The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of adults with HIV infection with antiretroviral therapy (ART). The scope includes: (i) guidance on the initiation of ART in those previously naïve to therapy; (ii)support of patients on treatment; (iii) management of patients experiencing virological failure; and (iv) recommendations in specific patient populations where other factors need to be taken into consideration. The guidelines are aimed at clinical professionals directly involved with and responsible for the care of adults with HIV infection and at community advocates responsible for promoting the best interests and care of HIV-positive adults. They should be read in conjunction with other published BHIVA guidelines.
"The 2012 BHIVA guidelines recommend that women opting to use ZDVm for PMTCT start ZDVm before 24 weeks of pregnancy . Pregnant women not on ART with CD4 ≤ 350 cells/mm3 are recommended to initiate long-term ART, as per the general UK HIV treatment guidelines . "
[Show abstract][Hide abstract] ABSTRACT: Short-term zidovudine monotherapy (ZDVm) remains an option for some pregnant HIV-positive women not requiring treatment for their own health but may affect treatment responses once antiretroviral therapy (ART) is subsequently started.
Data were obtained by linking two UK studies: the UK Collaborative HIV Cohort (UK CHIC) study and the National Study of HIV in Pregnancy and Childhood (NSHPC). Treatment responses were assessed for 2028 women initiating ART at least one year after HIV-diagnosis. Outcomes were compared using logistic regression, proportional hazards regression or linear regression.
In adjusted analyses, ART-naive (n = 1937) and ZDVm-experienced (n = 91) women had similar increases in CD4 count and a similar proportion achieving virological suppression; both groups had a low risk of AIDS.
In this setting, antenatal ZDVm exposure did not adversely impact on outcomes once ART was initiated for the woman's health.
[Show abstract][Hide abstract] ABSTRACT: Stavudine is being phased out because of its mitochondrial toxicity and tenofovir (TDF) is recommended as part of first-line highly active antiretroviral therapy (HAART) in South Africa. A prospective, open-label, randomized controlled trial comparing standard- and low-dose stavudine with TDF was performed to assess early differences in adipocyte mtDNA copy number, gene expression and metabolic parameters in Black South African HIV-infected patients.
Sixty patients were randomized 1:1:1 to either standard-dose (30–40 mg) or low-dose (20–30 mg) stavudine or TDF (300 mg) each combined with lamivudine and efavirenz. Subcutaneous fat biopsies were obtained at weeks 0 and 4. Adipocyte mtDNA copies/cell and gene expression were measured using quantitative polymerase chain reaction (qPCR). Markers of inflammation and lipid and glucose metabolism were also assessed.
A 29% and 32% decrease in the mean mtDNA copies/cell was noted in the standard-dose (P < 0.05) and low-dose stavudine (P < 0.005) arms, respectively, when compared with TDF at 4 weeks. Nuclear respiratory factor-1 (NRF1) and mitochondrial cytochrome B (MTCYB) gene expression levels were affected by stavudine, with a significantly (P < 0.05) greater fall in expression observed with the standard, but not the low dose compared with TDF. No significant differences were observed in markers of inflammation and lipid and glucose metabolism.
These results demonstrate early mitochondrial depletion among Black South African patients receiving low and standard doses of stavudine, with preservation of gene expression levels, except for NRF1 and MTCYB, when compared with patients on TDF.
HIV Medicine 10/2012; 14(4). DOI:10.1111/j.1468-1293.2012.01054.x
[Show abstract][Hide abstract] ABSTRACT: Following the rapid scale-up of the programme for universal access to antiretroviral therapy (ART) in southern Africa, resistance
to antiretroviral medications will occur. A detectable viral load must be treated as an emergency and should trigger intensive
patient tracking and adherence counselling. In contrast to the developed world, the incidence of transmitted resistance is still
low in most areas in the region. Therefore, in this consensus statement we do not recommend resistance testing in HIV-infected
adults upon diagnosis or ART initiation. However, baseline resistance testing is recommended for children who have been
exposed to ART for prevention of mother-to-child-transmission therapy and subsequently become HIV-infected. Resistance
testing is also recommended after virological failure of first- and second-line ART regimens.
Southern African Journal of HIV Medicine 11/2012; 13(4):162-167. DOI:10.7196/SAJHIVMED.874
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