ARVs: The Next Generation. Going Boldly Together to New Frontiers of HIV Treatment

Barnhart, Matthew D.; Shelton, James D

doi:10.9745/ghsp-d-14-00243

Cited by 36 publications

(20 citation statements)

References 14 publications

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“…Parallel efforts in academic laboratories and the pharmaceutical industry are directed towards developing personalized drug delivery systems that can selectively target body areas where virus hides in a latent, restricted or productive state. The inevitable outcome is to maximize the therapeutic index, improve ARV compliance and maximize viral control [11, 12, 13]. The question, though, is how best to achieve such a goal.…”

Section: Introductionmentioning

confidence: 99%

Long-acting slow effective release antiretroviral therapy

Edagwa

McMillan

Sillman

et al. 2017

Expert Opinion on Drug Delivery

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Introduction Advances in the development of long acting antiretroviral therapy (ART) can revolutionize current treatments for HIV/AIDS. We have coined the term long active slow effective release ART (LASER ART) based on properties of slow drug dissolution, poor water-solubility, excellent bioavailability, limited off target systemic toxicities, and excellent patient treatment adherence. Drug carrier technologies characterized by high payload of antiretroviral drugs (ARVs) in a single carrier are being developed to improve the pharmacokinetics and pharmacodynamics of the nanoformulated ART (nanoART). Additionally, surface modification of slow release antiretroviral carriers with targeting ligands has facilitated receptor-mediated transport across physiological barriers serves to improve therapeutic outcomes. Areas covered This review highlights current developments of reservoir targeted LASER ART delivery platforms that have the potential to improve HIV/AIDS therapeutic outcomes. Such nanoART delivery platforms include decorated multifunctional nano- and micro- particles, prodrugs and polymer conjugates. Therapeutic strategies such as anti-inflammatory and neuroprotective agents and CRISPR/Cas 9 based gene-editing technologies that affect drug depots, boost ART effectiveness and facilitate viral clearance are discussed. Expert opinion The persistence of HIV-1 in its lymphoid, gut and nervous system reservoirs poses a major challenge to viral eradication. Emerging innovative strategies for effective medicines and slow release products to target intracellular pathogens, immune based interventions, genome-editing technologies, compounds that sustain drug depots and combinations of nanoART and image contrast agents have the potential to meet the unmet clinical needs of HIV patients. Such efforts will bring the medicines to sites of active viral replication and accelerate viral clearance.

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Section: Introductionmentioning

confidence: 99%

Long-acting slow effective release antiretroviral therapy

Edagwa

McMillan

Sillman

et al. 2017

Expert Opinion on Drug Delivery

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“…There is evidence that in addition to limited supply of ARVs and ART in many low-income countries, PLH often encounter challenges in accessing ARVs and ART services even in contexts where these services are freely available [4–7]. For example, although the number of people receiving ART continues to rise in Africa, it is estimated that approximately three-quarters of adults living with HIV in sub-Saharan Africa have no access to ART [6, 8]. Of the 21.2 million people in Africa eligible for ART in 2013 based on the 2013 WHO guidelines for example, only 7.6 million people were receiving HIV treatment [6].…”

Section: Introductionmentioning

confidence: 99%

ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: a mixed method study

et al. 2016

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BackgroundTimely and enduring access to antiretroviral therapy (ART) by HIV-infected individuals has been shown to substantially reduce HIV transmission risk, HIV-related morbidity and mortality. However, there is evidence that in addition to limited supply of antiretrovirals (ARVs) and linkage to ART in many low-income countries, HIV+ persons often encounter barriers in accessing ART-related services even in contexts where these services are freely available. In Ghana, limited research evidence exists regarding the barriers HIV+ persons already linked to ART face. This paper explores ART access–related barriers that HIV+ persons linked to care in southern Ghana face.MethodsA mixed method study design, involving a cross-sectional survey and qualitative in-depth interviews, was conducted to collect data from four healthcare providers and a total of 540 adult HIV+ persons receiving ART at four treatment centres in Ghana. We used univariate analysis to generate descriptive tabulations for key variables from the survey. Data from qualitative in-depth interviews were thematically analysed. Results from the survey and in-depth interviews were brought together to illuminate the challenges of the HIV+ persons.ResultsAll (100%) the HIV+ persons interviewed were ARV-exposed and linked to ART. Reasons for taking ARVs ranged from beliefs that they will suppress the HIV virus, desire to maintain good health and prolong life, and desire to prevent infection in unborn children, desire both to avoid death and to become good therapeutic citizens (abide by doctors’ advice). Despite this, more than half of the study participants (63.3%) reported seven major factors as barriers hindering access to ART. These were high financial costs associated with accessing and receiving ART (26%), delays associated with receiving care from treatment centres (24%), shortage of drugs and other commodities (23%), stigma (8.8%), fear of side effects of taking ARVs (7.9%), job insecurity arising from regular leave of absence to receive ART (5.3%), and long distance to treatment centres (4.9%).ConclusionsThe results in this study suggest that efforts to provide and scale-up ART to all HIV+ persons must be accompanied by interventions that address structural and individual level access barriers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2075-0) contains supplementary material, which is available to authorized users.

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“…Finally, ART drug costs account for about a quarter of cost of HIV care in SA (it is a greater proportion in countries where salaries are lower and laboratory monitoring is more limited); therefore, attention to systemic cost drivers are still needed. [7,10] If successful, patients will benefit with a much safer and more forgiving regimen in a smaller tablet, government and other funders will save money, while pharmaceutical producers will have simplified manufacturing, using lower volumes of active pharmaceutical ingredients. In an age of escalating medical costs, we are seldom presented with a win-win scenario with regard to clinical care.…”

Section: Resultsmentioning

confidence: 99%

“…TAF is substantially cheaper than TDF, a major cost driver of first-line therapy, and provides some bone and renal toxicity benefits. [5,7] Co-formulating the two drugs with FTC or 3TC would also substantially reduce the size of the current tablet, making it easier to manufacture, while saving on packaging and storage space. However, the two drugs -TAF and DTG -are manufactured by competing companies, where commercial…”

Section: In Practicementioning

confidence: 99%

Cutting the cost of South African antiretroviral therapy using newer, safer drugs

et al. 2016

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Corresponding author: W D F Venter (fventer@wrhi.ac.za)Antiretrovirals are a significant cost driver for HIV programmes. Current first-line regimens have performed well in real-life programmes, but have a low barrier to virological resistance and still carry toxicity that limits adherence. New drug developments may mean that we have access to safer, more robust and cheaper regimens, but only if the appropriate clinical trials are conducted. We briefly discuss these trials, and demonstrate the large cost savings to the South African HIV programme if these are successful.

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ARVs: The Next Generation. Going Boldly Together to New Frontiers of HIV Treatment

Cited by 36 publications

References 14 publications

Long-acting slow effective release antiretroviral therapy

Long-acting slow effective release antiretroviral therapy

ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: a mixed method study

Cutting the cost of South African antiretroviral therapy using newer, safer drugs

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