Topics in HIV medicine : a publication of the International AIDS Society, USA最新文献

{"title":"Update of the drug resistance mutations in HIV-1: Fall 2006.","authors":"Victoria A Johnson,&nbsp;Francoise Brun-Vezinet,&nbsp;Bonaventura Clotet,&nbsp;Daniel R Kuritzkes,&nbsp;Deenan Pillay,&nbsp;Jonathan M Schapiro,&nbsp;Douglas D Richman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The International AIDS Society-USA (IAS-USA) Drug Resistance Mutations Group is marking 6 years as an independent volunteer panel of experts focused on identifying key HIV-1 drug resistance mutations. The goal of the effort is to quickly deliver accurate and unbiased information on these mutations to HIV clinical practitioners. This version of the IAS-USA Drug Resistance Mutations Figures replaces the version published in this journal in October/November 2005. The IAS-USA Drug Resistance Mutations Figures are designed for use in identifying mutations associated with viral resistance to antiretroviral drugs and in making therapeutic decisions. Care should be taken when using this list of mutations for surveillance or epidemiologic studies of transmission of drug-resistant virus. A number of amino acid substitutions, particularly minor mutations, represent polymorphisms that in isolation may not reflect prior drug selective pressure or reduced drug susceptibility.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"14 3","pages":"125-30"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26231900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment for adult HIV infection: 2006 recommendations of the International AIDS Society--USA panel.","authors":"Scott M Hammer,&nbsp;Michael S Saag,&nbsp;Mauro Schechter,&nbsp;Julio S G Montaner,&nbsp;Robert T Schooley,&nbsp;Donna M Jacobsen,&nbsp;Melanie A Thompson,&nbsp;Charles C J Carpenter,&nbsp;Margaret A Fischl,&nbsp;Brian G Gazzard,&nbsp;Jose M Gatell,&nbsp;Martin S Hirsch,&nbsp;David A Katzenstein,&nbsp;Douglas D Richman,&nbsp;Stefano Vella,&nbsp;Patrick G Yeni,&nbsp;Paul A Volberding","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Context: </strong>Guidelines for antiretroviral therapy are important for clinicians worldwide given the complexity of the field and the varied clinical situations in which these agents are used. The International AIDS Society-USA panel has updated its recommendations as warranted by new developments in the field.</p><p><strong>Objective: </strong>To provide physicians and other human immunodeficiency virus (HIV) clinicians with current recommendations for the use of antiretroviral therapy in HIV-infected adults in circumstances for which there is relatively unrestricted access to drugs and monitoring tools. The recommendations are centered on 4 key issues: when to start antiretroviral therapy; what to start; when to change; and what to change. Antiretroviral therapy in special circumstances is also described.</p><p><strong>Data sources and study selection: </strong>A 16-member noncompensated panel was appointed, based on expertise in HIV research and patient care internationally. Data published or presented at selected scientific conferences from mid 2004 through May 2006 were identified and reviewed by all members of the panel.</p><p><strong>Data extraction and synthesis: </strong>Data that might change previous guidelines were identified and reviewed. New guidelines were drafted by a writing committee and reviewed by the entire panel.</p><p><strong>Conclusions: </strong>Antiretroviral therapy in adults continues to evolve rapidly, making delivery of state-of-the-art care challenging. Initiation of therapy continues to be recommended in all symptomatic persons and in asymptomatic persons after the CD4 cell count falls below 350/microL and before it declines to 200/microL. A nonnucleoside reverse transcriptase inhibitor or a protease inhibitor boosted with low-dose ritonavir each combined with 2 nucleoside (or nucleotide) reverse transcriptase inhibitors is recommended with choice being based on the individual patient profile. Therapy should be changed when toxicity or intolerance mandate it or when treatment failure is documented. The virologic target for patients with treatment failure is now a plasma HIV-1 RNA level below 50 copies/mL. Adherence to antiretroviral therapy in the short-term and the long-term is crucial for treatment success and must be continually reinforced.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"14 3","pages":"827-43"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26288002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current concepts in antiretroviral therapy failure.","authors":"Carlos del Rio","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Currently, the goal for the first and second, possibly the third, antiretroviral regimen is the suppression of HIV replication to plasma levels below assay detection (ie, <50 HIV-1 RNA copies/mL). In patients with advanced treatment failure and resistance to numerous drugs, the goal of therapy has been to reduce viral load as much as possible and to maintain immunologic and clinical integrity. With the recent availability of new drugs and new classes of drugs, complete suppression of viral replication may be possible even in late salvage. When designing a regimen for a patient for whom antiretroviral therapy has failed, the regimen should contain at least 3 active drugs, and regimens are best selected with assistance from genotypic and phenotypic drug resistance testing. The selection should also be guided by knowledge of potential pharmacokinetic interactions among drugs. This article summarizes a presentation on antiretroviral failure by Carlos del Rio, MD, at the 8th Annual clinical meeting for Ryan White CARE Act clinicians in New Orleans in June 2005, sponsored by the International AIDS Society-USA and includes more recent data presented at the 13th Conference on Retroviruses and Opportunistic Infections (CROI) in 2006.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"14 3","pages":"102-6"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26231896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of treatment studies of depression in HIV.","authors":"Bunmi O Olatunji,&nbsp;Matthew J Mimiaga,&nbsp;Conall O'Cleirigh,&nbsp;Steven A Safren","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Depression is a prevalent and interfering, yet potentially treatable illness commonly comorbid with HIV/AIDS. In HIV, symptoms and diagnoses of depression have been associated with poor adherence to antiretroviral medication regimens and to accelerated disease progression. This article is a review of the existing literature on the treatment of depression in the context of HIV, including: (1) psychosocial and behavioral health interventions that directly target Diagnostic and Statistical Manual of Mental Disorders (DSM) unipolar depressive disorders, (2) psychosocial interventions that indirectly target depressive symptoms, and (3) psychopharmacologic treatment studies for DSM-IV unipolar depressive disorders. Psychosocial and psychopharmacologic treatments of depression appear to be effective for individuals with HIV. However, additional methodologically rigorous trials are needed for definitive inferences regarding treatment efficacy. Because of the high frequency of depression comorbid with HIV, and the association of depression with important self-care behaviors in this population, identification of efficacious treatments for depression has the potential to improve both overall quality of life and, potentially, health outcomes.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"14 3","pages":"112-24"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26231899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ryan White CARE Act reauthorization: we need help.","authors":"Michael S Saag","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"14 2","pages":"93-4"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26139185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug-drug interactions that matter.","authors":"David J Back","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>It is increasingly difficult to keep track of information on drug-drug interactions in HIV therapeutics, and the clinical implications of much of the data reported are not immediately evident. Nevertheless, knowledge of drug-drug interactions is necessary to preserve antiretroviral efficacy and to avoid undue risk of toxicity. The following article reviews important drug-drug interactions and accumulating data on newer antiretroviral agents.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"14 2","pages":"88-92"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26139183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methamphetamine use in urban gay and bisexual populations.","authors":"Steven Shoptaw","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>It is estimated that the use of methamphetamine is 5- to 10-times more common in urban gay and bisexual men than in the general US population. Given its effects in stimulating energy, confidence, and libido, as well as its relative inexpensiveness, the drug can efficiently address serious problems in functioning among HIV-infected men, who may suffer significant symptoms of depression or fatigue associated with chronic illness and HIV-related drug treatments. Long-term methamphetamine use is associated with physical, psychologic, and social adverse effects. Increased use of the drug associates with more frequent sexual risk behaviors and increased risks for HIV transmission. Behavioral therapies, notably the approach of contingency management, are being investigated for reducing methamphetamine use and risk behaviors in the urban gay population.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"14 2","pages":"84-7"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26139232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatitis C and B viruses: the new opportunists in HIV infection.","authors":"Raymond T Chung","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Coinfection with HIV accelerates disease progression in both hepatitis C virus (HCV) and hepatitis B virus (HBV) infection. Management of coinfected patients is complicated by a number of factors, including disease characteristics, drug-drug interactions, and augmented toxicity. Results of HCV and HBV treatment trials in HIV-coinfected patients and strategies for patient management are discussed herein.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"14 2","pages":"78-83"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26139231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications of HIV disease and antiretroviral therapy.","authors":"Diane V Havlir,&nbsp;Judith S Currier","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>As antiretroviral treatment regimens become more potent and easier to administer, differences in the rates of adverse events and complications associated with treatment will increasingly drive decisions regarding the selection of therapy. This year's Conference on Retroviruses and Opportunistic Infections featured a wide range of research directed toward understanding the pathogenesis, treatment, and long-term consequences of complications associated with HIV infection and the use of antiretroviral therapy in both resource-limited settings and in the developed world. This review will summarize information on complications of antiretroviral therapy in resource-limited settings, hepatitis C virus, tuberculosis, and discussion of metabolic, cardiovascular, and renal complications.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"14 1","pages":"27-35"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25997706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV pathogenesis and vaccine development.","authors":"R Paul Johnson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cautious optimism was a recurring theme of many of the AIDS vaccine-related presentations at the 13th annual Conference on Retroviruses and Opportunistic Infections. Several investigators suggested that the ability of HIV to escape cytotoxic T-lymphocyte responses may be more limited than previously thought, and encouraging results were presented regarding the ability of consensus ancestral sequences or polyvalent vaccines to increase the breadth of induced immune responses. A number of studies highlighted the potential efficacy of neutralizing antibodies: data from 2 groups suggested that neutralizing antibodies may play a role in preventing superinfection and previously unrecognized neutralizing epitopes were identified in the membrane proximal external region of envelope. Two studies documented that immunization with polyvalent simian immunodeficiency virus vaccines can induce sustained control of viremia following repeated low-dose mucosal challenge with pathogenic SIVmac strains and provided hope for the potential of T-cell-based vaccines to slow disease progression.</p>","PeriodicalId":85800,"journal":{"name":"Topics in HIV medicine : a publication of the International AIDS Society, USA","volume":"14 1","pages":"8-15"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25994984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}