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
Citations
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Towards an improved investment approach for an effective response to HIV/AIDS
Bernhard Schwartländer,John Stover,Timothy B. Hallett,Rifat Atun,Rifat Atun,Carlos Avila,Eleanor Gouws,Michael Bartos,Peter D. Ghys,Marjorie Opuni,David A Barr,Ramzi Alsallaq,Lori Bollinger,Marcelo de Freitas,Geoffrey P. Garnett,Charles B. Holmes,Ken E. Legins,Yogan Pillay,Anderson Stanciole,Craig McClure,Gottfried Hirnschall,Marie Laga,Nancy Padian +22 more
TL;DR: A strategic investment framework is proposed that is intended to support better management of national and international HIV/AIDS responses than exists with the present system and would avert 12·2 million new HIV infections and 7·4 million deaths from AIDS between 2011 and 2020.
Journal ArticleDOI
HIV-1 remission following CCR5Δ32/Δ32 haematopoietic stem-cell transplantation
Ravindra K. Gupta,Sultan Abdul-Jawad,Laura E. McCoy,Hoi Ping Mok,Dimitra Peppa,Maria Salgado,Javier Martinez-Picado,Javier Martinez-Picado,Monique Nijhuis,Annemarie M. J. Wensing,Helen Lee,Paul Grant,Eleni Nastouli,Jonathan Lambert,M Pace,Fanny Salasc,Christopher Monit,Andrew J. Innes,Andrew J. Innes,Luke Muir,Laura Waters,John Frater,Andrew M. L. Lever,Andrew M. L. Lever,Simon Edwards,Ian H Gabriel,Ian H Gabriel,Eduardo Olavarria,Eduardo Olavarria +28 more
TL;DR: It is suggested that a single allogeneic HSCT with homozygous CCR5Δ32 donor cells may be sufficient to achieve HIV-1 remission with reduced intensity conditioning and no irradiation, and the findings provide further support for the development of HIV- 1 remission strategies based on preventing CCR 5 expression.
Journal ArticleDOI
HIV treatment as prevention: Systematic comparison of mathematical models of the potential impact of antiretroviral therapy on HIV incidence in South Africa
Jeffrey W. Eaton,Leigh F. Johnson,Joshua A. Salomon,Till Bärnighausen,Till Bärnighausen,Eran Bendavid,Anna Bershteyn,David E. Bloom,Valentina Cambiano,Christophe Fraser,Jan A. C. Hontelez,Salal Humair,Salal Humair,Daniel J. Klein,Elisa F Long,Andrew N. Phillips,Carel Pretorius,John Stover,Edward Allen Wenger,Brian G. Williams,Timothy B. Hallett +20 more
TL;DR: In this article, the authors compared the predictions of several mathematical models simulating the same ART intervention programmes to determine the extent to which models agree about the epidemiological impact of expanded ART.
Journal ArticleDOI
Global trends in antiretroviral resistance in treatment-naive individuals with HIV after rollout of antiretroviral treatment in resource-limited settings: a global collaborative study and meta-regression analysis
Ravindra K. Gupta,Michael R. Jordan,Binta Sultan,Andrew Hill,Daniel Davis,John Gregson,Anthony W. Sawyer,Raph L. Hamers,Nicaise Ndembi,Deenan Pillay,Silvia Bertagnolio +10 more
TL;DR: A significant increase in prevalence of drug resistance over time since antiretroviral rollout in regions of sub-Saharan Africa is suggested; this rise is driven by NNRTI resistance in studies from east and southern Africa.
Journal ArticleDOI
Can the UNAIDS 90-90-90 target be achieved? A systematic analysis of national HIV treatment cascades.
TL;DR: Diosis was the greatest break point globally, but the most frequent key break point for individual countries was providing ART to those diagnosed, and large disparities were identified between countries.
References
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Journal ArticleDOI
Sub-optimal CD4 reconstitution despite viral suppression in an urban cohort on Antiretroviral Therapy (ART) in sub-Saharan Africa: Frequency and clinical significance
Damalie Nakanjako,Agnes Kiragga,Fowzia Ibrahim,Barbara Castelnuovo,Moses R. Kamya,Philippa Easterbrook,Philippa Easterbrook +6 more
TL;DR: The frequency and clinical significance of suboptimal CD4 reconstitution despite viral suppression (SO-CD4) in an urban HIV research cohort in Kampala, Uganda was determined and studies of CD4 T-cell functional recovery among patients with SO-CD 4 were recommended.
Journal ArticleDOI
Field assessment of generic antiretroviral drugs: a prospective cohort study in Cameroon.
Anke Bourgeois,Christian Laurent,Rose Mougnutou,Nathalie Nkoué,Bernadette Lactuock,Laura Ciaffi,Florian Liegeois,Isabelle Andrieux-Meyer,Leopold Zekeng,Alexandra Calmy,Eitel Mpoudi-Ngole,Eric Delaporte +11 more
TL;DR: It is suggested that these generic antiretroviral drugs can be used in developing countries as well as their tolerability and the emergence of viral resistance.
Journal ArticleDOI
Impact of genotypic drug resistance mutations on clinical and immunological outcomes in HIV-infected adults on HAART in West Africa.
Catherine Seyler,Christiane Adjé-Touré,Eugène Messou,Nicole Dakoury-Dogbo,François Rouet,Delphine Gabillard,Monica Nolan,Siaka Toure,Xavier Anglaret +8 more
TL;DR: In this setting with restricted access to second-line HAART, patients with major resistance mutations had higher rates of immunological failure, but most maintained stable CD4 cell counts and stayed alive for at least 20 months.
Journal ArticleDOI
Impact of baseline health and community support on antiretroviral treatment outcomes in HIV patients in South Africa.
TL;DR: Delayed ART initiation reduced ART response, whereas support from treatment buddies, community health workers and support groups significantly improved treatment outcomes.
Journal ArticleDOI
Therapeutic responses to AZT + 3TC + EFV in advanced antiretroviral naive HIV type 1-infected Ugandan patients.
TL;DR: A retrospective analysis of therapeutic responses in 11 antiretroviral (ARV) naïve HIV-1-infected Ugandan patients who had been initiated on zidovudine, lamivudine (3TC), and efavirenz (EFV), reflecting significant efficacy in the use of AZT + 3TC + EFV in advanced ARV naive non-B subtype HIV- 1-infecting patients.
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