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
Durable HIV RNA resuppression after virologic failure while remaining on a first-line regimen: a cohort study
Christopher J. Hoffmann,Salome Charalambous,Alison D. Grant,Lynn Morris,Gavin J. Churchyard,Gavin J. Churchyard,Richard E. Chaisson +6 more
TL;DR: Of 300 patients who resuppressed on the same regimen, 148 remained suppressed during follow-up for a median of 2.4 years, indicating resuppression can be durable following viraemia without a switch in antiretroviral therapy regimen.
Journal ArticleDOI
Actionable Adherence Monitoring: Technological Methods to Monitor and Support Adherence to Antiretroviral Therapy
Kate M Bell,Jessica E. Haberer +1 more
TL;DR: Current digital technologies are being used for “actionable adherence monitoring”; that is, technologies that can be used to identify episodes of non-adherence to ART in a timely manner such that tailored interventions based on adherence data can be provided when and where they are needed most.
Journal ArticleDOI
Virological success after 12 and 24 months of antiretroviral therapy in sub-Saharan Africa: Comparing results of trials, cohorts and cross-sectional studies using a systematic review and meta-analysis.
TL;DR: Evidence from this review suggests that the new international target of 90% of patients controlled is not yet being achieved, and that in order to improve the virological outcome, efforts should be made to improve retention in care.
Journal ArticleDOI
Dried plasma/blood spots for monitoring antiretroviral treatment efficacy and pharmacokinetics: a cross-sectional study in rural Burundi
Andrea Calcagno,Ilaria Motta,Maria Grazia Milia,Roberto Rostagno,Marco Simiele,Valentina Libanore,Silvia Fontana,Antonio D'Avolio,Valeria Ghisetti,Giovanni Di Perri,Stefano Bonora +10 more
TL;DR: Dried blood and plasma spots may be useful for monitoring HIV-positive patients including viral load and drug level measurement as part of treatment management in remote areas.
Journal ArticleDOI
HIV-1 Drug Resistance Among Ugandan Adults Attending an Urban Out-Patient Clinic.
Amrei von Braun,Amrei von Braun,Christine Sekaggya-Wiltshire,Nadine Bachmann,Deogratius Ssemwanga,Alexandra U. Scherrer,Maria Nanyonjo,Anne Kapaata,Pontiano Kaleebu,Huldrych F. Günthard,Barbara Castelnuovo,Jan Fehr,Andrew Kambugu +12 more
TL;DR: The prevalence of virological failure was low when a cutoff of 1000 copies per milliliter is applied, and is in line with the third of the 90-90-90 UNAIDS targets, however, most failing patients had developed multiclass drug resistance.
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.
Journal ArticleDOI
Efavirenz plus Zidovudine and Lamivudine, Efavirenz plus Indinavir, and Indinavir plus Zidovudine and Lamivudine in the Treatment of HIV-1 Infection in Adults
Schlomo Staszewski,Javier O Morales-Ramirez,Karen T. Tashima,Anita Rachlis,Daniel J. Skiest,James F. Stanford,Richard Stryker,Philip J. Johnson,Dominic F. Labriola,Dianne Farina,Douglas J. Manion,Nancy M. Ruiz +11 more
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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