Journal ArticleDOI
Virological follow-up of adult patients in antiretroviral treatment programmes in sub-Saharan Africa: a systematic review
Roos E. Barth,Maarten F. Schim van der Loeff,Rob Schuurman,Andy I.M. Hoepelman,Annemarie M. J. Wensing +4 more
TLDR
Profiles of drug resistance suggest that a second-line treatment regimen based on protease inhibitors, with a backbone of nucleoside reverse transcriptase inhibitor, is a reasonable option for patients with HIV in sub-Saharan Africa who experience first- line treatment failure.Abstract:
Following large-scale roll-out of antiretroviral therapy in sub-Saharan Africa, the non-clinical efficacy of antiretroviral therapy has received little attention. We aimed to systematically review virological efficacy and drug-resistance outcomes of programmes of antiretroviral therapy in sub-Saharan Africa. 89 studies with heterogeneous design, definitions, and methods were identified. Overall, in on-treatment analysis, 10 351 (78%) of 13 288 patients showed virological suppression after 6 months of antiretroviral therapy, 7413 (76%) of 9794 after 12 months, and 3840 (67%) of 5690 after 24 months. Long-term virological data are scarce. Genotyping results were available for patients with virological failure (HIV-1 RNA greater than 1000 copies per mL). Most patients (839 of 849; 99%) were infected with a non-B HIV-1 subtype. However, drug-resistance patterns were largely similar to those in subtype B. Resistance profiles were associated with the antiretroviral drugs commonly used: the lamivudine-associated M184V mutation was most common, followed by K103N which is associated with non-nucleoside reverse transcriptase inhibitors. Thymidine-analogue mutations and the K65R mutation were less common. First-line antiretroviral therapy regimens used in sub-Saharan Africa are effective. Profiles of drug resistance suggest that a second-line treatment regimen based on protease inhibitors, with a backbone of nucleoside reverse transcriptase inhibitors, is a reasonable option for patients with HIV in sub-Saharan Africa who experience first-line treatment failure.read more
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Journal ArticleDOI
Adoption of routine virologic testing and predictors of virologic failure among HIV-infected children on antiretroviral treatment in western Kenya
Julie Kadima,Elizabeth Patterson,M. W. K. Mburu,Cinthia Blat,Margaret Nyanduko,Elizabeth A. Bukusi,Craig R. Cohen,Patrick Oyaro,Lisa Abuogi +8 more
TL;DR: There is an urgent need to improve management and viral load monitoring of children living with HIV experiencing treatment failure to ensure improved long-term outcomes and Coverage of initial routine viral load testing among children on ART in western Kenya is high, but subsequent testing and virologic suppression are low.
Journal ArticleDOI
Prospective Evaluation of Diagnostic Accuracy of Dried Blood Spots from Finger Prick Samples for Determination of HIV-1 Load with the NucliSENS Easy-Q HIV-1 Version 2.0 Assay in Malawi
Emmanuel Fajardo,C. Metcalf,Pascale Chaillet,Lucia Aleixo,Pieter Pannus,Isabella Panunzi,Laura Triviño,Tom Ellman,Andrew Likaka,Reuben Mwenda +9 more
TL;DR: This study shows that FP-DBS is an acceptable alternative to plasma for measuring VL using the NucliSENS Easy-Q HIV-1 v2.0 assay, and is conducting a second study to assess the proficiency of health workers at preparing FP- DBS in primary health care clinics.
Journal ArticleDOI
Outcomes in a Cohort of Patients Started on Antiretroviral Treatment and Followed up for a Decade in an Urban Clinic in Uganda.
Barbara Castelnuovo,Agnes Kiragga,Joseph Musaazi,Joseph Sempa,Frank Mubiru,Jane N Wanyama,Bonnie Wandera,Moses R. Kamya,Andrew Kambugu +8 more
TL;DR: Despite the high rate of early mortality due to advanced disease at presentation the outcomes from this cohort are encouraging, particularly the remarkable and incremental immune-recovery and a satisfactory rate of virologic suppression.
Journal ArticleDOI
The Importance of the Family: A Longitudinal Study of the Predictors of Depression in HIV Patients in South Africa
TL;DR: The results demonstrate that the familial context in which a person with HIV on ART resides is inextricably interconnected with his/her health outcomes, as the role of the family context in research into the mental health of HIV patients is incorporated.
Journal ArticleDOI
Long-Term Efficacy of First Line Antiretroviral Therapy in Indian HIV-1 Infected Patients: A Longitudinal Cohort Study
Ujjwal Neogi,Ujjwal Neogi,Elsa Heylen,Anita Shet,Sara Chandy,Ranjani Shamsunder,Anders Sönnerborg,Maria L. Ekstrand +7 more
TL;DR: A good long-term response to the first line therapy for a median of nearly four years is reported for the first time although a less than perfect adherence increases the risk for treatment failure and subsequent drug resistance development.
References
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Journal ArticleDOI
Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement
TL;DR: This report hopes this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.
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Efavirenz plus Zidovudine and Lamivudine, Efavirenz plus Indinavir, and Indinavir plus Zidovudine and Lamivudine in the Treatment of HIV-1 Infection in Adults
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TL;DR: As antiretroviral therapy in HIV-1-infected adults, the combination of efavirenz, zidovudine, and lamivudine has greater antiviral activity and is better tolerated than the combination.
Journal ArticleDOI
Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic Review
TL;DR: Better patient tracing procedures, better understanding of loss to follow-up, and earlier initiation of ART to reduce mortality are needed if retention in ART programs in sub-Saharan Africa is to be improved.
Journal ArticleDOI
Class-Sparing Regimens for Initial Treatment of HIV-1 Infection
Sharon A. Riddler,Richard Haubrich,A. Gregory DiRienzo,Lynne Peeples,William G. Powderly,Karin L. Klingman,Kevin W. Garren,Tania George,James F. Rooney,Barbara Brizz,Umesh G. Lalloo,Robert L. Murphy,Susan Swindells,Diane V. Havlir,John W. Mellors +14 more
TL;DR: The virologic efficacy of the NRTI-sparing regimen was similar to that of the efavirenz regimen but was more likely to be associated with drug resistance.
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