Highly Active Antiretroviral Therapy in a Large Urban Clinic: Risk Factors for Virologic Failure and Adverse Drug Reactions

Lucas, Gregory M.; Chaisson, Richard E.; Moore, Richard D.

doi:10.7326/0003-4819-131-2-199907200-00002

Cited by 770 publications

(398 citation statements)

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“…therapy and other human immunodeficiency virus (HIV)-related care, or to antiretroviral adverse effects (5)(6)(7)(8). It may also be related to a difference in the frequency of deaths unrelated to AIDS.…”

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confidence: 99%

Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy

Cohen

French

Benning

et al. 2002

The American Journal of Medicine

136

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PURPOSE-To examine changes in the causes of death and mortality in women with human immunodeficiency virus (HIV) infection in the era of combination antiretroviral therapy.METHODS-Among women with, or at risk of, HIV infection, who were enrolled in a national study from 1994 to 1995, we used an algorithm that classified cause of death as due to acquired immunodeficiency syndrome (AIDS) or non-AIDS causes based on data from death certificates and the CD4 count. Poisson regression models were used to estimate death rates and to determine the risk factors for AIDS and non-AIDS deaths.RESULTS-Of 2059 HIV-infected women and 569 who were at risk of HIV infection, 468 (18%) had died by April 2000 (451 HIV-infected and 17 not infected). Causes of death were available for 428 participants (414 HIV-infected and 14 not infected). Among HIV-infected women, deaths were classified as AIDS (n = 294), non-AIDS (n = 91), or indeterminate (n = 29). The non-AIDS causes included liver failure (n = 19), drug overdose (n = 16), non-AIDS malignancies (n = 12), cardiac disease (n = 10), and murder, suicide, or accident (n = 10). Allcause mortality declined an average of 26% per year (P = 0.03) and AIDS-related mortality declined by 39% per year (P = 0.01), whereas non-AIDS-related mortality remained stable (10% average annual decrease, P = 0.73). Factors that were independently associated with non-AIDSrelated mortality included depression, history of injection drug use with hepatitis C infection, cigarette smoking, and age.CONCLUSION-A substantial minority (20%) of deaths among women with HIV was due to causes other than AIDS. Our data suggest that to decrease mortality further among HIV-infected women, attention must be paid to treatable conditions, such as hepatitis C, depression, and drug and tobacco use.With the advent of combination antiretroviral therapy, mortality for persons with acquired immunodeficiency disease syndrome (AIDS) in the United States has declined markedly (1-3). For women with AIDS, these declines have been delayed and smaller in magnitude than those seen in men (1,4), perhaps due to racial and sex differences in access to antiretroviral ©2002 by Excerpta Medica, Inc. Although most studies have not found sex-related differences in HIV disease progression (9,10), some have noted a worse prognosis for women, especially those who inject drugs (11,12). Causes of death were not examined in these studies. Assessing causes of death may clarify the effects of other medical problems on mortality of women with HIV infection.The purpose of this investigation was to evaluate cause-specific mortality of participants in the Women's Interagency HIV Study, the largest U.S. longitudinal study of women with HIV infection. We examined non-HIV-related causes of death, compared the changes in mortality between those who died of AIDS and those who died of non-AIDS causes, and compared risk factors for AIDS and non-AIDS mortality in the era of combination antiretroviral therapy. METHODS SampleThe Women's Interagency HIV Study...

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confidence: 99%

Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy

Cohen

French

Benning

et al. 2002

The American Journal of Medicine

136

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“…The introduction of HAART has dramatically improved the survival of patients infected with HIV-1. However HAART is complicated by the continuing emergence of drug-resistant strains of HIV and toxicities associated with the anti-retroviral agents [64,65]. Furthermore, since the combination HAART regimens are unable to eradicate HIV infection, lifelong therapy is required to avoid disease progression [66,67].…”

Section: Current Targets Of Anti-hiv-1 Chemotherapymentioning

confidence: 99%

Viral surface glycoproteins, gp120 and gp41, as potential drug targets against HIV-1: Brief overview one quarter of a century past the approval of zidovudine, the first anti-retroviral drug

Teixeira

Gomes

et al. 2011

European Journal of Medicinal Chemistry

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“…HIV management also includes dealing with the toxicities of these drugs [27,28,[30][31][32][33], drug-drug interactions, difficulties with the need for 100% adherence [34], lack of long-term efficacy of regimens in real life settings [35][36][37][38][39], cost, co-morbid illnesses such as hepatitis and tuberculosis, opportunistic infections and their prophylaxis, substance abuse, mental illness, and the social situations of patients (housing, nutrition, stigma, family/reproductive counseling, secondary prevention, etc.). Adding to the complexity is the fact that there is no one answer for any of these issues.…”

Section: Key Principles and Complexities Of Antiretroviral Therapymentioning

confidence: 99%

Approaches to antiretroviral therapy in China

Gilliam

Redfield

2005

Cell Res

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China has recognized the threat of HIV to its population and responded with a national antiretroviral treatment (ART) program. However, high ART failure rates and the spread of resistance within populations are important realities to consider when developing and managing ART programs in China and worldwide. Concepts which will define treatment success and local and national programmatic goals are 1) access to ART, 2) durability of ART at the patient level, 3) scalability of treatment modalities, and the 4) sustainability of the program at the community or national level. In the face of limited resources, China must also consider when to start ARV therapy, which agents to use, when to switch them, and how to treat highly experienced patients with drug resistance. The optimal ARV regimen to start with is changing frequently with the introduction of new agents and the presentation of new data. Currently, a regimen including tenofovir, emtricitabine or lamivudine and a nonnucleoside reverse transcriptase inhibitor appears to have optimal characteristics to treat HIV/AIDS in China. However, critical to all of these choices is the evaluation of programs implemented to insure wide scale success. China has wisely begun this process of evaluating the performance of local programs through systematic monitoring and evaluation of treatment outcomes. This will allow regimens and programs that work to be expanded, and programs with high failure rates to be eliminated. In the end, evidence based data supporting treatment strategies will allow China to successfully confront its AIDS epidemic early and prevent its tragic consequences

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Highly Active Antiretroviral Therapy in a Large Urban Clinic: Risk Factors for Virologic Failure and Adverse Drug Reactions

Cited by 770 publications

References 23 publications

Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy

Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy

Viral surface glycoproteins, gp120 and gp41, as potential drug targets against HIV-1: Brief overview one quarter of a century past the approval of zidovudine, the first anti-retroviral drug

Approaches to antiretroviral therapy in China

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