Preferred antiretroviral drugs for the next decade of scale up

Andrieux-Meyer, Isabelle; Calmy, Alexandra; Cahn, Pedro; Clayden, Polly; Raguin, G; Katlama, Christine; Vitória, Marco; Levin, A.; Lynch, Sharonann; Goemaere, Eric; Ford, Nathan

doi:10.7448/ias.15.2.17986

Cited by 11 publications

(4 citation statements)

References 11 publications

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“…It is applicable for studies investigating the eradication of HIV infection and targeting of virus reservoirs 28,32 . Moreover, use of this technology during acute SIV infection may provide improved delineation of spatial kinetics of viral spread based on the route of infection and allow the identification of stages at which interruption of infection may be targeted using prophylactic methods 33 .…”

Section: Discussionmentioning

confidence: 99%

Whole-body immunoPET reveals active SIV dynamics in viremic and antiretroviral therapy–treated macaques

et al. 2015

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The detection of viral dynamics and localization in the context of controlled HIV infection remains a challenge and is limited to blood and biopsies. We developed a method to capture total-body simian immunodeficiency virus (SIV) replication using immunoPET (antibody-targeted positron emission tomography). The administration of a poly(ethylene glycol)-modified, 64Cu-labeled SIV Gp120–specifc antibody led to readily detectable signals in the gastrointestinal and respiratory tract, lymphoid tissues and reproductive organs of viremic monkeys. Viral signals were reduced in aviremic antiretroviral-treated monkeys but detectable in colon, select lymph nodes, small bowel, nasal turbinates, the genital tract and lung. In elite controllers, virus was detected primarily in foci in the small bowel, select lymphoid areas and the male reproductive tract, as confirmed by quantitative reverse-transcription PCR (qRT-PCR) and immunohistochemistry. This real-time, in vivo viral imaging method has broad applications to the study of immunodeficiency virus pathogenesis, drug and vaccine development, and the potential for clinical translation.

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Section: Discussionmentioning

confidence: 99%

Whole-body immunoPET reveals active SIV dynamics in viremic and antiretroviral therapy–treated macaques

et al. 2015

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“…Effective strategies to improve adherence among patients on ART comprise intensive and targeted adherence counselling and sending treatment reminders 10 37 45. Recommendations from patients attending ART clinics in the Johannesburg inner city (region F) include reducing the pill size, education on the benefits of taking ART and making injectable ART available 46 47. As the duration between clinic visits can span up to 6 months, it is also crucial to consider approaches to enable continued patient-provider engagement between these visits to promote retention, for instance, regular provision of health gamification and videos/health resources using mHealth platforms 48 49…”

Section: Discussionmentioning

confidence: 99%

Antiretroviral therapy uptake and predictors of virological failure in patients with HIV receiving first-line and second-line regimens in Johannesburg, South Africa: a retrospective cohort data analysis

et al. 2022

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ObjectiveThis study described the demographics, treatment information and identified characteristics associated with virological failure and being lost to follow-up (LTFU) for patients with HIV on first-line and second-line antiretroviral therapy (ART) regimens in a large South African cohort.DesignA quantitative retrospective cohort study using secondary data analysis.SettingSeven Johannesburg inner city facilities.ParticipantsUnique records of 123 002 people with HIV receiving ART at any point in the period 1 April 2004 to 29 February 2020 were included.MeasuresDemographic characteristics, ART status, CD4 count information and retention status were collected and analysed as covariates of outcomes (viral load (VL) and LTFU).ResultsOf the total study patients, 95% (n=1 17 260) were on a first-line regimen and 5% (n=5742) were on a second-line regimen. Almost two-thirds were female (64%, n=79 226). Most patients (60%, n=72 430) were initiated on an efavirenz-based, tenofovir disoproxil fumarate-based and emtricitabine-based regimen (fixed-dose combination). 91% (n=76 737) achieved viral suppression at least once since initiating on ART and 60% (n=57 981) remained in care as at the end of February 2020. Patients from the community health centre and primary healthcare clinics were not only more likely to be virally suppressed but also more likely to be LTFU. Patients on second-line regimens were less likely to reach viral suppression (adjusted OR (aOR)=0.26, CI=0.23 to 0.28) and more likely to be LTFU (aOR=1.21, CI=1.09 to 1.35). Being older (≥25 years) and having a recent CD4 cell count≥100 cells/µL were predictors of viral suppression and retention in patients on ART.ConclusionPatients on first-line regimens had higher VL suppression rates and were more likely to remain in care than those on a second-line regimen. Being younger and having low CD4 cell counts were associated with poor outcomes, suggesting priority groups for ART adherence support.

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“…Advances in the field of highly active antiretroviral therapy (HAART) have reduced HIV-associated morbidity and mortality, extending the mean life expectancy of HIV-positive patients. 1 , 2 However, this increased life expectancy has also led to an increase in the incidence of cardiovascular-associated mortality in this cohort. 3 QT interval prolongation is a precursor for fatal heart rhythm disorders, including ventricular fibrillation and torsades de pointes.…”

Section: Introductionmentioning

confidence: 98%

QT prolongation in HIV-positive patients: Review article

Liu

Shah

Basu‐Ray³

et al. 2019

Indian Heart Journal

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Introduction Antiretrovirals have immensely increased the average life expectancy of HIV-positive patients. However, the incidence of QT interval prolongation and other arrhythmias has also increased. Methods Pubmed and Google Scholar were searched for relevant literature published between 1990 and 2019. Results and discussion HIV-positive patients with high viral load, low CD4 count, chronic inflammation, and autonomic neuropathy can develop QT interval prolongation. Another factor prolonging QT interval includes exposure to the HIV transactivator protein, which inhibits hERG K (+) channels controlling IKr K (+) currents in cardiomyocytes. Protease inhibitors inhibiting the CYP3A4 enzyme can also lead to QT interval prolongation. QT interval prolongation can potentially be exacerbated by opioids, antipsychotics, antibiotics, and antifungals, the adjunct medications often used in HIV-positive patients. Hepatic insufficiency in seropositive patients on antiretrovirals may also increase the risk of QT interval prolongation. Conclusion Baseline and follow-up EKG in the susceptible population is suggested.

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Preferred antiretroviral drugs for the next decade of scale up

Cited by 11 publications

References 11 publications

Whole-body immunoPET reveals active SIV dynamics in viremic and antiretroviral therapy–treated macaques

Whole-body immunoPET reveals active SIV dynamics in viremic and antiretroviral therapy–treated macaques

Antiretroviral therapy uptake and predictors of virological failure in patients with HIV receiving first-line and second-line regimens in Johannesburg, South Africa: a retrospective cohort data analysis

QT prolongation in HIV-positive patients: Review article

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