Standard-dose efavirenz vs. standard-dose nevirapine in antiretroviral regimens among HIV-1 and tuberculosis co-infected patients who received rifampicin.
ABSTRACT There is limited comparative data between efavirenz (EFV) 600 mg/day and nevirapine (NVP) 400 mg/day-based antiretroviral therapy (ART) among HIV-1 patients with tuberculosis (TB) and receiving rifampicin.
A retrospective cohort study was conducted in all ART-naïve patients who were receiving rifampicin between January 2002 and December 2005.
Of 188 patients, 77 and 111 patients were initiated on EFV-based ART (EFV group) and NVP-based ART (NVP group), respectively. Overall, median [interquartile range (IQR)] CD4 count was 36 (15-77) cells/microL and median (IQR) viral load was 5.6 (5.2-5.9) HIV-1 RNA log copies/mL. At 48 weeks, 77.9% (60/77) in the EFV group and 67.6% (75/111) in the NVP group achieved HIV-1 RNA <50 copies/mL (P=0.140, odds ratio=0.590, 95% confidence interval=0.302-1.153). At 24 and 48 weeks, respective median CD4 counts were 174 and 254 cells/muL in the EFV group and 156 and 218 cells/microL in the NVP group (P>0.05). By binary logistic regression, treatment group was not associated with HIV-1 RNA <50 copies/mL (P>0.05). No patient in the EFV group and eight (7.2%) patients in the NVP group discontinued ART because of adverse reactions (P=0.084).
For HIV-TB co-infected patients who receive rifampicin, efficacy of 600 mg EFV-based and 400 mg NVP-based ART may be similar, although adverse events tend to be higher in NVP-based ART.
Full-textDOI: · Available from: Somnuek Sungkanuparph, Dec 18, 2014
- SourceAvailable from: thailand.digitaljournals.org[Show abstract] [Hide abstract]
ABSTRACT: R SpecialIssue ecently, a report suggested that the epidemic of human immune deficiency virus (HIV) infection may have reached its peak. Although the number of new cases is reducing, the number of people living with HIV has not decreased as the patients survive in this era in which effective antiretroviral therapy has been widely accessible. The knowledge about HIV disease has never been this immense. The challenges facing us have changed from treating the dying diseased cases complicated with opportunistic infections to dealing with the problems related to long-term treatment including life-long adhe-rence, drug adverse effects, drug resistance, and the need for a newer generation with less toxic drugs. In children, additional challenges are related to adolescent problems. This review summarizes the challenging issues of this era in treating HIV-infected children. The overview disease burden In 2009, there were 33.3 million people living with HIV worldwide, of which 5-10% were children. 1 The majority of them are living in Sub-Saharan Africa. In Thailand, an estimated 400,000 infected people with HIV were reported in 2009, of which approximately 15,000-20,000 were children. Nearly all of them were acquired perinatally. The prevalence of HIV infection among pregnant women in Thailand has declined from 1.74% in 1999 to 0.64% in 2009. After the implementation of a nation-wide prevention-of-mother-to-child-transmission (PMTCT) program, the rate of perinatal transmission has decreased from 25% to 2-4%. 2 Diagnosis of HIV infection in perinatally HIV-exposed infants Virologic assay, either HIV DNA-PCR or RNA-PCR assay, can be used for diagnosis of HIV infection in infants. Because of the maternally transferred anti-HIV antibody, the serologic test causes a false positive in uninfected young infants. The PCR is recommended to be performed at least 2 times at age 1-2 months and 4-6 months. At age 12-18 months of age, the HIV antibody test should always be performed to confirm the diagnosis regardless of the results of prior virologic tests. HIV infection can be definitely diagnosed by the presence of HIV antibody in children aged ≥ 18 months. Definitive exclusion of HIV infection can be made by no clinical or virologic evidence of HIV infection plus one of the fol-lowing criteria: 1) at least two negative HIV PCR assays which are performed at age ≥ 1 month and ≥ 4 months, 2) at least two negative HIV antibody tests at ≥ 6 months of age, 3) one negative HIV PCR at age ≥ 4 months and absence of HIV antibody after 6 months of age. 3 Management of HIV-infected children: the current Thai guidelines HIV-infected children require routine care and an-ticipatory guidance similar to normal children. All HIV-infected children should be immunized with the same schedule as uninfected children except that children with severe immune suppression (CD4 percentage < 15% or CD4 count < 200 cells/mm 3) or severely symptomatic disease status should not receive live-attenuated vaccine such as mumps-measles-rubella or varicella vaccine. Moreover, all HIV-exposed infants with unknown infection status from 4-6 weeks of age, should receive chemoprophylaxis against Pneumocystis jiroveci pneumonia (PCP) until HIV infection can be excluded. Cotrimoxazole is the drug of choice. Likewise, infected children younger than 12 months or those with CD4 < 15%; or < 200 cells/mm 3 in children older than 5 years, should also receive PCP prophylaxis. This is because the risk of PCP development is quite high in HIV-infected infants < 12 months regardless of their CD4 levels. Highly active antiretroviral therapy (HAART) has been the principle of treatment of HIV infection. HAART normalizes immunologic function, prevents opportunistic infection and mortality. With HAART, HIV has been changed from a deadly disease to a chronic disease in which patients can live a very normal life. HAART is generally composed of three drugs from at least two classes. The aims of antiretroviral therapy are to minimize viral load, maintain viral suppression, preserve immune function, maintain normal growth and development, and improve the quality of life.
Conference Paper: Asymptotic performance of product codes[Show abstract] [Hide abstract]
ABSTRACT: This paper presents the asymptotic performance of Hamming and extended Hamming product codes for the binary symmetric channel and the additive white Gaussian noise (AWGN) channel. Simulation results for very low complexity high dimensional single parity check product codes on the AWGN channel are also givenCommunications, 1999. ICC '99. 1999 IEEE International Conference on; 02/1999
Article: Tuberculosis and HIV in India.New England Journal of Medicine 04/2007; 356(12):1198-9. DOI:10.1056/NEJMp078049 · 54.42 Impact Factor