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Polygyny, concurrency, its impact and lack of impact on HIV 一夫多妻制，并发性，对艾滋病毒的影响和缺乏影响

HIV therapy

Pub Date : 2010-03-10 DOI: 10.2217/HIV.10.10

M. Boily

Evaluation of: Reniers G, Watkins S: Polygyny and the spread of HIV in sub-Saharan Africa: a case of benign concurrency. AIDS 24, 299–307 (2010). This ecological study aims to understand the role of concurrency on HIV in sub-Saharan Africa. The results showed a negative association between the prevalence of HIV and polygyny, independently of selected risk factors (e.g., age at sexual debut and extramarital sex). This reflects the potential protective role of this specific form of concurrency, which contrasts with the common understanding that concurrency favors the spread of HIV. More research is needed to understand how different concurrency patterns influence the global network structure, how they are associated with risk practices within partnerships and the motivation underlying concurrency. This is relevant for the design of intervention focusing on concurrency, to maximise impact and minimize the risk of negative compensatory risk behavior. These results illustrate a growing misinterpretation of ear...

评价:Reniers G, Watkins S:一夫多妻制与艾滋病毒在撒哈拉以南非洲的传播:一个良性并发病例。中国艾滋病防治杂志，2009,33(4):391 - 391。这项生态学研究的目的是了解并发性在撒哈拉以南非洲地区对艾滋病毒的作用。结果显示，艾滋病毒流行率与一夫多妻制之间存在负相关关系，独立于选定的风险因素(例如，初次性行为的年龄和婚外性行为)。这反映了这种特定形式的并发性的潜在保护作用，这与普遍认为的并发性有利于艾滋病毒的传播形成对比。需要更多的研究来了解不同的并发模式如何影响全球网络结构，它们如何与伙伴关系中的风险实践相关联，以及并发背后的动机。这与关注并发性的干预设计相关，以最大化影响并最小化负面补偿风险行为的风险。这些结果表明，人们对耳朵的误解越来越多。

引用次数: 5

Lessons from viral latency in T cells: manipulating HIV‑1 transcription by siRNA T细胞中病毒潜伏期的教训:通过siRNA操纵HIV - 1转录

HIV therapy

Pub Date : 2010-03-10 DOI: 10.2217/HIV.10.1

Kazuo Suzuki, A. Kelleher

Despite prolonged and intensive application, currently available combined antiretroviral therapy cannot eradicate HIV-1. It has little impact on provirus harbored within resting CD4+ T cells, which survive for long periods of time. One approach to clear this reservoir has been to administer either T cell-activating cytokines or histone deacetylase inhibitors to HIV-1 infected individuals in order to reactivate latent virus from the cellular compartment while continuing cART to avoid reseeding of the reservoir. These approaches have had limited success. Strategies for the eradication of HIV need to be refined. Rational design of these approaches requires a clear understanding of the determinants of viral latency, which is controlled, at least in part, by epigenetic modifications in histones and recruitment of suppressive proteins to form heterochromatin in the promoter region of the virus. Reactivation of virus correlates with dissociation of repressive modifications, including acetylation of histone tails...

尽管长期和密集的应用，目前可用的联合抗逆转录病毒治疗不能根除HIV-1。它对潜伏在静止的CD4+ T细胞中的原病毒几乎没有影响，这些细胞可以存活很长时间。清除这个储存库的一种方法是给HIV-1感染者施用T细胞活化细胞因子或组蛋白去乙酰化酶抑制剂，以便从细胞室重新激活潜伏病毒，同时继续cART以避免储存库的重新播种。这些方法取得了有限的成功。根除艾滋病毒的战略需要改进。这些方法的合理设计需要清楚地了解病毒潜伏期的决定因素，这至少在一定程度上是由组蛋白的表观遗传修饰和抑制蛋白的募集来控制的，从而在病毒的启动子区域形成异染色质。病毒的再激活与抑制修饰的解离相关，包括组蛋白尾部的乙酰化…

引用次数: 5

Treatment considerations for psychiatric syndromes associated with HIV infection 与HIV感染相关的精神综合征的治疗考虑

HIV therapy

Pub Date : 2010-03-10 DOI: 10.2217/HIV.10.12

Tami D. Benton, J. Blume, B. Dubé

Psychiatric syndromes associated with HIV disease were recognized early in the AIDS epidemic. Public education, new technologies and antiretroviral therapies have resulted in earlier recognition and therapautic interventions of HIV infection, improving the physical health for individuals living with HIV. While HIV-associated psychiatric symptoms have been recognized for more than 20 years, our understanding of the mechanisms underlying psychiatric symptoms among HIV-infected individuals and treatments for these symptoms have not kept pace with advances in HIV therapies. In this article, we discuss current knowledge of the psychiatric symptoms occurring with HIV disease, specifically mood, anxiety and psychotic disorders, evidence-based treatments and treatment considerations, new strategies for the treatments of psychiatric symptoms in HIV disease are also discussed.

与艾滋病毒疾病相关的精神综合症在艾滋病流行的早期就被发现。公共教育、新技术和抗逆转录病毒疗法使人们更早地认识到艾滋病毒感染并采取治疗干预措施，从而改善了艾滋病毒感染者的身体健康。虽然艾滋病毒相关的精神症状已经被认识了20多年，但我们对艾滋病毒感染者精神症状的潜在机制和这些症状的治疗方法的理解并没有跟上艾滋病毒治疗的进展。在这篇文章中，我们讨论了目前的知识发生与艾滋病毒疾病的精神症状，特别是情绪，焦虑和精神障碍，循证治疗和治疗的注意事项，新的策略治疗艾滋病毒疾病的精神症状也进行了讨论。

引用次数: 6

Psychiatric illness, access and adherence to HAART: a brief review of recent findings and implications for care 精神疾病、获得和坚持高效抗逆转录病毒治疗:近期研究结果及其对护理的影响的简要回顾

HIV therapy

Pub Date : 2010-03-10 DOI: 10.2217/HIV.10.4

N. Palmer, J. Basiński, K. Uldall

This review outlines research since 2006 addressing psychiatric illness and/or co-occurring psychiatric illness and substance abuse as it relates to HAART access and adherence. Highlighted here are effective or promising interventions, or models of care, designed to enhance adherence among HIV-infected individuals with mental illness. Overall, we found that recent studies reinforce earlier findings that co-occurring substance abuse and psychiatric illness are associated with HAART nonadherence. Studies of depression/anxiety disorders among HIV patients reviewed here show that while depression is related to poorer medication adherence, treatment for depression can lead to increased HAART adherence. New studies also suggest that HIV patients with psychiatric diagnoses can effectively maintain HAART adherence with close monitoring by providers. While there are still very few adherence interventions among HIV patients with co-occurring mental illness and substance abuse, promising interventions include cognit...

本综述概述了自2006年以来针对精神疾病和/或共存精神疾病和药物滥用的研究，因为它与HAART的获取和依从性有关。这里强调的是有效的或有希望的干预措施，或护理模式，旨在加强精神疾病艾滋病毒感染者的依从性。总的来说，我们发现最近的研究强化了早期的发现，即同时发生的药物滥用和精神疾病与HAART不依从性有关。对艾滋病患者抑郁/焦虑障碍的研究表明，虽然抑郁症与较差的药物依从性有关，但抑郁症的治疗可以增加HAART的依从性。新的研究还表明，被诊断为精神疾病的艾滋病毒患者可以在提供者的密切监测下有效地维持HAART的依从性。虽然在同时患有精神疾病和药物滥用的艾滋病毒患者中，仍然很少有依从性干预措施，但有希望的干预措施包括认知…

引用次数: 8

Successes and challenges of HIV treatment programs in Haiti: aftermath of the earthquake. 海地艾滋病治疗项目的成功与挑战:地震后。

HIV therapy

Pub Date : 2010-03-01 DOI: 10.2217/hiv.10.6

S Koenig, Lc Ivers, S Pace, R Destine, F Leandre, R Grandpierre, J Mukherjee, Pe Farmer, Jw Pape

Haiti's HIV/AIDS program is one of the most successful in the world, with a declining HIV prevalence, and treatment outcomes that rival those of industrialized nations. It is now on the way to providing universal treatment for HIV/AIDS nationwide. This success is tied to a strong foundation for HIV care that was in place before external funding became available that includes national guidelines prepared by the Ministry of Health, political commitment at the highest levels of government, non-governmental organizations that had been providing high quality care in Haiti for decades, and the assistance of the Global Fund to Fight AIDS, TB, and Malaria, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and other private donors.While the challenges of human resource shortages, widespread poverty, and limited infrastructure cannot be overstated, these are being addressed through the provision of integrated, comprehensive services. Haiti's successful treatment models are being duplicated around the world.

海地的艾滋病毒/艾滋病项目是世界上最成功的项目之一，艾滋病流行率下降，治疗效果可与工业化国家相媲美。目前，中国正在向全国普及艾滋病毒/艾滋病治疗迈进。这一成功与海地在获得外部资金之前就建立的坚实的艾滋病毒护理基础有关，包括卫生部制定的国家指导方针、政府最高层的政治承诺、几十年来一直在海地提供高质量护理的非政府组织，以及全球抗击艾滋病、结核病和疟疾基金、美国总统艾滋病紧急救援计划(PEPFAR)和其他私人捐助者的援助。虽然人力资源短缺、普遍贫穷和基础设施有限的挑战怎么强调都不为过，但这些挑战正在通过提供综合、全面的服务加以解决。海地成功的治疗模式正在世界各地被复制。

引用次数: 47

Measurement of antiretroviral drugs in the lungs of HIV-infected patients. 艾滋病毒感染者肺部抗逆转录病毒药物的测定。

HIV therapy

Pub Date : 2010-03-01 DOI: 10.2217/hiv.10.5

Homer L Twigg, Carol T Schnizlein-Bick, Michael Weiden, Fred Valentine, Joseph Wheat, Richard B Day, Helen Rominger, Lu Zheng, Ronald G Collman, Robert W Coombs, R Pat Bucy, Naser L Rezk, Angela Dm Kashuba

AIMS: Prior studies have shown that HAART is associated with decreased HIV viral load in the lungs. The correlation between antiretroviral exposure in bronchoalveolar lavage (BAL) fluid and virologic response was evaluated in patients starting HAART and enrolled in The AIDS Clinical Trial Group Protocol 723. MATERIALS #ENTITYSTARTX00026; METHODS: A total of 24 subjects underwent blood and BAL sampling prior to starting HAART, and after 4 and 24 weeks of HAART. Drug concentrations and HIV RNA were measured in paired plasma and BAL samples. RESULTS: Antiretroviral drugs, including efavirenz, were detectable in BAL fluid of HIV-infected subjects beginning HAART. Efavirenz was also associated with a higher likelihood of clearing HIV RNA from the lungs. CONCLUSION: These results suggest the excellent pulmonary virologic response to antiretroviral therapy may, in part, be due to penetration of antiretroviral drugs into the alveolar compartment.

目的:先前的研究表明，HAART与肺部HIV病毒载量的降低有关。在开始HAART治疗并加入艾滋病临床试验组方案723的患者中，评估了支气管肺泡灌洗液(BAL)中抗逆转录病毒暴露与病毒学反应之间的相关性。材料# ENTITYSTARTX00026;方法:共有24名受试者在开始HAART治疗前，以及在HAART治疗4周和24周后接受血液和BAL采样。在配对血浆和BAL样本中测量药物浓度和HIV RNA。结果:在开始HAART治疗的hiv感染者BAL液中检测到抗逆转录病毒药物，包括依非韦伦。依非韦伦还与从肺部清除HIV RNA的可能性更高有关。结论:这些结果表明，抗逆转录病毒治疗的优异的肺病毒学应答可能部分是由于抗逆转录病毒药物渗透到肺泡间室。

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引用次数: 26

At the forefront of retrovirology research: Frontiers of Retrovirology 逆转录病毒研究的前沿:逆转录病毒前沿

HIV therapy

Pub Date : 2010-01-01 DOI: 10.2217/HIV.09.54

T. Bar-Magen, Richard Sloan, M. Wainberg

The call for submissions at the first Frontiers of Retrovirology Conference was inclusive; all fields of retrovirology research were welcome and, as of such, participants presented on a wide range of topics; from endo-retroviruses through to HIV vaccines. With this broad palette, an enjoyable, concise exchange of thoughts and perspectives between different, though connected, fields of research was achieved. In this article, the range of topics addressed at this first meeting are discussed and we consider some of the major issues presented.

在第一届逆转录病毒前沿会议上的提交呼吁是包容性的;所有领域的逆转录病毒学研究都受到欢迎，因此，与会者就广泛的主题进行了介绍;从内逆转录病毒到HIV疫苗有了这个广阔的调色板，在不同的研究领域之间进行了一次愉快、简洁的思想和观点交流，尽管这些研究领域是相互联系的。在本文中，讨论了第一次会议上讨论的主题范围，并考虑了提出的一些主要问题。

引用次数: 0

Strategies and approaches to purge the latent reservoir of HIV 清除艾滋病毒潜伏库的策略和方法

HIV therapy

Pub Date : 2010-01-01 DOI: 10.2217/HIV.09.50

X. Contreras, K. Bartholomeeusen, B. Peterlin

Despite the many successes of HAART, HIV persists in the host and is rapidly reactivated following treatment interruption. In addition, all vaccines against primate lentiviruses have failed. Thus, there is renewed emphasis on efforts to purge the reservoir of HIV and, thereby, eliminate the virus from the infected host. Although only a small number of CD4+ T cells harbor silent integrated proviruses, some of these cells are long lived. Therefore, HIV infection persists for the life of the individual and the viral reservoir decays with extremely slow kinetics. Basic research on HIV for over 20 years, has revealed how the virus is silenced and how it can be reactivated. These findings suggest that in the setting of optimal HAART, the goal of purging the viral reservoir and eliminating HIV from the host might be achievable.

尽管HAART取得了许多成功，但艾滋病毒在宿主体内持续存在，并在治疗中断后迅速重新激活。此外，所有针对灵长类慢病毒的疫苗都失败了。因此，重新强调清除艾滋病毒储存库的努力，从而从受感染的宿主中消除病毒。虽然只有少数CD4+ T细胞携带沉默的整合前病毒，但其中一些细胞寿命很长。因此，HIV感染在个体的生命中持续存在，病毒库以极其缓慢的动力学衰变。对艾滋病毒进行了20多年的基础研究，揭示了这种病毒是如何沉默的，以及它是如何重新激活的。这些发现表明，在最佳HAART的设置下，清除病毒库和从宿主中消除HIV的目标可能是可以实现的。

引用次数: 0

Implementation of cervical cancer prevention services for HIV-infected women in Zambia: measuring program effectiveness. 在赞比亚为感染艾滋病毒的妇女提供宫颈癌预防服务:衡量方案效果。

HIV therapy

Pub Date : 2010-01-01 DOI: 10.2217/hiv.10.52

Groesbeck P Parham, Mulindi H Mwanahamuntu, Vikrant V Sahasrabuddhe, Andrew O Westfall, Kristin E King, Carla Chibwesha, Krista S Pfaendler, Gracilia Mkumba, Victor Mudenda, Sharon Kapambwe, Sten H Vermund, Michael L Hicks, Jeffrey Sa Stringer, Benjamin H Chi

Background: Cervical cancer kills more women in low-income nations than any other malignancy. A variety of research and demonstration efforts have proven the efficacy and effectiveness of low-cost cervical cancer prevention methods but none in routine program implementation settings of the developing world, particularly in HIV-infected women.

Methods: In our public sector cervical cancer prevention program in Zambia, nurses conduct screening using visual inspection with acetic acid aided by digital cervicography. Women with visible lesions are offered same-visit cryotherapy or referred for histologic evaluation and clinical management. We analyzed clinical outcomes and modeled program effectiveness among HIV-infected women by estimating the total number of cervical cancer deaths prevented through screening and treatment.

Results: Between 2006 and 2008, 6572 HIV-infected women were screened, 53.6% (3523) had visible lesions, 58.5% (2062) were eligible for cryotherapy and 41.5% (1461) were referred for histologic evaluation. A total of 75% (1095 out of 1462) of patients who were referred for evaluation complied. Pathology results from 65% (715 out of 1095) of women revealed benign abnormalities in 21% (151), cervical intraepithelial neoplasia (CIN) I in 30% (214), CIN 2/3 in 33% (235) and invasive cervical cancer in 16.1% (115, of which 69% were early stage). Using a conditional probability model, we estimated that our program prevented 142 cervical cancer deaths (high/low range: 238-96) among the 6572 HIV-infected women screened, or one cervical cancer death prevented per 46 (corresponding range: 28-68) HIV-infected women screened.

Conclusion: Our prevention efforts using setting-appropriate human resources and technology have reduced morbidity and mortality from cervical cancer among HIV-infected women in Zambia. Financial support for implementing cervical cancer prevention programs integrated within HIV/AIDS care programs is warranted. Our prevention model can serve as the implementation platform for future low-cost HPV-based screening methods, and our results may provide the basis for comparison of programmatic effectiveness of future prevention efforts.

背景:在低收入国家，宫颈癌比其他任何恶性肿瘤致死的妇女都多。各种研究和示范工作证明了低成本宫颈癌预防方法的功效和效果，但在发展中国家的常规方案执行环境中，特别是在感染艾滋病毒的妇女中，没有任何效果。方法:在赞比亚的公共部门宫颈癌预防项目中，护士使用醋酸目视检查辅助数字宫颈造影进行筛查。有明显病变的妇女可接受同访冷冻治疗或转诊进行组织学评估和临床处理。通过估计通过筛查和治疗预防的宫颈癌死亡总数，我们分析了艾滋病毒感染妇女的临床结果并模拟了项目的有效性。结果:2006年至2008年期间，6572名感染艾滋病毒的妇女接受了筛查，53.6%(3523人)有明显病变，58.5%(2062人)符合冷冻治疗条件，41.5%(1461人)接受了组织学评估。共有75%(1462名患者中的1095名)的患者接受了评估。65%(715 / 1095)的女性病理结果显示，良性异常21%(151)，宫颈上皮内瘤变(CIN) 1型占30% (214)，CIN 2/3型占33%(235)，浸润性宫颈癌占16.1%(115例，其中69%为早期)。使用条件概率模型，我们估计我们的方案在筛查的6572名感染艾滋病毒的妇女中预防了142例宫颈癌死亡(高/低范围:238-96)，或者每46名(相应范围:28-68)接受筛查的感染艾滋病毒的妇女中预防了1例宫颈癌死亡。结论:我们利用适当的人力资源和技术进行预防工作，降低了赞比亚感染艾滋病毒妇女宫颈癌的发病率和死亡率。为实施与艾滋病毒/艾滋病护理方案相结合的宫颈癌预防方案提供财政支持是必要的。我们的预防模型可以作为未来低成本hpv筛查方法的实施平台，我们的结果可以为未来预防工作的规划效果比较提供依据。

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引用次数: 3

Indian manufacture of new generic antiretrovirals: implications for global access to anti-HIV drugs 印度生产新的非专利抗逆转录病毒药物:对全球获得抗艾滋病毒药物的影响

HIV therapy

Pub Date : 2010-01-01 DOI: 10.2217/HIV.09.55

K. Venkatesh, N. Kumarasamy, K. Mayer

India’s ruling on patent protection India recently rejected patent applications on two antiretrovirals (ARVs), darunavir and tenofovir, which ensures the continued generic manufacturing of these drugs at substantially reduced costs compared with proprietary formulations [1]. The ruling by India’s Patent Office (IPO) to reject the exclusive licensing of the nucleoside reverse-transcriptase inhibitor tenofovir (Gilead Sciences, CA, USA) and protease inhibitor (PI) darunavir (Tibotec Pharmaceuticals, NJ, USA) also allows other countries to import generic versions produced in India. Cipla, the Mumbai-based generic drug manufacturer, had filed cases against both companies. Even before the anticipated outcome, Gilead had already offered 13 Indian drug manufactures the licensing rights to manufacture tenofovir, but with the caveat that the Indian manufacturers purchase the active drug ingredient from Gilead and that the product be sold only to the poorest 95 countries (which does not include middle-income countries, such as China and Brazil). The patent rejection potentially opens up the market for generic drug manufactures to further drive down the cost of these two ARVs, and may have wider implications for the future development and distribution of ARVs.

印度最近驳回了darunavir和tenofovir两种抗逆转录病毒药物(arv)的专利申请，这确保了与专利制剂相比，这些药物的仿制生产成本大大降低[1]。印度专利局(IPO)拒绝核苷类逆转录酶抑制剂替诺福韦(Gilead Sciences, CA, USA)和蛋白酶抑制剂darunavir (Tibotec Pharmaceuticals, NJ, USA)的独家许可的裁决也允许其他国家进口印度生产的仿制药。总部位于孟买的仿制药制造商Cipla对这两家公司提起了诉讼。甚至在预期结果出现之前，吉利德就已经向13家印度制药商提供了替诺福韦的生产许可，但有一个警告，即印度制药商必须从吉利德购买活性药物成分，而且该产品只能出售给最贫穷的95个国家(不包括中国和巴西等中等收入国家)。专利驳回可能为仿制药制造商打开市场，进一步降低这两种抗逆转录病毒药物的成本，并可能对未来抗逆转录病毒药物的开发和分销产生更广泛的影响。

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引用次数: 4

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