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Author Topic: HIV Resistance and Antiretrovirals  (Read 925 times)

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Offline Mishma

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  • Posts: 190
    • Marquis de Vauban
HIV Resistance and Antiretrovirals
« on: July 22, 2012, 04:07:51 PM »
From Medscape Medical News
WHO: HIV Resistance From Antiretrovirals Still Manageable
Emma Hitt, PhD

 

July 20, 2012 Although HIV drug resistance in low- and middle-income countries is on the rise, it has not occurred at the levels that would be expected after the rapid scale-up of antiretroviral therapy that has occurred since 2003, according to a new report from the World Health Organization (WHO).

The WHO report, available on the organization's Web site, reviews data on HIV drug resistance in low- and middle-income countries between 2003 and 2010.

The authors of the report conclude that with respect to acquired drug resistance, when people are switched to second-line regimens soon after virological failure, standard second-line treatment combinations are likely to be effective for most patients. They also conclude that drug resistance surveillance provides important information on the effectiveness of treatment programs and services.

According to the WHO, some 8 million people are now taking antiretroviral drugs (ARVs) in low- and middle-income countries, a dramatic 26-fold increase from December 2003.

"By 2010, the amount of HIV that was resistant to ARVs among people initiating treatment in the areas surveyed for the report, stood at 6.8%," the WHO press release states. "Over a similar period of time after introducing ARVs in high income countries, slightly higher rates of drug resistance between 8-14%, depending on the region were being reported."

According to Silvia Bertagnolio, MD, from the WHO's HIV Department, and colleagues, factors that have contributed to these low levels of resistance include "good program management and the use of simpler, more effective combinations of antiretrovirals than those originally introduced in high-income countries in the 1990s."

"Simpler regimens using fixed-dose combinations have made it much easier for people to adhere to antiretroviral treatment, limiting the spread of drug resistance in recent years. This is good news for public health," noted Gottfried Hirnschall, MD, MPH, director of WHO's HIV Department, in the news release. "Our task now is to ensure that drug resistance remains limited and manageable."

The surveys were conducted in 12 low- and middle-income countries and show that more than a third of people who start taking ARVs lose contact with their healthcare facilities, which increases the risk for drug resistance resulting from lack of adherence and the emergence of resistant strains.

"The surveys also highlight the need for stronger tracing and routine surveillance of HIV drug resistance in low- and middle-income countries to alert programme planners to patterns of drug resistance," the WHO states in its release.

The WHO recommends that every clinic providing antiretroviral treatment use a set of early warning indicators that could point to drug resistance. These indicators (or lack thereof) include adherence to treatment, the type of medicines used, continuous drug supply, and access to health facilities.

HIV viral load at 12 months should be used to identify treatment failure at an early stage, the WHO notes.

 
2016 CD4 25% UD (less than 20). 27+ years positive. Isentress, Truvada, Acyclovir, Clonazepam, Zolpidem, Bupropion, Lisinopril, Pravastatin, Quetiapine, Doxcycline, Testosterone, Suatriptan/Naproxen, Restasis, Dorzolamide, Latanoprost, Asprin, lortab, Levothyroxine, Fioricet, Restasis, Triamclinolone, Nitrostat.

Offline leatherman

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Re: HIV Resistance and Antiretrovirals
« Reply #1 on: July 22, 2012, 06:01:34 PM »
"By 2010, the amount of HIV that was resistant to ARVs among people initiating treatment in the areas surveyed for the report, stood at 6.8%,"

The surveys were conducted in 12 low- and middle-income countries and show that more than a third of people who start taking ARVs lose contact with their healthcare facilities, which increases the risk for drug resistance resulting from lack of adherence and the emergence of resistant strains.
wonder if this means in the future we'll see that 6.8% rising? A situation like over a third of the people losing contact with their healthcare facilities doesn't bode well to remaining adherent and suggests that the rate of resistance could increase.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline Mishma

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  • Posts: 190
    • Marquis de Vauban
Re: HIV Resistance and Antiretrovirals
« Reply #2 on: July 22, 2012, 06:27:10 PM »
According to my doc at the VA, medication compliance among the new generation of Vets is horrible and we are in the first world.
 
2016 CD4 25% UD (less than 20). 27+ years positive. Isentress, Truvada, Acyclovir, Clonazepam, Zolpidem, Bupropion, Lisinopril, Pravastatin, Quetiapine, Doxcycline, Testosterone, Suatriptan/Naproxen, Restasis, Dorzolamide, Latanoprost, Asprin, lortab, Levothyroxine, Fioricet, Restasis, Triamclinolone, Nitrostat.

 


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