Improved life expectancy of people living with HIV: who is left behind?

Katz, Ingrid T.; Maughan-Brown, Brendan

doi:10.1016/s2352-3018(17)30086-3

Cited by 83 publications

(51 citation statements)

References 15 publications

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“…One of the remarkable public health success stories of the past 40 years has been the development of combination antiretroviral therapy (cART), from the era of ineffective treatment with monotherapy, through multiple medications with a considerable pill burden and severe side effects, to a time when single, well tolerated and highly effective fixed‐dose combination tablets are initiated as cART therapy around the time of diagnosis of HIV infection. In countries with good access to health care, people living with HIV (PLHIV) now have a variety of simple, better‐tolerated regimens resulting in improved life expectancy approaching that of the general population. Both in guidelines and in clinical practice, single tablet regimens (STRs) that include an integrase strand transfer inhibitor (INSTI) and two reverse transcriptase inhibitors (RTIs) have become the usual first‐line therapy.…”

Section: Introductionmentioning

confidence: 99%

The potential role of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) single‐tablet regimen in the expanding spectrum of fixed‐dose combination therapy for HIV

et al. 2020

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Single‐tablet regimens (STRs) of highly safe and effective combination antiretroviral therapy (cART) have had a significant beneficial impact on the clinical outcomes and lives of people living with HIV (PLHIV). As a consequence, healthcare professionals caring for PLHIV in high‐income countries have increasingly focused on issues beyond those related to HIV itself, i.e. HIV‐related neurological disease, or associated opportunistic infections, which include co‐infections, and primarily age‐ and lifestyle‐related comorbidities such as cardiovascular disease, diabetes mellitus, renal impairment, osteoporosis and frailty. This review considers drug side effects and comorbidities seen in PLHIV and evaluates the role of a recently licensed STR – bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) – in mitigating some of those challenges. Factors that need to be evaluated for initial cART regimens include: pretreatment CD4 cell count; plasma HIV RNA; HIV drug resistance; hepatitis B co‐infection; HLA‐B*5701 status; drug‐drug interactions; pregnancy and pregnancy potential; psychiatric and physical comorbidities such as renal or bone disease, as well as simplicity and adherence‐friendliness, all of which need to be considered in all lines of therapy. BIC/FTC/TAF constitutes a new STR that includes an unboosted integrase strand transfer inhibitor with a high barrier against resistance with TAF and FTC. Its virological efficacy was non‐inferior to dolutegravir‐based regimens previously recommended by most guidelines for treatment initiation in large double‐blind, randomised clinical trials in treatment‐naïve or switch patients over 96 weeks. Tolerability and pharmacological properties of the regimen make it a useful tool to address several of the clinical management issues raised above.

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Section: Introductionmentioning

confidence: 99%

The potential role of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) single‐tablet regimen in the expanding spectrum of fixed‐dose combination therapy for HIV

et al. 2020

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“…The early start of antiretroviral treatment (ART) preserves CD4 ϩ T cells and maintains important helper function (7,8). Indeed, individuals infected with HIV-1 have almost comparable life expectancy to HIV-1-negative individuals when treated early and effectively (9). However, HIV-1 infection is still a chronic infection, and there is no promising approach for a cure.…”

mentioning

confidence: 99%

Expansion of Stem Cell-Like CD4⁺Memory T Cells during Acute HIV-1 Infection Is Linked to Rapid Disease Progression

Pušnik

Eller

Tassaneetrithep

et al. 2019

J Virol

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Acute HIV-1 infection is characterized by high viremia and massive depletion of CD4+T cells throughout all tissue compartments. During this time the latent viral reservoir is established but the dynamics of memory CD4+T cell subset development, their infectability and influence on disease progression during acute HIV-1 infection has not been carefully described. We therefore investigated the dynamics of CD4+T cell memory populations in the RV217 (ECHO) cohort during the acute phase of infection. Interestingly, while we found only small changes in central or effector memory compartments, we observed a profound expansion of stem cell-like memory CD4+T cells (SCM) (2.7-fold;P < 0.0001). Furthermore, we demonstrated that the HIV-1 integration and replication preferentially take place in highly differentiated CD4+T cells such as transitional memory (TM) and effector memory (EM) CD4+T cells, while naive and less mature memory cells prove to be more resistant. Despite the relatively low frequency of productively infected SCM, we suggest that their quiescent phenotype, increased susceptibility to HIV-1 integration compared to naive cells and extensive expansion make them one of the key players in establishment and persistence of the HIV-1 reservoir. Moreover, the expansion of SCM in acute HIV-1 infection was a result of Fas upregulation on the surface of naive CD4+T cells. Interestingly, the upregulation of Fas receptor and expansion of SCM in acute HIV-1 infection was associated with the early viral set point and disease progression (rho = 0.47,P = 0.02, and rho = 0.42,P = 0.041, respectively). Taken together, our data demonstrate an expansion of SCM during early acute HIV-1 infection which is associated with disease outcome.IMPORTANCEUnderstanding the immunopathology of acute HIV-1 infection will help to develop eradication strategies. We demonstrate here that a CD4+T cell memory subset expands during acute HIV-1 infection, which is associated with disease progression.

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“…For example, recent data support the view that "people living with HIV in countries, such as South Africa, can have a near-normal life expectancy, assuming they start ART before their CD4 count drops below 200 cells per μL" (Katz & Maughan-Brown, 2017).…”

Section: Discussion Of Research Findingsmentioning

confidence: 98%

Black South Africans’ Perceptions and Experiences of the Legal Child Adoption Assessment Process

Gerrand

Stevens

2019

SWORK

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Improved life expectancy of people living with HIV: who is left behind?

Cited by 83 publications

References 15 publications

The potential role of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) single‐tablet regimen in the expanding spectrum of fixed‐dose combination therapy for HIV

The potential role of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) single‐tablet regimen in the expanding spectrum of fixed‐dose combination therapy for HIV

Expansion of Stem Cell-Like CD4⁺Memory T Cells during Acute HIV-1 Infection Is Linked to Rapid Disease Progression

Black South Africans’ Perceptions and Experiences of the Legal Child Adoption Assessment Process

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Improved life expectancy of people living with HIV: who is left behind?

Cited by 83 publications

References 15 publications

The potential role of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) single‐tablet regimen in the expanding spectrum of fixed‐dose combination therapy for HIV

The potential role of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) single‐tablet regimen in the expanding spectrum of fixed‐dose combination therapy for HIV

Expansion of Stem Cell-Like CD4+Memory T Cells during Acute HIV-1 Infection Is Linked to Rapid Disease Progression

Black South Africans’ Perceptions and Experiences of the Legal Child Adoption Assessment Process

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Product

Resources

About

Expansion of Stem Cell-Like CD4⁺Memory T Cells during Acute HIV-1 Infection Is Linked to Rapid Disease Progression