HIV therapy最新文献

{"title":"HAART for children with treatment failure","authors":"A. Sohn, J. Ananworanich","doi":"10.2217/HIV.09.28","DOIUrl":"https://doi.org/10.2217/HIV.09.28","url":null,"abstract":"Even as pediatric rollout programs are struggling to meet global need, increasing numbers of children are failing first-line antiretroviral therapy in low- and middle-income countries. Without better access to viral load monitoring, second-line antiretrovirals and research to guide optimal regimen selection, it will be difficult to ensure that HIV-infected children will survive into adulthood. Data available on pediatric drug resistance demonstrate that failure occurs early in childhood. Studies of salvage drug options have been promising, but are primarily conducted in adults. Evidence-based approaches to regimen selection, pediatric antiretroviral formulations and expanded access to novel drugs are now required to prepare for the future.","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"5 1","pages":"485-499"},"PeriodicalIF":0.0,"publicationDate":"2009-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75982506","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-1 nonsubtype B distribution across certain resource-rich countries.","authors":"G. Brindicci, A. Tartaglia, A. Saracino, L. Monno, G. Angarano","doi":"10.2217/HIV.09.25","DOIUrl":"https://doi.org/10.2217/HIV.09.25","url":null,"abstract":"The distribution of different HIV subtypes follows a geographical trend. HIV-1 (the most widespread type of HIV worldwide) is classified into three genetic groups: major (M), outlier (O) and novel (N). HIV-1 group M viruses have been classified into nine subtypes. Analysis of full-length genome sequencing has revealed intersubtype recombinants, which are thought to originate from individuals simultaneously infected with viruses of two or more subtypes. The extensive genetic variability of HIV-1 and international travel are important factors in its spread worldwide. The aim of this review is to describe the changing patterns of nonsubtype B prevalence in resource-rich countries and verify how these subtypes influence transmission, disease progression, mutational patterns of resistance, as well as response to therapy.","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"28 1","pages":"467-483"},"PeriodicalIF":0.0,"publicationDate":"2009-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91016523","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":"Adult combination antiretroviral therapy in sub-Saharan Africa: lessons from Botswana and future challenges.","authors":"C William Wester, Hermann Bussmann, John Koethe, Claire Moffat, Sten Vermund, Max Essex, Richard G Marlink","doi":"10.2217/hiv.09.35","DOIUrl":"10.2217/hiv.09.35","url":null,"abstract":"<p><p>Numerous national public initiatives offering first-line combination antiretroviral therapy (cART) for HIV infection have commenced in sub-Saharan Africa since 2002. Presently, 2.1 million of an estimated seven million Africans in need of cART are receiving treatment. Analyses from the region report favorable clinical/treatment outcomes and impressive declines in AIDS-related mortality among HIV-1-infected adults and children receiving cART. While immunologic recovery, virologic suppression and cART adherence rates are on par with resource-rich settings, loss to follow-up and high mortality rates, especially within the first 6 months of treatment, remain a significant problem. Over the next decade, cART coverage rates are expected to improve across the region, with attendant increases in healthcare utilization for HIV- and non-HIV-related complications and the need for expanded laboratory and clinical services. Planned and in-progress trials will evaluate the use of cART to prevent primary HIV-1 infection with so-called 'test and treat' expansions of coverage and treatment. Education and training programs as well as patient-retention strategies will need to be strengthened as national cART programs are expanded and more people require lifelong monitoring and care.</p>","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"3 5","pages":"501-526"},"PeriodicalIF":0.0,"publicationDate":"2009-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2774911/pdf/nihms-155260.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28719111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transmitted drug resistance in nonsubtype B HIV-1 infection.","authors":"Philip A Chan,&nbsp;Rami Kantor","doi":"10.2217/hiv.09.30","DOIUrl":"https://doi.org/10.2217/hiv.09.30","url":null,"abstract":"<p><p>HIV-1 nonsubtype B variants account for the majority of HIV infections worldwide. Drug resistance in individuals who have never undergone antiretroviral therapy can lead to early failure and limited treatment options and, therefore, is an important concern. Evaluation of reported transmitted drug resistance (TDR) is challenging owing to varying definitions and study designs, and is further complicated by HIV-1 subtype diversity. In this article, we discuss the importance of various mutation lists for TDR definition, summarize TDR in nonsubtype B HIV-1 and highlight TDR reporting and interpreting challenges in the context of HIV-1 diversity. When examined carefully, TDR in HIV-1 non-B protease and reverse transcriptase is still relatively low in most regions. Whether it will increase with time and therapy access, as observed in subtype-B-predominant regions, remains to be determined.</p>","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"3 5","pages":"447-465"},"PeriodicalIF":0.0,"publicationDate":"2009-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/hiv.09.30","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28717402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking the role of the local community in HIV epidemic spread in sub-Saharan Africa: a proximate-determinants approach.","authors":"Till Bärnighausen,&nbsp;Frank Tanser","doi":"10.2217/hiv.09.33","DOIUrl":"10.2217/hiv.09.33","url":null,"abstract":"<p><p>The spread of HIV in sub-Saharan Africa continues largely unabated. To improve prevention interventions, a better understanding of the determinants of HIV infection is required. Conceptual frameworks can guide epidemiological investigation and prevent a misguided focus on single risk factors in isolation. Existing frameworks of HIV infection focus on transmission. However, the transmitting individual is rarely known. By contrast, data on individual HIV acquisition are available from longitudinal studies and tests for recent HIV infection. From the perspective of individuals susceptible to HIV, it is important to distinguish between factors determining the individual's biological disposition and sexual behavior and community-level factors, which can affect both HIV acquisition and the likelihood that a sex partner chosen from a community will be infected with HIV and transmit the infection. We propose a framework that takes the susceptible individual as a starting point and links distal, proximate and biological determinants of HIV infection at both the individual and the community level. We describe three necessary ingredients for the use of the framework (identification of the relevant community, multilevel analysis and methods for causal inference).</p>","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"3 5","pages":"435-445"},"PeriodicalIF":0.0,"publicationDate":"2009-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/hiv.09.33","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28968348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing HIV infection in infants, children and adolescents with HAART","authors":"Dolly Sharma, R. Chakraborty","doi":"10.2217/HIV.09.18","DOIUrl":"https://doi.org/10.2217/HIV.09.18","url":null,"abstract":"HIV continues to threaten the lives of millions of children worldwide. Despite the development of effective treatment, young infants, children and adolescents experience alarmingly high rates of morbidity and mortality without appropriate and timely implementation of combination antiretroviral therapy. Vertical transmission accounts for the majority of transmitted cases, reflecting the need for maternal screening and interventions during pregnancy and postnatally. Clinicians who care for infants and children with HIV infection encounter numerous challenges, including unpalatable formulations, lack of pediatric pharmacokinetic data, variable safety and efficacy profiles and reliance on a primary caregiver to administer complex drug regimens. The emergence of drug-resistant virus as a consequence of nonadherence is one of the leading causes of treatment failure and undermines future therapeutic options. Therefore, the purpose of this article is to address antiretroviral therapy management in infants, childr...","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"86 1","pages":"391-404"},"PeriodicalIF":0.0,"publicationDate":"2009-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76344070","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":"Advances in HIV care and treatment in resource-poor countries","authors":"A. Ammann","doi":"10.2217/HIV.09.22","DOIUrl":"https://doi.org/10.2217/HIV.09.22","url":null,"abstract":"Advances in HIV prevention and care are often readily available. Cotrimoxazole costs less than US$10 per patient per year and reduces opportunistic infections and, new and recurrent episodes of malaria. Generic drugs dramatically impact the availability of antiretroviral treatment. Universal offering of rapid HIV testing increases the number of individuals who know their HIV status and increases early access to treatment. Treatment with HAART during pregnancy and breastfeeding reduces HIV transmission to levels observed in formula feed populations. Male circumcision is recommended as a means for decreasing transmission of HIV to males. International guidelines require frequent revisions to keep pace with clinical advances to ensure that all HIV-infected individuals benefit from life-saving treatment. Guidelines should integrate diseases to avoid disjointed recommendations, for example HIV and TB. Contact tracing has been ignored as a means of preventing HIV transmission, raising ethical concerns related t...","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"20 1","pages":"329-338"},"PeriodicalIF":0.0,"publicationDate":"2009-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78635926","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":"Clinical implications of antiretroviral pharmacokinetics and pharmacodynamics in the CNS","authors":"A. Winston, L. Garvey","doi":"10.2217/HIV.09.13","DOIUrl":"https://doi.org/10.2217/HIV.09.13","url":null,"abstract":"The prevalence of HIV-associated brain disease remains high in the combination antiretroviral era. Factors associated with the development of HIV-associated neurocognitive impairment remain poorly understood. The selection of an antiretroviral regimen that can successfully penetrate the CNS compartment and control cerebrospinal fluid HIV replication may prove a crucial strategy in preventing the emergence and progression of HIV-associated neurocognitive impairment. Different antiretroviral agents and drug classes vary in their ability to penetrate the CNS. In this review, data on the CNS penetration of antiretrovirals are evaluated, including the clinical studies examining their relevance. Prospective studies examining the effect of different treatment strategies on CNS clinical outcomes are needed.","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"13 1","pages":"361-367"},"PeriodicalIF":0.0,"publicationDate":"2009-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86656727","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":"International and domestic funding for HIV research: how much and how is it spent?","authors":"E. Beck, C. Ávila, P. Delay","doi":"10.2217/HIV.09.17","DOIUrl":"https://doi.org/10.2217/HIV.09.17","url":null,"abstract":"Since the recognition of AIDS and the HIV pandemic in the early 1980s, the amount of money spent on HIV-related research has increased from millions to billions of US dollars per year. In 2001, the United Nations Special Assembly on HIV/AIDS highlighted the importance of mobilizing massive amounts of newly available resources to mount an effective and comprehensive response to the pandemic. In particular, it called for an increased investment in research related to HIV and AIDS and, more specifically, for the development of sustainable and affordable prevention technologies, such as vaccines and microbicides. These investments contributed to HIV being the most studied virus in research history, both in terms of the number of annual grants, monies available and HIVrelated publications generated through this work. Few organizations can clearly document their specific contributions to HIV-related research, and on the whole it is difficult to ascertain the source and annual amounts of financial support for HIV research at global and national levels. Investments for research are difficult to quantify since the information covers different sources of funding for diverse products and resources are often spent in both donor and recipient countries, creating the possibility of double counting. The different types of HIV research include medical, behavioral, social and economic research at both individual and population levels. Any long-term, sustained and effective response to the HIV pandemic requires multisectoral interventions at the level of the agent, host and environment, and their respective interactions as described by the Ecological Model of Disease Causation [1]. Expenditure on product development includes spending in five stages; basic research, preclinical research, clinical research, cohort and site development, and advocacy and policy development. R&D does not only include product development, but also clinical trials, advocacy and education at the community level, and monitoring and evaluating the implementation of new interventions into routine programs or services. The outcomes and impacts of these research efforts are reflected in terms of a reduction in the number of people newly infected with HIV and improving the morbidity and mortality of people living with HIV, ensuring that they can continue to have productive social and economic lives. To date, resources for HIV-related research have relied on three main sources of funding:","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"138 1","pages":"307-310"},"PeriodicalIF":0.0,"publicationDate":"2009-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89138319","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":"Public–private partnerships and HIV vaccine research","authors":"James A. Smith","doi":"10.2217/HIV.09.21","DOIUrl":"https://doi.org/10.2217/HIV.09.21","url":null,"abstract":"This perspective explores some of the issues surrounding the rise of public–private partnerships, so-called product development partnerships, as the main organizational form for global HIV vaccine research. Product development partnerships, such as the International Aids Vaccine Initiative and the Global Alliance for Vaccines and Immunization, attempt to draw together the strengths of the public and private sectors to advance vaccine science and develop pathways for the delivery of vaccines to those most in need. These partnerships present new ways of organizing complex HIV vaccine research, but in doing, so raise questions about how research should be prioritized, how the public and private sectors can work together, and how vaccine research must be developed alongside the strengthening of health systems in countries where a vaccine is most needed.","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"41 1","pages":"345-349"},"PeriodicalIF":0.0,"publicationDate":"2009-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72763180","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}