Scaling Up Treatment for the Global AIDS Pandemic Challenges and Opportunities (2005) / Chapter Skim
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Appendix B: Primer on Humanimmunodeficiency Virus, Acquired Immune Deficiency Syndrome and Antiretroviral Therapy
Appendix B: Primer on Humanimmunodeficiency Virus, Acquired Immune Deficiency Syndrome and Antiretroviral Therapy
Pages 207-219
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From page 207... ...
HUMAN IMMUNODEFICIENCY VIRUS AND THE ACQUIRED IMMUNE DEFICIENCY SYNDROME Human immunodeficiency virus (HIV) is a single-stranded RNA virus of the Retroviridae family.
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From page 208... ...
In resource-rich countries where ARVs have been available and affordable for several years, HIV infection has ceased to be considered an automatic death sentence. With carefully managed therapy and a motivated patient, HIV infection is a serious but treatable chronic disease that does not necessarily preclude additional decades of good quality life.
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From page 209... ...
. The NNRTIs bind to the reverse transcriptase enzyme and change the "shape" of the enzyme thereby preventing the enzyme's action of transcribing viral RNA into viral DNA.
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From page 210... ...
Nearly 10 years after the introduction of AZT, the PIs and NNRTIs were approved. Based on clinical trials using these newer drug classes, it was quickly learned that combination therapy was superior in reducing viral load, delaying the emergence of HIV drug resistance, slowing the rate of immune destruction (i.e., CD4 cell decline)
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From page 211... ...
Metabolic derangements, as described above, also are more frequently associated with this class of drugs. Based on early clinical trial studies of the newest class of drugs, the fusion inhibitors, adverse events associated with the drug in this class include: local injection-site reactions such as the development of painful, pruritic subcutaneous nodules; eosinophilia (rarely associated with systemic hypersensitivity)
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From page 212... ...
Suboptimal exposure can result from underdosing, improper prescription of antiretroviral regimens, poor adherence, altered drug metabolism, and the presence of tissue sanctuaries where virions "hide" from the action of drug therapy (Deeks, 2002)
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From page 213... ...
Invirase hyperlipidemia Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs) Delavirdine Rescriptor transient rash; increase in liver enzymes Efavirenz Sustiva transient rash; insomnia; vivid dreams; rare suicidal/homicidal ideation Nevirapine Viramune transient rash; hepatitis Fusion Inhibitors Enfuvirtide (T-20)
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From page 214... ...
Mono or dual therapy combinations should be avoided because of their inferior antiretroviral activity and high risk of fostering resistance. A combination therapy with three or more drugs -- from different classes -- is the recommended treatment regimen.
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From page 215... ...
recommendations for starting therapy based on laboratory criteria are (U.S.
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From page 216... ...
The ability to use laboratory testing to monitor toxicities may influence the regimens chosen in the developing world where technological infrastructure may be limited. Finally, pharmacological interactions between antiretroviral and antituberculosis drugs is a more common concern in resource constrained settings.
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From page 217... ...
The WHO recognizes this fact and recommends using clinical criteria and, when available, laboratory criteria to initiate and monitor therapy for HIV-infected persons in these constrained settings. For further information regarding the advantages and disadvantages of the WHO-recommended regimens and the criteria used to start therapy, the reader is directed to the WHO 2003 Revision of Scaling Up Antiretroviral Therapy in Resource-Limited Setting: Treatment Guidelines for a Public Health Approach available at http://www.who.int/3by5/publications/documents/arv_guidelines/en/.
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From page 218... ...
2003. Antiretroviral drug resistance testing in adults infected with human immunodeficiency virus type 1: 2003 recommendations of an international AIDS society-USA panel.
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From page 219... ...
2003a. Scaling Up Antiretroviral Therapy in Resource Limited Settings: Treatment Guidelines for a Public Health Approach.
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