The HIV pediatric epidemic in low-income countries is still growing with an increasing impact on children. By the end of 2007, more than 2 million children under 15 years of age worldwide were living with HIV, 90% in subSaharan Africa. In that year alone, 370,000 children were newly infected and 270,000 died. AIDS has become one of the leading causes of mortality among children under the age of 5 years in developing countries [101]. In the absence of combination antiretroviral therapy (cART), 52% of children infected with perinatally acquired HIV infection will die by the age of 2 years [1]. Numerous studies have confirmed the clinical efficacy and feasibility of cART in HIVinfected adults in Africa [2,3] but, to date, resources and programs targeting HIV-infected children in resource-poor settings remain limited. Even though the use of cART to treat children has increased in recent years in subSaharan Africa, less than 15% of children needing cART in Africa currently receive it [102]. It is estimated that more than 780,000 children are in need of cART in lowand middle-income countries [103]. When made accessible, treatment for children in this context has proved highly effective [4]. Studies have found the survival probability at 12 months for children on cART to be more than 95% in settings in sub-Saharan Africa [5] and Asia [6]. Education and adherence counseling are therefore essential components of cART and adherence in HIV-infected children is critical to the success of cART.
{"title":"Pediatric adherence to antiretroviral therapy in resource-poor settings: challenges and future perspectives","authors":"F. Pérez, V. Leroy","doi":"10.2217/HIV.09.2","DOIUrl":"https://doi.org/10.2217/HIV.09.2","url":null,"abstract":"The HIV pediatric epidemic in low-income countries is still growing with an increasing impact on children. By the end of 2007, more than 2 million children under 15 years of age worldwide were living with HIV, 90% in subSaharan Africa. In that year alone, 370,000 children were newly infected and 270,000 died. AIDS has become one of the leading causes of mortality among children under the age of 5 years in developing countries [101]. In the absence of combination antiretroviral therapy (cART), 52% of children infected with perinatally acquired HIV infection will die by the age of 2 years [1]. Numerous studies have confirmed the clinical efficacy and feasibility of cART in HIVinfected adults in Africa [2,3] but, to date, resources and programs targeting HIV-infected children in resource-poor settings remain limited. Even though the use of cART to treat children has increased in recent years in subSaharan Africa, less than 15% of children needing cART in Africa currently receive it [102]. It is estimated that more than 780,000 children are in need of cART in lowand middle-income countries [103]. When made accessible, treatment for children in this context has proved highly effective [4]. Studies have found the survival probability at 12 months for children on cART to be more than 95% in settings in sub-Saharan Africa [5] and Asia [6]. Education and adherence counseling are therefore essential components of cART and adherence in HIV-infected children is critical to the success of cART.","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"159 1","pages":"213-219"},"PeriodicalIF":0.0,"publicationDate":"2009-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77902638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The recent literature has highlighted several classes of antiretrovirals used as powerful weapons against AIDS. Current antiretrovirals include drugs that act as inhibitors of integrase, protease or even the fusion entry step of HIV-1. However, reverse transcriptase remains an attractive target for new anti-HIV-1 drug design. The clinical base already established and relatively low cytotoxicity support reverse transcriptase inhibitors as an important field of research and also a fruitful source of potentially new antiretrovirals. The goal of this article is to provide an overview of some recently approved drugs and drug candidates, which are endowed with novel mechanisms of action, and to discuss new approaches that may be an alternative to clinically available reverse transcriptase inhibitors. Some of these drugs are promising options for future treatments against multiresistant HIV-1 strains found in treatment-experienced patients.
{"title":"Promising novel compounds for the generation of new anti-HIV-RT therapeutic drugs","authors":"T. M. Souza, Carlos Frederico Leite Fontes","doi":"10.2217/HIV.09.3","DOIUrl":"https://doi.org/10.2217/HIV.09.3","url":null,"abstract":"The recent literature has highlighted several classes of antiretrovirals used as powerful weapons against AIDS. Current antiretrovirals include drugs that act as inhibitors of integrase, protease or even the fusion entry step of HIV-1. However, reverse transcriptase remains an attractive target for new anti-HIV-1 drug design. The clinical base already established and relatively low cytotoxicity support reverse transcriptase inhibitors as an important field of research and also a fruitful source of potentially new antiretrovirals. The goal of this article is to provide an overview of some recently approved drugs and drug candidates, which are endowed with novel mechanisms of action, and to discuss new approaches that may be an alternative to clinically available reverse transcriptase inhibitors. Some of these drugs are promising options for future treatments against multiresistant HIV-1 strains found in treatment-experienced patients.","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"6 1","pages":"255-267"},"PeriodicalIF":0.0,"publicationDate":"2009-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89149739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Male circumcision (MC) has been associated with a reduced risk for female–male HIV transmission in observational and ecological studies, as well as clinical trials. Three recent randomized, controlled trials in sub-Saharan Africa demonstrated a 50–60% reduction in HIV incidence among men randomized to circumcision compared with uncircumcised men. In 2007, WHO/UNAIDS recommended that MC be recognized as an additional efficacious intervention to prevent sexual transmission of HIV from women to men. This article reviews information on the potential role of MC for HIV prevention in the USA where, compared with the African clinical trial countries, the prevalence of HIV infection is lower, the main route of HIV transmission is male–male sex rather than heterosexual sex and the prevalence of MC is higher.
{"title":"Considerations in the role of male circumcision in the prevention of HIV transmission in the USA","authors":"P. Kilmarx, K. Kretsinger, G. Millett","doi":"10.2217/HIV.09.6","DOIUrl":"https://doi.org/10.2217/HIV.09.6","url":null,"abstract":"Male circumcision (MC) has been associated with a reduced risk for female–male HIV transmission in observational and ecological studies, as well as clinical trials. Three recent randomized, controlled trials in sub-Saharan Africa demonstrated a 50–60% reduction in HIV incidence among men randomized to circumcision compared with uncircumcised men. In 2007, WHO/UNAIDS recommended that MC be recognized as an additional efficacious intervention to prevent sexual transmission of HIV from women to men. This article reviews information on the potential role of MC for HIV prevention in the USA where, compared with the African clinical trial countries, the prevalence of HIV infection is lower, the main route of HIV transmission is male–male sex rather than heterosexual sex and the prevalence of MC is higher.","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"13 1","pages":"241-254"},"PeriodicalIF":0.0,"publicationDate":"2009-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87000116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Drug abuse re-emerged in mainland China in the 1980s and has spread dramatically over the last decades; the cumulative number of registered drug users increased to 1.16 million by the end of 2005. Among them, 78.3% were heroin addicts and the majority of them (50–70%) were injecting drug users. The abuse of amphetamine-type stimulants emerged at the end of the 1990s and spread quickly. Injecting drug use and unsafe sexual behavior among drug users have been the key factors in the spread of HIV/AIDS. By the end of September 2008, the cumulative total of reported HIV/AIDS cases was 264,302 in China. The Chinese government takes great measures and strategies to prevent HIV/AIDS transmission and reduce drug-related harms, including methadone-maintenance treatment and needle-exchange programs. Moreover, antiretroviral therapy has been provided for AIDS patients. The Chinese government will continue to implement strategies to prevent the spread of HIV/AIDS among drug users in the future.
{"title":"Current situation and trends of drug abuse and HIV/AIDS in China","authors":"Y. Bao, Zhi-Min Liu","doi":"10.2217/HIV.09.4","DOIUrl":"https://doi.org/10.2217/HIV.09.4","url":null,"abstract":"Drug abuse re-emerged in mainland China in the 1980s and has spread dramatically over the last decades; the cumulative number of registered drug users increased to 1.16 million by the end of 2005. Among them, 78.3% were heroin addicts and the majority of them (50–70%) were injecting drug users. The abuse of amphetamine-type stimulants emerged at the end of the 1990s and spread quickly. Injecting drug use and unsafe sexual behavior among drug users have been the key factors in the spread of HIV/AIDS. By the end of September 2008, the cumulative total of reported HIV/AIDS cases was 264,302 in China. The Chinese government takes great measures and strategies to prevent HIV/AIDS transmission and reduce drug-related harms, including methadone-maintenance treatment and needle-exchange programs. Moreover, antiretroviral therapy has been provided for AIDS patients. The Chinese government will continue to implement strategies to prevent the spread of HIV/AIDS among drug users in the future.","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"41 1","pages":"237-240"},"PeriodicalIF":0.0,"publicationDate":"2009-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81434648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite a good public healthcare infrastructure and greater availability of antiretroviral drugs in Malaysia since 2005, the number of HIV-infected patients receiving treatment remains disproportionately small. Barriers to greater access include a lack of trained human resources to deliver antiretroviral therapy (ART) in a highly individualized and specialized model and, until recently, a lack of treatment for substance abuse in a predominantly injecting drug-use epidemic. However, one of the biggest barriers, and perhaps the most challenging to overcome, is the stigma and discrimination towards HIV-infected people, especially injecting drug users, which prevented many from accessing treatment and care. Increasing and improved access to ART for HIV-infected patients will entail a multipronged strategy that includes the decentralization of clinical care, increased and ongoing training of healthcare workers and support staff, and a comprehensive and intensive effort to reduce stigma and discrimination. Crea...
{"title":"Antiretroviral therapy in Malaysia: identifying barriers to universal access","authors":"A. Kamarulzaman","doi":"10.2217/HIV.09.41","DOIUrl":"https://doi.org/10.2217/HIV.09.41","url":null,"abstract":"Despite a good public healthcare infrastructure and greater availability of antiretroviral drugs in Malaysia since 2005, the number of HIV-infected patients receiving treatment remains disproportionately small. Barriers to greater access include a lack of trained human resources to deliver antiretroviral therapy (ART) in a highly individualized and specialized model and, until recently, a lack of treatment for substance abuse in a predominantly injecting drug-use epidemic. However, one of the biggest barriers, and perhaps the most challenging to overcome, is the stigma and discrimination towards HIV-infected people, especially injecting drug users, which prevented many from accessing treatment and care. Increasing and improved access to ART for HIV-infected patients will entail a multipronged strategy that includes the decentralization of clinical care, increased and ongoing training of healthcare workers and support staff, and a comprehensive and intensive effort to reduce stigma and discrimination. Crea...","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"3 1","pages":"573-582"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81623806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-03-06DOI: 10.2217/17584310.3.2.189
M. Potter, M. Klein
An increasing number of people are chronically infected with HIV and HCV, and/or HBV owing to shared routes of transmission. With the advent of HAART, liver disease secondary to hepatitis co-infections has emerged as a leading cause of morbidity and mortality in HIV-infected persons. There is increasing need to manage dual infection, but treatment is complicated by co-morbidities, overlapping toxicities, drug activities and resistance. A model of treatment that builds on the lessons learned from the treatment of HIV has evolved to maximize success of treating dual infections. This review will address current strategies for the management of HIV in the setting of HCV and HBV co-infection and discuss future treatment directions and challenges.
{"title":"Co-infections and co-therapies: treatment of HIV in the presence of hepatitis C and hepatitis B","authors":"M. Potter, M. Klein","doi":"10.2217/17584310.3.2.189","DOIUrl":"https://doi.org/10.2217/17584310.3.2.189","url":null,"abstract":"An increasing number of people are chronically infected with HIV and HCV, and/or HBV owing to shared routes of transmission. With the advent of HAART, liver disease secondary to hepatitis co-infections has emerged as a leading cause of morbidity and mortality in HIV-infected persons. There is increasing need to manage dual infection, but treatment is complicated by co-morbidities, overlapping toxicities, drug activities and resistance. A model of treatment that builds on the lessons learned from the treatment of HIV has evolved to maximize success of treating dual infections. This review will address current strategies for the management of HIV in the setting of HCV and HBV co-infection and discuss future treatment directions and challenges.","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"40 1","pages":"189-207"},"PeriodicalIF":0.0,"publicationDate":"2009-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90172888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-03-06DOI: 10.2217/17584310.3.2.105
B. Jakobsen, A. Sewell, C. June
, suggesting that under rare circumstances HIV-1 infection can be effectively controlled by a protective T-cell response.T-cell exhaustion has been most thoroughly studied using the lymphocytic choriomenin-gitis virus (LCMV) model. Mice clear wild-type LCMV infection rapidly and protective memory develops. By contrast, a two amino-acid substitu-tion mutant of LCMV (Clone 13) is not cleared and a chronic, persistent infection ensues
{"title":"Are affinity-enhanced T cells the future of HIV therapy?","authors":"B. Jakobsen, A. Sewell, C. June","doi":"10.2217/17584310.3.2.105","DOIUrl":"https://doi.org/10.2217/17584310.3.2.105","url":null,"abstract":", suggesting that under rare circumstances HIV-1 infection can be effectively controlled by a protective T-cell response.T-cell exhaustion has been most thoroughly studied using the lymphocytic choriomenin-gitis virus (LCMV) model. Mice clear wild-type LCMV infection rapidly and protective memory develops. By contrast, a two amino-acid substitu-tion mutant of LCMV (Clone 13) is not cleared and a chronic, persistent infection ensues","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"5 1","pages":"105-108"},"PeriodicalIF":0.0,"publicationDate":"2009-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78917677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-03-06DOI: 10.2217/17584310.3.2.135
W. Stevens
Evaluation of: Kuller LH, Tracey R, Belloso W et al.: Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLOS Med. 5(10), e203 (2008). The authors of this paper investigate a number of biomarkers associated with inflammation (high sensitivity C-reactive protein, IL-6, amyloid A, and amyloid P) and coagulation (D-dimer and prothrombin fragment 1+2) in the Strategies for Management of Antiretroviral Therapy (SMART) trial. In the SMART study an increased risk of all-cause mortality was demonstrated in the therapy interruption arm, as compared with standard practice of continuous antiretroviral treatment. Kuller and colleagues demonstrated that IL-6 and D-dimer levels were strongly associated with all-cause mortality. The authors postulate that HIV leads to activation of inflammation and coagulation increasing the risk of death in HIV-infected individuals and that interrupting antiretroviral treatment increases this risk.
{"title":"Inflammation and coagulation in HIV infection contributes significantly to patient mortality","authors":"W. Stevens","doi":"10.2217/17584310.3.2.135","DOIUrl":"https://doi.org/10.2217/17584310.3.2.135","url":null,"abstract":"Evaluation of: Kuller LH, Tracey R, Belloso W et al.: Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLOS Med. 5(10), e203 (2008). The authors of this paper investigate a number of biomarkers associated with inflammation (high sensitivity C-reactive protein, IL-6, amyloid A, and amyloid P) and coagulation (D-dimer and prothrombin fragment 1+2) in the Strategies for Management of Antiretroviral Therapy (SMART) trial. In the SMART study an increased risk of all-cause mortality was demonstrated in the therapy interruption arm, as compared with standard practice of continuous antiretroviral treatment. Kuller and colleagues demonstrated that IL-6 and D-dimer levels were strongly associated with all-cause mortality. The authors postulate that HIV leads to activation of inflammation and coagulation increasing the risk of death in HIV-infected individuals and that interrupting antiretroviral treatment increases this risk.","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"107 1","pages":"135-139"},"PeriodicalIF":0.0,"publicationDate":"2009-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90761788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-03-06DOI: 10.2217/17584310.3.2.109
J. Bartlett, V. Maro
{"title":"Stavudine in first-line antiretroviral regimens in resource-limited settings: time for a better solution","authors":"J. Bartlett, V. Maro","doi":"10.2217/17584310.3.2.109","DOIUrl":"https://doi.org/10.2217/17584310.3.2.109","url":null,"abstract":"","PeriodicalId":88510,"journal":{"name":"HIV therapy","volume":"24 1","pages":"109-111"},"PeriodicalIF":0.0,"publicationDate":"2009-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89705743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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