Antiretroviral Treatment 2010: Progress and Controversies

Division of Infectious Diseases, Weill Medical College of Cornell University, New York, NY 10065, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 12/2010; 55 Suppl 1(Suppl 1):S43-8. DOI: 10.1097/QAI.0b013e3181f9c09e
Source: PubMed


Effective antiretroviral therapy (ART) changes the clinical course of HIV infection. There are 25 antiretroviral drugs approved for the treatment of HIV infection, and current antiretroviral drug regimens are highly effective, convenient, and relatively nontoxic. ART regimens should be chosen in consideration of a patient's particular clinical situation. Successful treatment is associated with durable suppression of HIV viremia over years, and consequently, ART reduces the risk of clinical progression. In fact, current models estimate that an HIV-infected individual appropriately treated with antiretroviral drugs has a life expectancy that approaches that of the general HIV-uninfected population, although some patient groups such as injection drug users do less well. Despite these advances, continued questions about ART persist: What is the optimal time to start ART? What is the best regimen to start? When is the optimal time to change ART? What is the best regimen to change to? In addition, newer antiretroviral agents are in development, both in existing classes and in new classes such as the CD4 receptor attachment inhibitors and the maturation inhibitors. Further research will help optimize current antiretroviral treatments and strategies.

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    • "A high level of adherence to antiretroviral therapy (ART) is necessary to maintain viral suppression and achieve optimal clinical outcomes for HIV-infected persons [1] [2], though there is little consensus on the minimum threshold of adherence needed for virologic suppression [3] [4]. "
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    ABSTRACT: Antiretroviral therapy (ART) is the cornerstone of HIV clinical care and is increasingly recognized as a key component of HIV prevention. However, the benefits of ART can be realized only if HIV-infected persons maintain high levels of adherence. We present interview data (collected from June 2007 through September 2008) from a national HIV surveillance system in the United States-the Medical Monitoring Project (MMP)-to describe persons taking ART. We used multivariate logistic regression to assess behavioral, sociodemographic, and medication regimen factors associated with three measures that capture different dimensions of nonadherence to ART: dose, schedule, and instruction. The use of ART among HIV-infected adults in care was high (85%), but adherence to ART was suboptimal and varied across the three measures of nonadherence. Of MMP participants currently taking ART, the following reported nonadherence during the past 48 hours: 13% to dose, 27% to schedule, and 30% to instruction. The determinants of the three measures also varied, although younger age and binge drinking were associated with all aspects of nonadherence. Our results support the measurement of multiple dimensions of medication-taking behavior in order to avoid overestimating adherence to ART.
    Full-text · Article · Sep 2012 · The Open AIDS Journal
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    • "In conclusion, the issue of HIV infection in gynecological treatment and care will become more prominent as more women in the US screen positive for HIV [4], and treatment adds years to women's lives [3]. Our study adds to the evidence that HIV infection is an important consideration in gynecologic treatment and care. "
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    ABSTRACT: To compare frequencies of complications among HIV-infected and-uninfected women undergoing common gynecological surgical procedures in inpatient settings. We used 1994-2007 data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, a nationally representative sample of inpatient hospitalizations. Our analysis included discharge records of women aged ≥15 undergoing hysterectomy, oophorectomy, salpingectomy for ectopic pregnancy, bilateral tubal sterilization, or dilation and curettage. Associations between HIV infection status and surgical complications were evaluated in multivariable logistic regression models, adjusting for key covariates. For each surgery, HIV infection was associated with experiencing ≥1 complication. Adjusted ORs ranged from 2.0 (95% confidence interval (CI): 1.7, 2.2) for hysterectomy with oophorectomy to 3.1 (95% CI: 2.4, 4.0) for bilateral tubal sterilization with no comorbidity present. HIV infection was positively associated with extended length of stay and infectious complications of all of the surgeries examined. For some surgeries, it was positively associated with transfusion and anemia due to acute blood loss. Among HIV-infected women, the odds of infectious and other complications did not decrease between 1994-2000 and 2001-2007. HIV infection was associated with elevated frequencies of complications of gynecologic surgeries in the US, even in the era of HAART.
    Full-text · Article · May 2012 · Infectious Diseases in Obstetrics and Gynecology
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    Preview · Article · Dec 2010 · JAIDS Journal of Acquired Immune Deficiency Syndromes
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