasad, Gajendra Prasad Rauniar, Roshan Chhetri, Shyam Prasad Kafle, Suchana Marahatta, Basudha Khanal, Sanjib Kumar Sharma, and Vivek Kattel. "Pharmacovigilance of Antiretroviral Drugs at B.P. Koirala Institute of Health sciences." Journal of Nepal Health Research Council 18, no. 4 (January 21, 2021): 596–603. http://dx.doi.org/10.33314/jnhrc.v18i4.2634.
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Background: Antiretroviral drugs are lifeline for patients living with HIV. Adverse drug reactions can compromise the compliance to antiretroviral therapy. The objectives of the study were to estimate the prevalence of adverse drug reactions and to assess its risk factors in patients living with HIV and receiving antiretroviral therapy.Methods: A prospective cohort study was conducted among 496 patients living with HIV at B.P. Koirala Institute of Health Sciences for a period of one year. Adverse drug reactions were evaluated based upon clinical history, clinical examination and investigations. Results: Majority of patients were of 31-45 year age group (58.1%) and on first-line antiretroviral therapy regimen (94.3%). Total of 240 adverse drug reactions were documented. Prevalence of adverse drug reaction was 34.7%. Skin rash, anemia and nausea and vomiting were the three most common adverse drug reactions. The adverse drug reactions were more common in patients having non-communicable diseases, chronic co-infections, taking more than 3 non-HIV drugs, second and third-line antiretroviral regimen and it was statistically significant (P-value < 0.05). Conclusions: Prevalence of adverse drug reaction was high in the patients living with HIV. Age, gender, co-infections, non-communicable diseases, taking more than three non-HIV drugs and second and third-line antiretroviral regimen were identified as possible risk factor for occurrence of adverse drug reactions and their prior identification is important to optimize the best suited antiretroviral regimen.Keywords: Adverse drug reactions; antiretroviral therapy; pharmacovigilance
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Belyakov, Nikolay A., Vadim V. Rassokhin, Elena V. Stepanova, Olga N. Leonova, and Ekaterina V. Boeva. "HIV infection, secondary conditions and comorbidities. Part 1: Epidemiology and the basis of the problem." Medical academic journal 18, no. 4 (December 15, 2018): 7–16. http://dx.doi.org/10.17816/maj1847-16.
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An analysis of the human immunodeficiency virus (HIV) epidemic’s trajectory with priority-setting taking into account HIV-associated comorbidities for each time period was performed. A classification of comorbid diseases and conditions in HIV infection by cause and setting of their occurrence is presented. Opportunistic infections and secondary diseases that remain some of the leading causes of severe complications and mortality are characterized. The difficulty of the development of immune reconstitution inflammatory syndrome against the background of late diagnosis of HIV infection and initiation of antiretroviral therapy is highlighted.
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Corbeau, Pierre, and Jacques Reynes. "Immune reconstitution under antiretroviral therapy: the new challenge in HIV-1 infection." Blood 117, no. 21 (May 26, 2011): 5582–90. http://dx.doi.org/10.1182/blood-2010-12-322453.
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AbstractAlthough highly active antiretroviral therapy has enabled constant progress in reducing HIV-1 replication, in some patients who are “aviremic” during treatment, the problem of insufficient immune restoration remains, and this exposes them to the risk of immune deficiency–associated pathologies. Various mechanisms may combine and account for this impaired immunologic response to treatment. A first possible mechanism is immune activation, which may be because of residual HIV production, microbial translocation, co-infections, immunosenescence, or lymphopenia per se. A second mechanism is ongoing HIV replication. Finally, deficient thymus output, sex, and genetic polymorphism influencing apoptosis may impair immune reconstitution. In this review we will discuss the tools at our disposal to identify the various mechanisms at work in a given patient and the specific therapeutic strategies we could propose based on this etiologic diagnosis.
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Rybalkina, T. N., N. V. Karazhas, P. A. Savinkov, R. E. Boshyan, M. Yu Lysenkova, M. N. Kornienko, E. M. Burmistrov, P. A. Veselovsky, and I. A. Soldatova. "DEPENDENCE OF DETECTION OF MARKERS OF OPPORTUNISTIC INFECTIONS FROM ADHERENCE TO ANTIRETROVIRAL THERAPY IN CHILDREN BORN BY HIV-INFECTED MATTERS." Journal of microbiology epidemiology immunobiology, no. 4 (August 28, 2018): 76–81. http://dx.doi.org/10.36233/0372-9311-2018-4-76-81.
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Aim. To study the dependence of detection of markers of opportunistic infections from afherence to antiretroviral therapy in children born to HIV-infected mothers on the example of herpesvirus infectionsand pneumocystis. Materials and methods. Samples of biological materials (blood serum and blood cells) of 66 children with HIV infection aged 1 month to 15 years old were treated in Children’s Boxed Department of Children’s Hospital No. 2 with diagnoses «incomplete HIV test» (children from the age of one month to one and a half years) and «HIV infection». To determine IgM and IgG to herpesviruses and pneumocyst, the method of enzyme immunoassay was used; indirect immunofluorescence reaction for the detection of herpesviruses and their antigens in the blood, early antigens and virus reproduction were determined using a rapid culture method. Results. 56.0% of the surveyed children received complete antiretroviral therapy, in 16,7% of cases they were not complete, and 27,3% of children did not fully adhere to ARVT. Despite the fact that 100% of children with an incomplete diagnosis of HIV infection were covered by ARVT due to the use of chemotherapy drugs by their mothers during pregnancy, they still had markers of both active and latent forms of herpesvirus infections and pneumocystis. In children with confirmed HIV infection living both in social institutions and in families, the markers of opportunistic infections were more often diagnosed in patients receiving ARVT in full and not in full volume than in children who did not have it. Conclusion. Identification of markers of active forms of herpesvirus infections and pneumocystis in HIV-positive children not receiving ARV is the basis for its immediate appointment.
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Newton, Pippa J. "HIV testing in Acute Care." Acute Medicine Journal 17, no. 2 (April 1, 2018): 61. http://dx.doi.org/10.52964/amja.0700.
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Readers may be aware of the need to improve uptake of HIV testing in health care-settings to reduce the number of individuals with undiagnosed infection who later present with advanced disease. Late presentation of HIV infection is associated with a poorer immune response to antiretroviral therapy, an increased morbidity and mortality with a resultant higher cost burden to health-care services. Individuals with undiagnosed HIV infection who inadvertently transmit their infection to others are thought to be responsible for more than half of new HIV infections in the USA.
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LOU, JIE, HONGMEI ZHANG, QUANBI ZHAO, LINGJIE LIAO, and LITAO HAN. "THE STUDY OF HIV INFECTION IN CHINESE ANTIRETROVIRAL THERAPY PATIENTS." Journal of Biological Systems 22, no. 01 (March 2014): 73–88. http://dx.doi.org/10.1142/s0218339014500041.
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Analysis of changes in viral load after initiation of treatment with potent antiretroviral agents has provided substantial insights into the dynamics of human immunodeficiency virus type 1. We built a simple mathematics model to study the effect of latent-infected resting memory CD4+ T cells during the HIV infection and highly active anti-retroviral therapy (HAART). Through analysis of eight patients who received HAART in China, we have an insight into the mechanisms of resting memory CD4+ T cells in HIV infection. Simulations show that new infections still exist in the eight patients even under the HAART. Also, because of the long half-life of resting infected memory CD4+ T cells, removal of HIV from patient could take considerably longer time or be unattainable.
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Govender, Rajeshree, Brian Eley, Kathleen Walker, Revena Petersen, and Jo M. Wilmshurst. "Neurologic and Neurobehavioral Sequelae in Children With Human Immunodeficiency Virus (HIV-1) Infection." Journal of Child Neurology 26, no. 11 (May 25, 2011): 1355–64. http://dx.doi.org/10.1177/0883073811405203.
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The range and extent of neurologic and neurobehavioral complications of human immunodeficiency virus (HIV-1) infection in children are under-described. Seventy-eight children with HIV-1 infection (32 females) were assessed for neurologic complications. Forty-six children had abnormal neurology examinations. Thirty-three children had global pyramidal tract signs, 5 had a hemiparesis, 4 had peripheral neuropathy, 18 had visual impairment, and 5 had hearing impairment. Thirty-nine of 63 children over 1 year of age had neurobehavioral problems. Of 24 children with HIV encephalopathy, 74% had severe immunosuppression and 45% were not receiving antiretroviral therapy. Twelve children had prior opportunistic central nervous system infections, and 9 had epilepsy. Diverse neurologic and neurobehavioral deficits are common in children with HIV-1 infection. Children with severe immunosuppression, who were not receiving antiretroviral therapy, were growth impaired and less than 1 year of age, were at greatest risk for developing neurologic complications.
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Jansson, James, Cliff C. Kerr, and David P. Wilson. "Predicting the population impact of increased HIV testing and treatment in Australia." Sexual Health 11, no. 2 (2014): 146. http://dx.doi.org/10.1071/sh13069.
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Introduction The treatment as prevention strategy has gained popularity as a way to reduce the incidence of HIV by suppressing viral load such that transmission risk is decreased. The effectiveness of the strategy also requires early diagnosis. Methods: Informed by data on the influence of diagnosis and treatment on reducing transmission risk, a model simulated the impact of increasing testing and treatment rates on the expected incidence of HIV in Australia under varying assumptions of treatment efficacy and risk compensation. The model utilises Australia’s National HIV Registry data, and simulates disease progression, testing, treatment, transmission and mortality. Results: Decreasing the average time between infection and diagnosis by 30% is expected to reduce population incidence by 12% (~126 cases per year, 95% confidence interval (CI): 82–198). Treatment of all people living with HIV with CD4 counts <500 cells μL–1 is expected to reduce new infections by 30.9% (95% CI: 15.9–37.6%) at 96% efficacy if no risk compensation occurs. The number of infections could increase up to 12.9% (95% CI: 20.1–7.4%) at 26% efficacy if a return to prediagnosis risk levels occur. Conclusion: Treatment as prevention has the potential to prevent HIV infections but its effectiveness depends on the efficacy outside trial settings among men who have sex with men and the level of risk compensation. If antiretroviral therapy has high efficacy, risk compensation will not greatly change the number of infections. If the efficacy of antiretroviral therapy is low, risk compensation could lead to increased infections.
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Ma, Ning, Min Liu, Min Zheng, Xi Chen, Hong-yan Lu, Hong-guang Chen, Jun Zheng, et al. "Estimation and Projection of HIV/AIDS Epidemic and Treatment Demand in Beijing and Hunan Province with Spectrum." Infection International 2, no. 1 (March 1, 2013): 13–24. http://dx.doi.org/10.1515/ii-2017-0035.
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Abstract Objective To estimate the HIV/AIDS epidemic and treatment demand and predict the situation in the next five years with Spectrum. Methods Using Spectrum (version:3.54) to estimate the number of new HIV infections, number of people living with HIV, need for ART in adults and children, need for PMTCT and cotrimoxazole in Beijing and Hunan Province. Data used in the model including high-risk populations monitoring data and demographic information, was collected from Beijing Center for Disease Control and Prevention, Hunan Center for Disease Control and Prevention and extracted from statistical yearbooks and published literatures. Results Few new HIV/AIDS were reported in Beijing prior to 1994, however, the number of HIV infections was increasing rapidly from 1995 to 2008, and decreased after that, increased rapidly again after 2012. The number of patients who need antiretroviral treatment was increasing among the group aged between 15-49 years with young patients aged 15-24 years peaked in 2010 and decreased rapidly after that. Few HIV-infected patients were reported before 1997 in Hunan Province, and the number of new infections was increasing rapidly since 1998. The number of patients who need antiretroviral treatment was increasing among the group aged between 15 - 49 years since 2000 with young patients aged 15-24 years in need of antiretroviral therapy increasing continuously. Conclusions After HIV infection was first founded in Beijing and Hunan Province, there was a slow growth and then a rapid growth of HIV epidemic. According to prediction of Spectrum, the demand for antiretroviral therapy in Beijing would begin to decline since 2011, meanwhile, the HIV epidemic in Hunan Province would enter a rapid growth period with the demand for antiviral therapy continuing to increase. In this study, Spectrum was applied to estimate the HIV epidemic situation and need for treatment in the next five years in Beijing and Hunan Province. It provides the basis for health resource allocation and policy formulation of HIV management.
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Horton, Helen, Colin Havenar-Daughton, Deborah Lee, Erin Moore, Jianhong Cao, John McNevin, Thomas Andrus, et al. "Induction of Human Immunodeficiency Virus Type 1 (HIV-1)-Specific T-Cell Responses in HIV Vaccine Trial Participants Who Subsequently Acquire HIV-1 Infection." Journal of Virology 80, no. 19 (October 1, 2006): 9779–88. http://dx.doi.org/10.1128/jvi.00794-06.
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ABSTRACT Candidate human immunodeficiency virus type 1 (HIV-1) vaccines designed to elicit T-cell immunity in HIV-1-uninfected persons are under investigation in phase I to III clinical trials. Little is known about how these vaccines impact the immunologic response postinfection in persons who break through despite vaccination. Here, we describe the first comprehensive characterization of HIV-specific T-cell immunity in vaccine study participants following breakthrough HIV-1 infection in comparison to 16 nonvaccinated subjects with primary HIV-1 infection. Whereas none of the 16 breakthrough infections possessed vaccine-induced HIV-1-specific T-cell responses preinfection, 85% of vaccinees and 86% of nonvaccinees with primary HIV-1 infection developed HIV-specific T-cell responses postinfection. Breakthrough subjects' T cells recognized 43 unique HIV-1 T-cell epitopes, of which 8 are newly described, and 25% were present in the vaccine. The frequencies of gamma interferon (IFN-γ)-secreting cells recognizing epitopes within gene products that were and were not encoded by the vaccine were not different (P = 0.64), which suggests that responses were not anamnestic. Epitopes within Nef and Gag proteins were the most commonly recognized in both vaccinated and nonvaccinated infected subjects. One individual controlled viral replication without antiretroviral therapy and, notably, mounted a novel HIV-specific HLA-C14-restricted Gag LYNTVATL-specific T-cell response. Longitudinally, HIV-specific T cells in this individual were able to secrete IFN-γ and tumor necrosis factor alpha, as well as proliferate and degranulate in response to their cognate antigenic peptides up to 5 years postinfection. In conclusion, a vaccinee's ability to mount an HIV-specific T-cell response postinfection is not compromised by previous immunization, since the CD8+ T-cell responses postinfection are similar to those seen in vaccine-naïve individuals. Finding an individual who is controlling infection highlights the importance of comprehensive studies of breakthrough infections in vaccine trials to determine whether host genetics/immune responses and/or viral characteristics are responsible for controlling viral replication.
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Wirawan, Dewa Nyoman. "Stigma and discrimination: Barrier for ending AIDS by 2030 and achieving the 90-90-90 targets by 2020." Public Health and Preventive Medicine Archive 7, no. 1 (July 31, 2019): 1. http://dx.doi.org/10.15562/phpma.v7i1.206.
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The Joint United Nations Programme on HIV-AIDS (UNAIDS) put forward an ambitious vision of “three zero” which consisted of zero new HIV infections, zero discrimination and zero AIDS-related deaths. In other words, it is envisaged there will be no new HIV infections, no more discrimination towards people living with HIV and no more AIDS-related deaths. UNAIDS also set the target of “ending AIDS” as a public health threat by 2030. In order to end the HIV epidemic by 2030, in 2014 UNAIDS established a fast tract strategy namely "90-90-90" which means by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained access to antiretroviral therapy (ART) and 90% of all people receiving antiretroviral therapy will achieve viral suppression. If this target of "90-90-90" is achieved, it is estimated that by 2020 at least 73% of all people living with HIV worldwide will experience viral suppression; further modeling suggests that if this target is achieved this will bring about the “end of AIDS” by 2030.
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Jaworowski, Anthony, Clare L. V. Maslin, and Steven L. Wesselingh. "The use of growth factors and cytokines to treat opportunistic infections in HIV-1 disease." Sexual Health 1, no. 3 (2004): 161. http://dx.doi.org/10.1071/sh03022.
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The success of highly active antiretroviral therapy (HAART) in reducing AIDS-related mortality means that in regions where HAART is available, HIV infection may now be regarded as a chronic disease. However the inability of HAART to eliminate HIV-1 from various anatomical and cellular reservoirs within the body means that HIV-infected individuals require life-long treatment with therapy that can have significant side effects. Management of HIV disease is therefore increasingly focused on drug-related toxicities and the improvement of current HAART regimens. Here we review the potential use of immunomodulatory cytokines to directly or indirectly stimulate the mononuclear phagocyte system as adjuncts to current HIV treatment as well as their use in the management of opportunistic infections in individuals who develop immunodeficiency. We argue that cytokines, which stimulate mononuclear phagocyte activity against opportunistic pathogens, may be useful for the treatment of individuals who develop recurrent opportunistic infections. Cytokines may act synergistically with antimicrobial agents to improve outcomes, which is of particular importance since recurrent infections frequently result in resistance to standard antimicrobial treatments. Before their use can be advocated however, given their toxicity and significant cost, the potential benefits of cytokines must be demonstrated in larger clinical trials.
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Jønsson, Kasper L., Martin Tolstrup, Johan Vad-Nielsen, Kathrine Kjær, Anders Laustsen, Morten N. Andersen, Thomas A. Rasmussen, et al. "Histone Deacetylase Inhibitor Romidepsin InhibitsDe NovoHIV-1 Infections." Antimicrobial Agents and Chemotherapy 59, no. 7 (April 20, 2015): 3984–94. http://dx.doi.org/10.1128/aac.00574-15.
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ABSTRACTAdjunct therapy with the histone deacetylase inhibitor (HDACi) romidepsin increases plasma viremia in HIV patients on combination antiretroviral therapy (cART). However, a potential concern is that reversing HIV latency with an HDACi may reactivate the virus in anatomical compartments with suboptimal cART concentrations, leading tode novoinfection of susceptible cells in these sites. We tested physiologically relevant romidepsin concentrations known to reactivate latent HIV in order to definitively address this concern. We found that romidepsin significantly inhibited HIV infection in peripheral blood mononuclear cells and CD4+T cells but not in monocyte-derived macrophages. In addition, romidepsin impaired HIV spreading in CD4+T cell cultures. When we evaluated the impact of romidepsin on quantitative viral outgrowth assays with primary resting CD4+T cells, we found that resting CD4+T cells exposed to romidepsin exhibited reduced proliferation and viability. This significantly lowered assay sensitivity when measuring the efficacy of romidepsin as an HIV latency reversal agent. Altogether, our data indicate that romidepsin-based HIV eradication strategies are unlikely to reseed a latent T cell reservoir, even under suboptimal cART conditions, because romidepsin profoundly restrictsde novoHIV infections.
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Lin, Kai, Sylwia Karwowska, Eric Lam, Kay Limoli, Thomas G. Evans, and Claudio Avila. "Telbivudine Exhibits No Inhibitory Activity against HIV-1 Clinical Isolates In Vitro." Antimicrobial Agents and Chemotherapy 54, no. 6 (March 22, 2010): 2670–73. http://dx.doi.org/10.1128/aac.01703-09.
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ABSTRACT Most approved drugs with activity against hepatitis B virus (HBV) have activity against human immunodeficiency virus type 1 (HIV-1), which precludes their use in patients who are coinfected with HBV and HIV-1 and who are not receiving antiretroviral therapy due to the risk of inducing resistance. The activity of telbivudine, a highly selective HBV inhibitor, against temporally and geographically distinct wild-type and multidrug-resistant HIV-1 clinical isolates was evaluated in vitro. No inhibition was observed with up to 600 μM drug, which supports further exploration of telbivudine as a therapeutic option for the treatment of HBV infections in patients coinfected with HIV-1.
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Galván-Díaz, Ana Luz, Juan Carlos Alzate, Esteban Villegas, Sofía Giraldo, Jorge Botero, and Gisela García-Montoya. "Chronic Cystoisospora belli infection in a Colombian patient living with HIV and poor adherence to highly active antiretroviral therapy." Biomédica 41, Supl. 1 (May 31, 2021): 17–22. http://dx.doi.org/10.7705/biomedica.5932.
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Cystoisospora belli is an intestinal Apicomplexan parasite associated with diarrheal illness and disseminated infections in humans, mainly immunocompromised individuals such as those living with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). An irregular administration of highly active antiretroviral therapy (HAART) in HIV patients may increase the risk of opportunistic infections like cystoisosporiasis.We describe here a case of C. belli infection in a Colombian HIV patient with chronic gastrointestinal syndrome and poor adherence to HAART. His clinical and parasitological cure was achieved with trimethoprim-sulfamethoxazole treatment. Although a reduction in the number of C. belli cases has been observed since the use of HAART, this parasite still has to be considered as a differential diagnosis of diarrheal disease in HIV/AIDS patients.Effective interventions enhancing adherence to HAART should be included in HIV patient care programs.
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Savasi, Valeria, Monica Oneta, Arianna Laoreti, Francesca Parisi, Bina Parrilla, Piergiorgio Duca, and Irene Cetin. "Effects of Antiretroviral Therapy on Sperm DNA Integrity of HIV-1-Infected Men." American Journal of Men's Health 12, no. 6 (August 22, 2018): 1835–42. http://dx.doi.org/10.1177/1557988318794282.
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HIV-1-affected couples’ desire to have children and free sexual intercourses with the use of pre-exposure prophylaxis for the negative partner has emerged as an alternative option to assisted reproduction in aviremic patients under highly active antiretroviral therapy (HAART). It is already known that sperm quality may be impaired in HIV-infected men. The underlying physiopathological mechanism is still debated. The aim of this study was to evaluate the effects of HAART on sperm DNA fragmentation, comparing HIV-1-infected patients taking HAART versus naïve HIV-1-infected patients. This is a prospective case-control study. Sperm nuclear DNA fragmentation rate was evaluated by the sperm chromatin dispersion test in 77 HIV-infected men: 53 HIV-1 patients receiving HAART (Group 1) versus 24 naïve HIV-1 patients not receiving HAART (Group 2). Complete semen analysis was performed according to WHO 2010 recommendations. Patients with HBV infection or HCV infection coinfections and genital tract infections wre excluded. All the patients did not present any clinical signs of their disease. Seminal parameters were examined in the two groups, showing no significant differences. Increased sperm DNA fragmentation > 30% was demonstrated in 67.9% of patients in Group 1 and 37.5% of patients in Group 2, respectively ( p = .02). A positive but nonsignificant trend toward increased fragmentation was reported with advancing patients’ age. In conclusion, sperm nuclear fragmentation rate is increased in HIV-1-infected patients taking HAART compared to HIV-1 patients not receiving HAART.
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Marques Pontinha, Carlos. "The Modern Value of Clinical Autopsies." Acta Médica Portuguesa 28, no. 6 (September 1, 2015): 797. http://dx.doi.org/10.20344/amp.6934.
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Daar, Eric S. "Novel approaches to HIV therapy." F1000Research 6 (May 31, 2017): 759. http://dx.doi.org/10.12688/f1000research.11164.1.
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There are approximately 35 million people infected by human immunodeficiency virus (HIV), with an estimated 2 million incident infections annually across the globe. While HIV infection was initially associated with high rates of morbidity and mortality, advances in therapy have transformed it into a chronic and manageable disease. In addition, there is very strong evidence that those on antiretroviral therapy are much less likely to transmit infection to their partners. The success rates for maintaining viral suppression in treated patients has dramatically increased owing to the development of agents that are potent and well tolerated and can often be co-formulated into single pills for simplification. This review will outline advances in treatment over the last several years as well as new strategies that may shift the existing treatment paradigm in the near future.
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Lötsch, Jörn, Sebastian Harder, Martin Stürmer, Hans-Wilhelm Doerr, Gerd Geisslinger, Schlomo Staszewski, and Nils von Hentig. "Association of Saquinavir Plasma Concentrations with Side Effects but Not with Antiretroviral Outcome in Patients Infected with Protease Inhibitor-Susceptible Human Immunodeficiency Virus Type 1." Antimicrobial Agents and Chemotherapy 51, no. 9 (June 18, 2007): 3264–72. http://dx.doi.org/10.1128/aac.00036-07.
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ABSTRACT The objective of this study was to identify parameters among saquinavir pharmacokinetics, patients' demographics or comedications, to be addressed for improved personalized therapy. The presence of human immunodeficiency virus type 1 (HIV-1) RNA at therapy week 48 (principal target parameter), CD4 cell count at week 48, infections and side effects during 48 weeks, indicators of liver toxicity and lipid abnormalities at week 48, and a 12-h saquinavir plasma concentration-versus-time profile were assessed in 56 patients receiving saquinavir-ritonavir (1,000 and 100 mg, respectively) twice daily (44 therapy-naïve and 12 antiretrovirally pretreated patients) for association with saquinavir plasma concentrations, demographics, baseline values of target parameters, and coadministered antiretrovirals. Antiretroviral failure was observed in 8 of the 56 patients in whom HIV-1 RNA was detectable at week 48. This therapeutic failure was not associated with individual saquinavir pharmacokinetics. More likely, therapeutic failure was related to incidences interfering with antiretroviral therapy, causing therapy interruptions or incompliance. Weak associations were, however, seen between high maximum saquinavir plasma concentrations and both CD4 counts of ≥200 cells μl−1 at week 48 (P = 0.014) and constitutional side effects during 48 weeks (P = 0.002). However, patients with high CD4 counts and constitutional side effects were not identical (P = 0.53). Saquinavir therapeutic drug monitoring in patients infected with protease inhibitor-susceptible HIV-1 taking saquinavir-ritonavir (1,000 and 100 mg, respectively) is not demanded for improving the antiretroviral effect. It may be contemplated in cases with constitutional side effects or low CD4 counts with weak immune responses.
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Syrjänen, S. "Human Papillomavirus Infection and Its Association with HIV." Advances in Dental Research 23, no. 1 (March 25, 2011): 84–89. http://dx.doi.org/10.1177/0022034511399914.
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Human papillomavirus (HPV) can infect oral mucosa, causing asymptomatic infection or warty lesions. Several case-control studies have confirmed HPV as an independent risk factor for squamous cell carcinoma. HPV-related cancers seem to have better prognoses and different risk factors than do HPV-negative ones. HIV-infected patients are known to be at increased risk for persistent genital and anal high-risk HPV infections and intraepithelial neoplasm. Since the era of highly active antiretroviral therapy, the prevalence and persistence of warty lesions in oral mucosa have increased. Oral squamous cell carcinoma was recently added in the case definitions for common HIV-related oral mucosa lesions. The increased risk of HPV infection in HIV patients has been associated with impaired immune response to HPV, highly active antiretroviral therapy, aging of the HIV-infected patients, and direct interaction between the 2 viruses. HPV32 seems to be much more prevalent in asymptomatic HPV infections and warts among those infected with HIV than among those in the general population. Regarding HIV genes, there is evidence of an interaction between HPV and tat, rev, and vpr. HIV might play a role in HPV-associated pathogenesis by exhorting oncogenic stimuli via tat and rev or visa versa.
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Desai, Kanan T., Fenil Patel, Prakash B. Patel, and RK Bansal. "Role of demographic and clinical factors in survival of HIV patients on antiretroviral therapy." Tropical Doctor 51, no. 3 (February 8, 2021): 403–8. http://dx.doi.org/10.1177/0049475520981257.
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Our retrospective cohort study assesses the survival probability and identifies the demographic and clinical predictors of mortality in HIV patients taking antiretroviral therapy using an antiretroviral therapy centre data in Western India. Secondary data on 7532 registered HIV-infected individuals between September 2006 and January 2013 were analysed. The probability of survival at 75 months was 84.9%. Significant indicators of poor chances of survival were greater age, lower occupation class, lower CD4 count, poor functional status; higher stage of disease, lower weight, the presence and type of opportunistic infections, co-trimoxazole therapy and poor adherence to antiretroviral therapy. We thus find that, in addition to pre-ART, antiretroviral therapy clinical status and treatment adherence, socioeconomic status plays an important influence on ultimate survival of HIV patients on antiretroviral therapy.
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Lawn, Stephen D., M. Estée Török, and Robin Wood. "Optimum time to start antiretroviral therapy during HIV-associated opportunistic infections." Current Opinion in Infectious Diseases 24, no. 1 (February 2011): 34–42. http://dx.doi.org/10.1097/qco.0b013e3283420f76.
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Shrestha, Rupendra, Sundar Khadka, Susbin Raj Wagle, and Alisha Sapkota. "Detection of Latent HIV-1 Infection and Drug Resistant Mutation Testing in Nepal: HIV-1 env V3 DNA Sequence and RT Gene (M184V) Mutation." Nepal Journal of Biotechnology 4, no. 1 (December 31, 2016): 18–25. http://dx.doi.org/10.3126/njb.v4i1.16342.
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HIV-1 resistance to antiretroviral therapy (ART) is a crucial issue, despite various effective drugs are available for the treatment. Although the viral RNA is suppressed below the detection limit (<50 copies/ml) with the use of potent antiviral drugs, the mutation can be archived in the cellular reservoir as proviral DNA. The detection of proviral DNA and mutation screening in HIV 1 RNA for genotypic resistance is the sole basis for monitoring the effectiveness of ART. Our study aim to access the extent of latent HIV infections by detecting env V3 DNA and also testing of M184V (meth184val; ATG - GTG substitution at 184th codon) specific mutations in HIV-1 RT gene to monitor the effectiveness of ART. The HIV-1 env V3 DNA sequence was amplified using multiple upstream and downstream primes to show the latent HIV infections, whereas polymerase chain reaction- restriction fragment digestion assay (PCR-RFDA) was used for testing M184V mutation in HIV-1 RT gene. In the study, out of 15 HIV infected patient blood samples, 12 shows amplification of env V3 DNA, confirming the latent HIV infections while 3 were negative for env V3 DNA. HIV-1 RT gene tested for M184V mutation in all 15 samples showed wild type after analysis using PCR-RFDA. After digestion with CviAII, three bands were observed in wild type whereas in mutant only two bands. Although the study shows negative for the M184V resistance mutation, screening of various panels of drug resistance mutations should be performed in recently infected HIV-1 patients for planning the effective ART strategy. The data is not enough to compare the overall scenario of the Nepal thus warrant urgency for large scale study with standard genotypic tools.
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Henderson, Duncan, Hugh P. Sims-Williams, Thomas Wilhelm, Helen Sims-Williams, Sanjay Bhagani, and Lewis Thorne. "Neurosurgery and human immunodeficiency virus in the era of combination antiretroviral therapy: a review." Journal of Neurosurgery 126, no. 3 (March 2017): 897–907. http://dx.doi.org/10.3171/2016.1.jns151194.
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Human immunodeficiency virus (HIV) is a global health problem. It renders the central nervous system susceptible to infectious and noninfectious diseases. HIV-positive individuals may present to neurosurgical services with brain lesions of unknown etiology. The differential diagnosis in these cases is broad, including opportunistic infections and malignancies, and investigation should be tailored accordingly. Opportunistic infections of the central nervous system can be complicated by hydrocephalus, and the management is pathogen dependent. Patients may also present to a neurosurgical service with conditions unrelated to their HIV status. This review outlines important conditions that cause brain lesions and hydrocephalus. It addresses the issues of diagnosis and intervention in HIV-positive patients in the era of combination antiretroviral therapy, while not ignoring the potential for opportunistic central nervous system infection in undiagnosed patients. The care of HIV-positive patients presenting to neurosurgical services requires a multidisciplinary approach, which is reflected in the authorship of this review, as well as in the guidance given.
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Demarchi, Izabel Galhardo, Daniela Maira Cardozo, Sandra Mara Alessi Aristides, Ricardo Alberto Moliterno, Thaís Gomes Verzignassi Silveira, Rosilene Fressatti Cardoso, Dennis Armando Bertolini, Terezinha Inez Estivalet Svidzinski, Jorge Juarez Vieira Teixeira, and Maria Valdrinez Campana Lonardoni. "Activity of antiretroviral drugs in human infections by opportunistic agents." Brazilian Journal of Pharmaceutical Sciences 48, no. 1 (March 2012): 171–85. http://dx.doi.org/10.1590/s1984-82502012000100019.
Full textAbstract:
Highly active antiretroviral therapy (HAART) is used in patients infected with HIV. This treatment has been shown to significantly decrease opportunist infections such as those caused by viruses, fungi and particularly, protozoa. The use of HAART in HIV-positive persons is associated with immune reconstitution as well as decreased prevalence of oral candidiasis and candidal carriage. Antiretroviral therapy benefits patients who are co-infected by the human immunodeficiency virus (HIV), human herpes virus 8 (HHV-8), Epstein-Barr virus, hepatitis B virus (HBV), parvovirus B19 and cytomegalovirus (CMV). HAART has also led to a significant reduction in the incidence, and the modification of characteristics, of bacteremia by etiological agents such as Staphylococcus aureus, coagulase negative staphylococcus, non-typhoid species of Salmonella, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Mycobacterium tuberculosis. HAART can modify the natural history of cryptosporidiosis and microsporidiosis, and restore mucosal immunity, leading to the eradication of Cryptosporidium parvum. A similar restoration of immune response occurs in infections by Toxoplasma gondii. The decline in the incidence of visceral leishmaniasis/HIV co-infection can be observed after the introduction of protease inhibitor therapy. Current findings are highly relevant for clinical medicine and may serve to reduce the number of prescribed drugs thereby improving the quality of life of patients with opportunistic diseases.
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Nugraheni, Ambar Yunita, Rizki Amelia, and Inesya Febrianing Rizki. "Evaluasi Terapi Antiretroviral Pasien HIV/AIDS." Jurnal Farmasetis 8, no. 2 (November 30, 2019): 45–54. http://dx.doi.org/10.32583/farmasetis.v8i2.567.
Full textAbstract:
Pengobatan antiretroviral (ARV) bertujuan untuk menurunkan jumlah virus (viral load) serta menghambat perburukan infeksi oportunistik. Ketidakrasionalan terapi ARV akan menyebabkan peningkatan resiko morbiditas dan mortalitas, serta resiko resistensi obat. Tujuan dari penelitian ini untuk mengevaluasi rasionalitas antiretroviral pada pasien HIV/AIDS di rumah sakit umum X Surakarta yang meliputi tepat indikasi, tepat pasien, tepat obat, dan tepat dosis. Penelitian ini merupakan penelitian observasional. Sampel penelitian berjumlah 99 pasien dengan metode purposive sampling. Data diambil melalui rekam medis pasien HIV/AIDS rawat inap di rumah sakit X Surakarta. Data dianalisis secara deskriptif berdasarkan Peraturan Menteri Kesehatan Republik Indonesia Nomor 87 Tahun 2014 tentang Pedoman Pengobatan Antiretroviral (2014), Pedoman Penerapan Terapi HIV pada Anak (2014), Pedoman Nasional Tatalaksana Klinis Infeksi HIV dan Terapi Antiretroviral pada Orang Dewasa (2011). Evaluasi dari 99 pasien yang memenuhi inklusi didapatkan hasil 100% tepat indikasi, 88,89% tepat pasien, 96,97% tepat obat dan 96,97% tepat dosis. Rasionalitas penggunaan terapi ARV pada pasien HIV/AIDS di rumah sakit umum X Surakarta sebesar 85,86%.
Katakunci: antiretroviral, HIV/AIDS, rasionalitas
EVALUATION OF ANTIRETROVIRAL THERAPY IN HIV/AIDS PATIENTS
ABSTRACT
Antiretroviral (ARV) treatment aims to reduce the amount of virus (viral load) and inhibit opportunistic infections. The irrationality of ARV therapy will cause an increased risk of morbidity and mortality, as well as the risk of drug resistance. The purpose of this study was to evaluate the rationality of antiretroviral in HIV/AIDS patients at general hospital X Surakarta which includes the right indication, the right patient, the right drug, and the right dose. This study was an observational study. The research sample was 99 patients with purposive sampling method. Data was collected from medical records of inpatient HIV / AIDS patients at general hospital X Surakarta. Data were analyzed descriptively based on Peraturan Menteri Kesehatan Republik Indonesia Nomor 87 Tahun 2014 tentang Pedoman Pengobatan Antiretroviral (2014), Pedoman Penerapan Terapi HIV pada Anak (2014), Pedoman Nasional Tatalaksana Klinis Infeksi HIV dan Terapi Antiretroviral pada Orang Dewasa (2011). An evaluation of 99 patients showed 100% correct indications, 88,89% right patients, 96,97% right drugs and 96,97% right doses. The rationality of antiretroviral therapy in HIV/AIDS patients at general hospital X Surakarta was 85,86%.
Keywords: antiretroviral, HIV/AIDS, rasionality
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Melzi, Sara, Laura Carenzi, Maria Vittoria Cossu, Simone Passerini, Amedeo Capetti, and Giuliano Rizzardini. "Lipid Metabolism and Cardiovascular Risk in HIV-1 Infection and HAART: Present and Future Problems." Cholesterol 2010 (October 31, 2010): 1–13. http://dx.doi.org/10.1155/2010/271504.
Full textAbstract:
Many infections favor or are directly implicated with lipid metabolism perturbations and/or increased risk of coronary heart disease (CHD). HIV itself has been shown to increase lipogenesis in the liver and to alter the lipid profile, while the presence of unsafe habits, addiction, comorbidities, and AIDS-related diseases increases substantially the risk of cardiovascular disease (CVD) in the HIV-infected population. Antiretroviral therapy reduces such stimuli but many drugs have intrinsic toxicity profiles impacting on metabolism or potential direct cardiotoxicity. In a moment when the main guidelines of HIV therapy are predating the point when to start treating, we mean to highlight the contribution of HIV-1 to lipid alteration and inflammation, the impact of antiretroviral therapy, the decisions on what drugs to use to reduce the probability of having a cardiovascular event, the increasing use of statins and fibrates in HIV-1 infected subjects, and finally the switch strategies, that balance effectiveness and toxicity to move the decision to change HIV drugs. Early treatment might reduce the negative effect of HIV on overall cardiovascular risk but may also evidence the impact of drugs, and the final balance (reduction or increase in CHD and lipid abnormalities) is not known up to date.