These are representative sample records from Science.gov related to your search topic.
For comprehensive and current results, perform a real-time search at Science.gov.
1

Agreement between physicians and non-physician clinicians in starting antiretroviral therapy in rural Uganda  

PubMed Central

Background The scarcity of physicians in sub-Saharan Africa – particularly in rural clinics staffed only by non-physician health workers – is constraining access to HIV treatment, as only they are legally allowed to start antiretroviral therapy in the HIV-positive patient. Here we present a pilot study from Uganda assessing agreement between non-physician clinicians (nurses and clinical officers) and physicians in their decisions as to whether to start therapy. Methods We conducted the study at 12 government antiretroviral therapy sites in three regions of Uganda, all of which had staff trained in delivery of antiretroviral therapy using the WHO Integrated Management of Adult and Adolescent Illness guidelines for chronic HIV care. We collected seven key variables to measure patient assessment and the decision as to whether to start antiretroviral therapy, the primary variable of interest being the Final Antiretroviral Therapy Recommendation. Patients saw either a clinical officer or nurse first, and then were screened identically by a blinded physician during the same clinic visit. We measured inter-rater agreement between the decisions of the non-physician health workers and physicians in the antiretroviral therapy assessment variables using simple and weighted Kappa analysis. Results Two hundred fifty-four patients were seen by a nurse and physician, while 267 were seen by a clinical officer and physician. The majority (> 50%) in each arm of the study were in World Health Organization Clinical Stages I and II and therefore not currently eligible for antiretroviral therapy according to national antiretroviral therapy guidelines. Nurses and clinical officers both showed moderate to almost perfect agreement with physicians in their Final Antiretroviral Therapy Recommendation (unweighted ? = 0.59 and ? = 0.91, respectively). Agreement was also substantial for nurses versus physicians for assigning World Health Organization Clinical Stage (weighted ? = 0.65), but moderate for clinical officers versus physicians (? = 0.44). Conclusion Both nurses and clinical officers demonstrated strong agreement with physicians in deciding whether to initiate antiretroviral therapy in the HIV patient. This could lead to immediate benefits with respect to antiretroviral therapy scale-up and decentralization to rural areas in Uganda, as non-physician clinicians – particularly clinical officers – demonstrated the capacity to make correct clinical decisions to start antiretroviral therapy. These preliminary data warrant more detailed and multicountry investigation into decision-making of non-physician clinicians in the management of HIV disease with antiretroviral therapy, and should lead policy-makers to more carefully explore task-shifting as a shorter-term response to addressing the human resource crisis in HIV care and treatment. PMID:19695083

Vasan, Ashwin; Kenya-Mugisha, Nathan; Seung, Kwonjune J; Achieng, Marion; Banura, Patrick; Lule, Frank; Beems, Megan; Todd, Jim; Madraa, Elizabeth

2009-01-01

2

When to start antiretroviral therapy and what to start with—a European perspective  

Microsoft Academic Search

Although antiretroviral combination therapy has greatly improved the life expectancy of HIV-infected individuals, its use\\u000a is hampered by considerable toxicity, the need for life-long near-perfect adherence to strict dosing regimens in order to\\u000a avoid the emergence of drug resistance, and high cost. In this paper we review current understanding of when to best initiate\\u000a antiretroviral therapy and what regimen to

Ferdinand W. N. M. Wit; Peter Reiss

2003-01-01

3

Mortality of HIV-Infected Patients Starting Antiretroviral Therapy in Sub-Saharan Africa: Comparison with HIV-  

E-print Network

active antiretroviral therapy (ART) has declined in sub-Saharan Africa, but it is unclear how mortalityMortality of HIV-Infected Patients Starting Antiretroviral Therapy in Sub-Saharan Africa patients starting ART with non-HIV­related background mortality in four countries in sub- Saharan Africa

Paris-Sud XI, Université de

4

Early loss to program in HIV-infected patients starting potent antiretroviral therapy in lower-income countries  

E-print Network

starting antiretroviral therapy (ART) is important to monitor clinical outcomes and evaluate program combination therapy (ART) has substantially improved the prognosis of HIV-infected patients in industrialized1 Early loss to program in HIV-infected patients starting potent antiretroviral therapy in lower

Paris-Sud XI, Université de

5

Agreement between physicians and non-physician clinicians in starting antiretroviral therapy in rural Uganda  

Microsoft Academic Search

BACKGROUND: The scarcity of physicians in sub-Saharan Africa – particularly in rural clinics staffed only by non-physician health workers – is constraining access to HIV treatment, as only they are legally allowed to start antiretroviral therapy in the HIV-positive patient. Here we present a pilot study from Uganda assessing agreement between non-physician clinicians (nurses and clinical officers) and physicians in

Ashwin Vasan; Kwonjune J Seung; Marion Achieng; Patrick Banura; Frank Lule; Megan Beems; Jim Todd; Elizabeth Madraa

2009-01-01

6

Immune reconstitution inflammatory syndrome in an HIV/TB co-infected patient four years after starting antiretroviral therapy.  

PubMed

The Immune reconstitution inflammatory syndrome (IRIS) after starting antiretroviral therapy for HIV is well known. We describe an HIV seropositive woman, presenting 2 IRIS episodes associated with Mycobacterium tuberculosis. Exceptional was that the last episode occurred 4 years after initiating antiretroviral treatment, when her CD4+ lymphocyte count had been around 300 cells/mm3 for one year. PMID:17547295

Huyst, V; Lynen, L; Bottieau, E; Zolfo, M; Kestens, L; Colebunders, R

2007-01-01

7

When to start antiretroviral therapy in resource-limited settings: a human rights analysis  

PubMed Central

Background Recent evidence from developed and developing countries shows clear clinical and public health benefit to starting antiretroviral therapy (ART) earlier. While discussions about when to start ART have often focused on the clinical risks and benefits, the main issue is one of fair limit-setting. We applied a human rights framework to assess a policy of early treatment initiation according to the following criteria: public-health purpose; likely effectiveness; specificity; human rights burdens and benefits; potential for less restrictive approaches; and fair administration. Discussion According to our analysis, a policy of earlier ART initiation would better serve both public health and human rights objectives. We highlight a number of policy approaches that could be taken to help meet this aim, including increased international financial support, alternative models of care, and policies to secure the most affordable sources of appropriate antiretroviral drugs. Summary Widespread implementation of earlier ART initiation is challenging in resource-limited settings. Nevertheless, rationing of essential medicines is a restriction of human rights, and the principle of least restriction serves to focus attention on alternative measures such as adapting health service models to increase capacity, decreasing costs, and seeking additional international funding. Progressive realisation using well-defined steps will be necessary to allow for a phased implementation as part of a framework of short-term targets towards nationwide policy adoption, and will require international technical and financial support. PMID:20356356

2010-01-01

8

The effect of efavirenz versus nevirapine-containing regimens on immunologic, virologic and clinical outcomes in a prospective observational study  

PubMed Central

Objective To compare regimens consisting of either efavirenz or nevirapine and two or more nucleoside reverse transcriptase inhibitors (NRTIs) among HIV-infected, antiretroviral-naive, and AIDS-free individuals with respect to clinical, immunologic, and virologic outcomes. Design Prospective studies of HIV-infected individuals in Europe and the US included in the HIV-CAUSAL Collaboration. Methods Antiretroviral therapy-naive and AIDS-free individuals were followed from the time they started an NRTI, efavirenz or nevirapine, classified as following one or both types of regimens at baseline, and censored when they started an ineligible drug or at 6 months if their regimen was not yet complete. We estimated the ‘intention-to-treat’ effect for nevirapine versus efavirenz regimens on clinical, immunologic, and virologic outcomes. Our models included baseline covariates and adjusted for potential bias introduced by censoring via inverse probability weighting. Results A total of 15 336 individuals initiated an efavirenz regimen (274 deaths, 774 AIDS-defining illnesses) and 8129 individuals initiated a nevirapine regimen (203 deaths, 441 AIDS-defining illnesses). The intention-to-treat hazard ratios [95% confidence interval (CI)] for nevirapine versus efavirenz regimens were 1.59 (1.27, 1.98) for death and 1.28 (1.09, 1.50) for AIDS-defining illness. Individuals on nevirapine regimens experienced a smaller 12-month increase in CD4 cell count by 11.49 cells/?l and were 52% more likely to have virologic failure at 12 months as those on efavirenz regimens. Conclusions Our intention-to-treat estimates are consistent with a lower mortality, a lower incidence of AIDS-defining illness, a larger 12-month increase in CD4 cell count, and a smaller risk of virologic failure at 12 months for efavirenz compared with nevirapine. PMID:22546987

2013-01-01

9

Improved retention of patients starting antiretroviral treatment in Karonga District, northern Malawi, 2005-2012  

PubMed Central

Background Patient retention in antiretroviral therapy (ART) programs remains a major challenge in sub-Saharan Africa. We examined whether and why retention in ART care has changed with increasing access. Methods Retrospective cohort study combining individual data from ART registers and interview data, enabling us to link patients across different ART clinics in Karonga District, Malawi. We recorded information on all adults (?15 years) starting ART between July 2005 and August 2012, including those initiating due to pregnancy and breastfeeding (Option B+). Retention in care was defined as being alive and receiving ART at the end of study. Predictors of attrition were assessed using a multi-variable Cox-proportional hazards model. Results The number of clinics providing ART increased from one in 2005 to 16 in 2012. Six month retention increased from 73% (95%CI 71-76) to 93% (92-94) when comparing the 2005-06 and 2011-12 cohorts, and 12-month retention increased from 70% (67-73) to 92% (90-93). Over the study period, the proportion of patients starting ART at WHO stage 4 declined from 62% to 10%. Being a man, younger than 35 years, having a more advanced WHO stage and being part of an earlier cohort were all independently associated with attrition. Women starting ART for Option B+ experienced higher attrition than women of child-bearing age starting for other reasons. Conclusions In this area retention in care has increased dramatically. Improved health in patients starting ART and decentralization of ART care to peripheral health centres appear to be the major drivers for this change. PMID:24977375

Mzembe, Themba; Van Boeckel, Thomas P; Kayange, Michael; Jahn, Andreas; Chimbwandira, Frank; Glynn, Judith R; Crampin, Amelia C

2014-01-01

10

Life Expectancies of South African Adults Starting Antiretroviral Treatment: Collaborative Analysis of Cohort Studies  

PubMed Central

Background Few estimates exist of the life expectancy of HIV-positive adults receiving antiretroviral treatment (ART) in low- and middle-income countries. We aimed to estimate the life expectancy of patients starting ART in South Africa and compare it with that of HIV-negative adults. Methods and Findings Data were collected from six South African ART cohorts. Analysis was restricted to 37,740 HIV-positive adults starting ART for the first time. Estimates of mortality were obtained by linking patient records to the national population register. Relative survival models were used to estimate the excess mortality attributable to HIV by age, for different baseline CD4 categories and different durations. Non-HIV mortality was estimated using a South African demographic model. The average life expectancy of men starting ART varied between 27.6 y (95% CI: 25.2–30.2) at age 20 y and 10.1 y (95% CI: 9.3–10.8) at age 60 y, while estimates for women at the same ages were substantially higher, at 36.8 y (95% CI: 34.0–39.7) and 14.4 y (95% CI: 13.3–15.3), respectively. The life expectancy of a 20-y-old woman was 43.1 y (95% CI: 40.1–46.0) if her baseline CD4 count was ?200 cells/µl, compared to 29.5 y (95% CI: 26.2–33.0) if her baseline CD4 count was <50 cells/µl. Life expectancies of patients with baseline CD4 counts ?200 cells/µl were between 70% and 86% of those in HIV-negative adults of the same age and sex, and life expectancies were increased by 15%–20% in patients who had survived 2 y after starting ART. However, the analysis was limited by a lack of mortality data at longer durations. Conclusions South African HIV-positive adults can have a near-normal life expectancy, provided that they start ART before their CD4 count drops below 200 cells/µl. These findings demonstrate that the near-normal life expectancies of HIV-positive individuals receiving ART in high-income countries can apply to low- and middle-income countries as well. Please see later in the article for the Editors' Summary PMID:23585736

Johnson, Leigh F.; Mossong, Joel; Dorrington, Rob E.; Schomaker, Michael; Hoffmann, Christopher J.; Keiser, Olivia; Fox, Matthew P.; Wood, Robin; Prozesky, Hans; Giddy, Janet; Garone, Daniela Belen; Cornell, Morna; Egger, Matthias; Boulle, Andrew

2013-01-01

11

Serum Phosphate Predicts Early Mortality in Adults Starting Antiretroviral Therapy in Lusaka, Zambia: A Prospective Cohort Study  

Microsoft Academic Search

BackgroundPatients starting antiretroviral therapy (ART) for acquired immunodeficiency syndrome (AIDS) in sub-Saharan Africa have high rates of mortality in the initial weeks of treatment. We assessed the association of serum phosphate with early mortality among HIV-infected adults with severe malnutrition and\\/or advanced immunosuppression.Methodology\\/Principal FindingsAn observational cohort of 142 HIV-infected adults initiating ART in Lusaka, Zambia with body mass index (BMI)

Douglas C. Heimburger; John R. Koethe; Christopher Nyirenda; Claire Bosire; Janelle M. Chiasera; Meridith Blevins; Andres Julian Munoz; Bryan E. Shepherd; Dara Potter; Isaac Zulu; Angela Chisembele-Taylor; Benjamin H. Chi; Jeffrey S. A. Stringer; Edmond K. Kabagambe; Robert J. Wilkinson

2010-01-01

12

Predictors of virologic response in persons who start antiretroviral therapy during recent HIV infection  

PubMed Central

Objective Despite evidence supporting antiretroviral therapy (ART) in recent HIV infection, little is known about factors that are associated with successful ART. We assessed demographic, virologic, and immunologic parameters to identify predictors of virologic response. Design A 24-week observational study of ART on persons enrolled within 6 months of their estimated date of infection (EDI) evaluated baseline demographics and the collection of blood and gut specimens. Methods Flow cytometry analyses of blood and gut lymphocytes allowed characterization of CD4+ and CD8+ T cells at study entry and end. Additional assessments included soluble CD14 (sCD14), lipopolysaccharide, CD4+ T-cell counts, and HIV RNA levels. Results Twenty nine participants initiated ART, and 17 achieved undetectable HIV RNA by study end. A longer time from EDI to ART, older age, higher sCD14, lower proportions of central memory CD4+ T cells, and higher proportions of activated CD8+ T cells were associated with detectable viremia. Multivariable logistic regression found only older age and elevated sCD14 were independently associated with persistent viremia. Additionally, we observed that ART in recent infection did not result in discernible recovery of CD4+ T cells in the gut. Conclusion In persons who started ART within 3–33 weeks from EDI, age and microbial translocation were associated with detectable HIV RNA. As observed in other cohorts, ART in recent infection did not improve proportions of total CD4+ T cells in gut-associated lymphoid tissue (GALT). This lends support to further evaluate the use of more potent ART or regimens that protect the GALT in recent HIV infection. PMID:24401640

Karris, Maile Y.; Kao, Yu-ting; Patel, Derek; Dawson, Matthew; Woods, Steven P.; Vaida, Florin; Spina, Celsa; Richman, Douglas; Little, Susan; Smith, Davey M.

2014-01-01

13

Immunologic Risk Factors for Early Mortality After Starting Antiretroviral Therapy in HIV-Infected Zambian Children  

PubMed Central

Abstract To explore immunologic risk factors for death within 90 days of highly active antiretroviral therapy (HAART) initiation, CD4+ and CD8+ T cell subsets were measured by flow cytometry and characterized by logistic regression in 149 Zambian children between 9 months and 10 years of age enrolled in a prospective, observational study of the impact of HAART on measles immunity. Of 21 children who died during follow-up, 17 (81%) had known dates of death and 16 (76%) died within 90 days of initiating HAART. Young age and low weight-for-age z-scores were associated with increased risks of mortality within 90 days of starting HAART, whereas CD4+ T cell percentage was not associated with mortality. After adjusting for these factors, each 10% increase in CD8+ effector T cells increased the odds of overall mortality [OR=1.43 (95% CI: 1.08, 1.90)] and was marginally associated with early mortality [OR=1.29 (95% CI: 0.97, 1.72)]. Conversely, each 10% increase in CD4+ central memory T cells decreased the odds of overall [OR=0.06 (95% CI: 0.01, 0.59)] and early mortality [OR=0.09 (95% CI: 0.01, 0.97)]. Logistic regression prediction models demonstrated areas under the receiver-operator characteristic curves of ?85% for early and overall mortality, with bootstrapped sensitivities of 82–85% upon validation, supporting the predictive accuracy of the models. CD4+ and CD8+ T cell subsets may be more accurate predictors of early mortality than CD4+ T cell percentages and could be used to identify children who would benefit from more frequent clinical monitoring after initiating HAART. PMID:23025633

Rainwater-Lovett, Kaitlin; Nkamba, Hope C.; Mubiana-Mbewe, Mwangelwa; Moore, Carolyn Bolton

2013-01-01

14

Considerations in the rationale, design and methods of the Strategic Timing of AntiRetroviral Treatment (START) study  

PubMed Central

Background Untreated human immunodeficiency virus (HIV) infection is characterized by progressive depletion of CD4+ T lymphocyte (CD4) count leading to the development of opportunistic diseases (acquired immunodeficiency syndrome (AIDS)), and more recent data suggest that HIV is also associated with an increased risk of serious non-AIDS (SNA) diseases including cardiovascular, renal, and liver diseases and non-AIDS-defining cancers. Although combination antiretroviral treatment (ART) has resulted in a substantial decrease in morbidity and mortality in persons with HIV infection, viral eradication is not feasible with currently available drugs. The optimal time to start ART for asymptomatic HIV infection is controversial and remains one of the key unanswered questions in the clinical management of HIV-infected individuals. Purpose In this article, we outline the rationale and methods of the Strategic Timing of AntiRetroviral Treatment (START) study, an ongoing multicenter international trial designed to assess the risks and benefits of initiating ART earlier than is currently practiced. We also describe some of the challenges encountered in the design and implementation of the study and how these challenges were addressed. Methods A total of 4000 study participants who are HIV type 1 (HIV-1) infected, ART naïve with CD4 count > 500 cells/?L are to be randomly allocated in a 1:1 ratio to start ART immediately (early ART) or defer treatment until CD4 count is <350 cells/ ?L (deferred ART) and followed for a minimum of 3 years. The primary outcome is time to AIDS, SNA, or death. The study had a pilot phase to establish feasibility of accrual, which was set as the enrollment of at least 900 participants in the first year. Results Challenges encountered in the design and implementation of the study included the limited amount of data on the risk of a major component of the primary endpoint (SNA) in the study population, changes in treatment guidelines when the pilot phase was well underway, and the complexities of conducting the trial in a geographically wide population with diverse regulatory requirements. With the successful completion of the pilot phase, more than 1000 participants from 100 sites in 23 countries have been enrolled. The study will expand to include 237 sites in 36 countries to reach the target accrual of 4000 participants. Conclusions START is addressing one of the most important questions in the clinical management of ART. The randomization provided a platform for the conduct of several substudies aimed at increasing our understanding of HIV disease and the effects of antiretroviral therapy beyond the primary question of the trial. The lessons learned from its design and implementation will hopefully be of use to future publicly funded international trials. PMID:22547421

Babiker, Abdel G; Emery, Sean; Fatkenheuer, Gerd; Gordin, Fred M; Grund, Birgit; Lundgren, Jens D; Neaton, James D; Pett, Sarah L; Phillips, Andrew; Touloumi, Giota; Vjecha, Michael J

2012-01-01

15

Endothelial Function in HIV-Infected Antiretroviral Na?ve Subjects Before and After Starting Potent Antiretroviral Therapy: AIDS Clinical Trials Group Study 5152s  

PubMed Central

Objectives This study evaluated the effects of three class-sparing antiretroviral therapy (ART) regimens on endothelial function in HIV-infected subjects participating in a randomized trial. Background Endothelial dysfunction has been observed in patients receiving ART for human immunodeficiency virus (HIV) infection. Methods This was a prospective, multicenter study of treatment-naïve subjects who were randomly assigned to receive a protease inhibitor-sparing regimen of nucleoside reverse transcriptase inhibitors (NRTIs) + efavirenz, a non-nucleoside reverse transcriptase inhibitor-sparing regimen of NRTIs + lopinavir/ritonavir, or a NRTI-sparing regimen of efavirenz + lopinavir/ritonavir. NRTIs were lamivudine + stavudine, zidovudine, or tenofovir. Brachial artery flow-mediated dilation (FMD) was determined by B-mode ultrasound before starting on ART, then after 4 and 24 weeks. Results There were 82 subjects (median age 35 years, 91% men, 54% white). Baseline CD4 cell counts and plasma HIV RNA values were 245 cells/mm3 and 4.8 log10 copies/ml, respectively. At baseline, FMD was 3.68% (interquartile range 1.98 – 5.51%). After 4 and 24 weeks of ART, plasma HIV RNA decreased by 2.1 and 3.0 log10 copies/mL, respectively. FMD increased by 0.74% (?0.62 – +2.74, p=0.003) and 1.48% (?0.20 – +4.30%, p< 0.001), respectively, with similar changes in each arm (pKW>0.600). The decrease in plasma HIV RNA at 24 weeks was associated with greater FMD (rs=? 0.30, p=0.017). Conclusions Among treatment-naïve individuals with HIV, three different ART regimens rapidly improved endothelial function. Benefits were similar for all ART regimens, appeared quickly, and persisted at 24 weeks. Condensed Abstract Among 82 treatment-naïve HIV-infected subjects participating in a prospective, multicenter study of three class-sparing antiretroviral therapy regimens, flow-mediated dilation of the brachial artery improved after 4 (+0.74%, p=0.003) and 24 weeks (+1.48%, p< 0.001), with similar changes in each arm (pKW>0.600). PMID:18687253

Torriani, Francesca J.; Komarow, Lauren; Parker, Robert A.; Cotter, Bruno R.; Currier, Judith S.; Dube, Michael P.; Fichtenbaum, Carl J.; Gerschenson, Mariana; Mitchell, Carol K.C.; Murphy, Robert L.; Squires, Kathleen; Stein, James H.

2008-01-01

16

Site-nurse initiated Adherence and Symptom Support Telephone Calls for HIV-positive individuals starting antiretroviral therapy, ACTG 5031, a substudy of ACTG 384.  

PubMed Central

Background: Effective and easy to implement interventions to improve adherence to antiretroviral therapy are needed. Objective: To compare a site-nurse initiated adherence and symptom support telephone calls for HIV-positive individuals starting antiretroviral therapy compare to the study site’s standard of care. Methods: A randomized controlled trial of site-nurse initiated adherence and symptom support telephone calls for HIV-positive individuals starting antiretrovirals. Subjects were randomized to receive site-nurse initiated telephone calls (intervention) or no additional calls above the site’s standard of care (control). Subjects received calls 1-3 days after initiating antiretrovirals, weeks 1, 2, 3, 6, 10, 14, 18, 22, 26, and every 8 weeks thereafter. Self-reported adherence was captured during study visits. Results: A total of 333 subjects starting antiretrovirals as part of ACTG 384 were co-enrolled into ACTG 5031. Subjects were followed for up to 160 weeks and were contacted for 74% of scheduled calls. There was no significant difference in proportion of patients with >95% mean Total Adherence, 87.9% and 91.2% (p=0.34) and mean self-reported Total Adherence, 97.9% and 98.4% in the intervention and control, respectively, or in symptom distress and clinical endpoints. Conclusions: In the context of a clinical trial, where self-reported adherence was exceptionally high, the site-nurse initiated telephone calls did not further improve self-reported adherence, symptom distress or clinical outcomes. PMID:24144900

Robbins, Gregory K.; Testa, Marcia A.; Su, Max; Safren, Steven A.; Morse, Gene; Lammert, Sara; Shafer, Robert W.; Reynolds, Nancy R.; Chesney, Margaret A.

2013-01-01

17

Is long term virological response related to CCR 5 32 deletion in HIV infected patients started on highly active antiretroviral therapy?  

E-print Network

Is long term virological response related to CCR 5 32 deletion in HIV infected patients started, antiretroviral therapy, CCR5 32 deletion, virological response Corresponding author : Dr. Jean to have a sustained virological response if all plasma HIV-RNA measurements between month 4 and years 3

Boyer, Edmond

18

Outcomes among HIV-1 Infected Individuals First Starting Antiretroviral Therapy with Concurrent Active TB or Other AIDS-Defining Disease  

PubMed Central

Background Tuberculosis (TB) is common among HIV-infected individuals in many resource-limited countries and has been associated with poor survival. We evaluated morbidity and mortality among individuals first starting antiretroviral therapy (ART) with concurrent active TB or other AIDS-defining disease using data from the “Prospective Evaluation of Antiretrovirals in Resource-Limited Settings” (PEARLS) study. Methods Participants were categorized retrospectively into three groups according to presence of active confirmed or presumptive disease at ART initiation: those with pulmonary and/or extrapulmonary TB (“TB” group), those with other non-TB AIDS-defining disease (“other disease”), or those without concurrent TB or other AIDS-defining disease (“no disease”). Primary outcome was time to the first of virologic failure, HIV disease progression or death. Since the groups differed in characteristics, proportional hazard models were used to compare the hazard of the primary outcome among study groups, adjusting for age, sex, country, screening CD4 count, baseline viral load and ART regimen. Results 31 of 102 participants (30%) in the “TB” group, 11 of 56 (20%) in the “other disease” group, and 287 of 1413 (20%) in the “no disease” group experienced a primary outcome event (p?=?0.042). This difference reflected higher mortality in the TB group: 15 (15%), 0 (0%) and 41 (3%) participants died, respectively (p<0.001). The adjusted hazard ratio comparing the “TB” and “no disease” groups was 1.39 (95% confidence interval: 0.93–2.10; p?=?0.11) for the primary outcome and 3.41 (1.72–6.75; p<0.001) for death. Conclusions Active TB at ART initiation was associated with increased risk of mortality in HIV-1 infected patients. PMID:24391801

Perisse, Andre R. S.; Smeaton, Laura; Chen, Yun; La Rosa, Alberto; Walawander, Ann; Nair, Apsara; Grinsztejn, Beatriz; Santos, Breno; Kanyama, Cecilia; Hakim, James; Nyirenda, Mulinda; Kumarasamy, Nagalingeswaran; Lalloo, Umesh G.; Flanigan, Timothy; Campbell, Thomas B.; Hughes, Michael D.

2013-01-01

19

When to start antiretroviral therapy: the need for an evidence base during early HIV infection  

PubMed Central

Background Strategies for use of antiretroviral therapy (ART) have traditionally focused on providing treatment to persons who stand to benefit immediately from initiating the therapy. There is global consensus that any HIV+ person with CD4 counts less than 350 cells/?l should initiate ART. However, it remains controversial whether ART is indicated in asymptomatic HIV-infected persons with CD4 counts above 350 cells/?l, or whether it is more advisable to defer initiation until the CD4 count has dropped to 350 cells/?l. The question of when the best time is to initiate ART during early HIV infection has always been vigorously debated. The lack of an evidence base from randomized trials, in conjunction with varying degrees of therapeutic aggressiveness and optimism tempered by the risks of drug resistance and side effects, has resulted in divided expert opinion and inconsistencies among treatment guidelines. Discussion On the basis of recent data showing that early ART initiation reduces heterosexual HIV transmission, some countries are considering adopting a strategy of universal treatment of all HIV+ persons irrespective of their CD4 count and whether ART is of benefit to the individual or not, in order to reduce onward HIV transmission. Since ART has been found to be associated with both short-term and long-term toxicity, defining the benefit:risk ratio is the critical missing link in the discussion on earlier use of ART. For early ART initiation to be justified, this ratio must favor benefit over risk. An unfavorable ratio would argue against using early ART. Summary There is currently no evidence from randomized controlled trials to suggest that a strategy of initiating ART when the CD4 count is above 350 cells/?l (versus deferring initiation to around 350 cells/?l) results in benefit to the HIV+ person and data from observational studies are inconsistent. Large, clinical endpoint-driven randomized studies to determine the individual health benefits versus risks of earlier ART initiation are sorely needed. The counter-argument to this debate topic can be freely accessed here: http://www.biomedcentral.com/1741-7015/11/147. PMID:23767777

2013-01-01

20

Further benefits by early start of HIV treatment in low income countries: Survival estimates of early versus deferred antiretroviral therapy  

PubMed Central

Background International HIV guidelines have recently shifted from a medium-late to an early-start treatment strategy. As a consequence, more people will be eligible to Highly Active Antiretroviral Therapy (HAART). We estimate mean life years gained using different treatment indications in low income countries. Methods We carried out a systematic search to identify relevant studies on the treatment effect of HAART. Outcome from identified observational studies were combined in a pooled-analyses and we apply these data in a Markov life cycle model based on a hypothetical Tanzanian HIV population. Survival for three different HIV populations with and without any treatment is estimated. The number of patients included in our pooled-analysis is 35 047. Results Providing HAART early when CD4 is 200-350 cells/?l is likely to be the best outcome strategy with an expected net benefit of 14.5 life years per patient. The model predicts diminishing treatment benefits for patients starting treatment when CD4 counts are lower. Patients starting treatment at CD4 50-199 and <50 cells/?l have expected net health benefits of 7.6 and 7.3 life years. Without treatment, HIV patients with CD4 counts 200-350; 50-199 and < 50 cells/?l can expect to live 4.8; 2.0 and 0.7 life years respectively. Conclusions This study demonstrates that HIV patients live longer with early start strategies in low income countries. Since low income countries have many constraints to full coverage of HAART, this study provides input to a more transparent debate regarding where to draw explicit eligibility criteria during further scale up of HAART. PMID:20180966

2010-01-01

21

DEPRESSION AND SEXUAL RISKBEHAVIOR AMONG CLIENTS ABOUT TO START HIV ANTIRETROVIRAL THERAPY IN UGANDA  

PubMed Central

Objective We investigated depression in relationship to sexual risk behavior with primary partners among HIVclients in Uganda. Methods Baseline data were analyzed from a cohort of clients starting ART. The Patient Health Questionnaire (PHQ-9) was used to classify depressive severity (none, minor and major depression) and symptom type (cognitive and somatic). Condom use was assessed over the past 6 months and during the last episode of sexual intercourse. Results 386 participants had a primary sex partner, with whom 41.6% always used condoms during sex over the past 6 months, and 62.4% during last sex. Use of a condom during last sex was associated with having no depression and lower PHQ-9 total and cognitive and somatic subscale scores in bivariate analyses; most of these relationships were marginally significant for sex over the past 6 months. Controlling for demographics, HIV disclosure and partner HIV status, only minor depression was associated with unprotected sex. Conclusion Depressive symptoms, even if not a clinical disorder, warrant early detection and treatment for promoting HIV prevention among HIV-affected couples. PMID:23970636

Musisi, Seggane; Wagner, Glenn J.; Ghosh-Dastidar, Bonnie; Nakasujja, Noeline; Dickens, Akena; Okello, Elialilia

2013-01-01

22

Laboratory adverse events and discontinuation of therapy according to CD4+ cell count at the start of antiretroviral therapy  

PubMed Central

Objective: Few data describe antiretroviral treatment (ART)-related adverse events when treatment is initiated at CD4+ cell counts more than 350?cells/?l. We compared rates of laboratory-defined adverse events (LDAEs) according to CD4+ cell count at ART initiation. Design: Analysis of on-going cohort study. Methods: ART-naive persons initiating ART from 2000 to 2010 were included. Chi-square, analysis of variance (ANOVA) and Kruskal–Wallis tests compared characteristics among those starting ART with a CD4+ cell count of 350 or less, 351–499 and at least 500?cells/?l. Time-updated Poisson regression compared rates of LDAE in the three CD4+ cell strata. Cox proportional hazard models compared risk of ART discontinuation. Results: Nine thousand, four hundred and six individuals were included: median age 37 years, 61% white, 80% men, median viral load 4.8?log copies/ml. Four hundred and forty-seven (4.9%) and 1099 (11.7%) started ART with a CD4+ cell count at least 500 and 351–499?cells/?l, respectively. One thousand, two hundred and eighty-three (13.6%) patients experienced at least one LDAE. The rate of LDAE did not differ between those starting ART with a CD4+ cell count 351–499 and less than 350?cells/?l [relative rate 0.90, 95% confidence interval (CI) 0.74–1.09)], but an increased risk of ART discontinuation was observed (hazard ratio 1.58, 95% CI 1.10–2.27). Those starting ART at CD4+ cell count at least 500?cells/?l had an increased rate of LDAE (relative rate 1.44, 95% CI 1.13–1.82) but were not more likely to discontinue ART (hazard ratio 1.15, 95% CI 0.64–2.09). Conclusion: This study demonstrates the need to consider ART-related toxicities when initiating therapy at CD4+ cell counts at least 500?cells/?l. Whilst evidence from randomized controlled trials is awaited, the timing of ART initiation in terms of benefits and risks of ART remains an important question. PMID:24583670

Jose, Sophie; Quinn, Killian; Hill, Teresa; Leen, Clifford; Walsh, John; Hay, Phillip; Fisher, Martin; Post, Frank; Nelson, Mark; Gompels, Mark; Johnson, Margaret; Chadwick, David; Gilson, Richard; Sabin, Caroline; Fidler, Sarah

2014-01-01

23

Alcohol use and incarceration adversely affect HIV-1 RNA suppression among injection drug users starting antiretroviral therapy.  

PubMed

We conducted this study among HIV-infected injection drug users to determine the effect of self-reported alcohol use and prior incarceration at the time of initiating antiretroviral therapy on subsequent HIV-1 RNA suppression. We examined the demographics, recent incarceration history, and drug and alcohol use history from the Vancouver Injection Drug User Study (VIDUS) questionnaire closest to the date of initiating antiretroviral therapy. We linked these data to the HIV/AIDS Drug Treatment Program. There were 234 VIDUS participants who accessed antiretroviral therapy through the Drug Treatment Program from August 1, 1996, to July 31, 2001. In terms of illicit drug use, 196 (84%) reported injecting heroin and cocaine at the time of initiating antiretroviral therapy. Multiple logistic regression revealed that in the 6 months prior to initiating antiretroviral therapy, alcohol use (adjusted odds ratio [AOR] 0.32; 95% CI 0.13-0.81) and incarceration (AOR 0.22; 95% CI 0.09-0.58) were independently associated with lower odds of HIV-1 RNA suppression. Factors positively associated with HIV-1 RNA suppression included: adherence (AOR 1.27; 95% CI 1.06-1.51); lower baseline HIV-1 RNA (AOR 1.30; 95% CI 1.01-1.66); highly active antiretroviral therapy (AOR 4.10; 95% CI 1.56-10.6); months on therapy (AOR 1.1; 95% CI 1.06-1.14). Among HIV-infected injection drug users who were on antiretroviral therapy, any alcohol use and incarceration in the 6 months prior to initiating antiretroviral therapy were negatively associated with achieving HIV-1 RNA suppression. In addition to addiction treatment for active heroin and cocaine use, the identification and treatment of alcohol problems should be supported in this setting. As well, increased outreach to HIV-infected drug users recently released from prison to ensure continuity of care needs to be further developed. PMID:14709714

Palepu, Anita; Tyndall, Mark W; Li, Kathy; Yip, Benita; O'Shaughnessy, Michael V; Schechter, Martin T; Montaner, Julio S G; Hogg, Robert S

2003-12-01

24

Gender Differences in Survival among Adult Patients Starting Antiretroviral Therapy in South Africa: A Multicentre Cohort Study  

PubMed Central

Background Increased mortality among men on antiretroviral therapy (ART) has been documented but remains poorly understood. We examined the magnitude of and risk factors for gender differences in mortality on ART. Methods and Findings Analyses included 46,201 ART-naïve adults starting ART between January 2002 and December 2009 in eight ART programmes across South Africa (SA). Patients were followed from initiation of ART to outcome or analysis closure. The primary outcome was mortality; secondary outcomes were loss to follow-up (LTF), virologic suppression, and CD4+ cell count responses. Survival analyses were used to examine the hazard of death on ART by gender. Sensitivity analyses were limited to patients who were virologically suppressed and patients whose CD4+ cell count reached >200 cells/µl. We compared gender differences in mortality among HIV+ patients on ART with mortality in an age-standardised HIV-negative population. Among 46,201 adults (65% female, median age 35 years), during 77,578 person-years of follow-up, men had lower median CD4+ cell counts than women (85 versus 110 cells/µl, p<0.001), were more likely to be classified WHO stage III/IV (86 versus 77%, p<0.001), and had higher mortality in crude (8.5 versus 5.7 deaths/100 person-years, p<0.001) and adjusted analyses (adjusted hazard ratio [AHR] 1.31, 95% CI 1.22–1.41). After 36 months on ART, men were more likely than women to be truly LTF (AHR 1.20, 95% CI 1.12–1.28) but not to die after LTF (AHR 1.04, 95% CI 0.86–1.25). Findings were consistent across all eight programmes. Virologic suppression was similar by gender; women had slightly better immunologic responses than men. Notably, the observed gender differences in mortality on ART were smaller than gender differences in age-standardised death rates in the HIV-negative South African population. Over time, non-HIV mortality appeared to account for an increasing proportion of observed mortality. The analysis was limited by missing data on baseline HIV disease characteristics, and we did not observe directly mortality in HIV-negative populations where the participating cohorts were located. Conclusions HIV-infected men have higher mortality on ART than women in South African programmes, but these differences are only partly explained by more advanced HIV disease at the time of ART initiation, differential LTF and subsequent mortality, and differences in responses to treatment. The observed differences in mortality on ART may be best explained by background differences in mortality between men and women in the South African population unrelated to the HIV/AIDS epidemic. Please see later in the article for the Editors' Summary. PMID:22973181

Cornell, Morna; Schomaker, Michael; Garone, Daniela Belen; Giddy, Janet; Hoffmann, Christopher J.; Lessells, Richard; Maskew, Mhairi; Prozesky, Hans; Wood, Robin; Johnson, Leigh F.; Egger, Matthias; Boulle, Andrew; Myer, Landon

2012-01-01

25

Incidence and Lethality of Immune Reconstitution Disease in HIV-Infected Patients Starting Antiretroviral Therapy: Systematic Review and Meta-Analysis  

PubMed Central

Summary This systematic review examines the incidence of Immune Reconstitution Disease (IRD) in HIV-1 infected patients starting antiretroviral combination therapy (ART). We analysed 13103 patients from 54 cohort studies; 1685 patients developed IRD. Pooled incidences with 95% credibility intervals (CrI) were calculated using Bayesian methods. In patients with previously diagnosed AIDS-defining conditions the incidence was 37.7% (95% CrI 26.6–49.4%) for CMV retinitis, 19.5% (6.7–44.8%) for cryptococcal meningitis, 15.7% (9.7–24.5%) for tuberculosis, 16.7% (2.3–50.7%) for progressive multifocal leukencephalopathy and 6.4% (1.2–24.7%) for Kaposi’s sarcoma. The incidence of any type of IRD, based on studies of unselected patients starting ART, was 16.1% (11.1–22.9%). Lethality was 4.5% (2.1–8.6%) for any type of IRD, 3.2% (0.7–9.2%) for tuberculosis and 20.8% (5.0–52.7%) for cryptococcal meningitis. Meta-regression analyses showed that the incidence is largely determined by the CD4 cell count at the start of ART, with a high risk in patients starting below 50 cells/?l. Many of the IRD events might therefore be prevented with earlier initiation of ART. PMID:20334848

Muller, Monika; Wandel, Simon; Colebunders, Robert; Attia, Suzanna; Furrer, Hansjakob; Egger, Matthias

2013-01-01

26

Quality of life among individuals with HIV starting antiretroviral therapy in diverse resource-limited areas of the world.  

PubMed

As Antiretroviral Therapy (ART) is scaled up in low- and middle-income countries, it is important to understand Quality of Life (QOL) correlates including disease severity and person characteristics and to determine the extent of between-country differences among those with HIV. QOL and medical data were collected from 1,563 of the 1,571 participants at entry into a randomized clinical trial of ART conducted in the U.S. (n = 203) and 8 resource-limited countries (n = 1,360) in the Caribbean, South America, Asia, and Africa. Participants were interviewed prior to initiation of ART using a modified version of the ACTG SF-21, a health-related QOL measure including 8 subscales: general health perception, physical functioning, role functioning, social functioning, cognitive functioning, pain, mental health, and energy/fatigue. Other measures included demographics, CD4+ lymphocyte count, plasma HIV-1 RNA viral load. Higher quality of life in each of the 8 QOL subscales was associated with higher CD4+ lymphocyte category. General health perception, physical functioning, role functioning, and energy/fatigue varied by plasma HIV-1 RNA viral load categories. Each QOL subscale included significant variation by country. Only the social functioning subscale varied by sex, with men having greater impairments than women, and only the physical functioning subscale varied by age category. This was the first large-scale international ART trial to conduct a standardized assessment of QOL in diverse international settings, thus demonstrating that implementation of the behavioral assessment was feasible. QOL indicators at study entry varied with disease severity, demographics, and country. The relationship of these measures to treatment outcomes can and should be examined in clinical trials of ART in resource-limited settings using similar methodologies. PMID:21499794

Safren, Steven A; Hendriksen, Ellen S; Smeaton, Laura; Celentano, David D; Hosseinipour, Mina C; Barnett, Ronald; Guanira, Juan; Flanigan, Timothy; Kumarasamy, N; Klingman, Karin; Campbell, Thomas

2012-02-01

27

Predicting Patterns of Long-Term CD4 Reconstitution in HIV-Infected Children Starting Antiretroviral Therapy in Sub-Saharan Africa: A Cohort-Based Modelling Study  

PubMed Central

Background Long-term immune reconstitution on antiretroviral therapy (ART) has important implications for HIV-infected children, who increasingly survive into adulthood. Children's response to ART differs from adults', and better descriptive and predictive models of reconstitution are needed to guide policy and direct research. We present statistical models characterising, qualitatively and quantitatively, patterns of long-term CD4 recovery. Methods and Findings CD4 counts every 12 wk over a median (interquartile range) of 4.0 (3.7, 4.4) y in 1,206 HIV-infected children, aged 0.4–17.6 y, starting ART in the Antiretroviral Research for Watoto trial (ISRCTN 24791884) were analysed in an exploratory analysis supplementary to the trial's pre-specified outcomes. Most (n?=?914; 76%) children's CD4 counts rose quickly on ART to a constant age-corrected level. Using nonlinear mixed-effects models, higher long-term CD4 counts were predicted for children starting ART younger, and with higher CD4 counts (p<0.001). These results suggest that current World Health Organization–recommended CD4 thresholds for starting ART in children ?5 y will result in lower CD4 counts in older children when they become adults, such that vertically infected children who remain ART-naïve beyond 10 y of age are unlikely ever to normalise CD4 count, regardless of CD4 count at ART initiation. CD4 profiles with four qualitatively distinct reconstitution patterns were seen in the remaining 292 (24%) children. Study limitations included incomplete viral load data, and that the uncertainty in allocating children to distinct reconstitution groups was not modelled. Conclusions Although younger ART-naïve children are at high risk of disease progression, they have good potential for achieving high CD4 counts on ART in later life provided ART is initiated following current World Health Organization (WHO), Paediatric European Network for Treatment of AIDS, or US Centers for Disease Control and Prevention guidelines. In contrast, to maximise CD4 reconstitution in treatment-naïve children >10 y, ART should ideally be considered even if there is a low risk of immediate disease progression. Further exploration of the immunological mechanisms for these CD4 recovery profiles should help guide management of paediatric HIV infection and optimise children's immunological development. Please see later in the article for the Editors' Summary PMID:24204216

Musiime, Victor; Prendergast, Andrew; Nathoo, Kusum; Kekitiinwa, Addy; Nahirya Ntege, Patricia; Gibb, Diana M.; Thiebaut, Rodolphe; Walker, A. Sarah; Klein, Nigel; Callard, Robin

2013-01-01

28

Estimating the cost-effectiveness of nutrition supplementation for malnourished, HIV-infected adults starting antiretroviral therapy in a resource-constrained setting  

PubMed Central

Background Low body mass index (BMI) individuals starting antiretroviral therapy (ART) for HIV infection in sub-Saharan Africa have high rates of death and loss to follow-up in the first 6 months of treatment. Nutritional supplementation may improve health outcomes in this population, but the anticipated benefit of any intervention should be commensurate with the cost given resource limitations and the need to expand access to ART in the region. Methods We used Markov models incorporating historical data and program-wide estimates of treatment costs and health benefits from the Zambian national ART program to estimate the improvements in 6-month survival and program retention among malnourished adults necessary for a combined nutrition support and ART treatment program to maintain cost-effectiveness parity with ART treatment alone. Patients were stratified according to World Health Organization criteria for severe (BMI <16.0 kg/m2), moderate (16.00-16.99 kg/m2), and mild (17.00-18.49 kg/m2) malnutrition categories. Results 19,247 patients contributed data between May 2004 and October 2010. Quarterly survival and retention were lowest in the BMI <16.0 kg/m2 category compared to higher BMI levels, and there was less variation in both measures across BMI strata after 180 days. ART treatment was estimated to cost $556 per year and averted 7.3 disability-adjusted life years. To maintain cost-effectiveness parity with ART alone, a supplement needed to cost $10.99 per quarter and confer a 20% reduction in both 6-month mortality and loss to follow-up among BMI <16.0 kg/m2 patients. Among BMI 17.00-18.49 kg/m2 patients, supplement costs accompanying a 20% reduction in mortality and loss to follow-up could not exceed $5.18 per quarter. In sensitivity analyses, the maximum permitted supplement cost increased if the ART program cost rose, and fell if patients classified as lost to follow-up at 6 months subsequently returned to care. Conclusions Low BMI adults starting ART in sub-Saharan Africa are at high risk of early mortality and loss to follow-up. The expense of providing nutrition supplementation would require only modest improvements in survival and program retention to be cost-effective for the most severely malnourished individuals starting ART, but interventions are unlikely to be cost-effective among those in higher BMI strata. PMID:24839400

2014-01-01

29

Antiretroviral Treatment Start-Time during Primary SIVmac Infection in Macaques Exerts a Different Impact on Early Viral Replication and Dissemination  

Microsoft Academic Search

BackgroundThe time of infection is rarely known in human cases; thus, the effects of delaying the initiation of antiretroviral therapy (ART) on the peripheral viral load and the establishment of viral reservoirs are poorly understood.Methodology\\/Principal FindingsSix groups of macaques, infected intravenously with SIVmac251, were given placebo or antiretroviral therapy to explore reservoir establishment; macaques were treated for 2 weeks, with

Pierre Sellier; Abdelkrim Mannioui; Olivier Bourry; Nathalie Dereuddre-Bosquet; Benoit Delache; Patricia Brochard; Julien Calvo; Sophie Prévot; Pierre Roques; Zandrea Ambrose

2010-01-01

30

Impact of nutritional supplementation on immune response, body mass index and bioelectrical impedance in HIV-positive patients starting antiretroviral therapy  

PubMed Central

Background Challenges to HIV care in resource limited settings (RLS) include malnutrition. Limited evidence supports the benefit of nutritional supplementation when starting antiretroviral therapy (ART) in RLS. Methods Randomized controlled pilot study. HIV-positive ART-naive adults with self-reported weight loss were randomized to receive ART plus FutureLife porridge® nutritional supplement (NS) (388 kcal/day) or ART alone (Controls) for 6 months. Patients returned for monthly assessments and blood was drawn at enrolment and 6 months on ART. Differences in body composition, biochemical and laboratory parameters were estimated at 6 months on treatment. Results Of the 36 randomized patients, 26 completed the 6 month follow-up (11 NS vs 15 Controls). At enrolment, groups were similar in terms of age, gender, body mass index (BMI) and bioelectrical impedance. NS patients had a lower median CD4 count (60 cells/mm3 [IQR 12–105 vs 107 cells/mm3 [IQR 63–165]; p?=?0.149) and hemoglobin (10.3 g/dL [IQR 9.0-11.3] vs 13.1 g/dL [IQR 11.1-14.7]; p?=?0.001). At 6 months, NS patients increased their median CD4 count by 151 cells/mm3 [IQR 120–174) vs 77 cells/mm3 [IQR 33–145] in the Controls. NS patients had higher mean percentage change in body weight (12.7% vs 4.9%; p?=?0.047), BMI (7.8% vs 5.5%; p?=?0.007), absolute CD4 count (83.0% vs 46.4%, p?=?0.002) and hemoglobin (9.5% vs 1.0%; p?=?0.026). Patients in the NS arm had a higher mean percentage fat-free mass (16.7% vs ?3.5%, p?=?0.036), total body water (13.0% vs ?1.9%, p?=?0.026), intracellular water (16.1% vs ?4.1%, p?=?0.010) and basal metabolic rate (5.3% vs ?0.2%, p?=?0.014) compared to Controls. Patients in the NS arm also showed an improvement in physical activity at 6 months post-ART initiation compared to Controls (p?=?0.037). Conclusion Preliminary results are encouraging and suggest that NS taken concurrently with ART can promote weight gain, improve immune response and improve physical activity in HIV-positive patients that present at ART initiation with weight loss. PMID:23919622

2013-01-01

31

Initiation of antiretroviral therapy.  

PubMed

With the widespread availability of antiretroviral therapy, there is a dramatic decline in HIV related morbidity and mortality in both developed and developing countries. Further, the current antiretroviral drug combinations are safer and the availability of newer monitoring assays and guidelines has vastly improved the patient management. The clinician needs to evaluate several key issues prior to institution of antiretroviral regimen including the correct stage of starting the treatment and the kind of regimen to initiate. In addition to various disease related factors, it is also critical to assess the patient's general condition including nutritional status, presence of co-morbidities and mental preparedness prior to starting the therapy. The patients need to develop an overall understanding of the treatment and its benefits and the importance of lifelong adherence to the drugs. The presence of special situations like pediatric age, older patients, pregnancy, lactation and presence of opportunistic infections also require modification of the therapy. This review briefly summarizes issues relevant to the clinician prior to the initiation of antiretroviral therapy. PMID:24958979

Pandhi, Deepika; Ailawadi, Pallavi

2014-01-01

32

Initiation of antiretroviral therapy  

PubMed Central

With the widespread availability of antiretroviral therapy, there is a dramatic decline in HIV related morbidity and mortality in both developed and developing countries. Further, the current antiretroviral drug combinations are safer and the availability of newer monitoring assays and guidelines has vastly improved the patient management. The clinician needs to evaluate several key issues prior to institution of antiretroviral regimen including the correct stage of starting the treatment and the kind of regimen to initiate. In addition to various disease related factors, it is also critical to assess the patient's general condition including nutritional status, presence of co-morbidities and mental preparedness prior to starting the therapy. The patients need to develop an overall understanding of the treatment and its benefits and the importance of lifelong adherence to the drugs. The presence of special situations like pediatric age, older patients, pregnancy, lactation and presence of opportunistic infections also require modification of the therapy. This review briefly summarizes issues relevant to the clinician prior to the initiation of antiretroviral therapy. PMID:24958979

Pandhi, Deepika; Ailawadi, Pallavi

2014-01-01

33

Utility of Cryptococcal Antigen Screening and Evolution of Asymptomatic Cryptococcal Antigenemia among HIV-Infected Women Starting Antiretroviral Therapy in Thailand.  

PubMed

Cryptococcal meningitis (CM) remains a significant HIV-associated opportunistic infection in Southeast Asia and Africa, with a high burden of disease and a high mortality rate despite the availability of antiretroviral therapy (ART). We retrospectively examined the utility of cryptococcal antigen screening to identify risk for CM among 211 Thai women initiating ART. Antigenemia prevalence was 11% (n = 9) among 84 women with a CD4 count <100 cells/mm(3). Screening identified all women who later developed CM. Cryptococcal antigen titers decreased over time with ART. Our study confirmed findings from previous studies in Thailand and South Africa and provided novel observational data regarding the course of cryptococcal antigenemia in patients initiating ART and the poor efficacy of low-dose fluconazole prophylaxis in preventing CM among patients with antigenemia. PMID:24003059

Kwan, Candice K; Leelawiwat, Wanna; Intalapaporn, Poj; Anekthananon, Thanomsak; Raengsakulrach, Boonyos; Peters, Philip J; McNicholl, Janet M; Park, Benjamin J; McConnell, Michelle S; Weidle, Paul J

2014-09-01

34

Home-based versus clinic-based care for patients starting antiretroviral therapy with low CD4+ cell counts: findings from a cluster-randomized trial  

PubMed Central

Objectives: African health services have shortages of clinical staff. We showed previously, in a cluster-randomized trial, that a home-based strategy using trained lay-workers is as effective as a clinic-based strategy. It is not known whether home-based care is suitable for patients with advanced HIV disease. Methods: The trial was conducted in Jinja, Uganda. One thousand, four hundred and fifty-three adults initiating ART between February 2005 and January 2009 were randomized to receive either home-based care or routine clinic-based care, and followed up for about 3 years. Trained lay workers, supervised by clinical staff based in a clinic, delivered the home-based care. In this sub-analysis, we compared survival between the two strategies for those who presented with CD4+ cell count less than 50 cells/?l and those who presented with higher CD4+ cell counts. We used Kaplan–Meier methods and Poisson regression. Results: Four hundred and forty four of 1453 (31%) participants had baseline CD4+ cell count less than 50?cells/?l. Overall, 110 (25%) deaths occurred among participants with baseline CD4+ cell count less than 50?cells/?l and 87 (9%) in those with higher CD4+ cell count. Among participants with CD4+ cell count less than 50?cells/?l, mortality rates were similar for the home and facility-based arms; adjusted mortality rate ratio 0.80 [95% confidence interval (CI) 0.53–1.18] compared with 1.22 (95% CI 0.78–1.89) for those who presented with higher CD4+ cell count. Conclusion: HIV home-based care, with lay workers playing a major role in the delivery of care including providing monthly adherence support, leads to similar survival rates as clinic-based care even among patients who present with very low CD4+ cell count. This emphasises the critical role of adherence to antiretroviral therapy. PMID:24468997

Woodd, Susannah L.; Grosskurth, Heiner; Levin, Jonathan; Amuron, Barbara; Namara, Geoffrey; Birunghi, Josephine; Coutinho, Alex; Jaffar, Shabbar

2014-01-01

35

Cardiovascular effects of antiretroviral drugs: clinical review.  

PubMed

In HIV infected patients an increased occurence of cardiac events has been demontrated from the introduction of highly active antiretroviral therapy (HAART). Antiretroviral drugs' regimens are, in fact, associated with several metabolic side effects, such as dyslipidemia, impaired glucose metabolism and abnormal body fat distribution, that increase the cardiovascular risk of HIV subjects. In addition, HIV infection itself, the chronic inflammatory status and the relevant presence in this population of some of the traditional cardiovascular risk factors contribute to an higher incidence of cardio and cerebrovascular events. In last years several studies showed the occurence of carotid vascular impairment in patients in treatment with protease inhibitors (PI). Similarly the DAD Study reported an increase of 26% of the risk of myocardial infarction in patients on HAART and that this risk is indipendently associated with longer exposure to PI, even after multivariate adjustments. A correct evaluation of the metabolic status before starting HAART and an adeguate control of the drugs-related metabolic abnormalities may reduce the incidence of cardiac events and still improve HIV patients prognosis. This review will focus on the metbolic effects of antiretroviral drugs and to the contribution of combination antiretroviral therapy on cardiovascular risk. PMID:19075633

Filardi, Pasquale Perrone; Paolillo, Stefania; Marciano, Caterina; Iorio, Annamaria; Losco, Teresa; Marsico, Fabio; Scala, Oriana; Ruggiero, Donatella; Ferraro, Sergio; Chiariello, Massimo

2008-12-01

36

Proliferation responses to HIVp24 during antiretroviral therapy do not reflect improved immune phenotype or  

E-print Network

infected patients treated with antiretroviral therapy (ART) predict an improved cytolytic T-cell phenotypeProliferation responses to HIVp24 during antiretroviral therapy do not reflect improved immune started ART during chronic infection and who achieved viral suppression (HIV-RNA , 400 copies/ml for . 12

Lieberman, Judy

37

Use of antiretrovirals during pregnancy and breastfeeding in low-income and middle-income countries  

PubMed Central

Purpose of review The purpose of the study was to review recent evidence on the use of antiretrovirals during pregnancy and breastfeeding in low-income and middle-income settings. Recent findings Access to antiretroviral prophylaxis strategies for HIV-infected pregnant women has increased globally, but two-thirds of women in need still do not receive even the simplest regimen for the prevention of mother-to-child transmission of HIV, and most pregnant women in need of antiretroviral treatment do not receive it. The use of combination antiretroviral treatment in pregnancy in low-resource settings is safe and effective, and increasing evidence supports starting ongoing antiretroviral treatment at a CD4 cell count below 350/?l in pregnant women. The use of appropriate short-course antiretroviral prophylactic regimens is effective for prevention of mother-to-child transmission of HIV in women with higher CD4 cell counts. New data on the use of antiretroviral prophylaxis to prevent transmission through breastfeeding demonstrate that both maternal antiretroviral treatment and extended infant prophylaxis are effective. Summary Antiretroviral use in pregnancy can benefit mothers in need of treatment and reduce the risk of mother-to-child transmission. Emerging evidence of the effectiveness of antiretroviral prophylaxis in preventing transmission through breastfeeding is encouraging and likely to influence practice in the future. PMID:20046147

McIntyre, James

2010-01-01

38

Managing antiretroviral resistance  

Microsoft Academic Search

E. Bogner and A. Holzenburg (eds.), New Concepts of Antiviral Therapy, 255-279. Abstract: Human immunodeficiency virus type 1 (HIV-1) was identified as causative agent of the acquired immune deficiency syndrome (AIDS) in 1983. Since then, 20 antiretroviral drugs inhibiting different steps of the viral life cycle have been approved for the treatment of HIV-infected individuals. Combinations of these drugs enable

Barbara Schmidt; Monika Tschoschner; Hauke Walter; Klaus Korn

39

The Start of Head Start  

ERIC Educational Resources Information Center

The creation of the Head Start program occurred at break-neck speed with many dramatic turns and many colorful players. No one tells the story better than Edward Zigler in "Head Start: The Inside Story of America's Most Successful Educational Experiment"--a detailed and personal, behind the scenes look at the program's inception. From this…

Neugebauer, Roger

2010-01-01

40

Fractures after antiretroviral initiation  

PubMed Central

Background Bone mineral density declines by 2–6% within 1–2 years after initiation of antiretroviral therapy (ART); however, it is uncertain whether this results in an immediate or cumulative increase in fracture rates. Methods We evaluated the incidence and predictors of fracture in 4640 HIV-positive participants from 26 randomized ART studies followed in the AIDS Clinical Trials Group (ACTG) Longitudinal-Linked Randomized Trial study for a median of 5 years. Fragility and nonfragility fractures were recorded prospectively at semiannual visits. Incidence was calculated as fractures/total person-years. Cox proportional hazards models evaluated effects of traditional fracture risks, HIV disease characteristics, and ART exposure on fracture incidence. Results Median (interquartile range) age was 39 (33, 45) years; 83% were men, 48% white, and median nadir CD4 cell count was 187 (65, 308) cells/?l. Overall, 116 fractures were reported in 106 participants with median time-to-first fracture of 2.3 years. Fracture incidence was 0.40 of 100 person-years among all participants and 0.38 of 100 person-years among 3398 participants who were ART naive at enrollment into ACTG parent studies. Among ART-naive participants, fracture rates were higher within the first 2 years after ART initiation (0.53/100 person-years) than subsequent years (0.30/100 person-years). In a multivariate analysis of ART-naive participants, increased hazard of fracture was associated with current smoking and glucocorticoid use but not with exposure to specific antiretrovirals. Conclusion Fracture rates were higher within the first 2 years after ART initiation, relative to subsequent years. However, continuation of ART was not associated with increasing fracture rates in these relatively young HIV-positive individuals. PMID:22951635

Yin, Michael T.; Kendall, Michelle A.; Wu, Xingye; Tassiopoulos, Katherine; Hochberg, Marc; Huang, Jeannie S.; Glesby, Marshall J.; Bolivar, Hector; McComsey, Grace A.

2013-01-01

41

Start Young!  

ERIC Educational Resources Information Center

Discusses the importance of early interest in science and how effective it is on career choice in adult stages of life. Recommends starting mathematics and science activities in preschool and kindergarten. Describes how to create a career-oriented learning center in the classroom with examples of kitchen chemistry, nutrition/botany, zoology,…

Rubin, Penni

2002-01-01

42

Press Start  

NASA Astrophysics Data System (ADS)

This level sets the stage for the design philosophy called “Triadic Game Design” (TGD). This design philosophy can be summarized with the following sentence: it takes two to tango, but it takes three to design a meaningful game or a game with a purpose. Before the philosophy is further explained, this level will first delve into what is meant by a meaningful game or a game with a purpose. Many terms and definitions have seen the light and in this book I will specifically orient at digital games that aim to have an effect beyond the context of the game itself. Subsequently, a historical overview is given of the usage of games with a serious purpose which starts from the moment we human beings started to walk on our feet till our contemporary society. It turns out that we have been using games for all kinds of non-entertainment purposes for already quite a long time. With this introductory material in the back of our minds, I will explain the concept of TGD by means of a puzzle. After that, the protagonist of this book, the game Levee Patroller, is introduced. Based on the development of this game, the idea of TGD, which stresses to balance three different worlds, the worlds of Reality, Meaning, and Play, came into being. Interested? Then I suggest to quickly “press start!”

Harteveld, Casper

43

Comparison among antiretroviral adherence questions  

PubMed Central

Our objective was to compare antiretroviral adherence questions. Among 53 methadone maintained HIV-infected drug users, we compared five measures, including two single item measures using qualitative Likert-type responses, one measure of percent adherence, one visual analog scale, and one measure that averaged responses across antiretrovirals. Responses were termed inconsistent if respondents endorsed the highest adherence level on at least one measure but middle levels on others. We examined ceiling effects, concordance, and correlations with VL. Response distributions differed markedly between measures. A ceiling effect was less pronounced for the single-item measures than for the measure that averaged responses for each antiretroviral: the proportion with 100% adherence varied from 22% (single item measure) to 58% (multi-item measure). Overall agreement between measures ranged from fair to good; 49% of participants had inconsistent responses. Though responses correlated with VL, single-item measures had higher correlations. Future studies should compare single-item questions to objective measures. PMID:21181252

Berg, Karina M.; Wilson, Ira B.; Li, Xuan; Arnsten, Julia H.

2013-01-01

44

Adherence to antiretroviral treatment in Nepal.  

E-print Network

??Introduction Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence… (more)

Wasti, Sharada Prasad

2012-01-01

45

Utilization of antiretroviral treatment in Ethiopia between February and December 2006: spatial, temporal, and demographic patterns  

Microsoft Academic Search

BACKGROUND: In 2003, the Ethiopian Ministry of Health (MOH) started to implement a national antiretroviral treatment (ART) program. Using data in the monthly HIV\\/AIDS Updates issued by the MOH, this paper examines the spatial and temporal distribution of ART on a population basis for Ethiopian towns and administrative zones and regions for the period February to December 2006. RESULTS: The

Helmut Kloos; Yibeltal Assefa; Aynalem Adugna; Mesfin Samuel Mulatu; Damen Haile Mariam

2007-01-01

46

The Starting Early Starting Smart Story.  

ERIC Educational Resources Information Center

Starting Early Starting Smart (SESS) is an early childhood public/private initiative designed to identify new, empirical knowledge about the effectiveness of integrating substance abuse prevention, addictions treatment, and mental health services with primary health care and childcare service settings (e.g., Head Start, day care, preschool) to…

Casey Family Programs, Seattle, WA.

47

[Side effects of antiretroviral therapy].  

PubMed

Highly active antiretroviral therapy (HAART) has changed the natural history of HIV infection, but the presence of adverse events may limit its efficacy. Nucleoside reverse transcriptase inhibitors can cause mitochondrial toxicity and anemia, non-nucleoside reverse transcriptase inhibitors are associated with rash and central nervous system disturbance; protease inhibitors elicit gastrointestinal adverse effects and metabolic abnormalities including lipodystrophy syndrome, hyperlipidemia and insulin resistance. These complications have the potential to increase morbidity and mortality significantly in those requiring long-term treatment of HIV-infection. The presence of such abnormalities also has an impact on adherence to treatment. Besides providing health benefits, HAART may have a negative impact on patients' quality of life. Identifying and treating these complications has important implications for patient survival. PMID:15688751

Teodor, Andra; Teodor, D; Luca, V

2004-01-01

48

Antiretroviral Pharmacology in Mucosal Tissues  

PubMed Central

Strategies to prevent HIV infection using pre-exposure prophylaxis (PrEP) are required to curtail the HIV pandemic. The mucosal tissues of the genital and rectal tracts play a critical role in HIV acquisition, but antiretroviral (ARV) disposition and correlates of efficacy within these tissues are not well understood. Pre-clinical and clinical strategies to describe ARV pharmacokinetic-pharmacodynamic relationships (PK/PD) within mucosal tissues are currently being investigated. In this review, we summarize the physiochemical and biologic factors influencing ARV tissue exposure. Further, we discuss the necessary steps to generate relevant PK/PD data and the challenges associated with this process. Finally, we suggest how pre-clinical and clinical data might be practically translated into optimal PrEP dosing strategies for clinical trials testing using mathematical modeling and simulation. PMID:23764642

Thompson, Corbin G.; Cohen, Myron S.; Kashuba, Angela D.M.

2014-01-01

49

How does Antiretroviral Therapy Affect HIV Mutation?  

NSDL National Science Digital Library

You are a physician who works with people who are infected with HIV. You study HIV-1 protease and reverse transcriptase to determine which anti-retroviral drugs might be effective and which drugs might be ineffective.

Devin Iimoto (Whittier College;)

2005-06-11

50

Housing Starts: May 1984.  

National Technical Information Service (NTIS)

This report presents statistics on new housing units started from 1964 to 1984. Statistics cover new privately owned housing units started in permit - issuing places, units authorized but not started in permit - issuing places, and manufacturers's shipmen...

1984-01-01

51

Episodic antiretroviral therapy increases HIV transmission risk compared to continuous therapy: results of a randomized controlled trial  

PubMed Central

Objective To compare HIV transmission risk among patients randomized to episodic vs. continuous antiretroviral therapy. Design This was a substudy of the Strategies of Management of Antiretroviral Therapy (SMART) study, in which patients were randomized to continuous vs. CD4+ guided episodic antiretroviral therapy. Participants were surveyed about sexual activity and needle-sharing and had laboratory testing for gonorrhea, chlamydia, and syphilis. Results 883 patients enrolled; the mean age was 45 years, 25% were women, and 78% were on antiretroviral therapy. At baseline, 136 participants (15.4%) had high-risk behavior (vaginal or anal sex without a condom, needle-sharing, or incident bacterial sexually-transmitted infection). Following randomization, the proportion of participants reporting high-risk behavior was stable and did not differ by randomized arm (p = 0.39). Among participants off therapy at baseline, high-risk behavior was less common 4 months after randomization among those who were randomized to start antiretroviral therapy (p = 0.03). HIV transmission risk (high-risk behavior while HIV-RNA level > 1500 copies/ml) with partners perceived to be HIV-uninfected was higher in the episodic therapy arm (p = 0.02). Conclusions Patients on episodic antiretroviral therapy did not decrease high-risk behavior, and because HIV-RNA levels were higher, this strategy may result in increased HIV transmission. PMID:18769356

Burman, William; Grund, Birgit; Neuhaus, Jacqueline; Douglas, John; Friedland, Gerald; Telzak, Edward; Colebunders, Robert; Paton, Nicholas; Fisher, Martin; Rietmeijer, Cornelis

2009-01-01

52

Starting Time Ending Time Starting Time  

E-print Network

Starting Time Ending Time Starting Time Name Of The Department/Unit Organizing The Event N How Would You Like Parking Arrangements Handled? Attendant Time (3 hour minimun): ) r e b m u N t n u-business hours. We may not be able to provide parking, depending on time of day and location. Consider public

Sjölander, Kimmen

53

Starting Time Ending Time Starting Time  

E-print Network

Starting Time Ending Time Starting Time Name Of The Department/Unit Organizing The Event N How Would You Like Parking Arrangements Handled? Attendant Time (3 hour minimun): Campus Department to schedule your event during non-business hours. We may not be able to provide parking, depending on time

Sjölander, Kimmen

54

Impact of Antiretroviral Therapy on Renal Function among HIV-Infected Tanzanian Adults: A Retrospective Cohort Study  

PubMed Central

Background Data regarding the outcomes of HIV-infected adults with baseline renal dysfunction who start antiretroviral therapy are conflicting. Methods We followed up a previously-published cohort of HIV-infected adult outpatients in northwest Tanzania who had high prevalence of renal dysfunction at the time of starting antiretroviral therapy (between November 2009 and February 2010). Patients had serum creatinine, proteinuria, microalbuminuria, and CD4+ T-cell count measured at the time of antiretroviral therapy initiation and at follow-up. We used the adjusted Cockroft-Gault equation to calculate estimated glomerular filtration rates (eGFRs). Results In this cohort of 171 adults who had taken antiretroviral therapy for a median of two years, the prevalence of renal dysfunction (eGFR <90 mL/min/1.73 m2) decreased from 131/171 (76.6%) at the time of ART initiation to 50/171 (29.2%) at the time of follow-up (p<0.001). Moderate dysfunction (eGFR<60 mL/min/1.73 m2) decreased from 21.1% at antiretroviral therapy initiation to 1.1% at follow-up (p<0.001), as did the prevalence of microalbuminuria (72% to 44%, p<0.001). Use of tenofovir was not associated with renal dysfunction at follow-up. Conclusion Mild and moderate renal dysfunction were common in this cohort of HIV-infected adults initiating antiretroviral therapy, and both significantly improved after a median follow-up time of 2 years. Our work supports the renal safety of antiretroviral therapy in African adults with mild-moderate renal dysfunction, suggesting that these regimens do not lead to renal damage in the majority of patients and that they may even improve renal function in patients with mild to moderate renal dysfunction. PMID:24586882

Mpondo, Bonaventura C. T.; Kalluvya, Samuel E.; Peck, Robert N.; Kabangila, Rodrick; Kidenya, Benson R.; Ephraim, Lucheri; Fitzgerald, Daniel W.; Downs, Jennifer A.

2014-01-01

55

When should AIDS-free HIV-1 infected persons initiate antiretroviral therapy? Collaborative analysis of HIV cohort studies  

E-print Network

1 When should AIDS-free HIV-1 infected persons initiate antiretroviral therapy? Collaborative. The best way to address this question is to randomize AIDS-free HIV-1 infected patients to either initiate analysis of HIV cohort studies When To Start Consortium* * Complete lists including writing committee

56

"Risk factors associated with virologic failure in HIV-infected patients receiving antiretroviral therapy at a public hospital in Peru"  

PubMed Central

OBJECTIVE To describe clinical and biological characteristics of subjects with virologic failure who participated in the sexually transmitted diseases HIV/AIDS National Program from a Peruvian public hospital. MATERIALS AND METHODS An exploratory descriptive study was performed with data from subjects older than 18 who started high activity antiretroviral therapy (HAART) between May 2004 and December 2009 and who had a viral load control after 24 weeks of HAART. Virologic failure was defined as a viral load value above 1000 copies/mL on follow up after 24 weeks on HAART. RESULTS Of 1 478 records of patients on HAART analized, the median age was 35 years [IQR, 29-41] and 69.6% were male. Also, virologic failure occurred in 24% and 3.7% died. Of subjects with virologic failure, 9.5% died. On multivariate analysis, age, history of antiretroviral use before starting HAART, change of antiretroviral therapy due to toxicity, opportunistic infections during HAART, level of CD4 + lymphocytes below 100 cells/ml at start of HAART, adherence and clinical stage were independently associated with virologic failure. In the group of patient with no history of antiretroviral use before starting HAART, age, opportunistic infections during HAART were associated with virologic failure. CONCLUSION This study identified factors associated with virologic failure. Further studies are needed to evaluate whether the use of these factors can help to identify prospectively patients at high risk of failure, and to design interventions aimed to reduce this risk. PMID:23450408

Jorge, Alave R; Jorge, Paz B; Elsa, Gonzalez L; Miguel, Campos S; Rodriguez, Martin; Willig, James; Juan, Echevarria Z

2013-01-01

57

Intellectual property rights, market competition and access to affordable antiretrovirals.  

PubMed

The number of patients receiving antiretroviral therapy (ART) has increased from around half a million in 2003 to almost 10 million in only 10 years, and will continue to increase in the coming years. Over 16 million more are eligible to start ART according to the last World Health Organization (WHO) guidelines. The demand is also switching from the less expensive antiretrovirals (ARVs) that allowed such scale-up to newer more expensive ones with fewer side effects or those that can be used by people who have developed resistance to first-line treatment. However, patents on these new drugs can delay robust generic competition and, consequently, price reduction made possible by economies of scale. Various ways to address this issue have been envisaged or implemented, including the use of the flexibilities available under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), systematic widespread voluntary licensing, of which the Medicines Patent Pool (MPP) is an example, and the application of different prices in different countries, called tiered pricing. This paper helps explain the impact of patents on market competition for ARVs and analyses various approaches available today to minimize this impact. PMID:25309984

Pascual, Fernando

2014-01-01

58

[Adhesion to the antiretroviral treatment].  

PubMed

The objective of the therapy antiretroviral is to improve the quality of life and the survival of the persons affected by the VIH through the suppression of the viral replication. Nevertheless one of the present problems is the resistant apparition of stumps to the new medicines caused by an incorrect management of the therapeutic plan; by an incorrect adhesion of the personal processing. Since the therapeutic success will depend, among others factors, and of important form of the degree of implication and commitment of the person affected, is a matter of identifying prematurely the possible situations concomitants (personal factors and of addiction, psycho-social, related to the processing and its possible secondary effects, associated factors to the own illness or even to the relation professional-patient) that can interfere in a correct adhesion. For it is necessary of the interaction multidisciplinary of the welfare team, and fundamental the work of nursing at the moment of to detect the possible determinant factors and the intervention definition of strategies arrived at by consensus with the own person, that they promote it or it improve. The quantification of the degree of adhesion (measure in %) values through various direct and indirect methods and should keep in mind in it takes of therapeutic decisions being able to come to be advised the suspension of the processing until obtaining to conscience to the person affected of the importance of a correct therapeutic compliance. PMID:15672996

Carballo, M

2004-12-01

59

HIV-1 Antiretroviral Drug Therapy  

PubMed Central

The most significant advance in the medical management of HIV-1 infection has been the treatment of patients with antiviral drugs, which can suppress HIV-1 replication to undetectable levels. The discovery of HIV-1 as the causative agent of AIDS together with an ever-increasing understanding of the virus replication cycle have been instrumental in this effort by providing researchers with the knowledge and tools required to prosecute drug discovery efforts focused on targeted inhibition with specific pharmacological agents. To date, an arsenal of 24 Food and Drug Administration (FDA)-approved drugs are available for treatment of HIV-1 infections. These drugs are distributed into six distinct classes based on their molecular mechanism and resistance profiles: (1) nucleoside-analog reverse transcriptase inhibitors (NNRTIs), (2) non–nucleoside reverse transcriptase inhibitors (NNRTIs), (3) integrase inhibitors, (4) protease inhibitors (PIs), (5) fusion inhibitors, and (6) coreceptor antagonists. In this article, we will review the basic principles of antiretroviral drug therapy, the mode of drug action, and the factors leading to treatment failure (i.e., drug resistance). PMID:22474613

Arts, Eric J.; Hazuda, Daria J.

2012-01-01

60

Linkage to HIV Care and Antiretroviral Therapy in Cape Town, South Africa  

Microsoft Academic Search

BackgroundAntiretroviral therapy (ART) has been scaled-up rapidly in Africa. Programme reports typically focus on loss to follow-up and mortality among patients receiving ART. However, little is known about linkage and retention in care of individuals prior to starting ART.MethodologyData on adult residents from a periurban community in Cape Town were collected at a primary care clinic and hospital. HIV testing

Katharina Kranzer; Jennifer Zeinecker; Philip Ginsberg; Catherine Orrell; Nosindiso N. Kalawe; Stephen D. Lawn; Linda-Gail Bekker; Robin Wood; David Joseph Diemert

2010-01-01

61

HIV-infected patients' adherence to highly active antiretroviral therapy: a phenomenological study.  

PubMed

Adherence to the treatment regimen is essential to the success of highly active antiretroviral therapy for patients who are infected with HIV. The evidence suggests that poor adherence to antiretroviral drug therapy is a major problem that has the potential to diminish effective viral suppression, promote viral resistance, and place patients at risk for hospitalization, opportunistic infections, and an increased risk of HIV transmission. The primary aim of this study was to understand patients' experiences regarding their adherence to antiretroviral drug therapy. Thus, 19 participants were recruited for in-depth interviews regarding their adherence to drug regimens. All the interviews were transcribed verbatim and analyzed by using Benner's phenomenological analysis approach. Four main themes emerged from the data: (i) choosing to live and the decision to start taking medications; (ii) strategies for adhering to the regimen and managing the side-effects; (iii) relationships with healthcare providers; and (iv) advantages of the medications as a motivator to continue one's adherence to the regimen. Studying and understanding the experiences of patients can provide new insights and strategies in order to enhance patients' adherence to highly active antiretroviral therapy. PMID:21210925

Mohammadpour, Ali; Yekta, Zohre Parsa; Nikbakht Nasrabadi, Ali R

2010-12-01

62

Preferred antiretroviral drugs for the next decade of scale up  

PubMed Central

Global commitments aim to provide antiretroviral therapy (ART) to 15 million people living with HIV by 2015, and recent studies have demonstrated the potential for widespread ART to prevent HIV transmission. Increasingly, countries are adapting their national guidelines to start ART earlier, for both clinical and preventive benefits. To maximize the benefits of ART in resource-limited settings, six key principles need to guide ART choice: simplicity, tolerability and safety, durability, universal applicability, affordability and heat stability. Currently available drugs, combined with those in late-stage clinical development, hold great promise to simplify treatment in the short term. Over the longer term, newer technologies, such as long-acting formulations and nanotechnology, could radically alter the treatment paradigm. This commentary reviews recommendations made in an expert consultation on treatment scale up in resource-limited settings. PMID:23010379

Andrieux-Meyer, Isabelle; Calmy, Alexandra; Cahn, Pedro; Clayden, Polly; Raguin, Gilles; Katlama, Christine; Vitoria, Marco; Levin, Andrew; Lynch, Sharonann; Goemaere, Eric; Ford, Nathan

2012-01-01

63

Brief report Tuberculosis following initiation of antiretroviral therapy  

E-print Network

1 Brief report Tuberculosis following initiation of antiretroviral therapy in low-income and high-income countries Running title: Tuberculosis on antiretroviral therapy The ART-LINC Collaboration words, 1 table, 1 figure, 13 references Key words: tuberculosis; antiretroviral therapy; HIV/AIDS; low

Paris-Sud XI, Université de

64

Recent progress in antiretrovirals - lessons from resistance  

PubMed Central

Recent failures in efforts to develop an effective vaccine against HIV-1 infection have emphasized the importance of antiretroviral therapy in treating HIV-1-infected patients. Thus far, inhibitors of two viral enzymes, reverse transcriptase and protease, have had a profoundly positive impact on the survival of HIV-1-infected patients. However, new inhibitors that act at diverse steps in the viral replication cycle are urgently needed because of the development of resistance to currently available antiretrovirals. This review summarizes recent progress in antiretroviral drug discovery and development by specifically focusing on novel inhibitors of three phases of replication: viral entry, integration of the viral DNA into the host cell genome and virus particle maturation. PMID:18468560

Adamson, Catherine S.; Freed, Eric O.

2008-01-01

65

Nevada Head Start, 2002.  

ERIC Educational Resources Information Center

This pamphlet describes the current services of the Nevada Head Start program. Information is provided on program eligibility requirements, the number of children and families served during the 2001-2002 program year, the counties served by Head Start programs, health services provided, demographic characteristics of families served by Head Start,…

Biagi, Kathy

66

The Head Start Debates  

ERIC Educational Resources Information Center

The future of Head Start depends on how well people learn from and apply the lessons from its past. That's why everyone involved in early education needs this timely, forward-thinking book from the leader of Head Start. The first book to capture the Head Start debates in all their complexity and diversity, this landmark volume brings together the…

Zigler, Edward, Ed.; Styfco, Sally J., Ed.

2004-01-01

67

The metabolic toxicities of antiretroviral therapy.  

PubMed

Since the adoption of highly active antiretroviral therapy (HAART) in the mid-1990s, certain metabolic toxicities have been increasingly recognized. These include a fat redistribution syndrome (lipohypertrophy, lipoatrophy), hyperlipidaemia, altered glucose metabolism and insulin resistance, mitochondrial toxicity (presenting as anaemia, myopathy, pancreatitis, neuropathy, hepatic steatosis and lactic acidosis), and bone density abnormalities (osteoporosis and osteonecrosis). Metabolic complications are principally reported with protease inhibitors and nucleoside reverse transcriptase inhibitors, but may be seen with all classes of antiretroviral therapy. In this review, we summarize the epidemiology, pathogenesis and management of these various toxicities. PMID:11516363

Herman, J S; Easterbrook, P J

2001-09-01

68

Early Antiretroviral Therapy reduces the incidence of otorrhea in a randomized study of early and deferred antiretroviral therapy: Evidence from the Children with HIV Early Antiretroviral Therapy (CHER) Study  

PubMed Central

Background Although otorrhea occurs commonly in HIV-infected infants, there are few data. We compared the incidence of otorrhea in infants receiving early vs deferred ART in the Children with HIV Early Antiretroviral (CHER) trial. Infants aged 6 to 12 weeks of age with confirmed HIV infection and a CD4 percentage greater than or equal to 25% were randomized to early or deferred ART at two sites in South Africa. Medical records from one study site were reviewed for otorrhea. Findings Data were reviewed from the start of the trial in July 2005 until 20 June 2007, when the Data Safety Monitoring Board recommended that randomization to the deferred arm should stop and that all infants in this arm be reviewed for commencing antiretroviral therapy. Infants entered the study at a median of 7.4 weeks of age. Eleven of 38 (29%) on deferred therapy and 7 of 75 (9%) in the early-therapy group developed otorrhea (risk ratio 3.1, 95% confidence interval (CI) 1.31-7.36; p = 0.01). Conclusions Early initiation of antiretroviral therapy is associated with significantly less otorrhea than when a deferred strategy is followed. Trial registration NCT00102960. ClinicalTrials.Gov PMID:22029910

2011-01-01

69

Continuous antiretroviral therapy decreases bone mineral density  

Microsoft Academic Search

Objectives: To assess the effects of anti retroviral therapy (ART) on bone mineral density (BMD) Design: Randomized comparison of continuous ART (viral suppression group; VS) with intermittent ART (drug conservation group; DC) Setting: Outpatient clinics in the United States, Australia, and Spain. Participants: Participants in the Strategies for Management of Antiretroviral Therapy (SMART) Body Composition substudy. Main outcome measures: Annual

Birgit Grund; Grace Peng; Cynthia L Gibert; Jennifer F Hoy; Rachel L Isaksson; Judith C Shlay; Esteban Martinez; Peter Reiss; Fehmida Visnegarwala; Andrew D Carr

2009-01-01

70

Update on opportunistic infections in the era of effective antiretroviral therapy.  

PubMed

Despite enormous improvements in effectiveness of treatment for HIV infection, opportunistic infections continue to occur in those who have not yet been diagnosed with HIV and in those who are not receiving antiretroviral therapy. This review focuses on tuberculosis and cryptococcal infections, the most common opportunistic infections (OIs) in patients living with human immunodeficiency virus infection around the world, as well as on new developments in progressive multifocal leukoencephalopathy and pneumocystis pneumonia. In the sections on these conditions, updates on diagnosis, treatment, and complications, as well as information on when to start antiretroviral therapy is provided. The article concludes with a discussion of new data on 2 vaccine-preventable OIs, human papillomavirus and varicella-zoster virus. PMID:25151568

Zanoni, Brian C; Gandhi, Rajesh T

2014-09-01

71

Start with Science  

ERIC Educational Resources Information Center

The author has found over her 13 years of teaching that starting off the school year with a science investigation has been a great method to learn about her students, to engage them about science before the school year even starts, and to build a foundation for a year of engaging science experiences. This article describes four such activities…

Erickson, Susan

2012-01-01

72

Starting a Small Business  

NSDL National Science Digital Library

This is the first of several lessons on starting a small business. This class is intended for adults entrepreneurs who may be thinking of starting a business. This lesson gives economic information on small businesses. It also provides information to help the student determine whether they are ready to be a business owner and whether their particular business could succeed. QUESTION: If you were to start a small business or home occupation, what would it be? Create a document giving a brief description of a potential business idea. (You will not be required to share the information with class members.) LESSON: Please read the following articles. 1. Go to the ...

Duke, Sonya

2008-10-07

73

Why Kids Start  

MedlinePLUS

... to portray smokers as cool, sexy, independent, fun, attractive, and living on the edge – images that are ... 2009, contains several provisions aimed at preventing young people from starting to smoke. >> Learn More A A ...

74

Starting an Investment Club  

E-print Network

the treasurer and one other member are given these E-161 8-02 STARTING AN INVESTMENT CLUB Jason Johnson, Bill Thompson and Wade Polk* * Assistant Professor and Extension Economist?Management, Assistant Professor and Extension Economist, and Extension Program... the treasurer and one other member are given these E-161 8-02 STARTING AN INVESTMENT CLUB Jason Johnson, Bill Thompson and Wade Polk* * Assistant Professor and Extension Economist?Management, Assistant Professor and Extension Economist, and Extension Program...

Johnson, Jason; Thompson, Bill; Polk, Wade

2002-08-12

75

Pediatric adherence to HIV antiretroviral therapy  

Microsoft Academic Search

More than 2 million children are infected with HIV globally. Pediatric antiretroviral therapy (ART) adherence is complex,\\u000a and current levels are often suboptimal. As established treatment programs in developed settings struggle with chronic therapy\\u000a and nascent treatment programs in resource-limited settings expand, the importance and challenges of good adherence to ART\\u000a are becoming ever more clear. Adherence behavior is influenced

Jessica Haberer; Claude Mellins

2009-01-01

76

Antiretroviral medications during pregnancy for therapy or prophylaxis  

Microsoft Academic Search

The use of combination antiretroviral therapy during pregnancy has enabled us to decrease perinatal HIV transmission to less\\u000a than 1%, in areas with adequate resources. Questions remain regarding the safety of these medications for the mother, fetus,\\u000a and child. Recent publications present conflicting data about associations between antiretrovirals and prematurity and other\\u000a adverse pregnancy outcomes, and if highly active antiretroviral

Alice Marie Stek

2009-01-01

77

Start School Later  

NSDL National Science Digital Library

Last month, Pediatrics, the official journal of the American Academy of Pediatrics (AAP), issued a formal policy statement concerning School Start Times for Adolescents (http://pediatrics.aappublications.org/content/early/2014/08/19/peds.2014-1697.abstract?sid=3f739b0e-a552-4a4a-bd0a-907809e20255). In essence, the AAP called for schools to start later, citing sleep deprivation among teenagers as âÂÂan important public health issue.â This site from Start School Later, a group advocating for âÂÂhealth, safety and equity in education,â provides good, if somewhat one-sided, information on the topic. If youâÂÂre unfamiliar, start with Research & Info, which provides links to a number of informative sites about adolescent sleep needs and the impact of early school start times. Success Stories takes readers to schools around the country that have experimented with, and benefited from, later start times. If you're inspired, you can also Get Involved. Whatever your position on the issue, this is an informative and interesting site.

78

Psychiatric Advance Directives: Getting Started  

MedlinePLUS

... Home Getting Started National Resource Center on Psychiatric Advance Directives - Getting Started Getting Started Psychiatric advance directives (PADs) are relatively new legal instruments that may ...

79

Challenges in initiating antiretroviral therapy in 2010  

PubMed Central

Many clinical trials have shown that initiating antiretroviral therapy (ART) at higher rather than lower CD4 T cell-positive counts results in survival benefit. Early treatment can help prevent end-organ damage associated with HIV replication and can decrease infectivity. The mainstay of treatment is either a non-nucleoside reverse transcriptase inhibitor or a ritonavir-boosted protease inhibitor in combination with two nucleoside reverse transcriptase inhibitors. While effective at combating HIV, ART can produce adverse alterations of lipid parameters, with some studies suggesting a relationship between some anti-retroviral agents and cardiovascular disease. As the HIV-positive population ages, issues such as hypertension and diabetes must be taken into account when initiating ART. Adhering to ART can be difficult; however, nonoptimal adherence to ART can result in the development of resistance; thus, drug characteristics and the patient’s preparedness to begin therapy must be considered. Reducing the pill burden through the use of fixed-dose antiretroviral drug combinations can facilitate adherence. PMID:23365594

Tremblay, Cecile L; Baril, Jean-Guy; Fletcher, David; Kilby, Donald; MacPherson, Paul; Shafran, Stephen D; Tyndall, Mark W

2010-01-01

80

Global Challenges in the Development and Delivery of Paediatric Antiretrovirals  

PubMed Central

By the end of 2006, compared with 28% coverage for adults, only 15% of children with HIV who needed antiretroviral treatment were receiving it. Major challenges in delivering treatment include the lack of paediatric antiretrovirals that can be dosed in small children and limited studies examining safety and efficacy for existing antiretroviral formulations. The high costs of treatment have been reduced through the use of generic, fixed-dose combination drugs. Evidence-based strategies for managing resistance and the scale-up of pharmacological trials for children in low- and middle-income countries are critical to the success and future development of paediatric antiretrovirals. PMID:18549980

Bowen, Asha; Palasanthiran, Pamela; Sohn, Annette H.

2008-01-01

81

Monochromatic precursor starts  

NASA Astrophysics Data System (ADS)

Whistler precursors are discrete emissions that precede two-hop whistlers, starting shortly after the one-hop delay. More evidence is presented that the precursor and associated whistler propagate through the same duct, and observations of a new type of precursor are presented. This new precursor has a monochromatic precursor start (MPS) which may or may not trigger a riser. Although MPS's may be emissions entrained by power line radiation (PLR), phase analysis of the starting frequencies shows that they are not simply related to harmonics of the power line frequencies in the two conjugate regions (50 Hz in New Zealand, 60 Hz in Alaska). If the MPS is due to entrainment by PLR, then previous theories of precursor generation need not be discarded. Forward triggering of a precursor at a power line harmonic by a hybrid whistler may occur.

Rietveld, M. T.

1980-05-01

82

Modeling Antiretroviral Drug Responses for HIV-1 infected Patients Using Differential Equation Models  

PubMed Central

Summary We review mathematical modeling and related statistical issues of HIV dynamics primarily in response to antiretroviral drug therapy in this article. We start from a basic model of virus infection and then review a number of more advanced models with considering, e.g., pharmacokinetic factors, adherence and drug resistance. Specifically, we illustrate how mathematical models can be developed and parameterized to understand effects of long-term treatment and different treatment strategies on disease progression. In addition, we discuss a variety of parameter estimation methods for differential equation models that are applicable to either within- or between-host viral dynamics. PMID:23603208

Xiao, Yanni; Miao, Hongyu; Tang, Sanyi; Wu, Hulin

2014-01-01

83

Starting up the upstarts.  

PubMed

Venture capitalists pour $1 billion a year into health care--and that investment may be the most overlooked indicator of new business opportunities. Signs show that companies focused on consolidation and cost-cutting are off the A list for risk capital. Instead, venture capitalists are targeting start-ups that save money on the front lines by truly managing care. PMID:9435477

Greene, J

1997-12-20

84

Blogs: Getting Started  

ERIC Educational Resources Information Center

Blogs are communication tools, they serve as vehicles to transmit messages. Before deciding to blog, one needs to devise a strategy on how this medium will fit in with his or her communication needs. This will also help later in deciding which features one will need to include in his or her blog. This article discusses ways on how to start and…

Dyrud, Marilyn A.; Worley, Rebecca B.; Schultz, Benjamin

2005-01-01

85

StartMe  

NSDL National Science Digital Library

The StartMe application gives Internet users the opportunity to create their own personal browser startpage with their favorite bookmarks and RSS feeds. The drag and drop interface is user-friendly, particularly for computer neophytes. Visitors can also incorporate extensions for popular browsers or tweak the appearance of their startpage as they see fit. This version is compatible with all operating systems.

86

PHP: Getting Started Introduction  

E-print Network

PHP: Getting Started Introduction This document describes the basic syntax for PHP code, how to execute PHP scripts, methods for sending output to the browser, how to comment your code, and the handling of whitespace. Basic PHP syntax PHP code typically resides in a plaintext file with a .php extension. The code

Vander Zanden, Brad

87

[Metabolic and cardiovascular effects of combined antiretroviral therapy in patients with HIV infection. Systematic review of literature].  

PubMed

In HIV infected patients an increased incidence of cardiac events has been reported since the introduction of highly active antiretroviral therapy (HAART). Antiretroviral drugs' regimens are, in fact, associated with several metabolic side effects, such as dyslipidemia, impaired glucose metabolism and abnormal body fat distribution, that increase cardiovascular risk of HIV subjects. In addition, HIV infection itself, the chronic inflammatory status and the frequent presence in this population of traditional risk factors contribute to an higher incidence of cardio and cerebrovascular events. In last years several studies showed the occurrence of carotid vascular impairment in patients treated with protease inhibitors (PI). Similarly the DAD Study reported an increase of 26% of the risk of myocardial infarction in patients on HAART and that this risk was independently associated with longer exposure to PI, after multivariate adjustments. A correct evaluation of the metabolic status before starting HAART and an adequate control of drugs-related metabolic abnormalities may reduce the incidence of cardiac events and still improve HIV patients prognosis. This review will focus on the metabolic effects of antiretroviral drugs and on the contribution of combination antiretroviral therapy on cardiovascular risk. PMID:22567733

Casaretti, Laura; Paolillo, Stefania; Formisano, Roberto; Bologna, Ada; Mattiello, Giacomo; Conte, Sirio; Petraglia, Laura; Lo ludice, Francesco; Fabiani, Irma; Cirillo, Anna Paola; Vitagliano, Alice; Gambardella, Francesco; della Ratta, Giuseppe Luca; Filardi, Pasquale Perrone

2011-12-01

88

Toxicity of antiretroviral therapy and implications for drug development  

Microsoft Academic Search

The toxicity of antiretroviral therapy is an increasingly important issue in the management of patients with human immunodeficiency virus (HIV). With sustained major declines in opportunistic complications, HIV infection is increasingly a more chronic disease, and so more drugs are being used in more patients for longer periods. However, permanent and near-perfect adherence to antiretroviral therapy is needed to maximize

Andrew Carr

2003-01-01

89

Switching antiretroviral therapy to minimize metabolic complications  

PubMed Central

Advances in HIV therapy have made living with HIV for decades a reality for many patients. However, antiretroviral therapy has been associated with multiple long-term complications, including dyslipidemia, fat redistribution, insulin resistance and increased cardiovascular risk. As newer agents with improved metabolic profiles have become available, there is growing interest in the safety and efficacy of switching ART as a strategy to reduce long-term complications. This article reviews recently published data on switching ART to minimize the contributions of specific agents to these complications. PMID:22171239

Lake, Jordan E; Currier, Judith S

2011-01-01

90

Cost-Effectiveness of Antiretroviral Therapy for Prevention  

PubMed Central

Recent empirical studies and analyses have heightened interest in the use of expanded antiretroviral therapy (ART) for prevention of HIV transmission. However, ART is expensive, approximately $600 per person per year, raising issues of the cost and cost-effectiveness of ambitious ART expansion. The goal of this review is to equip the reader with the conceptual tools and substantive background needed to understand and evaluate the policy and programmatic implications of cost-effectiveness assessments of ART for prevention. We provide this review in six sections. We start by introducing and explaining basic concepts of health economics as they relate to this issue, including resources, costs, health metrics (such as Disability-Adjusted Life Years), and different types of economic analysis. We then review research on the cost and cost-effectiveness of ART as treatment, and on the cost-effectiveness of traditional HIV prevention. We describe critical issues in the epidemic impact of ART, such as suppression of transmission and the role of the acute phase of infection. We then present a conceptual model for conducting and interpreting cost-effectiveness analyses of ART as prevention, and review the existing preliminary estimates in this area. We end with a discussion of future directions for programmatic demonstrations and evaluation. PMID:21999776

Kahn, James G; Marseille, Elliot A; Bennett, Rod; Williams, Brian G; Granich, Reuben

2011-01-01

91

Waltz Quick Start  

E-print Network

ion. For a more detailed explanation of the facilities and functions of the Waltz visualization system refer to the Waltz User Manual [Rob96]. ffl The Generalization Process splits the data into spatially connected groups. ffl A specialization is formed from a subset (selection) of these groups. ffl The results are displayed in multiple abstract views of the same data. These abstractions are formed by losing or augmenting the data to facilitate in the understanding of the data. Waltz implicitly connects the abstractions together as Linkages. By default most of the Linkages between the different abstractions are switched on; they are turned off by using the Linkages Form. 1.1 Starting a Waltz Session A Waltz session is started by typing the command: % waltz 1.2 Finishing a Waltz Session The session is ended by selecting the Quit option from the File menu at the top of the Waltz canvas; or by typing Alt q (the hot key configuration of the menu command). Waltz Quick Start Version...

unknown authors

1996-01-01

92

Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection  

E-print Network

Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection Developed by the HHS Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children--A Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the Use of Antiretroviral

Levin, Judith G.

93

Highly active antiretroviral treatment for the prevention of HIV transmission  

PubMed Central

In 2007 an estimated 33 million people were living with HIV; 67% resided in sub-Saharan Africa, with 35% in eight countries alone. In 2007, there were about 1.4 million HIV-positive tuberculosis cases. Globally, approximately 4 million people had been given highly active antiretroviral therapy (HAART) by the end of 2008, but in 2007, an estimated 6.7 million were still in need of HAART and 2.7 million more became infected with HIV. Although there has been unprecedented investment in confronting HIV/AIDS - the Joint United Nations Programme on HIV/AIDS estimates $13.8 billion was spent in 2008 - a key challenge is how to address the HIV/AIDS epidemic given limited and potentially shrinking resources. Economic disparities may further exacerbate human rights issues and widen the increasingly divergent approaches to HIV prevention, care and treatment. HIV transmission only occurs from people with HIV, and viral load is the single greatest risk factor for all modes of transmission. HAART can lower viral load to nearly undetectable levels. Prevention of mother to child transmission offers proof of the concept of HAART interrupting transmission, and observational studies and previous modelling work support using HAART for prevention. Although knowing one's HIV status is key for prevention efforts, it is not known with certainty when to start HAART. Building on previous modelling work, we used an HIV/AIDS epidemic of South African intensity to explore the impact of testing all adults annually and starting persons on HAART immediately after they are diagnosed as HIV positive. This theoretical strategy would reduce annual HIV incidence and mortality to less than one case per 1000 people within 10 years and it would reduce the prevalence of HIV to less than 1% within 50 years. To explore HAART as a prevention strategy, we recommend further discussions to explore human rights and ethical considerations, clarify research priorities and review feasibility and acceptability issues. PMID:20205768

2010-01-01

94

The Setpoint Study (ACTG A5217): Effect of Immediate Versus Deferred Antiretroviral Therapy on Virologic Set Point in Recently HIV-1–Infected Individuals  

PubMed Central

(See the editorial commentary by Tossonian and Conway, on pages 10–12.) Background.?The benefits of antiretroviral therapy during early human immunodeficiency virus type 1 (HIV-1) infection remain unproved. Methods.?A5217 study team randomized patients within 6 months of HIV-1 seroconversion to receive either 36 weeks of antiretrovirals (immediate treatment [IT]) or no treatment (deferred treatment [DT]). Patients were to start or restart antiretroviral therapy if they met predefined criteria. The primary end point was a composite of requiring treatment or retreatment and the log10 HIV-1 RNA level at week 72 (both groups) and 36 (DT group). Results.?At the June 2009 Data Safety Monitoring Board (DSMB) review, 130 of 150 targeted participants had enrolled. Efficacy analysis included 79 individuals randomized ?72 weeks previously. For the primary end point, the IT group at week 72 had a better outcome than the DT group at week 72 (P = .005) and the DT group at week 36 (P = .002). The differences were primarily due to the higher rate of progression to needing treatment in the DT group (50%) versus the IT (10%) group. The DSMB recommended stopping the study because further follow-up was unlikely to change these findings. Conclusions.?Progression to meeting criteria for antiretroviral initiation in the DT group occurred more frequently than anticipated, limiting the ability to evaluate virologic set point. Antiretrovirals during early HIV-1 infection modestly delayed the need for subsequent treatment. Clinical Trials Registration.?NCT00090779. PMID:22180621

DeGruttola, Victor; Sun, Xin; Fiscus, Susan A.; Del Rio, Carlos; Hare, C. Bradley; Markowitz, Martin; Connick, Elizabeth; Macatangay, Bernard; Tashima, Karen T.; Kallungal, Beatrice; Camp, Rob; Morton, Tia; Daar, Eric S.; Little, Susan

2012-01-01

95

Variable Impact on Mortality of AIDS-Defining Events Diagnosed during Combination Antiretroviral Therapy: Not All AIDS-Defining Conditions Are Created Equal  

PubMed Central

Background The extent to which mortality differs following individual acquired immunodeficiency syndrome (AIDS)–defining events (ADEs) has not been assessed among patients initiating combination antiretroviral therapy. Methods We analyzed data from 31,620 patients with no prior ADEs who started combination antiretroviral therapy. Cox proportional hazards models were used to estimate mortality hazard ratios for each ADE that occurred in >50 patients, after stratification by cohort and adjustment for sex, HIV transmission group, number of anti-retroviral drugs initiated, regimen, age, date of starting combination antiretroviral therapy, and CD4+ cell count and HIV RNA load at initiation of combination antiretroviral therapy. ADEs that occurred in <50 patients were grouped together to form a “rare ADEs” category. Results During a median follow-up period of 43 months (interquartile range, 19–70 months), 2880 ADEs were diagnosed in 2262 patients; 1146 patients died. The most common ADEs were esophageal candidiasis (in 360 patients), Pneumocystis jiroveci pneumonia (320 patients), and Kaposi sarcoma (308 patients). The greatest mortality hazard ratio was associated with non-Hodgkin’s lymphoma (hazard ratio, 17.59; 95% confidence interval, 13.84–22.35) and progressive multifocal leukoencephalopathy (hazard ratio, 10.0; 95% confidence interval, 6.70–14.92). Three groups of ADEs were identified on the basis of the ranked hazard ratios with bootstrapped confidence intervals: severe (non-Hodgkin’s lymphoma and progressive multifocal leukoencephalopathy [hazard ratio, 7.26; 95% confidence interval, 5.55–9.48]), moderate (cryptococcosis, cerebral toxoplasmosis, AIDS dementia complex, disseminated Mycobacterium avium complex, and rare ADEs [hazard ratio, 2.35; 95% confidence interval, 1.76–3.13]), and mild (all other ADEs [hazard ratio, 1.47; 95% confidence interval, 1.08–2.00]). Conclusions In the combination antiretroviral therapy era, mortality rates subsequent to an ADE depend on the specific diagnosis. The proposed classification of ADEs may be useful in clinical end point trials, prognostic studies, and patient management. PMID:19275498

2011-01-01

96

Calculating the affordability of antiretrovirals in St Lucia.  

PubMed

The cost of antiretrovirals is borne by donors in many low- and middle-income countries, including St Lucia. Although donor involvement has facilitated access to antiretrovirals, donor engagement in HIV/AIDS has changed over the years. This paper assesses the affordability of antiretrovirals at the individual level if donors were no longer available to fund the cost of first and second-line antiretrovirals and a prospective third-line regimen. Various conceptions of affordability are reviewed using different assumptions of what is required to maintain a standard of living that would avoid individuals descending into poverty as a result of antiretroviral purchases. These concepts of affordability are operationalized using data from the Household Budgeting Survey conducted in St Lucia in 2005/2006. While there is a range of results for the affordability of first and second-line antiretrovirals depending on which standard of affordability is used, third-line antiretrovirals are unaffordable to more than 80% of the population across the four standards of affordability used - the national poverty line, 50% of median annual consumption, 10% of annual consumption and a proposed reasonable minimum standard. PMID:24756598

Reddock, J R; Grignon, M

2013-01-01

97

StartUpNation  

NSDL National Science Digital Library

It would seem that more and more people are interested in developing their own business, and a number of websites are dedicated to helping these persons achieve that goal. One valuable website in that realm is StartUpNation. Created by Jeff and Rich Sloan, the site contains a well-designed homepage that includes links to sections dedicated to areas of interest to the prospective entrepreneur, including those that deal with customer service and creating strategic marketing plans. A good place to start is the âÂÂLean from the Expertsâ area, located on the left-hand side of the homepage. Here, visitors can learn from successful individuals, such as Glenn Coggeshell of Black Dot Coffee. Along the same side, visitors can also read about how to choose a business for themselves and also how to plan to make this business a reality. In keeping with the times, the site also affords users the opportunity to sign up for RSS feeds and the ability to listen (and download) a number of podcasts.

98

Current Perspectives on HIV-1 Antiretroviral Drug Resistance  

PubMed Central

Current advancements in antiretroviral therapy (ART) have turned HIV-1 infection into a chronic and manageable disease. However, treatment is only effective until HIV-1 develops resistance against the administered drugs. The most recent antiretroviral drugs have become superior at delaying the evolution of acquired drug resistance. In this review, the viral fitness and its correlation to HIV-1 mutation rates and drug resistance are discussed while emphasizing the concept of lethal mutagenesis as an alternative therapy. The development of resistance to the different classes of approved drugs and the importance of monitoring antiretroviral drug resistance are also summarized briefly. PMID:25341668

Iyidogan, Pinar; Anderson, Karen S.

2014-01-01

99

Experiencing antiretroviral adherence: helping healthcare staff better understand adherence to paediatric antiretrovirals  

PubMed Central

Background Lack of adherence to antiretroviral medications is one of the key challenges for paediatric HIV care and treatment programmes. There are few hands-on opportunities for healthcare workers to gain awareness of the psychosocial and logistic challenges that caregivers face when administering daily antiretroviral therapy to children. This article describes an educational activity that allows healthcare workers to simulate this caregiver role. Methods Paediatric formulations of several antiretroviral medications were dispensed to a convenience sample of staff at the Baylor College of Medicine-Bristol-Myers Squibb Children's Clinical Center of Excellence in Mbabane, Swaziland. The amounts of the medications remaining were collected and measured one week later. Adherence rates were calculated. Following the exercise, a brief questionnaire was administered to all staff participants. Results The 27 clinic staff involved in the exercise had varying and low adherence rates over the week during which the exercise was conducted. Leading perceived barriers to adherence included: "family friends don't help me remember/tell me I shouldn't take it" and "forgot". Participants reported that the exercise was useful as it allowed them to better address the challenges faced by paediatric patients and caregivers. Conclusions Promoting good adherence practices among caregivers of children on antiretrovirals is challenging but essential in the treatment of paediatric HIV. Participants in this exercise achieved poor adherence rates, but identified with many of the barriers commonly reported by caregivers. Simulations such as this have the potential to promote awareness of paediatric ARV adherence issues among healthcare staff and ultimately improve adherence support and patient outcomes. PMID:21134284

2010-01-01

100

Plasma and Intracellular Antiretroviral Concentrations in HIV-Infected Patients under Short Cycles of Antiretroviral Therapy  

PubMed Central

Study of plasma and intracellular concentrations of atazanavir, lopinavir, nevirapine, and efavirenz was conducted on 48 patients under short cycles of antiretroviral therapy. Intracellular concentrations (IC) were still measurable for all drugs after 85?h or 110?h drug intake despite the absence of drug in plasma for atazanavir and lopinavir. A linear relationship between plasma and intracellular efavirenz was observed. Further studies to fully understand the impact of IC in the intermittent antiviral treatment are required.

Zehnacker, Laura; Abe, Emuri; Mathez, Dominique; Alvarez, Jean-Claude; Leibowitch, Jacques; Azoulay, Stéphane

2014-01-01

101

HLA-Bw4 homozygosity is associated with an impaired CD4 T cell recovery after initiation of antiretroviral therapy.  

PubMed

We assessed the influence of human leukocyte antigen (HLA) alleles HLA-Bw4 and HLA-Bw6 on CD4 T cell recovery after starting successful combination antiretroviral therapy in 265 individuals. The median gains in the CD4 T cell count after 4 years were 258 cells/microL for HLA-Bw4 homozygotes, 321 cells/microL for HLA-Bw4/Bw6 heterozygotes, and 363 cells/microL for HLA-Bw6 homozygotes (P = .01, compared with HLA-Bw4 homozygotes). HLA-Bw4 homozygosity appears to predict an impaired CD4 T cell recovery after initiation of combination antiretroviral therapy. PMID:18466093

Rauch, Andri; Nolan, David; Furrer, Hansjakob; McKinnon, Elizabeth; John, Mina; Mallal, Simon; Gaudieri, Silvana; Günthard, Huldrych F; Schmid, Patrick; Battegay, Manuel; Hirschel, Bernard; Telenti, Amalio; James, Ian

2008-06-15

102

Minnesota: Early Head Start Initiatiive  

ERIC Educational Resources Information Center

Minnesota provides supplemental state funding to existing federal Head Start and Early Head Start (EHS) grantees to increase their capacity to serve additional infants, toddlers, and pregnant women. The initiative was started in 1997 when the state legislature earmarked $1 million of the general state Head Start supplemental funds for children…

Center for Law and Social Policy, Inc. (CLASP), 2012

2012-01-01

103

HIV-1 Antiretroviral Drug Therapy Eric J. Arts1  

E-print Network

HIV-1 Antiretroviral Drug Therapy Eric J. Arts1 and Daria J. Hazuda2 1 Ugandan CFAR Laboratories 44106 2 Merck Research Laboratories, West Point, Pennsylvania 19486 Correspondence: eja3@case.edu; daria

Levin, Judith G.

104

Increasing antiretroviral drug access for children with HIV infection.  

PubMed

Although there have been great gains in the prevention of pediatric HIV infection and provision of antiretroviral therapy for children with HIV infection in resource-rich countries, many barriers remain to scaling up HIV prevention and treatment for children in resource-limited areas of the world. Appropriate testing technologies need to be made more widely available to identify HIV infection in infants. Training of practitioners in the skills required to care for children with HIV infection is required to increase the number of children receiving antiretroviral therapy. Lack of availability of appropriate antiretroviral drug formulations that are easily usable and inexpensive is a major impediment to optimal care for children with HIV. The time and energy spent trying to develop liquid antiretroviral formulations might be better used in the manufacture of smaller pill sizes or crushable tablets, which are easier to dispense, transport, store, and administer to children. PMID:17403860

Havens, Peter L; Gibb, Diana M

2007-04-01

105

Microneedle delivery for improved efficacy of antiretroviral and antibiotic drugs  

E-print Network

Two classes of drugs, antiretrovirals and antibiotics, could benefit greatly from delivery through microneedles. Microneedles (MN) offer an increase in efficacy for these drugs by providing delivery to the lymphatic system ...

Stauber, Zachary Jason

2012-01-01

106

Effect of antiretroviral therapy on pulmonary hypertension in HIV patients.  

PubMed

Pulmonary hypertension is an important cause of dyspnoea in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients. The effect highly active antiretroviral therapy on pulmonary artery pressure has been an area of controversy. The purpose of this study was to evaluate the effect of antiretroviral therapy on pulmonary hypertension in HIV patients. This prospective cohort study was performed in a peripheral medical college of West Bengal with 88 patients from October 2008 to September 2011. By echocardiography, pulmonary artery pressure was recorded before initiation of antiretroviral therapy. After one year of antiretroviral therapy repeat echocardiography was done and pulmonary artery pressure was evaluated. The values were analysed. The present study showed that highly active antiretroviral therapy improves pulmonary artery pressure in HIV/AIDS patients if instituted at early stages (WHO classes I and II). However, at more advanced stages of pulmonary artery hypertension, it does not have any significant effect on reduction of the same. The present study documents that early detection of pulmonary artery hypertension in HIV/AIDS patients is essential and prompt institution of highly active antiretroviral therapy should be considered in them even when those patients do not fulfill the conventional criteria for initiation of this treatment. PMID:25154159

Pal, Jyotirmoy; Sen, Kaushik; Sarkar, Gauranga; Mandal, Anupam; Chakraborty, Supratik; Deb, Animesh

2013-12-01

107

From Head Start to Sure Start: Reflections on Policy Transfer  

ERIC Educational Resources Information Center

This article uses the history of debates over the US Head Start programme (1965), Early Head Start (1994) and the UK Sure Start initiative (1998), as a window on to policy transfer. In all the three, the aim was that early intervention could offer a means of boosting children's educational attainment and of countering the wider effects of poverty…

Welshman, John

2010-01-01

108

The Survival Benefits of Antiretroviral Therapy in South Africa  

PubMed Central

Background.?We sought to quantify the survival benefits attributable to antiretroviral therapy (ART) in South Africa since 2004. Methods.?We used the Cost-Effectiveness of Preventing AIDS Complications–International model (CEPAC) to simulate 8 cohorts of human immunodeficiency virus (HIV)–infected patients initiating ART each year during 2004–2011. Model inputs included cohort-specific mean CD4+ T-cell count at ART initiation (112–178 cells/µL), 24-week ART suppressive efficacy (78%), second-line ART availability (2.4% of ART recipients), and cohort-specific 36-month retention rate (55%–71%). CEPAC simulated survival twice for each cohort, once with and once without ART. The sum of the products of per capita survival differences and the total numbers of persons initiating ART for each cohort yielded the total survival benefits. Results.?Lifetime per capita survival benefits ranged from 9.3 to 10.2 life-years across the 8 cohorts. Total estimated population lifetime survival benefit for all persons starting ART during 2004–2011 was 21.7 million life-years, of which 2.8 million life-years (12.7%) had been realized by December 2012. By 2030, benefits reached 17.9 million life-years under current policies, 21.7 million life-years with universal second-line ART, 23.3 million life-years with increased linkage to care of eligible untreated patients, and 28.0 million life-years with both linkage to care and universal second-line ART. Conclusions.?We found dramatic past and potential future survival benefits attributable to ART, justifying international support of ART rollout in South Africa. PMID:24307741

April, Michael D.; Wood, Robin; Berkowitz, Bethany K.; Paltiel, A. David; Anglaret, Xavier; Losina, Elena; Freedberg, Kenneth A.; Walensky, Rochelle P.

2014-01-01

109

Funding Category START-Programme  

E-print Network

Funding Category START-Programme Programme aims The fundamental aim of the START-Programme of awards between subject areas. The START Programme is one of the most generously supported research programmes in Austria. As such, it attracts considerable media attention and thus contributes significantly

Fuchs, Clemens

110

Maryland Early Head Start Initiative  

ERIC Educational Resources Information Center

Since 2000, Maryland has provided state supplemental funds to Head Start and Early Head Start (EHS) programs to improve access. Local EHS programs may use funds, through child care partnerships, to extend the EHS day or year. Maryland's approach to building on EHS includes: (1) Increase the capacity of existing Head Start and EHS programs to…

Center for Law and Social Policy, Inc. (CLASP), 2012

2012-01-01

111

Integration of Antiretroviral Therapy with Tuberculosis Treatment  

PubMed Central

Background We previously reported that integrating antiretroviral therapy (ART) with tuberculosis treatment reduces mortality. However, optimal time to initiate ART during tuberculosis treatment remains contentious. Methods To address this, we conducted a 3-arm, open-label randomized controlled trial in South Africa in acid-fast bacilli smear positive patients (n=642) with HIV and CD4+ counts <500 cells/mm3. Findings on the early therapy group (ART initiated within 4 weeks of tuberculosis treatment initiation, n=214) and late therapy group (ART initiated within the first 4 weeks of the continuation phase of tuberculosis treatment, n=215) are presented here. Results Median CD4+ count and viral load at baseline was 150 cells/mm3 and 161000 copies/ml, being similar in both groups. Incidence rate of AIDS or death was 6.9 (18/259.4) and 7.8 (19/244.2) per 100 person-years in the early and late therapy groups respectively (Incidence Rate Ratio (IRR)=0.89; 95%Confidence Interval (95%CI): 0.44,1.79; P=0.73). However, in patients with CD4+ counts <50 cells/mm3, the incidence rates of AIDS or death were 8.5 (early) and 26.3 (late) per 100 person-years (IRR=0.32; 95%CI: 0.07,1.13; P=0.06). Immune reconstitution inflammatory syndrome (IRIS) incidence rates were 20.2 (early) and 7.7 (late) per 100 person-years (IRR=2.62; 95%CI: 1.48,4.82; P<0.001). Adverse events requiring antiretroviral drug switches occurred in 10 (early) and 1 (late) patients (P=0.006). Conclusions The benefits of AIDS-free survival balanced against the risks of IRIS and ART-related adverse events, support early ART initiation in patients with CD4+ counts <50 cells/mm3 and deferred ART initiation to the continuation phase of tuberculosis treatment when CD4+ counts are higher. PMID:22010915

Abdool Karim, Salim S.; Naidoo, Kogieleum; Grobler, Anneke; Padayatchi, Nesri; Baxter, Cheryl; Gray, Andrew L.; Gengiah, Tanuja; Gengiah, Santhanalakshmi; Naidoo, Anushka; Jithoo, Niraksha; Nair, Gonasagrie; El-Sadr, Wafaa M.; Friedland, Gerald; Abdool Karim, Quarraisha

2011-01-01

112

The Cost-Effectiveness of Early Access to HIV Services and Starting cART in the UK 1996–2008  

Microsoft Academic Search

AimTo calculate use, cost and cost-effectiveness of people living with HIV (PLHIV) starting routine treatment and care before starting combination antiretroviral therapy (cART) and PLHIV starting first-line 2NRTIs+NNRTI or 2NRTIs+PIboosted, comparing PLHIV with CD4?200 cells\\/mm3 and CD4>200 cells\\/mm3. Few studies have calculated the use, cost and cost-effectiveness of routine treatment and care before starting cART and starting cART above and

Eduard J. Beck; Sundhiya Mandalia; Roshni Sangha; Peter Sharott; Mike Youle; Guy Baily; Ray Brettle; Mark Gompels; Margaret Johnson; Brendan McCarron; Ed Ong; Anton Pozniak; Achim Schwenk; Stephen Taylor; John Walsh; Ed Wilkins; Ian Williams; Brian Gazzard

2011-01-01

113

Nearly Full Employment Recovery Among South African HIV Patients On Antiretroviral Therapy: Evidence From A Large Population Cohort  

PubMed Central

Antiretroviral therapy for HIV may have important economic benefits for patients and their households. We quantified the impact of HIV treatment on employment status among HIV patients in rural South Africa who were enrolled in a public-sector HIV treatment program supported by the U.S. President’s Emergency Plan for AIDS Relief. We linked clinical data from more than 2000 patients in the treatment program with ten years of longitudinal socioeconomic data from a complete community-based population cohort of over 30,000 adults residing in the clinical catchment area. We estimated the employment effects of HIV treatment in fixed effects regressions. Four years after the initiation of antiretroviral therapy, employment among HIV patients had recovered to about 90 percent of baseline rates observed in the same patients three to five years before they started treatment. Many patients initiated treatment early enough that they were able to avoid any loss of employment due to HIV. These results represent the first estimates of employment recovery among HIV patients in a general population, relative to the employment levels that these patients had prior to job-threatening illness and the decision to seek care. We find large economic benefits to HIV treatment. For some patients, further gains could be obtained from initiating antiretroviral therapy earlier, prior to HIV-related job loss. PMID:22778335

Bor, Jacob; Tanser, Frank; Newell, Marie-Louise; Barnighausen, Till

2013-01-01

114

Antiretroviral procurement and supply chain management.  

PubMed

Procurement, the country-level process of ordering antiretrovirals (ARVs), and supply chain management, the mechanism by which they are delivered to health-care facilities, are critical processes required to move ARVs from manufacturers to patients. To provide a glimpse into the ARV procurement and supply chain, the following pages provide an overview of the primary stakeholders, principal operating models, and policies and regulations involved in ARV procurement. Also presented are key challenges that need to be addressed to ensure that the supply chain is not a barrier to the goal of universal coverage. This article will cover the steps necessary to order and distribute ARVs, including different models of delivery, key stakeholders involved, strategic considerations that vary depending on context and policies affecting them. The single drug examples given illustrate the complications inherent in fragmented supply and demand-driven models of procurement and supply chain management, and suggest tools for navigating these hurdles that will ultimately result in more secure and reliable ARV provision. Understanding the dynamics of ARV supply chain is important for the global health community, both to ensure full and efficient treatment of persons living with HIV as well as to inform the supply chain decisions for other public health products. PMID:25310145

Ripin, David J; Jamieson, David; Meyers, Amy; Warty, Umesh; Dain, Mary; Khamsi, Cyril

2014-01-01

115

Conceptualizing antiretroviral adherence in Beijing, China.  

PubMed

International health experts agree that China is on the verge of an AIDS crisis. In response, the Chinese government initiated the "Four Frees and One Care" policy in 2003 to decrease economic barriers and increase access to antiretroviral therapies for people with HIV. However, long-term treatment success requires not only access, but high rates of medication adherence. This qualitative interview study with 29 persons receiving HIV care at Beijing's Ditan Hospital identified barriers to and facilitators of medication adherence. The interviews were guided by an a priori conceptual model of adherence with four components: access, knowledge about medications, motivation, and proximal cues to action. Barriers to adherence were related to stigma and fear of discrimination; the medications themselves (including side-effects and complicated dosing regimens); and other economic issues (i.e. costs of transportation, lab tests and hospitalizations). Facilitators included participants' strong will to live, use of electronic reminders and family support. These results support the conceptual model and suggest that successful interventions must minimize stigma as it negatively affects all components of the model for adherence. PMID:18576162

Starks, H; Simoni, J; Zhao, H; Huang, B; Fredriksen-Goldsen, K; Pearson, C; Chen, W-T; Lu, L; Zhang, F

2008-07-01

116

Antiretroviral Therapy: A Promising HIV Prevention Strategy?  

PubMed Central

The use of antiretroviral therapy (ART) has been associated with significant improvement in morbidity and survival of persons living with HIV. In addition, recently, there has also been intense interest in the potential impact of ART on HIV transmission and consequently on the trajectory of the HIV epidemic globally. Evidence from mathematical modeling analyses as well as observational, and ecological studies supports the potential for ART as prevention. However, definitive data from clinical trials are awaited. In the United States, the feasibility and potential of using ART as a prevention strategy presents particular challenges: the large number of individuals with undiagnosed HIV; the predominance of disenfranchised individuals affected by the epidemic; evidence of delay in engagement in HIV care after diagnosis with attendant late initiation of ART; and difficulties with consistent, long-term adherence to ART as well as concerns regarding long-term risk-behavior change. Thus, for this novel effort to succeed, a multidimensional approach is necessary that must include policy changes, social mobilization, and improved access to clinical and supportive services for persons living with HIV, with a particular focus on the unique needs of at-risk populations, combined with engagement of all cadres of health care providers and community constituencies. PMID:21406980

El-Sadr, Wafaa M.; Affrunti, Megan; Gamble, Theresa; Zerbe, Allison

2010-01-01

117

Evaluating Sure Start, Head Start, and Early Head Start: Finding Their Signals Amidst Methodological Static  

Microsoft Academic Search

Evaluations of three national early childhood programs–Sure Start in England and Head Start and Early Head Start in the United States–are examined to determine what their respective methodological strengths and weaknesses are and to detect impacts or signals common to all of these evaluations. These shared signals include improved family functioning and parenting practices and strong signs of parental and

Benjamin L. Allen

2008-01-01

118

Antiretroviral Therapy Optimisation without Genotype Resistance Testing: A Perspective on Treatment History  

E-print Network

Antiretroviral Therapy Optimisation without Genotype Resistance Testing: A Perspective on Treatment Medical Centre Rotterdam, Utrecht, The Netherlands, 11 Rega Institute, Katholieke Universiteit Leuven resistance testing (GRT) is recommended to guide combination antiretroviral therapy (cART), funding and

Amsterdam, Universiteit van

119

AIDS . Author manuscript Switching to second-line antiretroviral therapy in resource-limited settings  

E-print Network

(VL) is routinely measured to detect failure of antiretroviral therapy (ART) and guide switching the prognosis of HIV infection has improved considerably since highly active antiretroviral therapy (ARTAIDS . Author manuscript Page /1 9 Switching to second-line antiretroviral therapy in resource

Paris-Sud XI, Université de

120

Appropriateness of antiretroviral therapy in clients of an HIV\\/AIDS case management organization  

Microsoft Academic Search

We sought to assess appropriateness of antiretroviral therapy (ART) reported by clients of an HIV\\/AIDS case management organization and identify variables associated with appropriate ART receipt. A total of 295 such clients were mailed a survey asking them to identify antiretroviral medications they were taking.Of them 220 (75%) returned surveys; 201 (93%) were taking antiretrovirals. Of these, 159 were on

W. C. Holmes; J. L. Pace; I. Frank

2007-01-01

121

Antiretroviral HIV treatment and care for injecting drug users: an evidence-based overview  

E-print Network

1 COMMENTARY Antiretroviral HIV treatment and care for injecting drug users: an evidence the advent of highly-active antiretroviral treatment (HAART). The overall benefit from antiretroviral HIV treatment has, however, been lesser in HIV-infected IDUs than in other patient groups (e.g. men who have sex

Paris-Sud XI, Université de

122

Factors influencing global antiretroviral procurement prices  

PubMed Central

Background Antiretroviral medicines (ARVs) are one of the most costly parts of HIV/AIDS treatment. Many countries are struggling to provide universal access to ARVs for all people living with HIV and AIDS. Although substantial price reductions of ARVs have occurred, especially between 2002 and 2008, achieving sustainable access for the next several decades remains a major challenge for most low- and middle-income countries. The objectives of the present study were twofold: first, to analyze global ARV prices between 2005 and 2008 and associated factors, particularly procurement methods and key donor policies on ARV procurement efficiency; second, to discuss the options of procurement processes and policies that should be considered when implementing or reforming access to ARV programs. Methods An ARV-medicines price-analysis was carried out using the Global Price Reporting Mechanism from the World Health Organization. For a selection of 12 ARVs, global median prices and price variation were calculated. Linear regression models for each ARV were used to identify factors that were associated with lower procurement prices. Logistic regression models were used to identify the characteristics of those countries which procure below the highest and lowest direct manufactured costs. Results Three key factors appear to have an influence on a country's ARV prices: (a) whether the product is generic or not; (b) the socioeconomic status of the country; (c) whether the country is a member of the Clinton HIV/AIDS Initiative. Factors which did not influence procurement below the highest direct manufactured costs were HIV prevalence, procurement volume, whether the country belongs to the least developed countries or a focus country of the United States President's Emergency Plan For AIDS Relief. Conclusion One of the principal mechanisms that can help to lower prices for ARV over the next several decades is increasing procurement efficiency. Benchmarking prices could be one useful tool to achieve this. PMID:19922690

2009-01-01

123

French 2013 guidelines for antiretroviral therapy of HIV-1 infection in adults  

PubMed Central

Introduction These guidelines are part of the French Experts’ recommendations for the management of people living with HIV/AIDS, which were made public and submitted to the French health authorities in September 2013. The objective was to provide updated recommendations for antiretroviral treatment (ART) of HIV-positive adults. Guidelines included the following topics: when to start, what to start, specific situations for the choice of the first session of antiretroviral therapy, optimization of antiretroviral therapy after virologic suppression, and management of virologic failure. Methods Ten members of the French HIV 2013 expert group were responsible for guidelines on ART. They systematically reviewed the most recent literature. The chairman of the subgroup was responsible for drafting the guidelines, which were subsequently discussed within, and finalized by the whole expert group to obtain a consensus. Recommendations were graded for strength and level of evidence using predefined criteria. Economic considerations were part of the decision-making process for selecting preferred first-line options. Potential conflicts of interest were actively managed throughout the whole process. Results ART should be initiated in any HIV-positive person, whatever his/her CD4 T-cell count, even when >500/mm3. The level of evidence of the individual benefit of ART in terms of mortality or progression to AIDS increases with decreasing CD4 cell count. Preferred initial regimens include two nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine or abacavir/lamivudine) plus a non-nucleoside reverse transcriptase inhibitor (efavirenz or rilpivirine), or a ritonavir-boosted protease inhibitor (atazanavir or darunavir). Raltegravir, lopinavir/r, and nevirapine are recommended as alternative third agents, with specific indications and restrictions. Specific situations such as HIV infection in women, primary HIV infection, severe immune suppression with or without identified opportunistic infection, and person who injects drugs are addressed. Options for optimization of ART once virologic suppression is achieved are discussed. Evaluation and management of virologic failure are described, the aim of any intervention in such situation being to reduce plasma viral load to <50 copies/ml. Conclusion These guidelines recommend that any HIV-positive individual should be treated with ART. This recommendation was issued both for the patient’s own sake and for promoting treatment as prevention. PMID:24942364

Hoen, Bruno; Bonnet, Fabrice; Delaugerre, Constance; Delobel, Pierre; Goujard, Cecile; L'Henaff, Marianne; Persiaux, Renaud; Rey, David; Rouzioux, Christine; Taburet, Anne-Marie; Morlat, Philippe

2014-01-01

124

The development of antiretroviral therapy and its impact on the HIV-1/AIDS pandemic  

PubMed Central

In the last 25 years, HIV-1, the retrovirus responsible for the Acquired Immunodeficiency Syndrome (AIDS), has gone from being an “inherently untreatable” infectious agent to one eminently susceptible to a range of approved therapies. During a five-year period, starting in the mid-1980s, my group at the National Cancer Institute played a role in the discovery and development of the first generation of antiretroviral agents, starting in 1985 with Retrovir® (zidovudine, AZT) in a collaboration with scientists at the Burroughs-Wellcome Company (now GlaxoSmithKline). We focused on AZT and related congeners in the dideoxynucleoside family of nucleoside reverse transcriptase inhibitors (NRTIs), taking them from the laboratory to the clinic in response to the pandemic of AIDS, then a terrifying and lethal disease. These drugs proved, above all else, that HIV-1 infection is treatable, and such proof provided momentum for new therapies from many sources, directed at a range of viral targets, at a pace that has rarely if ever been matched in modern drug development. Antiretroviral therapy has brought about a substantial decrease in the death rate due to HIV-1 infection, changing it from a rapidly lethal disease into a chronic manageable condition, compatible with very long survival. This has special implications within the classic boundaries of public health around the world, but at the same time in certain regions may also affect a cycle of economic and civil instability in which HIV-1/AIDS is both cause and consequence. Many challenges remain, including 1.) the life-long duration of therapy; 2.) the ultimate role of pre-exposure prophylaxis (PrEP); 3.) the cardiometabolic side effects or other toxicities of long-term therapy; 4.) the emergence of drug-resistance and viral genetic diversity (non-B subtypes); 5.) the specter of new cross-species transmissions from established retroviral reservoirs in apes and Old World monkeys; and 6.) the continued pace of new HIV-1 infections in many parts of the world. All of these factors make refining current therapies and developing new therapeutic paradigms essential priorities, topics covered in articles within this special issue of Antiviral Research. Fortunately, there are exciting new insights into the biology of HIV-1, its interaction with cellular resistance factors, and novel points of attack for future therapies. Moreover, it is a short journey from basic research to public health benefit around the world. The current science will lead to new therapeutic strategies with far-reaching implications in the HIV-1/AIDS pandemic. This article forms part of a special issue of Antiviral Research marking the 25th anniversary of antiretroviral drug discovery and development, Vol 85, issue 1, 2010. PMID:20018391

Broder, Samuel

2010-01-01

125

The next generation of the World Health Organization's global antiretroviral guidance  

PubMed Central

The 2013 World Health Organization’s (WHO) Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection provide more than 50 new recommendations across the continuum of HIV care, including recommendations on HIV testing, using antiretroviral drugs for prevention, linking individuals to HIV care and treatment services, initiating and maintaining antiretroviral therapy (ART) and monitoring treatment. Guidance is provided across all age groups and populations of adults, pregnant and breastfeeding women, adolescents and key populations. The guidelines are based on a public health approach to expanding the use of ARV drugs for HIV treatment and prevention, with a particular focus on resource-limited settings. The most important new clinical recommendations include: treating adults, adolescents and older children earlier – starting ART in all individuals with a CD4 cell count of 500 cells/mm3 or less (but giving priority to those with advanced clinical disease or a CD4 cell count less than 350 cells/mm3); starting ART at any CD4 cell count in certain populations, including those with active TB (existing recommendation), Hepatitis B infection and severe chronic liver disease, HIV-positive partners in serodiscordant couples (existing recommendation), pregnant and breastfeeding women, and children younger than 5 years of age; a preferred first-line ART regimen of Tenofovir+3TC or FTC+ Efavirenz as a once-daily fixed-dose combination for adults, pregnant women, and children aged 3 years and older; and the use of viral load testing as the preferred approach to monitoring the response to ART and to diagnose treatment failure. Guidance is also provided on enhancing the efficiency and effectiveness of HIV services, including strategies to improve retention in care, and adherence to ART; task-shifting to address human resource gaps; decentralizing delivery of ART to primary health care, and integrating ART services within maternal and child health, TB or drug dependency clinics. There is additional guidance for programme managers on how to plan HIV programmes and use resources most efficiently. PMID:23819908

Hirnschall, Gottfried; Harries, Anthony D; Easterbrook, Philippa J; Doherty, Meg C; Ball, Andrew

2013-01-01

126

Comparative manufacture and cell-based delivery of antiretroviral nanoformulations  

PubMed Central

Nanoformulations of crystalline indinavir, ritonavir, atazanavir, and efavirenz were manufactured by wet milling, homogenization or sonication with a variety of excipients. The chemical, biological, immune, virological, and toxicological properties of these formulations were compared using an established monocyte-derived macrophage scoring indicator system. Measurements of drug uptake, retention, release, and antiretroviral activity demonstrated differences amongst preparation methods. Interestingly, for drug cell targeting and antiretroviral responses the most significant difference among the particles was the drug itself. We posit that the choice of drug and formulation composition may ultimately affect clinical utility. PMID:22267924

Balkundi, Shantanu; Nowacek, Ari S; Veerubhotla, Ram S; Chen, Han; Martinez-Skinner, Andrea; Roy, Upal; Mosley, R Lee; Kanmogne, Georgette; Liu, Xinming; Kabanov, Alexander V; Bronich, Tatiana; McMillan, JoEllyn; Gendelman, Howard E

2011-01-01

127

Kansas: Early Head Start Initiative  

ERIC Educational Resources Information Center

Kansas Early Head Start (KEHS) provides comprehensive services following federal Head Start Program Performance Standards for pregnant women and eligible families with children from birth to age 4. KEHS was implemented in 1998 using Child Care and Development Block Grant (CCDBG) quality set-aside dollars augmented by a transfer of federal…

Center for Law and Social Policy, Inc. (CLASP), 2012

2012-01-01

128

Research Services START UP FUNDS  

E-print Network

Research Services START UP FUNDS www.ucalgary.ca/research START UP FUNDS From time to time some of their research program. The nature of the grants can vary. For example, some grants are discretionary allowing the researcher to use the funds for a wide variety of activities such as travel, office furniture, students

de Leon, Alex R.

129

Maine: Early Head Start Initiatives  

ERIC Educational Resources Information Center

Maine has two initiatives that build on Early Head Start (EHS). The first initiative, Fund for a Healthy Maine, has since 2001 provided tobacco settlement money to existing Head Start and EHS programs to expand the number of children who receive full-day, full-year services. Local programs have the option of using these funds for EHS, depending on…

Center for Law and Social Policy, Inc. (CLASP), 2012

2012-01-01

130

How to start up a start-up  

NASA Astrophysics Data System (ADS)

Researchers are increasingly toying with the idea of taking their ideas out of universities and into the marketplace. Starting your own company can be extremely rewarding, but it requires perseverance and a great deal of hard work.

Wyant, James C.

2007-06-01

131

Tackling group-level traits by starting at the start.  

PubMed

We agree that emergent group-level properties are important; however, we disagree that current approaches, especially culture-gene coevolutionary (CGC) approaches, have neglected them. We explain how CGC helps demystify the tumult of humans' group-level complexity by "starting at the start," and why (a) assuming undifferentiated individuals and (b) focusing on cooperation are actually powerful tools to this end. PMID:24970402

Chudek, Maciej; Henrich, Joseph

2014-06-01

132

Hydrazine engine start system air start performance and controls sizing  

SciTech Connect

Hydrazine has been used as an energy source in many applications to fuel in-flight main engine starting. In a current application, an existing hydrazine engine start system (ESS) design was adapted to meet new fuel control requirements. This paper presents a brief system description, historical context, and the motivating factors for the hydrazine controls changes and three case studies of controls design and analysis from the ESS program. 4 refs.

Johnson, A.T.

1992-01-01

133

The START III bargaining space  

SciTech Connect

The declining state of the Russian military and precarious Russian economic condition will give the US considerable advantages at the START III bargaining table. Taking the US-RF asymmetries into account, this paper discusses a menu of START III measures the US could ask for, and measures it could offer in return, in attempting to negotiate an equitable treaty. Measures the US might seek in a START III treaty include: further reductions in deployed strategic nuclear warheads, irreversibility of reductions through warhead dismantlement; beginning to bring theater nuclear weapons under mutual control, and increased transparency into the Russian nuclear weapons complex. The US may, however, wish to apply its bargaining advantages to attempting to achieve the first steps toward two long-range goals that would enhance US security: bringing theater nuclear weapons into the US-RF arms control arena, and increasing transparency into the Russian nuclear weapons complex. In exchange for measures relating to these objectives, the US might consider offering to Russia: Further strategic weapons reductions approaching levels at which the Russians believe they could maintain a degree of parity with the US; Measures to decrease the large disparities in potential deliver-system uploading capabilities that appear likely under current START II/START III scenarios; and Financial assistance in achieving START II/START III reductions as rapidly as is technically possible.

Karas, T.H.

1998-08-01

134

The emergence of drug resistant HIV variants and novel anti-retroviral therapy  

PubMed Central

After its identification in 1980s, HIV has infected more than 30 million people worldwide. In the era of highly active anti-retroviral therapy, anti-retroviral drug resistance results from insufficient anti-retroviral pressure, which may lead to treatment failure. Preliminary studies support the idea that anti-retroviral drug resistance has evolved largely as a result of low-adherence of patients to therapy and extensive use of anti-retroviral drugs in the developed world; however, a highly heterogeneous horde of viral quasi-species are currently circulating in developing nations. Thus, the prioritizing of strategies adopted in such two worlds should be quite different considering the varying anti-retroviral drug resistance prevalence. In this article, we explore differences in anti-retroviral drug resistance patterns between developed and developing countries, as they represent two distinct ecological niches of HIV from an evolutionary standpoint. PMID:23835806

Paydary, Koosha; Khaghani, Parisa; Emamzadeh-Fard, Sahra; Alinaghi, Seyed Ahmad Seyed; Baesi, Kazem

2013-01-01

135

The emergence of drug resistant HIV variants and novel anti-retroviral therapy.  

PubMed

After its identification in 1980s, HIV has infected more than 30 million people worldwide. In the era of highly active anti-retroviral therapy, anti-retroviral drug resistance results from insufficient anti-retroviral pressure, which may lead to treatment failure. Preliminary studies support the idea that anti-retroviral drug resistance has evolved largely as a result of low-adherence of patients to therapy and extensive use of anti-retroviral drugs in the developed world; however, a highly heterogeneous horde of viral quasi-species are currently circulating in developing nations. Thus, the prioritizing of strategies adopted in such two worlds should be quite different considering the varying anti-retroviral drug resistance prevalence. In this article, we explore differences in anti-retroviral drug resistance patterns between developed and developing countries, as they represent two distinct ecological niches of HIV from an evolutionary standpoint. PMID:23835806

Paydary, Koosha; Khaghani, Parisa; Emamzadeh-Fard, Sahra; Alinaghi, Seyed Ahmad Seyed; Baesi, Kazem

2013-07-01

136

Absence of Hypersensitivity to Glucocorticoids in Antiretroviral-associated Lipodystrophy  

Microsoft Academic Search

Objective: The lipodystrophy syndrome, which is associated with the use of antiretroviral drugs in some human immunodeficiency virus (HIV)-infected individuals, bears a striking similarity to the fat redistribution observed in Cushing’s disease. Although urinary free cortisol excretion and glucocorticoid receptor binding affinity are not elevated in subjects with lipodystrophy, glucocorticoid action at the cellular level has not been examined in

Ian P. Martin; Patricia A. Breen; David S. Weigle

2003-01-01

137

Dangerous medicines: Unproven AIDS cures and counterfeit antiretroviral drugs  

Microsoft Academic Search

BACKGROUND: Increasing access to antiretroviral therapy (ART) is a critical goal endorsed by the United Nations and all of its member states. At the same time, anecdotal accounts suggest that the promotion of unproven AIDS 'cures' and remedies are widespread, and in the case of The Gambia, Iran and South Africa, have been promoted by governments directly. Although a range

Joseph J Amon

2008-01-01

138

Antiretroviral treatment programmes in Nepal: Problems and barriers  

Microsoft Academic Search

Background: Antiretroviral (ARV) drugs have become the cornerstone of HIV (Human Immunodefi ciency Virus) care and treatment. Its use has led to a marked reduction in AIDS (Acquired Immune Defi ciency Syndrome) related morbidity and mortality. However, more than fi ve years after their introduction few HIV infected people in Nepal are receiving ARVs. Objective: The main aim of this

Wasti SP; Simkhada P; Van Teijlingen

139

Social support, disclosure, and use of antiretroviral therapy.  

PubMed

This paper investigates the association between social support, disclosure of HIV/AIDS, and odds of initiating combination antiretroviral drug therapy in its first years on the market. Data are drawn from the first three rounds of the Community Health Advisory and Information Network (CHAIN) survey, collected between 1994 and 1997. CHAIN documents service needs and rates of service utilization among a representative sample of persons with HIV/AIDS in New York City. A two-step logistic regression estimated associations between (1) perceived social support and use of combination antiretroviral therapy, and (2) the interaction between concealing HIV/AIDS and perceived social support. Results offered evidence that the positive association between social support and use of highly active antiretroviral treatment (HAART) and other combination antiretroviral therapies is contingent upon disclosure of HIV status within the household or among friend and acquaintance networks. A positive association between social support and odds of using combination therapy was only observed among those who disclosed their HIV status. PMID:16496089

Waddell, Elizabeth Needham; Messeri, Peter A

2006-05-01

140

Christian identity and men's attitudes to antiretroviral therapy in Zambia  

Microsoft Academic Search

Increasing access to antiretroviral therapy (ART), especially in urban areas in Zambia, has transformed the landscape of the HIV epidemic to include hope. Drawing upon long-term ethnographic research, this article briefly describes the religious ideas of a cohort of former students of a Catholic mission boarding school for boys. The discussion outlines their understanding of masculinity and charts their responses,

Anthony Simpson

2010-01-01

141

Gender and Access to Antiretroviral Treatment in South Africa  

Microsoft Academic Search

This paper explores the gender dimensions of access to highly active antiretroviral therapy (HAART) in South Africa. It shows that women are more vulnerable to HIV infection than men, but that women access HAART in disproportionately large numbers. Regression analysis on data from the South African Demographic and Health Survey suggests that men in general access health services less readily

Nicoli Nattrass

2008-01-01

142

Susceptibility of the human retrovirus XMRV to antiretroviral inhibitors  

Microsoft Academic Search

BACKGROUND: XMRV (xenotropic murine leukemia virus-related virus) is the first known example of an exogenous gammaretrovirus that can infect humans. A limited number of reports suggest that XMRV is intrinsically resistant to many of the antiretroviral drugs used to treat HIV-1 infection, but is sensitive to a small subset of these inhibitors. In the present study, we used a novel

Robert A Smith; Geoffrey S Gottlieb; A Dusty Miller

2010-01-01

143

Clinical Pharmacokinetics of Antiretroviral Drugs in Older Persons  

PubMed Central

Introduction Combination antiretroviral therapy has enabled HIV infected persons to reach older ages in high numbers. Hepatic and renal changes that normally occur with advancing age occur earlier and with higher incidence in HIV-infected individuals. A limited number of prospective controlled studies have demonstrated small reductions (17% to 41%) in lopinavir, atazanavir, and lamivudine clearance in older versus younger adults. A much larger number of retrospective studies in adults (age range ~20 to 60 years), including all antiretroviral drugs, have evaluated age as a covariate for pharmacokinetics. Most studies did not detect substantial associations between drug exposures and age. Areas Covered This review summarizes antiretroviral drug pharmacokinetics in older persons. The authors review articles from PubMed (search terms: elderly, antiretroviral, pharmacokinetics) in addition to the bibliographies of those selected. Expert Opinion The evidence to date does not support major pharmacokinetic changes in adults between ~20 and 60 years of age. However, additional prospective, well-controlled studies are needed in more persons > 60 years, including those with frailty and comorbidities, with assessment of unbound drug clearance, and incorporation of adherence, pharmacogenetics, and concomitant medications. Until then, guidelines for drug-drug interactions and dosing in renal and hepatic impairment should be followed in older HIV infected individuals. PMID:23514375

Schoen, John C.; Erlandson, Kristine Mace

2013-01-01

144

RESEARCH ARTICLE Open Access Prevalence, genetic diversity and antiretroviral  

E-print Network

-associated mutations among untreated HIV-1-infected pregnant women in Gabon, central Africa Mélanie Caron1 , Sonia to antiretroviral drugs, Untreated pregnant women, Gabon, Central Africa Background Human immunodeficiency virus described [2]. Previous studies showed that the HIV-1 pandemic originated in central Africa, where

Paris-Sud XI, Université de

145

Running a tightrope: regulatory challenges in the development of antiretrovirals.  

PubMed

Since the approval of Retrovir, (zidovudine, AZT) in 1987 by the Food and Drug Administration, a number of regulatory initiatives were codified into regulation which contributed to the rapid development of new treatments for HIV-1 infection. These initiatives are a testament to the efforts of AIDS activists and regulators to improve access to drugs for serious and life-threatening diseases. Currently, 28 antiretroviral drugs and combinations of antiretrovirals are available to treat HIV-1 infection. The broadening armamentarium of approved antiretroviral drugs provides new options and more choices for physicians and HIV patients. Importantly, the introduction of these newly approved HIV drugs has shown that the majority of HIV-1-infected treatment-naïve and treatment-experienced patients can achieve maximal virologic suppression (less than 50 copies/mL HIV-1 RNA). This article describes the past and current regulatory challenges in the development of new HIV treatments and provides an overview of the drug regulations that were required for the approval of HIV drugs. This article forms part of a special issue of Antiviral Research marking the 25th anniversary of antiretroviral drug discovery and development, Vol 85, issue 1, 2010. PMID:19665489

Naeger, Lisa K; Struble, Kimberly A; Murray, Jeffrey S; Birnkrant, Debra B

2010-01-01

146

Three Generic Nevirapine-Based Antiretroviral Treatments in Chinese HIV/AIDS Patients: Multicentric Observation Cohort  

PubMed Central

Background The purpose of this study was to evaluate the efficacy and safety of three nevirapine-based antiretroviral treatments for adult antiretroviral-naïve Chinese patients with HIV-1 infection. Methodology This was a prospective, multicenter study. 198 antiretroviral-naïve HIV-1 positive subjects with CD4 lymphocyte counts between 100/ul and 350/ul and plasma HIV-1 RNA levels more than 500 copies/ml were randomized to start three NVP-based antiretroviral treatments: group A, NVP+AZT+ddI; group B, NVP+3TC+d4T; group C, NVP+AZT+3TC. Viral responses, immunologic responses, adverse events and drug resistence were monitored at baseline and the end of week 4, 12, 24, 36, 52. Viralogical response and immunological response were also comparaed in different strata of baseline CD4 T lymphocyte counts and plasma HIV-1 RNA concentrations. At baseline, the plasma HIV-1 RNA was 4.44±0.68, 4.52±0.71 and 4.41±0.63 lg copies/ml in group A, B and C respectively (p?=?0.628). At the end of the study, the plasma viral load reached 2.54±1.11, 1.89±0.46 and 1.92±0.58 lg copies/ml in group A, B and C respectively (p<0.001). At week 52, suppression of plasma HIV-1 RNA to less than 50 copies/ml was achieved in more patients in group B and C than in group A (68.2%, 69% vs. 39.7%; p<0.001). In planned subgroup analyses, the decrease of viral response rate was seen in group A when CD4 cell count >200/ul (subgroup H). But in subgroup L, viral response rate of three groups has no significant statistic difference. There were no statistically significant differences among three groups in immunological response wthin any of the CD4 or pVL strata. 3 out of 193 patients with available genotype at baseline showed primary drug resistant. Of 26 patients with virologic failure, 17 patients showed secondary drug resistant, 16 subjects in group A and 1 subject in group B. Logistic regression analysis indicated that presence of hepatotoxicity was associated with HCV-Ab positive (OR?=?2.096, 95%CI: 1.106–3.973, P?=?0.023) and higher CD4 baseline (CD4 count >250/ul)(OR?=?2.096, 95%CI: 1.07–4.107, P?=?0.031). Conclusion Our findings strongly support the use of 3TC+d4T and 3TC+AZT as the nucleoside analogue combination in NVP-based antiretroviral therapy. The regimen of AZT+ddI+NVP produced poor virological response especially in the stratum of CD4 count more than 200/ul. More patients showed secondary drug resistant in this arm too. Patients with HCV-Ab+ and CD4 count >250/ul appear to have significantly high risk of hepatoxicity. Trial Registration ClinicalTrials.gov NCT00618176 PMID:19081791

Li, Taisheng; Dai, Yi; Kuang, Jiqiu; Jiang, Jingmei; Han, Yang; Qiu, Zhifeng; Xie, Jing; Zuo, Lingyan; Li, Yanling

2008-01-01

147

Quantum Espresso Quick Start Introduction  

E-print Network

Quantum Espresso Quick Start Introduction Quantum Espresso (http://www.quantum properties eg., phonon dispersion, NMR shifts and band structure to name a few. Quantum Espresso is available. Matter 21, 395502 (2009). Online Guide for QE : http://www.quantum

Bjørnstad, Ottar Nordal

148

Importance of Baseline Prognostic Factors With Increasing Time Since Initiation of Highly Active Antiretroviral Therapy  

PubMed Central

Background The extent to which the prognosis for AIDS and death of patients initiating highly active antiretroviral therapy (HAART) continues to be affected by their characteristics at the time of initiation (baseline) is unclear. Methods We analyzed data on 20,379 treatment-naive HIV-1–infected adults who started HAART in 1 of 12 cohort studies in Europe and North America (61,798 person-years of follow-up, 1844 AIDS events, and 1005 deaths). Results Although baseline CD4 cell count became less prognostic with time, individuals with a baseline CD4 count <25 cells/µL had persistently higher progression rates than individuals with a baseline CD4 count >350 cells/µL (hazard ratio for AIDS = 2.3, 95% confidence interval [CI]: 1.0 to 2.3; mortality hazard ratio = 2.5, 95% CI: 1.2 to 5.5, 4 to 6 years after starting HAART). Rates of AIDS were persistently higher in individuals who had experienced an AIDS event before starting HAART. Individuals with presumed transmission by means of injection drug use experienced substantially higher rates of AIDS and death than other individuals throughout follow-up (AIDS hazard ratio = 1.6, 95% CI: 0.8 to 3.0; mortality hazard ratio = 3.5, 95% CI: 2.2 to 5.5, 4 to 6 years after starting HAART). Conclusions Compared with other patient groups, injection drug users and patients with advanced immunodeficiency at baseline experience substantially increased rates of AIDS and death up to 6 years after starting HAART. PMID:18043315

2012-01-01

149

Time to Initiation of Antiretroviral Therapy Among Patients With HIV-Associated Tuberculosis in Cape Town, South Africa  

PubMed Central

We studied the time interval between starting tuberculosis treatment and commencing antiretroviral treatment (ART) in HIV-infected patients (n=1433; median CD4 count 71 cells/?L, IQR,32-132) attending three South African township ART services between 2002-2008. The overall median delay was 2.66 months (IQR,1.58-4.17). In adjusted analyses, delays varied between treatment sites but were shorter for patients with lower CD4 counts and those treated in more recent calendar years. During the most recent period (2007-2008), 4.7%, 19.7% and 51.1% of patients started ART within 2, 4 and 8 weeks of TB treatment, respectively. Operational barriers must be tackled to permit further acceleration of ART initiation as recommended by 2010 WHO ART guidelines. PMID:21436714

Lawn, Stephen D.; Campbell, Lucy; Kaplan, Richard; Boulle, Andrew; Cornell, Morna; Kerschberger, Bernhard; Morrow, Carl; Little, Francesca; Egger, Matthias; Wood, Robin

2013-01-01

150

Enhanced antiretroviral therapy in rhesus macaques improves RT-SHIV viral decay kinetics.  

PubMed

Using an established nonhuman primate model, rhesus macaques were infected intravenously with a chimeric simian immunodeficiency virus (SIV) consisting of SIVmac239 with the human immunodeficiency virus type 1 (HIV-1) reverse transcriptase from clone HXBc2 (RT-SHIV). The impacts of two enhanced (four- and five-drug) highly active antiretroviral therapies (HAART) on early viral decay and rebound were determined. The four-drug combination consisted of an integrase inhibitor, L-870-812 (L-812), together with a three-drug regimen comprising emtricitabine [(-)-FTC], tenofovir (TFV), and efavirenz (EFV). The five-drug combination consisted of one analog for each of the four DNA precursors {using TFV, (-)-FTC, (-)-?-D-(2R,4R)-1,3-dioxolane-2,6-diaminopurine (amdoxovir [DAPD]), and zidovudine (AZT)}, together with EFV. A cohort treated with a three-drug combination of (-)-FTC, TFV, and EFV served as treated controls. Daily administration of a three-, four-, or five-drug combination of antiretroviral agents was initiated at week 6 or 8 after inoculation and continued up to week 50, followed by a rebound period. Plasma samples were collected routinely, and drug levels were monitored using liquid chromatography-tandem mass spectrometry (LC-MS-MS). Viral loads were monitored with a standard TaqMan quantitative reverse transcriptase PCR (qRT-PCR) assay. Comprehensive analyses of replication dynamics were performed. RT-SHIV infection in rhesus macaques produced typical viral infection kinetics, with untreated controls establishing persistent viral loads of >10(4) copies of RNA/ml. RT-SHIV loads at the start of treatment (V0) were similar in all treated cohorts (P > 0.5). All antiretroviral drug levels were measureable in plasma. The four-drug and five-drug combination regimens (enhanced HAART) improved suppression of the viral load (within 1 week; P < 0.01) and had overall greater potency (P < 0.02) than the three-drug regimen (HAART). Moreover, rebound viremia occurred rapidly following cessation of any treatment. The enhanced HAART (four- or five-drug combination) showed significant improvement in viral suppression compared to the three-drug combination, but no combination was sufficient to eliminate viral reservoirs. PMID:24777106

North, Thomas W; Villalobos, Andradi; Hurwitz, Selwyn J; Deere, Jesse D; Higgins, Joanne; Chatterjee, Payel; Tao, Sijia; Kauffman, Robert C; Luciw, Paul A; Kohler, James J; Schinazi, Raymond F

2014-07-01

151

Parents Should Start Talking Before They Start Drinking  

Microsoft Academic Search

Most Oakland County youth who drink alcohol usually began drinking in the seventh, eighth or ninth grades. When youth drink alcohol at such young ages, serious harm begins. More children are killed by alcohol than all illegal drugs combined. In addition, children who begin drinking alcohol before the age of 15 are 5 times more likely than those who start

Donnis Reese

152

Start Where Your Students Are  

ERIC Educational Resources Information Center

Starting where your students are means understanding how currencies are negotiated and traded in the classroom. Any behavior that students use to acquire the knowledge and skills needed in the classroom functions as currency. Teachers communicate the kinds of currencies they accept in their classrooms, such as getting good grades; students do…

Jackson, Robyn R.

2010-01-01

153

Rigor Made Easy: Getting Started  

ERIC Educational Resources Information Center

Bestselling author and noted rigor expert Barbara Blackburn shares the secrets to getting started, maintaining momentum, and reaching your goals. Learn what rigor looks like in the classroom, understand what it means for your students, and get the keys to successful implementation. Learn how to use rigor to raise expectations, provide appropriate…

Blackburn, Barbara R.

2012-01-01

154

Start with Breakfast Snack Right  

E-print Network

, disability, genetic information or veteran status. #12;Educational programs of the Texas A&M Agri, disability, genetic information or veteran status. Three Easy Bites Date Instructor Location Name & Phone, national origin, age, disability, genetic information or veteran status. Name & Phone Number Start

155

HANDBOOK FOR PROJECT HEAD START.  

ERIC Educational Resources Information Center

THIS BOOKLET WAS DESIGNED TO MEET SOME IMMEDIATE NEEDS FOR THE FIRST SUMMER SESSION OF PROJECT HEAD START. IT CONTAINS SOME OF THE MOST WORKABLE AND PROMISING TEACHING METHODS IN THE ENTIRE FIELD OF COMPENSATORY EDUCATIONS, METHODS THAT HAVE BEEN USED IN PRIVATELY SPONSORED CENTERS AND HAVE PROVED VALUABLE IN COPING WITH PROBLEMS ENCOUNTERED IN…

GRAHAM, JORY

156

Starting with the Business Basics.  

ERIC Educational Resources Information Center

A nonprofit community action agency, BusinesStart, provides business training and small loans to entrepreneurs in 18 rural counties in southwestern Virginia and northeastern Tennessee. The entrepreneurs, many with no previous business experience, cite the agency's basic business training as key to their success. (SV)

Hoffman, Carl

1999-01-01

157

Getting Started with Mathematica Introduction  

E-print Network

Getting Started with Mathematica Introduction What is Mathematica? Mathematica is a computer. Mathematica is extraordinary well-rounded. It is suitable for both numeric and symbolic work, and it has from within Mathematica. Its weaknesses include a somewhat steep learning curve, an interface

Barkana, Rennan

158

Math Club Starting in Kindergarten  

ERIC Educational Resources Information Center

Starting a math club as early as kindergarten and having a range of grade levels in attendance can be successful. With the help of the older students, the varied age groups are entertained and excited about attending math club. The purpose of the club is to enrich the classroom mathematics curriculum with hands-on activities and to have members…

Perry, Ann M.

2011-01-01

159

Head Start Dental Health Curriculum.  

ERIC Educational Resources Information Center

This curriculum for Head Start programs provides preschool learning experiences that teach about dental health. The majority of the curriculum guide is devoted to the following lesson plans: (1) "Introduction of 'Smiley the Super Pup'," an optional puppet character which may be used to review the concepts covered in each lesson; (2) "Visiting the…

Administration for Children, Youth, and Families (DHHS), Washington, DC. Head Start Bureau.

160

Rates of Switching Antiretroviral Drugs in a Primary Care Service in South Africa before and after Introduction of Tenofovir  

PubMed Central

Introduction Antiretroviral changes (single drug substitutions and regimen switches) limit treatment options and introduce challenges such as increased cost, monitoring and adherence difficulties. Patterns of drug substitutions and regimen switches from stavudine (d4T) and zidovudine (AZT) regimens have been well described but data on tenofovir (TDF) are more limited. This study describes the patterns and risk factors for drug changes of these antiretroviral drugs in adults. Method This retrospective cohort study included HIV positive, antiretroviral treatment (ART) naïve adults aged ?18 years who started ART with two nucleoside reverse transcriptase inhibitors (NRTIs) and a non-nucleoside reverse transcriptase inhibitor. Follow-up was censored at first drug change and analysis focused on NRTI changes only. Results Between September 2002 and April 2011, 5095 adults initiated ART in Gugulethu. This comprised 948 subjects on TDF, 3438 on d4T and 709 subjects on AZT. Virological suppression rates at 1 year, regimen switching due to virological failure and overall losses to the programme were similar across the three groups. TDF had the lowest incidence rate of drug substitutions (2.6 per 100 P/Ys) compared to 17.9 for d4T and 8.5 per 100 P/Ys for AZT. Adverse drug reactions (ADRs) accounted for the majority of drug substitutions of d4T. Multivariate analysis showed that increasing age, female sex and d4T exposure were associated with increased hazard of drug substitution due to ADRs. Conversely, TDF exposure was associated with a substantially lower risk of substitution (adjusted hazards ratio 0.38; 95% CI 0.20–0.72). Conclusion Regimen switches and virological suppression were similar for patients exposed to TDF, d4T and AZT, suggesting all regimens were equally effective. However, TDF was better tolerated with a substantially lower rate of drug substitutions due to ADRs. PMID:23717451

Njuguna, Christine; Orrell, Catherine; Kaplan, Richard; Bekker, Linda-Gail; Wood, Robin; Lawn, Stephen D.

2013-01-01

161

Dangerous medicines: Unproven AIDS cures and counterfeit antiretroviral drugs  

PubMed Central

Background Increasing access to antiretroviral therapy (ART) is a critical goal endorsed by the United Nations and all of its member states. At the same time, anecdotal accounts suggest that the promotion of unproven AIDS 'cures' and remedies are widespread, and in the case of The Gambia, Iran and South Africa, have been promoted by governments directly. Although a range of legislative and regulatory measures have been adopted by some governments, and technical assistance has been provided by international agencies to address counterfeit medicines generally, the threat of counterfeit antiretroviral drugs is not being addressed. Discussion Countries, charged with fulfilling the right to health and committed to expanding access to ART must explicitly recognize their obligation to combat unproven AIDS treatments and ensure the availability of a safe and efficacious drugs supply. International donors must help support and coordinate these efforts. PMID:18304316

Amon, Joseph J

2008-01-01

162

Sex differences in pharmacokinetics and toxicity of antiretroviral therapy.  

PubMed

Worldwide, the rate of new HIV infections continues to increase among women. Over the past 5 years there has been a growing focus on the clinical aspects of HIV infection among women. Historically, the majority of subjects enrolled in HIV clinical trials were male patients. Consequently, most knowledge about antiretroviral efficacy and toxicity has been derived from studies of predominately male subjects. More recently, results from clinical trials, especially those that have focused on HIV-infected female subjects, suggest that there may be clinically important gender-related differences in several aspects of HIV disease. These include, but are not limited to, differences in natural history, efficacy and safety of drug treatment. This chapter reviews current data on gender differences in antiretroviral pharmacokinetics and toxicity. PMID:16866613

Umeh, Obiamiwe C; Currier, Judith S

2006-04-01

163

Antiretroviral Outcomes in South African Prisoners: A Retrospective Cohort Analysis  

Microsoft Academic Search

Background and MethodsLittle is known about antiretroviral therapy (ART) outcomes in prisoners in Africa. We conducted a retrospective review of outcomes of a large cohort of prisoners referred to a public sector, urban HIV clinic. The review included baseline characteristics, sequential CD4 cell counts and viral load results, complications and co-morbidities, mortality and loss to follow-up up to 96 weeks

Natasha E. C. G. Davies; Alan S. Karstaedt

2012-01-01

164

Active site remodeling switches HIV specificity of antiretroviral TRIMCyp  

Microsoft Academic Search

TRIMCyps are primate antiretroviral proteins that potently inhibit HIV replication. Here we describe how rhesus macaque TRIMCyp (RhTC) has evolved to target and restrict HIV-2. We show that the ancestral cyclophilin A (CypA) domain of RhTC targets HIV-2 capsid with weak affinity, which is strongly increased in RhTC by two mutations (D66N and R69H) at the expense of HIV-1 binding.

Amanda J Price; Flavia Marzetta; Michael Lammers; Laura M J Ylinen; Torsten Schaller; Sam J Wilson; Greg J Towers; Leo C James

2009-01-01

165

Human Immunodeficiency Virus: Resistance to Antiretroviral Drugs in Developing Countries  

Microsoft Academic Search

\\u000a This chapter reviews issues central to understanding the emergence and transmission of drug-resistant human immunodeficiency\\u000a virus (HIV) and its impact on developing countries. We first give an overview of HIV, HIV treatment using antiretroviral drugs,\\u000a and access to treatment in developing countries. Then we review current understanding of the impact of adherence and treatment\\u000a interruption on the emergence of resistance

Rebecca F. Baggaley; Maya L. Petersen; Marcelo A. Soares; Marie-Claude Boily; Francisco I. Bastos

166

Highly active antiretroviral treatment for the prevention of HIV transmission  

Microsoft Academic Search

In 2007 an estimated 33 million people were living with HIV; 67% resided in sub-Saharan Africa, with 35% in eight countries alone. In 2007, there were about 1.4 million HIV-positive tuberculosis cases. Globally, approximately 4 million people had been given highly active antiretroviral therapy (HAART) by the end of 2008, but in 2007, an estimated 6.7 million were still in

Reuben Granich; Siobhan Crowley; Marco Vitoria; Ying-Ru Lo; Yves Souteyrand; Christopher Dye; Charlie Gilks; Teguest Guerma; Kevin M De Cock; Brian Williams

2010-01-01

167

General Health Status and Adherence to Antiretroviral Therapy  

Microsoft Academic Search

Highly active antiretroviral therapy (HAART) adherence is crucial in lowering HIV\\/AIDS-related mortality. General health status is known to predict mortality, but no study has assessed its association with HAART adherence. A total of 103 whites, African Americans, and Hispanic\\/Latinos with HIV\\/AIDS underwent an interview using validated measures. Regression analyses assessed the relationship between general health status and HAART adherence while

Roberto Cardarelli; Stephen Weis; Elvin Adams; Debbie Radaford; Isabel Vecino; Guadalupe Munguia; Katandria Love Johnson; Kimberly G. Fulda

2008-01-01

168

Therapeutic Drug Monitoring of Antiretroviral Drugs with HPLC-MS  

Microsoft Academic Search

Prospective and retrospective studies have provided some evidence of the clinical and virological benefit of incorporating TDM into routine patient care. Because antiretroviral therapy consists always of a combination of different drugs, analysis can be simplified if different drugs are measured at the same time. Therefore, LC-MS or LC-MS\\/MS is nowadays the analytical method of choice. In 2003 we have

Ursula Gutteck-Amsler; Katharina M. Rentsch

169

Assessing relationships between health-related quality of life and adherence to antiretroviral therapy  

Microsoft Academic Search

Objective: To investigate associations between health-related quality of life (HRQoL), as assessed using the multidimensional quality of life-HIV (MQOL-HIV) questionnaire, and adherence to antiretroviral treatment in HIV-infected subjects. Design: Multicentre cross-sectional study in three institutional tertiary hospitals in northwest Spain. Patients and methods: The MQOL-HIV was completed by 235 HIV-infected adults undergoing antiretroviral treatment. Adherence to antiretroviral therapy was assessed

E. Carballo; C. Cadarso-Suárez; I. Carrera; J. Fraga; J. de la Fuente; A. Ocampo; R. Ojea; A. Prieto

2004-01-01

170

Factors associated with suboptimal adherence to antiretroviral therapy in Asia  

PubMed Central

Introduction Adherence to antiretroviral therapy (ART) plays an important role in treatment outcomes. It is crucial to identify factors influencing adherence in order to optimize treatment responses. The aim of this study was to assess the rates of, and factors associated with, suboptimal adherence (SubAdh) in the first 24 months of ART in an Asian HIV cohort. Methods As part of a prospective resistance monitoring study, the TREAT Asia Studies to Evaluate Resistance Monitoring Study (TASER-M) collected patients’ adherence based on the World Health Organization-validated Adherence Visual Analogue Scale. SubAdh was defined in two ways: (i) <100% and (ii) <95%. Follow-up time started from ART initiation and was censored at 24 months, loss to follow-up, death, treatment switch, or treatment cessation for >14 days. Time was divided into four intervals: 0–6, 6–12, 12–18 and 18–24 months. Factors associated with SubAdh were analysed using generalized estimating equations. Results Out of 1316 patients, 32% ever reported <100% adherence and 17% ever reported <95%. Defining the outcome as SubAdh <100%, the rates of SubAdh for the four time intervals were 26%, 17%, 12% and 10%. Sites with an average of >2 assessments per patient per year had an odds ratio (OR)=0.7 (95% confidence interval (CI) (0.55 to 0.90), p=0.006), compared to sites with ?2 assessments per patient per year. Compared to heterosexual exposure, SubAdh was higher in injecting drug users (IDUs) (OR=1.92, 95% CI (1.23 to 3.00), p=0.004) and lower in homosexual exposure (OR=0.52, 95% CI (0.38 to 0.71), p<0.001). Patients taking a nucleoside transcriptase inhibitor and protease inhibitor (NRTI+PI) combination were less likely to report adherence <100% (OR=0.36, 95% CI (0.20 to 0.67), p=0.001) compared to patients taking an NRTI and non-nucleoside transcriptase inhibitor (NRTI+NNRTI) combination. SubAdh decreased with increasing time on ART (all p<0.001). Similar associations were found with adherence <95% as the outcome. Conclusions We found that SubAdh, defined as either <100% and <95%, was associated with mode of HIV exposure, ART regimen, time on ART and frequency of adherence measurement. The more frequently sites assessed patients, the lower the SubAdh, possibly reflecting site resourcing for patient counselling. Although social desirability bias could not be excluded, a greater emphasis on more frequent adherence counselling immediately following ART initiation and through the first six months may be valuable in promoting treatment and programme retention. PMID:24836775

Jiamsakul, Awachana; Kumarasamy, Nagalingeswaran; Ditangco, Rossana; Li, Patrick CK; Phanuphak, Praphan; Sirisanthana, Thira; Sungkanuparph, Somnuek; Kantipong, Pacharee; Lee, Christopher KC; Mustafa, Mahiran; Merati, Tuti; Kamarulzaman, Adeeba; Singtoroj, Thida; Law, Matthew

2014-01-01

171

Pharmacokinetics and pharmacodynamics of antiretrovirals in the central nervous system.  

PubMed

HIV-positive patients may be effectively treated with highly active antiretroviral therapy and such a strategy is associated with striking immune recovery and viral load reduction to very low levels. Despite undeniable results, the central nervous system (CNS) is commonly affected during the course of HIV infection, with neurocognitive disorders being as prevalent as 20-50 % of treated subjects. This review discusses the pathophysiology of CNS infection by HIV and the barriers to efficacious control of such a mechanism, including the available data on compartmental drug penetration and on pharmacokinetic/pharmacodynamic relationships. In the reviewed articles, a high variability in drug transfer to the CNS is highlighted with several mechanisms as well as methodological issues potentially influencing the observed results. Nevirapine and zidovudine showed the highest cerebrospinal fluid (CSF) to plasma ratios, although target concentrations are currently unknown for the CNS. The use of the composite CSF concentration effectiveness score has been associated with better virological outcomes (lower HIV RNA) but has been inconsistently associated with neurocognitive outcomes. These findings support the CNS effectiveness of commonly used highly antiretroviral therapies. The use of antiretroviral drugs with increased CSF penetration and/or effectiveness in treating or preventing neurocognitive disorders however needs to be assessed in well-designed prospective studies. PMID:25200312

Calcagno, Andrea; Di Perri, Giovanni; Bonora, Stefano

2014-10-01

172

Threshold virus dynamics with impulsive antiretroviral drug effects  

PubMed Central

The purposes of this paper are twofold: to develop a rigorous approach to analyze the threshold behaviors of nonlinear virus dynamics models with impulsive drug effects and to examine the feasibility of virus clearance following the Manuals of National AIDS Free Antiviral Treatment in China. An impulsive system of differential equations is developed to describe the within-host virus dynamics of both wild-type and drug-resistant strains when a combination of antiretroviral drugs is used to induce instantaneous drug effects at a sequence of dosing times equally spaced while drug concentrations decay exponentially after the dosing time. Threshold parameters are derived using the basic reproduction number of periodic epidemic models, and are used to depict virus clearance/persistence scenarios using the theory of asymptotic periodic systems and the persistence theory of discrete dynamical systems. Numerical simulations using model systems parametrized in terms of the antiretroviral therapy recommended in the aforementioned Manuals illustrate the theoretical threshold virus dynamics, and examine conditions under which the impulsive antiretroviral therapy leads to treatment success. In particular, our results show that only the drug-resistant strain can dominate (the first-line treatment program guided by the Manuals) or both strains may be rapidly eliminated (the second-line treatment program), thus the work indicates the importance of implementing the second-line treatment program as soon as possible. PMID:21987085

Lou, Jie; Lou, Yijun; Wu, Jianhong

2013-01-01

173

Antiretrovirals and safer conception for HIV-serodiscordant couples  

PubMed Central

Purpose of review Many men and women living with HIV and their uninfected partners attempt to conceive children. HIV-prevention science can be applied to reduce sexual transmission risk while respecting couples’ reproductive goals. Here we discuss antiretrovirals as prevention in the context of safer conception for HIV-serodiscordant couples. Recent findings Antiretroviral therapy (ART) for the infected partner and pre-exposure prophylaxis (PrEP) for the uninfected partner reduce the risk of heterosexual HIV transmission. Several demonstration projects suggest the feasibility and acceptability of antiretroviral (ARV)s as periconception HIV-prevention for HIV-serodiscordant couples. The application of ARVs to periconception risk reduction may be limited by adherence. Summary For male-infected (M+F?) couples who cannot access sperm processing and female-infected (F+M?) couples unwilling to carry out insemination without intercourse, ART for the infected partner, PrEP for the uninfected partner, combined with treatment for sexually transmitted infections, sex limited to peak fertility, and medical male circumcision (for F+M couples) provide excellent, well tolerated options for reducing the risk of periconception HIV sexual transmission. PMID:23032734

Matthews, Lynn T.; Smit, Jennifer A.; Cu-Uvin, Susan; Cohan, Deborah

2013-01-01

174

[Plasmatic dosage of antiretroviral drugs by high performance liquid chromathography ].  

PubMed

A high-performance liquid chromatographic method has been developed for the determination of eight antiretroviral drugs (amprenavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, efavirenz and nevirapine) in a single run. After a liquid-liquid extraction with diethylether, the antiretroviral drugs are separated on a Stability RP18 column eluted with a gradient of acetonitrile and phosphate buffer (50 mM pH 5.65). A sequential ultraviolet detection allowed for simultaneous quantitation of antiretroviral drugs (240, 215, 260 nm). Calibration curves were linear in the range 100-10,000 ng/ml. The limit of quantitation was 50 ng/ml for all drugs except for nevirapine (100 ng/ml). The accuracies ranged from 88.2% to 110.9% and both inter- and intra-day coefficients of variation were lower than 11%. The extraction recoveries were higher than 62%. This method is simple and shows good specificity with respect to commonly coprescribed drugs. PMID:12185966

Titier, K; Lagrange, F; Péhourcq, F; Edno-Mcheik, L; Moore, N; Molimard, M

2002-01-01

175

Anaemia and zidovudine-containing antiretroviral therapy in paediatric antiretroviral programmes in the IeDEA Paediatric West African Database to evaluate AIDS  

PubMed Central

Introduction There is a risk of anaemia among HIV-infected children on antiretroviral therapy (ART) containing zidovudine (ZDV) recommended in first-line regimens in the WHO guidelines. We estimated the risk of severe anaemia after initiation of a ZDV-containing regimen in HIV-infected children included in the IeDEA West African database. Methods Standardized collection of data from HIV-infected children (positive PCR<18 months or positive serology ?18 months) followed up in HIV programmes was included in the regional IeDEA West Africa collaboration. Ten clinical centres from seven countries contributed (Benin, Burkina Faso, Côte d'Ivoire, Gambia, Ghana, Mali and Senegal) to this collection. Inclusion criteria were age <16 years and starting ART. We explored the data quality of haemoglobin documentation over time and the incidence and predictors of severe anaemia (Hb<7g/dL) per 100 child-years of follow-up over the duration of first-line antiretroviral therapy. Results As of December 2009, among the 2933 children included in the collaboration, 45% were girls, median age was five years; median CD4 cell percentage was 13%; median weight-for-age z-score was ?2.7; and 1772 (60.4%) had a first-line ZDV-containing regimen. At baseline, 70% of the children with a first-line ZDV-containing regimen had a haemoglobin measure available versus 76% in those not on ZDV (p?0.01): the prevalence of severe anaemia was 3.0% (n=38) in the ZDV group versus 10.2% (n=89) in those without (p<0. 01). Over the first-line follow-up, 58.9% of the children had ?1 measure of haemoglobin available in those exposed to ZDV versus 60.4% of those not (p=0.45). Severe anaemia occurred in 92 children with an incidence of 2.47 per 100 child-years of follow-up in those on a ZDV-containing regimen versus 4.25 in those not (p?0.01). Adjusted for age at ART initiation and first-line regimen, a weight-for-age z-score ??3 was a strong predictor associated with a 5.59 times risk of severe anaemia (p<0.01). Conclusions Severe anaemia is frequent at baseline and guides the first-line ART prescription, but its incidence seems rare among children on ART. Severe malnutrition at baseline is a strong predictor for development of severe anaemia, and interventions to address this should form an integral component of clinical care. PMID:24047928

Renner, Lorna A; Dicko, Fatoumata; Koueta, Fla; Malateste, Karen; Gueye, Ramatoulaye D; Aka, Edmond; Eboua, Tanoh K; Azondekon, Alain; Okomo, Uduok; Toure, Pety; Ekouevi, Didier; Leroy, Valeriane

2013-01-01

176

Managing Sure Start in partnership.  

PubMed

In March 2006, Sure Start programmes were mainstreamed, becoming 'Children's Centres' for which local authorities have assumed strategic responsibility. This paper describes an evaluation of a Sure Start local programme Management Board which was conducted in preparation for this transition. Focusing on practices relating to partnership working and community involvement, a distinctive trident evaluation model was used to explore outcomes, processes and multiple stakeholder perspectives through a multi-method approach (incorporating interviews, questionnaires and documentary analysis). This revealed that an effective, collaborative style of working had been fostered between board members, resulting in synergy. Furthermore, a number of governance arrangements were identified that specifically supported partnership developments, including quorum regulations and adherence to decision-making by consensus. A series of recommendations are presented that were made with the aim of strengthening the community voice on the board and preserving the most effective and empowering elements of practice following the transition. PMID:16922033

Hassan, Lamiece; Spencer, Joy; Hogard, Elaine

2006-08-01

177

School start times for adolescents.  

PubMed

The American Academy of Pediatrics recognizes insufficient sleep in adolescents as an important public health issue that significantly affects the health and safety, as well as the academic success, of our nation's middle and high school students. Although a number of factors, including biological changes in sleep associated with puberty, lifestyle choices, and academic demands, negatively affect middle and high school students' ability to obtain sufficient sleep, the evidence strongly implicates earlier school start times (ie, before 8:30 am) as a key modifiable contributor to insufficient sleep, as well as circadian rhythm disruption, in this population. Furthermore, a substantial body of research has now demonstrated that delaying school start times is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits to students with regard to physical and mental health, safety, and academic achievement. The American Academy of Pediatrics strongly supports the efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times that allow students the opportunity to achieve optimal levels of sleep (8.5-9.5 hours) and to improve physical (eg, reduced obesity risk) and mental (eg, lower rates of depression) health, safety (eg, drowsy driving crashes), academic performance, and quality of life. PMID:25156998

2014-09-01

178

Starting apparatus for internal combustion engines  

DOEpatents

This report is a patent description for a system to start an internal combustion engine. Remote starting and starting by hearing impaired persons are addressed. The system monitors the amount of current being drawn by the starter motor to determine when the engine is started. When the engine is started the system automatically deactivates the starter motor. Five figures are included.

Dyches, G.M.; Dudar, A.M.

1995-01-01

179

Head Start Impact Study: First Year Findings  

ERIC Educational Resources Information Center

The Congressionally-mandated Head Start Impact Study is being conducted across 84 nationally representative grantee/delegate agencies. Approximately 5,000 newly entering 3- and 4-year-old children applying for Head Start were randomly assigned to either a Head Start group that had access to Head Start program services or to a non-Head Start group…

Puma, Michael; Bell, Stephen; Cook, Ronna; Heid, Camilla; Lopez, Michael

2005-01-01

180

Maternal or Infant Antiretroviral Drugs to Reduce HIV-1 Transmission  

PubMed Central

Background We evaluated the efficacy of a maternal triple-drug antiretroviral regimen or infant nevirapine prophylaxis for 28 weeks during breast-feeding to reduce postnatal transmission of human immunodeficiency virus type 1 (HIV-1) in Malawi. Methods We randomly assigned 2369 HIV-1–positive, breast-feeding mothers with a CD4+ lymphocyte count of at least 250 cells per cubic millimeter and their infants to receive a maternal antiretroviral regimen, infant nevirapine, or no extended postnatal antiretroviral regimen (control group). All mothers and infants received perinatal prophylaxis with single-dose nevirapine and 1 week of zidovudine plus lamivudine. We used the Kaplan–Meier method to estimate the cumulative risk of HIV-1 transmission or death by 28 weeks among infants who were HIV-1–negative 2 weeks after birth. Rates were compared with the use of the log-rank test. Results Among mother–infant pairs, 5.0% of infants were HIV-1–positive at 2 weeks of life. The estimated risk of HIV-1 transmission between 2 and 28 weeks was higher in the control group (5.7%) than in either the maternal-regimen group (2.9%, P = 0.009) or the infant-regimen group (1.7%, P<0.001). The estimated risk of infant HIV-1 infection or death between 2 and 28 weeks was 7.0% in the control group, 4.1% in the maternal-regimen group (P = 0.02), and 2.6% in the infant-regimen group (P<0.001). The proportion of women with neutropenia was higher among those receiving the antiretroviral regimen (6.2%) than among those in either the nevirapine group (2.6%) or the control group (2.3%). Among infants receiving nevirapine, 1.9% had a hypersensitivity reaction. Conclusions The use of either a maternal antiretroviral regimen or infant nevirapine for 28 weeks was effective in reducing HIV-1 transmission during breast-feeding. (ClinicalTrials.gov number, NCT00164736.) PMID:20554982

Chasela, Charles S.; Hudgens, Michael G.; Jamieson, Denise J.; Kayira, Dumbani; Hosseinipour, Mina C.; Kourtis, Athena P.; Martinson, Francis; Tegha, Gerald; Knight, Rodney J.; Ahmed, Yusuf I.; Kamwendo, Deborah D.; Hoffman, Irving F.; Ellington, Sascha R.; Kacheche, Zebrone; Soko, Alice; Wiener, Jeffrey B.; Fiscus, Susan A.; Kazembe, Peter; Mofolo, Innocent A.; Chigwenembe, Maggie; Sichali, Dorothy S.; van der Horst, Charles M.

2012-01-01

181

Factors influencing utilization of postpartum CD4 count testing by HIV-positive women not yet eligible for antiretroviral treatment.  

PubMed

Delayed antiretroviral initiation is associated with increased mortality, but individuals frequently delay seeking treatment. To increase early antiretroviral therapy (ART) enrollment of HIV-positive women, antenatal clinics are implementing regular, postpartum CD4 count testing. We examined factors influencing women's utilization of extended CD4 count testing. About 53 in-depth interviews were conducted with nurses, patients, social support persons, and government health officials at three antenatal clinics in Lilongwe, Malawi. Counseling and positive interactions with staff emerged as facilitating factors. Women wanted to know their CD4 count, but didn't understand the importance of early ART initiation. Support from husbands facilitated women's return to the clinic. Reminders were perceived as helpful but ineffectively employed. Staff identified lack of communication, difficulty in tracking, and referring women as barriers. Counseling messages should emphasize the importance of starting ART early. Clinics should focus on male partner involvement, case management, staff communication, and appointment reminders. Follow-up should be offered at multiple service points. PMID:21347895

Gilles, Kate P; Zimba, Chifundo; Mofolo, Innocent; Bobrow, Emily; Hamela, Gloria; Martinson, Francis; Hoffman, Irving; Hosseinipour, Mina

2011-03-01

182

Adherence to antiretroviral drug therapy in adult patients who are HIV-positive in Northwest Ethiopia: a study protocol  

PubMed Central

Introduction Achievement of optimal medication adherence and management of antiretroviral toxicity pose great challenges among Ethiopian patients with HIV/AIDS. There is currently a lack of long-term follow-up studies that identify the barriers to, and facilitators of, adherence to antiretroviral therapy (ART) in the Ethiopian setting. Therefore, we aim to investigate the level of adherence to ART and a wide range of potential influencing factors, including adverse drug reactions occurring with ART. Methods and analysis We are conducting a 1-year prospective cohort study involving adult patients with HIV/AIDS starting on ART between December 2012 and March 2013. Data are being collected on patients’ appointment dates in the ART clinics. Adherence to ART is being measured using pill count, medication possession ratio and patient's self-report. The primary outcome of the study will be the proportion of patients who are adherent to their ART regimen at 3, 6 and 12?months using pill count. Taking 95% or more of the dispensed ART regimen using pill count at given points of time will be considered the optimal level of adherence in this study. Data will be analysed using descriptive and inferential statistical procedures. Ethics and dissemination Ethics approval was obtained from the Tasmania Health and Medical Human Research Ethics Committee and Bahir-Dar University's Ethics Committee. The results of the study will be reported in peer-reviewed scientific journals, conferences and seminar presentations. PMID:24176794

Bezabhe, Woldesellassie M; Peterson, Gregory M; Bereznicki, Luke; Chalmers, Leanne; Gee, Peter

2013-01-01

183

The history of antiretroviral therapy and of its implementation in resource-limited areas of the world.  

PubMed

HIV/AIDS not only represents the most severe epidemic in modern times, but also the greatest public health challenge in history. The response of the scientific community has been impressive and in just a few years, turned an inevitably fatal disease into a chronic manageable although not yet curable condition. The development of antiretroviral therapy is not only the history of scientific advancements: it is the result of the passionate 'alliance' towards a common goal between researchers, doctors and nurses, pharmaceutical industries, regulators, public health officials and the community of HIV-infected patients, which is rather unique in the history of medicine. In addition, the rapid and progressive development of antiretroviral therapy has not only proven to be life-saving for many millions but has been instrumental in unveiling the inequities in access to health between rich and poor countries of the world. Optimal benefits indeed, are not accessible to all people living with HIV, with challenges to coverage and sustainability in low and middle income countries. This paper will review the progress made, starting from the initial despairing times, till the current battle towards universal access to treatment and care for all people living with HIV. PMID:22706009

Vella, Stefano; Schwartländer, Bernard; Sow, Salif Papa; Eholie, Serge Paul; Murphy, Robert L

2012-06-19

184

Pharmacodynamic and Antiretroviral Activities of Combination Nanoformulated Antiretrovirals in HIV-1–Infected Human Peripheral Blood Lymphocyte–Reconstituted Mice  

PubMed Central

Lack of adherence, inaccessibility to viral reservoirs, long-term drug toxicities, and treatment failures are limitations of current antiretroviral therapy (ART). These limitations lead to increased viral loads, medicine resistance, immunocompromise, and comorbid conditions. To this end, we developed long-acting nanoformulated ART (nanoART) through modifications of existing atazanavir, ritonavir, and efavirenz suspensions in order to establish cell and tissue drug depots to achieve sustained antiretroviral responses. NanoART's abilities to affect immune and antiviral responses, before or following human immunodeficiency virus type 1 infection were tested in nonobese severe combined immune-deficient mice reconstituted with human peripheral blood lymphocytes. Weekly subcutaneous injections of drug nanoformulations at doses from 80 mg/kg to 250 mg/kg, 1 day before and/or 1 and 7 days after viral exposure, elicited drug levels that paralleled the human median effective concentration, and with limited toxicities. NanoART treatment attenuated viral replication and preserved CD4+ Tcell numbers beyond that seen with orally administered native drugs. These investigations bring us one step closer toward using long-acting antiretrovirals in humans. PMID:22811299

Roy, Upal; McMillan, JoEllyn; Alnouti, Yazen; Gautum, Nagsen; Smith, Nathan; Balkundi, Shantanu; Dash, Prasanta; Gorantla, Santhi; Martinez-Skinner, Andrea; Meza, Jane; Kanmogne, Georgette; Swindells, Susan; Cohen, Samuel M.; Mosley, R. Lee; Poluektova, Larisa; Gendelman, Howard E.

2012-01-01

185

30 CFR 75.1913 - Starting aids.  

Code of Federal Regulations, 2011 CFR

...2011-07-01 2011-07-01 false Starting aids. 75.1913 Section 75.1913 Mineral Resources...Diesel-Powered Equipment § 75.1913 Starting aids. (a) Volatile fuel starting aids shall be used in accordance with...

2011-07-01

186

30 CFR 75.1913 - Starting aids.  

Code of Federal Regulations, 2010 CFR

...2010-07-01 2010-07-01 false Starting aids. 75.1913 Section 75.1913 Mineral Resources...Diesel-Powered Equipment § 75.1913 Starting aids. (a) Volatile fuel starting aids shall be used in accordance with...

2010-07-01

187

30 CFR 75.1913 - Starting aids.  

Code of Federal Regulations, 2013 CFR

...2013-07-01 2013-07-01 false Starting aids. 75.1913 Section 75.1913 Mineral Resources...Diesel-Powered Equipment § 75.1913 Starting aids. (a) Volatile fuel starting aids shall be used in accordance with...

2013-07-01

188

30 CFR 75.1913 - Starting aids.  

Code of Federal Regulations, 2012 CFR

...2012-07-01 2012-07-01 false Starting aids. 75.1913 Section 75.1913 Mineral Resources...Diesel-Powered Equipment § 75.1913 Starting aids. (a) Volatile fuel starting aids shall be used in accordance with...

2012-07-01

189

30 CFR 75.1913 - Starting aids.  

...2014-07-01 2014-07-01 false Starting aids. 75.1913 Section 75.1913 Mineral Resources...Diesel-Powered Equipment § 75.1913 Starting aids. (a) Volatile fuel starting aids shall be used in accordance with...

2014-07-01

190

High prevalence of lipoatrophy in pre-pubertal South African children on antiretroviral therapy: a cross-sectional study  

E-print Network

of antiretroviral therapy (ART) in sub- Saharan Africa hasat antiretroviral therapy (ART) Median age at recruitment (Therapy For Hiv Infection In Adults And Adolescents; 2007. http://www.who.int/hiv/art/

2012-01-01

191

The relation of price of antiretroviral drugs and foreign assistance with coverage of HIV treatment in Africa: retrospective study  

Microsoft Academic Search

Objective To determine the association of reductions in price of antiretroviral drugs and foreign assistance for HIV with coverage of antiretroviral treatment.Design Retrospective study.Setting Africa.Participants 13 African countries, 2003-8.Main outcome measures A price index of first line antiretroviral therapy with data on foreign assistance for HIV was used to estimate the associations of prices and foreign assistance with antiretroviral coverage

Eran Bendavid; Eric Leroux; Jay Bhattacharya; Nicole Smith; Grant Miller

2010-01-01

192

Starting a nursing consultation practice.  

PubMed

Because the clinical nurse specialist (CNS) role has been changed or eliminated in many hospital organizations, many CNSs in career transition are considering establishing collaborative or independent nursing consultation practices. Opportunities for consultants exist in diverse practice settings and specialties. Before starting a consultation practice, the CNS should carefully examine goals, identify resources, and begin contacting potential referral sources. He or she must also decide what form of business organization to establish and write a business plan to solidify ideas and prepare for the unexpected. Most CNS consultants rely on personal savings to cover initial business and personal expenses, and many continue working as a CNS until the consultation practice is established. Fees can be set based on community standards, what the market will bear, desired projected income, or a third-party payor's fee schedule. The consultation practice can be marketed by word of mouth, inexpensive advertising techniques such as distributing flyers and business cards, direct mall, and media advertising. In today's healthcare marketplace, opportunities abound for the CNS risk-taker interested in starting a nursing consultation practice. PMID:10382408

Schulmeister, L

1999-03-01

193

Rapid starting methanol reactor system  

DOEpatents

The invention relates to a methanol-to-hydrogen cracking reactor for use with a fuel cell vehicular power plant. The system is particularly designed for rapid start-up of the catalytic methanol cracking reactor after an extended shut-down period, i.e., after the vehicular fuel cell power plant has been inoperative overnight. Rapid system start-up is accomplished by a combination of direct and indirect heating of the cracking catalyst. Initially, liquid methanol is burned with a stoichiometric or slightly lean air mixture in the combustion chamber of the reactor assembly. The hot combustion gas travels down a flue gas chamber in heat exchange relationship with the catalytic cracking chamber transferring heat across the catalyst chamber wall to heat the catalyst indirectly. The combustion gas is then diverted back through the catalyst bed to heat the catalyst pellets directly. When the cracking reactor temperature reaches operating temperature, methanol combustion is stopped and a hot gas valve is switched to route the flue gas overboard, with methanol being fed directly to the catalytic cracking reactor. Thereafter, the burner operates on excess hydrogen from the fuel cells.

Chludzinski, Paul J. (38 Berkshire St., Swampscott, MA 01907); Dantowitz, Philip (39 Nancy Ave., Peabody, MA 01960); McElroy, James F. (12 Old Cart Rd., Hamilton, MA 01936)

1984-01-01

194

Uncertainty quantification for a model of HIV-1 patient response to antiretroviral therapy interruptions  

E-print Network

Uncertainty quantification for a model of HIV-1 patient response to antiretroviral therapy and validated with patient data in earlier work[1]. We revisit the earlier model in light of progress over with antiretroviral therapy (ART) can have disparate outcomes. A recent study showed that 11 HIV-1 patients maintained

195

Prevalence of adverse events associated with potent antiretroviral treatment: Swiss HIV Cohort Study  

Microsoft Academic Search

Summary Background Data on adverse events to antiretroviral treatment have been recorded in clinical trials, post- marketing analyses, and anecdotal reports. Such data might not be an up-to-date or comprehensive assessment of all possible treatment combinations defined as potent antiretroviral treatment. Methods Using a standard clinical and laboratory method, we assessed prevalence of adverse events in 1160 patients who were

Jacques Fellay; Bruno Ledergerber; Enos Bernasconi; Hansjakob Furrer; Manuel Battegay; Bernard Hirschel; Pietro Vernazza; Patrick Francioli; Gilbert Greub; Markus Flepp; Amalio Telenti

2001-01-01

196

Progress of the National Pediatric Free Antiretroviral Therapy program in China  

Microsoft Academic Search

In 2003, the Chinese Government initiated a free antiretroviral therapy (ART) program focusing on adult AIDS patients. Pediatric antiretroviral (ARV) formulations were yet unavailable. It was not until July 2005, with the initiation of a two-stage program implemented by the Chinese Ministry of Health, that pediatric formulations became accessible in China. Initially, the pediatric ART program was piloted in six

Yan Zhao; Xin Sun; Yun He; Zhirong Tang; Guoping Peng; Aiwen Liu; Xiaochun Qiao; Huiqin Li; Zhiqiang Chen; Zhihui Dou; Ye Ma; Zhongfu Liu; Fujie Zhang

2010-01-01

197

AIDS . Author manuscript Long-term immunologic response to antiretroviral therapy in low-income  

E-print Network

in resource-limited settings, where antiretroviral therapy (ART) is being scaled up using a public health to ART among patients remaining on therapy. Public health and programmatic interventions leading to antiretroviral therapy (ART) are important measures of the efficacy of ART in individual patients

Paris-Sud XI, Université de

198

Evolution of Drug-resistant Viral Populations during Interruption of Antiretroviral Therapy  

E-print Network

therapy (ART), some HIV-2 infected patients still fail treatment due to drug resistance, poor adherence1 Evolution of Drug-resistant Viral Populations during Interruption of Antiretroviral Therapy antiretroviral treatment (ART) interruption allows determination of the evolution of3 drug-resistant viruses

Ahlers, Guenter

199

Transmission of HIV-1 minority resistant variants and response to first-line antiretroviral therapy  

E-print Network

of drug-resistant HIV-1 can impair the virological response to antiretroviral therapy (ART). Minority drugs (ARV) is one important factor limiting the effect of antiretroviral therapy (ART). In ART therapy O Peuchant 1 , R Thiébaut 2 , S Capdepont 1 , V Lavignolle-Aurillac 2 , D Neau 2,3 , P Morlat 3

Paris-Sud XI, Université de

200

Evolution and recombination of genes encoding HIV-1 drug resistance and tropism during antiretroviral therapy  

E-print Network

therapy (ART) is a high priority to improve understanding of HIV-1 pathogenesis and therapy. To understand antiretroviral therapy (ART) in some infected individuals resulting in the emergence of drug resistance mutations et al., 2008). Combination antiretroviral therapy (cART) has been successful in suppressing HIV-1

Suchard, Marc A.

201

Measuring adherence to antiretroviral treatment in resource-poor settings: The clinical validity of key indicators  

Microsoft Academic Search

BACKGROUND: Access to antiretroviral therapy has dramatically expanded in Africa in recent years, but there are no validated approaches to measure treatment adherence in these settings. METHODS: In 16 health facilities, we observed a retrospective cohort of patients initiating antiretroviral therapy. We constructed eight indicators of adherence and visit attendance during the first 18 months of treatment from data in

Dennis Ross-Degnan; Marsha Pierre-Jacques; Fang Zhang; Hailu Tadeg; Lillian Gitau; Joseph Ntaganira; Robert Balikuddembe; John Chalker; Anita K Wagner

2010-01-01

202

Human resources requirements for highly active antiretroviral therapy scale-up in Malawi  

Microsoft Academic Search

BACKGROUND: Twelve percent of the adult population in Malawi is estimated to be HIV infected. About 15% to 20% of these are in need of life saving antiretroviral therapy. The country has a public sector-led antiretroviral treatment program both in the private and public health sectors. Estimation of the clinical human resources needs is required to inform the planning and

Adamson S Muula; John Chipeta; Seter Siziya; Emmanuel Rudatsikira; Ronald H Mataya; Edward Kataika

2007-01-01

203

Correlates of HIV antiretroviral adherence in persons with serious mental illness  

Microsoft Academic Search

Although several studies have examined the relationship between symptoms of depression or psychological distress and medication adherence, this is the first published study of HIV antiretroviral adherence and its correlates among persons diagnosed with serious mental illness. Forty-five of 47 (96%) participants completed a two-week study in which their adherence to antiretroviral medication was measured using electronic monitoring caps. Mean

G. J. Wagner; D. E. Kanouse; P. Koegel; G. Sullivan

2004-01-01

204

Is there a role for generic antiretroviral drugs in the United States?  

PubMed

The high cost of antiretroviral drugs has limited access to treatment for some HIV-infected patients in the United States and strained public resources. With the introduction of much cheaper generic versions of some of these agents, and with more to come in the next few years, the need increases to define the role of generic antiretroviral drugs in patient management. PMID:24918192

Wormser, Gary P; Lappas, Thomas

2014-08-01

205

Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa  

Microsoft Academic Search

BACKGROUND: Successful antiretroviral treatment is dependent on sustaining high rates of adherence. In the southern African context, only a handful of studies (both quantitative and qualitative) have looked at the determinants including a health behaviour theory of adherence to antiretroviral therapy. The aim of this study is to assess factors including the information, motivation and behavioural skills model (IMB) contributing

Karl Peltzer; Natalie Friend-du Preez; Shandir Ramlagan; Jane Anderson

2010-01-01

206

Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal  

E-print Network

. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1- Infected Women for Maternal Health-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the UnitedRecommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal

Levin, Judith G.

207

Virological response and HIV drug resistance 12 months after antiretroviral therapy initiation at 2 clinics in Nigeria.  

PubMed

This report describes a pilot study, conducted in Nigeria, of the World Health Organization protocol for monitoring human immunodeficiency virus (HIV) drug resistance (HIVDR) and associated program factors among patients receiving first-line antiretroviral therapy (ART). In 2008, 283 HIV-infected patients starting ART were consecutively enrolled at 2 ART clinics in Abuja. Twelve months after ART initiation, 62% were alive and on first-line ART, 3% had died, 1% had transferred out of the program, and 34% were lost to follow-up. Among patients on first-line ART at 12 months, 90% had viral suppression. However, in view of the high loss to follow-up rate (34%), strategies for patient retention and tracking are critical to minimize possible HIVDR and optimize treatment outcomes. PMID:22544206

Ugbena, Richard; Aberle-Grasse, John; Diallo, Karidia; Bassey, Orji; Jelpe, Tapdiyel; Rottinghaus, Erin; Azeez, Aderemi; Akpan, Raphael; Muhammad, Mukhtar; Shanmugam, Vedapuri; Singh, Satvinder; Yang, Chunfu

2012-05-01

208

Gender and access to HIV testing and antiretroviral treatments in Thailand: Why do women have more and earlier access?  

Microsoft Academic Search

In the recent scale-up of antiretroviral treatment, gender differences in access to treatment have been reported. In Thailand, as the HIV epidemic became more generalised, there has been a shift from men being disproportionately affected to increased vulnerability of women. In 2007, the Living with Antiretrovirals (LIWA-ANRS 12141) study investigated the gender distribution of all adult patients receiving antiretroviral therapy

Sophie Le Coeur; Intira J. Collins; Julie Pannetier; Éva Lelièvre

2009-01-01

209

Impact of adherence counseling dose on antiretroviral adherence and HIV viral load among HIV-infected methadone maintained drug users  

Microsoft Academic Search

Adherence counseling can improve antiretroviral adherence and related health outcomes in HIV-infected individuals. However, little is known about how much counseling is necessary to achieve clinically significant effects. We investigated antiretroviral adherence and HIV viral load relative to the number of hours of adherence counseling received by 60 HIV-infected drug users participating in a trial of directly observed antiretroviral therapy

Nina A. Cooperman; Moonseong Heo; Karina M. Berg; Xuan Li; Alain H. Litwin; Shadi Nahvi; Julia H. Arnsten

2012-01-01

210

Approaches to rationing antiretroviral treatment: ethical and equity implications.  

PubMed Central

Despite a growing global commitment to the provision of antiretroviral therapy (ART), its availability is still likely to be less than the need. This imbalance raises ethical dilemmas about who should be granted access to publicly-subsidized ART programmes. This paper reviews the eligibility and targeting criteria used in four case-study countries at different points in the scale-up of ART, with the aim of drawing lessons regarding ethical approaches to rationing. Mexico, Senegal, Thailand and Uganda have each made an explicit policy commitment to provide antiretrovirals to all those in need, but are achieving this goal in steps--beginning with explicit rationing of access to care. Drawing upon the case-studies and experiences elsewhere, categories of explicit rationing criteria have been identified. These include biomedical factors, adherence to treatment, prevention-driven factors, social and economic benefits, financial factors and factors driven by ethical arguments. The initial criteria for determining eligibility are typically clinical criteria and assessment of adherence prospects, followed by a number of other factors. Rationing mechanisms reflect several underlying ethical theories and the ethical underpinnings of explicit rationing criteria should reflect societal values. In order to ensure this alignment, widespread consultation with a variety of stakeholders, and not only policy-makers or physicians, is critical. Without such explicit debate, more rationing will occur implicitly and this may be more inequitable. The effects of rationing mechanisms upon equity are critically dependent upon the implementation processes. As antiretroviral programmes are implemented it is crucial to monitor who gains access to these programmes. PMID:16175829

Bennett, Sara; Chanfreau, Catherine

2005-01-01

211

Mediators of antiretroviral adherence: a multisite international study  

PubMed Central

The purpose of this study was to investigate the effects of stressful life events (SLE on medication adherence (3 day, 30 day) as mediated by sense of coherence (SOC), self-compassion (SCS), and engagement with the health care provider (eHCP) and whether this differed by international site. Data were obtained from a cross-sectional sample of 2082 HIV positive adults between September 2009 and January 2011 from sites in Canada, China, Namibia, Puerto Rico, Thailand and the U.S. Statistical tests to explore the effects of stressful life events on antiretroviral medication adherence included descriptive statistics, multivariate analysis of variance (MANOVA), analysis of variance (ANOVA) with Bonferroni post-hoc analysis, and path analysis. An examination by international site of the relationships between SLE, SCS, SOC and eHCP with adherence (3 day, 30 day) indicated these combined variables were related to adherence whether 3 day or 30 day to different degrees at the various sites. SLE, SCS, SOC, and eHCP were significant predictors of adherence past 3 days for the U.S (p= <.001), Canada (p= .006), and Namibia (p= .019). The combined independent variables were significant predictors of adherence past 30 days only in the U.S. and Canada. Engagement with the provider was a significant correlate for antiretroviral adherence in most, but not all, of these countries. Thus the importance of eHCP cannot be overstated. Nonetheless, our findings need to be accompanied by the caveat that research on variables of interest while enriched by a sample obtained from international sites, may not have the same relationships in each country. Mediators of antiretroviral adherence: a multisite international study PMID:22774796

Corless, I. B.; Guarino, A.J.; Nicholas, P.K.; Tyer-Viola, L; Kirksey, K.; Brion, J.; Rose, Dawson; Eller, L.S.; Rivero-Mendez, M.; Kemppainen, J.; Nokes, K.; Sefcik, E.; Voss, J.; Wantland, D.; Johnson, M.O.; Phillips, C.J.; Webel, A.; Iipinge, S.; Portillo, C.; Wei-Ti-Chen; Maryland, M.; Hamilton, M. J; Reid, P.; Hickey, D.; Holzemer, W.L.

2012-01-01

212

Antiretroviral Adherence During Pregnancy and Postpartum in Latin America  

PubMed Central

Abstract Adherence to antiretrovirals by pregnant women (and postpartum women if breastfeeding) is crucial to effectively decrease maternal viral load and decrease the risk of mother-to-child transmission of HIV. Our objectives were to describe self-reported adherence to antiretrovirals during the antepartum (after 22 weeks of pregnancy) and postpartum periods (6–12 weeks and 6 months), and identify predictors of adherence among HIV-infected women enrolled and followed in a prospective cohort study from June 2008 to June 2010 at multiple sites in Latin America. Adherence was evaluated using the number of missed and expected doses during the 3 days before the study visit. At the pre-delivery visit, 340 of 376 women (90%) reported perfect adherence. This rate significantly decreased by 6–12 weeks (171/214 [80%]) and 6 months postpartum (163/199 [82%], p<0.01). The odds for less than perfect adherence at the pre-delivery visit was significantly higher for pregnant women with current tobacco use (odds ratio [OR]=2.9, 95% confidence interval [CI]: 1.46–6.14; p=0.0029). At 6–12 weeks postpartum, the probability of non-perfect adherence increased by 6% for each 1 year increase in age (OR=1.06, 95% CI: 1.00–1.12, p=0.0497). At 6 months postpartum, the odds of nonperfect adherence was higher for those who were currently using alcohol (OR=3.04, 95% CI: 1.34–6.90; p=0.0079). Although a self-report measure of adherence based on only 3 days may lead to overestimation of actual adherence over time, women with perfect adherence had lower viral loads and higher CD4 counts. Adherence to antiretrovirals decreased significantly postpartum. Interventions should target women at high risk for lower adherence during pregnancy and postpartum, including tobacco and alcohol users. PMID:22663185

Harris, D. Robert; Kakehasi, Fabiana; Haberer, Jessica E.; Cahn, Pedro; Losso, Marcelo; Teles, Elizabete; Pilotto, Jose H.; Hofer, Cristina B.; Read, Jennifer S.

2012-01-01

213

Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared  

PubMed Central

Introduction Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs) to scale up the provision of antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. Methods The two catchment areas comprise two hospitals and 12 HCs. Patients ?16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU) was defined as not returning to the facility for ?180 days after the last visit, no follow-up (no FUP) as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender. Results Of 3747 patients, 2042 (54.5%) started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81) and 68.8% at HCs versus 54.7% at hospitals among men (p<0.001). These findings persisted in adjusted analyses, with similar retention at HCs and hospitals among women (odds ratio (OR): 0.89, 95% confidence interval (CI): 0.73–1.09) and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20–1.96). The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51–0.93). Conclusions In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals. PMID:24267671

Labhardt, Niklaus Daniel; Keiser, Olivia; Sello, Motlalepula; Lejone, Thabo Ishmael; Pfeiffer, Karolin; Davies, Mary-Ann; Egger, Matthias; Ehmer, Jochen; Wandeler, Gilles

2013-01-01

214

Regulatory considerations for antiretroviral prophylaxis to prevent HIV acquisition.  

PubMed

Antiretrovirals (ARVs) decrease the infectiousness of treated HIV-infected persons and can reduce the acquisition of HIV infection when taken by uninfected persons. Coformulated emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) is approved in the United States for the preexposure prophylaxis (PrEP) indication, changing the regulatory landscape for new prophylactic agents. We describe the challenge of conducting rigorous clinical end-point trials for prophylactic agents and point to alternatives that leverage new information about correlates of HIV risk and protection. PMID:25056397

Miller, V; Grant, R M

2014-08-01

215

Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil  

PubMed Central

Depression and anxiety are common among HIV-infected people and rank among the strongest predictors of non-adherence to antiretroviral therapy (ART). This longitudinal study aimed to assess whether symptoms of anxiety and depression are predictors of non-adherence among patients initiating ART at two public referral centers (n=293) in Belo Horizonte, Brazil. Prevalence of severe anxiety and depression symptoms before starting ART was 12.6% and 5.8%, respectively. Severe anxiety was a predictor of non-adherence to ART during follow-up period (RH=1.87; 95% CI=1.14–3.06) adjusted for low education, unemployment, alcohol use in the last month and symptoms of AIDS; while a history of injection drug use had borderline statistical significance with non-adherence. These findings suggest that using a brief screening procedure to assess anxiety and depression symptoms before initiating ART help identify individuals for interventions to improve adherence and quality of life. PMID:18648925

Campos, Lorenza Nogueira; Guimaraes, Mark Drew Crosland; Remien, Robert H.

2009-01-01

216

Impact of Previous Virological Treatment Failures and Adherence on the Outcome of Antiretroviral Therapy in  

E-print Network

Background: Combination antiretroviral treatment (cART) has been very successful, especially among selected patients in clinical trials. The aim of this study was to describe outcomes of cART on the population level in a large national cohort. Methods: Characteristics of participants of the Swiss HIV Cohort Study on stable cART at two semiannual visits in 2007 were analyzed with respect to era of treatment initiation, number of previous virologically failed regimens and self reported adherence. Starting ART in the mono/dual era before HIV-1 RNA assays became available was counted as one failed regimen. Logistic regression was used to identify risk factors for virological failure between the two consecutive visits. Results: Of 4541 patients 31.2 % and 68.8 % had initiated therapy in the mono/dual and cART era, respectively, and been on treatment for a median of 11.7 vs. 5.7 years. At visit 1 in 2007, the mean number of previous failed regimens was 3.2 vs. 0.5 and the viral load was undetectable (,50 copies/ml) in 84.6 % vs. 89.1 % of the participants, respectively. Adjusted odds ratios of a detectable viral load at visit 2 for participants from the mono/dual era with a history of 2 and 3, 4,.4 previous

Marie Ballif; Bruno Ledergerber; Manuel Battegay; Matthias Cavassini; Enos Bernasconi; Bernard Hirschel; Hansjakob Furrer; Martin Rickenbach; Milos Opravil; Rainer Weber

2007-01-01

217

Reduced adherence to antiretroviral therapy among HIV-infected Tanzanians seeking cure from the Loliondo healer.  

PubMed

: The predictors for seeking alternative therapies for HIV-infection in sub-Saharan Africa are unknown. Among a prospective cohort of 442 HIV-infected patients in Moshi, Tanzania, 249 (56%) sought cure from a newly popularized religious healer in Loliondo (450 km away), and their adherence to antiretrovirals (ARVs) dropped precipitously (odds ratio = 0.20, 95% confidence interval: 0.09 to 0.44, P < 0.001) after the visit. Compared with those not attending Loliondo, attendees were more likely to have been diagnosed with HIV more remotely (3.8 vs. 3.0 years before, P < 0.001), have taken ARVs longer (3.4 vs. 2.5 years, P < 0.001), have higher median CD4 lymphocyte counts (429 vs. 354 cells/mm, P < 0.001), be wealthier (wealth index: 10.9 vs. 8.8, P = 0.034), and receive care at the private versus the public hospital (P = 0.012). In multivariable logistic regression, only years since the start of ARVs remained significant (odds ratio = 1.49, 95% confidence interval: 1.23 to 1.80). Treatment fatigue may play a role in the lure of alternative healers. PMID:24525471

Thielman, Nathan M; Ostermann, Jan; Whetten, Kathryn; Whetten, Rachel; Itemba, Dafrosa; Maro, Venance; Pence, Brian; Reddy, Elizabeth

2014-03-01

218

A pilot study of health beliefs and attitudes concerning measures of antiretroviral adherence among prisoners receiving directly observed antiretroviral therapy.  

PubMed

High level adherence to antiretroviral therapy (ART) is required to achieve and maintain suppression of HIV replication. Although directly observed therapy (DOT) has been suggested as an intervention to improve adherence, there is a paucity of data describing the attitudes and beliefs regarding DOT for ART among HIV-infected individuals. This study was designed to evaluate the acceptability and psychometric properties of a survey instrument for use in assessing barriers and facilitators of adherence to ART DOT in prison. From July 1, 1999 to April 1, 2000, we piloted an interviewer-administered questionnaire to assess health beliefs and attitudes regarding HIV treatment among 65 HIV-infected prison inmates receiving one or more of their antiretrovirals via directly observed therapy (DOT). The first 24 participants were administered the questionnaire to determine the feasibility of surveying prisoners in a correctional setting. There were no adherence data collected on these participants. The remaining 41 participants had their adherence measured in addition to receiving the questionnaire. Thirty-one were included in the final analysis because 10 did not complete the study. Multiple antiretroviral adherence measures (electronic device medication monitoring [eDEM] caps, medication administration records [MARs], and pill counts) were assessed among a subset of the participants (n = 31) and correlated to the instrument response items. The median internal consistency reliability coefficient for the multi-item scales was 0.79. The strongest correlation between inmates' beliefs and their adherence was between "positive beliefs about protease inhibitors" and the MAR adherence measure (r = 0.72; p < 0.001). This study provides preliminary support for the psychometric properties of the survey in this correctional setting. PMID:16789854

White, Becky L; Wohl, David A; Hays, Ron D; Golin, Carol E; Liu, Honghu; Kiziah, C Nichole; Simpson, Gregory; Kaplan, Andrew H

2006-06-01

219

Antiretroviral treatment switch strategies for lowering the costs of antiretroviral therapy in subjects with suppressed HIV-1 viremia in Spain  

PubMed Central

Background The current economic recession in European countries has forced governments to design emergency measures to reduce spending on drugs, including antiretroviral therapy (ART). Switching antiretroviral drugs for others that have the same efficacy and safety profile at a lower cost (cost-reduction measures, CRM) could prove to be a valid means of generating savings. Methods Descriptive study of prospective consensus-based CRM undertaken in 2011 in a Catalonian hospital HIV unit among patients with prolonged plasma HIV-1 RNA <50 copies/mL. Results During the study period, we made 673 switches (87.5% more than the previous year), of which 378 (56.2%) were CRM (16% of all patients treated), leading to a savings of €87,410/month. Switching tenofovir/emtricitabine for abacavir/lamivudine was the most common CRM (129, 31.3%), followed by simplification to boosted protease inhibitor monotherapy (bPImono, 102, 26%). The CRM that generated the greatest saving were switching to bPImono (38%), withdrawal or replacement of raltegravir (24%), switching tenofovir/emtricitabine for abacavir/lamivudine (13%), and switching to nevirapine (5%). Cost savings with CRM were slightly higher than those achieved with medication paid for by clinical trial sponsors (€80,333/month) or through discount arrangements (€76,389/month). Conclusion Proactively switching antiretroviral therapy in selected treated patients with sustained virological suppression can generate significant cost savings in pharmacy spending in developed countries. These findings have implications for decision makers in designing safe strategies that maintain HIV-1 suppression at lower costs. PMID:23723714

Llibre, Josep M; Cardona, Gloria; Santos, Jose R; Andreu, Angels; Estrada, Josep O; Ara, Jordi; Bonafont, Xavier; Clotet, Bonaventura

2013-01-01

220

Reducing deaths from tuberculosis in antiretroviral treatment programmes in sub-Saharan Africa  

PubMed Central

Mortality rates are high in antiretroviral therapy (ART) programmes in sub-Saharan Africa, especially during the first few months of treatment. Tuberculosis (TB) has been identified as a major underlying cause. Under routine programme conditions, between 5% and 40% of adult patients enrolling in ART services have a baseline diagnosis of TB. There is also a high TB incidence during the first few months of ART (much of which is prevalent disease missed by baseline screening) and long-term rates remain several-fold higher than background. We identify three groups of patients entering ART programmes for which different interventions are required to reduce TB-related deaths. First, diagnostic screening is needed in patients who have undiagnosed active TB so that timely anti-tuberculosis treatment can be started. This may be greatly facilitated by new diagnostic assays such as the Xpert MTB/RIF assay. Second, patients with a diagnosis of active TB need optimised case management, which includes early initiation of ART (with timing now defined by randomised controlled trials), trimethoprim-sulphamethoxazole prophylaxis and treatment of co-morbidity. Third, all remaining patients who are TB-free at enrolment have high ongoing risk of developing TB and require optimised immune recovery (with ART ideally started early in the course of HIV infection), isoniazid preventive therapy and infection control to reduce infection risk. Further specific measures are needed to address multi-drug resistant TB (MDR-TB). Finally, scale-up of all these interventions requires nationally and locally tailored models of care that are patient-centred and provide integrated health care delivery for TB, HIV and other co-morbidities. PMID:22695302

Lawn, Stephen D.; Harries, Anthony D.; Meintjes, Graeme; Getahun, Haileyesus; Havlir, Diane V.; Wood, Robin

2013-01-01

221

Tuberculosis in Antiretroviral Treatment Programs in Lower Income Countries: Availability and Use of Diagnostics and Screening  

PubMed Central

Objectives In resource-constrained settings, tuberculosis (TB) is a common opportunistic infection and cause of death in HIV-infected persons. TB may be present at the start of antiretroviral therapy (ART), but it is often under-diagnosed. We describe approaches to TB diagnosis and screening of TB in ART programs in low- and middle-income countries. Methods and findings We surveyed ART programs treating HIV-infected adults in sub-Saharan Africa, Asia and Latin America in 2012 using online questionnaires to collect program-level and patient-level data. Forty-seven sites from 26 countries participated. Patient-level data were collected on 987 adult TB patients from 40 sites (median age 34.7 years; 54% female). Sputum smear microscopy and chest radiograph were available in 47 (100%) sites, TB culture in 44 (94%), and Xpert MTB/RIF in 23 (49%). Xpert MTB/RIF was rarely available in Central Africa and South America. In sites with access to these diagnostics, microscopy was used in 745 (76%) patients diagnosed with TB, culture in 220 (24%), and chest X-ray in 688 (70%) patients. When free of charge culture was done in 27% of patients, compared to 21% when there was a fee (p?=?0.033). Corresponding percentages for Xpert MTB/RIF were 26% and 15% of patients (p?=?0.001). Screening practices for active disease before starting ART included symptom screening (46 sites, 98%), chest X-ray (38, 81%), sputum microscopy (37, 79%), culture (16, 34%), and Xpert MTB/RIF (5, 11%). Conclusions Mycobacterial culture was infrequently used despite its availability at most sites, while Xpert MTB/RIF was not generally available. Use of available diagnostics was higher when offered free of charge. PMID:24147059

Fenner, Lukas; Ballif, Marie; Graber, Claire; Nhandu, Venerandah; Dusingize, Jean Claude; Cortes, Claudia P.; Carriquiry, Gabriela; Anastos, Kathryn; Garone, Daniela; Jong, Eefje; Gnokoro, Joachim Charles; Sued, Omar; Ajayi, Samuel; Diero, Lameck; Wools-Kaloustian, Kara; Kiertiburanakul, Sasisopin; Castelnuovo, Barbara; Lewden, Charlotte; Durier, Nicolas; Sterling, Timothy R.; Egger, Matthias

2013-01-01

222

Clinical Study Safety and Tolerability of Antiretrovirals during Pregnancy  

E-print Network

License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Combination antiretroviral therapy (CART) dramatically decreases mother-to-child HIV-1 transmission (MTCT), but maternal adverse events are not infrequent. A review of 117 locally followed pregnancies revealed 7 grade ?3 AEs possibly related to antiretrovirals, including 2 hematologic, 3 hepatic, and 2 obstetric cholestasis cases. A fetal demise was attributed to obstetric cholestasis, but no maternal deaths occurred. The drugs possibly associated with these AE were zidovudine, nelfinavir, lopinavir/ritonavir, and indinavir. AE or intolerability required discontinuation/substitution of nevirapine in 16 % of the users, zidovudine in 10%, nelfinavir in 9%, lopinavir/ritonavir in 1%, but epivir and stavudine in none. In conclusion, nevirapine, zidovudine, and nelfinavir had the highest frequency of AE and/or the lowest tolerability during pregnancy. Although nevirapine and nelfinavir are infrequently used in pregnancy at present, zidovudine is included in most MTCT preventative regimens. Our data emphasize the need to revise the treatment recommendations for pregnant women to include safer and better-tolerated drugs. 1.

Adriana Weinberg; Jeri Forster-harwood; Jill Davies; Elizabeth J. Mcfarl; Kay Kinzie; Emily Barr; Suzanne Paul; Carol Salbenblatt; Elizabeth Soda; Anna Vazquez; Myron J. Levin

2011-01-01

223

Antiretroviral chemoprophylaxis: state of evidence and the research agenda.  

PubMed

Oral antiretroviral preexposure prophylaxis (PrEP) has been shown to decrease human immunodeficiency virus (HIV) incidence in studies of men who have sex with men, heterosexual men and women, and injecting drug users. One study of pericoital tenofovir gel demonstrated that it reduced HIV incidence in South African women. However, other studies of African women failed to demonstrate protection with either oral tenofovir or tenofovir-emtricitabine, or daily tenofovir gel. The magnitude of PrEP protection appears to be highly correlated with medication adherence. New studies are evaluating whether different antiretrovirals, including dapivirine, rilpivirine, maraviroc, and new integrase inhibitors. Different formulations are also being evaluated, including gels, films, vaginal rings, and injectable medication. Although PrEP efficacy has been demonstrated, and several normative bodies (eg, the US Food and Drug Administration) have approved PrEP for clinical use, uptake has been slow. Reasons may include lack of sufficient provider and consumer education, residual concerns about costs, potential long-term toxicities, and behavioral disinhibition. Additional work is under way to determine how to best educate consumers and providers about optimal adherence and to use PrEP in conjunction with risk mitigation. PMID:24926034

Mayer, Kenneth H

2014-07-01

224

Barriers to antiretroviral therapy adherence in rural Mozambique  

PubMed Central

Background HIV is treated as a chronic disease, but high lost-to-follow-up rates and poor adherence to medication result in higher mortality, morbidity, and viral mutation. Within 18 clinical sites in rural Zambézia Province, Mozambique, patient adherence to antiretroviral therapy has been sub-optimal. Methods To better understand barriers to adherence, we conducted 18 community and clinic focus groups in six rural districts. We interviewed 76 women and 88 men, of whom 124 were community participants (CP; 60 women, 64 men) and 40 were health care workers (HCW; 16 women, 24 men) who provide care for those living with HIV. Results While there was some consensus, both CP and HCW provided complementary insights. CP focus groups noted a lack of confidentiality and poor treatment by hospital staff (42% CP vs. 0% HCW), doubt as to the benefits of antiretroviral therapy (75% CP vs. 0% HCW), and sharing medications with family members (66% CP vs. 0%HCW). Men expressed a greater concern about poor treatment by HCW than women (83% men vs. 0% women). Health care workers blamed patient preference for traditional medicine (42% CP vs. 100% HCW) and the side effects of medication for poor adherence (8% CP vs. 83% CHW). Conclusions Perspectives of CP and HCW likely reflect differing sociocultural and educational backgrounds. Health care workers must understand community perspectives on causes of suboptimal adherence as a first step toward effective intervention. PMID:21846344

2011-01-01

225

Interactions between alcohol and the antiretroviral medications ritonavir or efavirenz  

PubMed Central

Objective Alcohol abuse occurs frequently in those with HIV infection. Alcohol has been linked to poor response to HIV treatment and more rapid progression of HIV. One possible contributor to such observations is drug interactions between alcohol and antiretroviral medications (ARV). This study examined drug interactions between antiretroviral therapies (ART) containing either efavirenz or ritonavir with alcohol. Methods HIV-infected individuals not currently receiving ART participated in a randomized, double-blind, placebo-controlled, study in which alcohol (or placebo) was administered and followed by blood sampling for pharmacokinetics, subjective, cardiovascular, and neuropsychological responses obtained at pre-determined times. ART was then initiated and alcohol (or placebo) sessions were repeated after at least two weeks of observed ART. Results Blood alcohol concentrations (BAC) were lower following ART in a pattern consistent with decreased bioavailability. No effect of alcohol on ritonavir or efavirenz pharmacokinetics was observed. A pharmacodynamic interaction between alcohol and efavirenz was observed as evidenced by no change in intoxication or drowsiness before and after efavirenz ART despite lower BAC. Conclusions These results show the effectiveness of implementing ART and its role in diminution of BAC which could be associated with decreased risk of physiological toxicities related to alcohol consumption relative to those with untreated HIV infection. A potential pharmacodynamic interaction between alcohol and efavirenz was observed as demonstrated by a lack of decline in ratings of intoxication and drowsiness despite decreased BAC. Alcohol consumption did not alter the pharmacokinetics of ritonavir or efavirenz. PMID:23666322

McCance-Katz, Elinore F.; Gruber, Valerie A.; Beatty, George; Lum, Paula J.; Rainey, Petrie M.

2013-01-01

226

Photosensitization is required for antiretroviral activity of hypericin  

NASA Astrophysics Data System (ADS)

In a seminal series of papers, Meruelo and co-workers have described the potent antiretroviral effect of hypericin. Interestingly, hypericin was found to inhibit not only the production of infectious virus from chronically infected cells, but was also shown to directly inhibit reverse transcriptase activity of mature virions. The effect of hypericin on cells chronically infected with equine infectious anemia virus (EIAV), a retrovirus genetically related to HIV, is demonstrated. At concentrations of 10 (mu) g/ml, hypericin reduced production of infectious EIAV by 99.99 without causing obvious cytopathic effects. Interestingly, the results indicated that the antiretroviral activity of hypericin was wholly dependent on the presence of light. No decrease in viral infectivity was observed when hypericin and virus were incubated in the dark. Moreover, it appeared that light was an absolute requirement for the antiviral activity, as even high concentrations of hypericin (10 (mu) g/ml) were unable to reduce infectivity of as few as 100 infectious virions.

Carpenter, Susan; Tossberg, John; Kraus, George A.

1991-06-01

227

HIV-Antiretroviral Therapy Induced Liver, Gastrointestinal, and Pancreatic Injury.  

PubMed

The present paper describes possible connections between antiretroviral therapies (ARTs) used to treat human immunodeficiency virus (HIV) infection and adverse drug reactions (ADRs) encountered predominantly in the liver, including hypersensitivity syndrome reactions, as well as throughout the gastrointestinal system, including the pancreas. Highly active antiretroviral therapy (HAART) has a positive influence on the quality of life and longevity in HIV patients, substantially reducing morbidity and mortality in this population. However, HAART produces a spectrum of ADRs. Alcohol consumption can interact with HAART as well as other pharmaceutical agents used for the prevention of opportunistic infections such as pneumonia and tuberculosis. Other coinfections that occur in HIV, such as hepatitis viruses B or C, cytomegalovirus, or herpes simplex virus, further complicate the etiology of HAART-induced ADRs. The aspect of liver pathology including liver structure and function has received little attention and deserves further evaluation. The materials used provide a data-supported approach. They are based on systematic review and analysis of recently published world literature (MedLine search) and the experience of the authors in the specified topic. We conclude that therapeutic and drug monitoring of ART, using laboratory identification of phenotypic susceptibilities, drug interactions with other medications, drug interactions with herbal medicines, and alcohol intake might enable a safer use of this medication. PMID:22506127

Neuman, Manuela G; Schneider, Michelle; Nanau, Radu M; Parry, Charles

2012-01-01

228

Predictive models for maximum recommended therapeutic dose of antiretroviral drugs.  

PubMed

A novel method for predicting maximum recommended therapeutic dose (MRTD) is presented using quantitative structure property relationships (QSPRs) and artificial neural networks (ANNs). MRTD data of 31 structurally diverse Antiretroviral drugs (ARVs) were collected from FDA MRTD Database or package inserts. Molecular property descriptors of each compound, that is, molecular mass, aqueous solubility, lipophilicity, biotransformation half life, oxidation half life, and biodegradation probability were calculated from their SMILES codes. A training set (n = 23) was used to construct multiple linear regression and back propagation neural network models. The models were validated using an external test set (n = 8) which demonstrated that MRTD values may be predicted with reasonable accuracy. Model predictability was described by root mean squared errors (RMSEs), Kendall's correlation coefficients (tau), P-values, and Bland Altman plots for method comparisons. MRTD was predicted by a 6-3-1 neural network model (RMSE = 13.67, tau = 0.643, P = 0.035) more accurately than by the multiple linear regression (RMSE = 27.27, tau = 0.714, P = 0.019) model. Both models illustrated a moderate correlation between aqueous solubility of antiretroviral drugs and maximum therapeutic dose. MRTD prediction may assist in the design of safer, more effective treatments for HIV infection. PMID:22481974

Branham, Michael Lee; Ross, Edward A; Govender, Thirumala

2012-01-01

229

Predictive Models for Maximum Recommended Therapeutic Dose of Antiretroviral Drugs  

PubMed Central

A novel method for predicting maximum recommended therapeutic dose (MRTD) is presented using quantitative structure property relationships (QSPRs) and artificial neural networks (ANNs). MRTD data of 31 structurally diverse Antiretroviral drugs (ARVs) were collected from FDA MRTD Database or package inserts. Molecular property descriptors of each compound, that is, molecular mass, aqueous solubility, lipophilicity, biotransformation half life, oxidation half life, and biodegradation probability were calculated from their SMILES codes. A training set (n = 23) was used to construct multiple linear regression and back propagation neural network models. The models were validated using an external test set (n = 8) which demonstrated that MRTD values may be predicted with reasonable accuracy. Model predictability was described by root mean squared errors (RMSEs), Kendall's correlation coefficients (tau), P-values, and Bland Altman plots for method comparisons. MRTD was predicted by a 6-3-1 neural network model (RMSE = 13.67, tau = 0.643, P = 0.035) more accurately than by the multiple linear regression (RMSE = 27.27, tau = 0.714, P = 0.019) model. Both models illustrated a moderate correlation between aqueous solubility of antiretroviral drugs and maximum therapeutic dose. MRTD prediction may assist in the design of safer, more effective treatments for HIV infection. PMID:22481974

Branham, Michael Lee; Ross, Edward A.; Govender, Thirumala

2012-01-01

230

Trends and economic stress: a challenge to universal access to antiretroviral treatment in India.  

PubMed

The prospects for expanded access to antiretroviral therapy (ART) in resource-poor settings have greatly improved as a result of global and national efforts to reduce the cost of antiretroviral drugs (ARV), growing availability of cheaper generics, and increased financing available from the Global Funds like Medicines Sans Frontieres. Indian health set-up provides drugs free-of-cost to HIV infected patients through government network and also through open-market to those who intend to have personalized care. Post-2005, implementation of WTO agreement on TRIPS is expected to have a significant impact on pricing and availability of generic ARV. The study has been planned to explore the trends and gaps in availability & accessibility of ARV in India. The trends in per-patient-per-year (PPPY) cost of individual ARV and treatment regimes were also explored. The epidemiological data demonstrated stabilization of the epidemic in India. Most ARV are available in India by the generic manufacturers with a median drug lag period of 2.05 years (Range 0.75-6.51 years). There is a significant price difference in drugs available from generic and originator companies. Prices for patented and generic ARV in India reflect price negotiations that have taken place since the introduction of drugs in the country, still most of the ARVs are available at a much higher cost in the market [median 2.6 times (range 1-7)]. The per-patient per year (PPPY) cost of providing first-line regime in 2008 has decreased 2.75 times from that in 2003. The analysis shows the stabilization of prices of all drugs after 2006. HIV spending in India has seen a growth of 26 percent and 28 percent in 2005-06 and 2006-07 respectively. Still, the expected expenditure to cover the whole patient population needing therapy is considerably higher than the actual expenditure incurred for providing ARV. Despite the price reductions and availability of ARV at a lower cost through agencies like MSF, there is a large gap in the expenditure incurred and patient population covered. These trends may foreshadow future AIDS treatment cost trends in the country as more people start treatment, AIDS patients live longer and move from first-line to second and third-line treatment, AIDS treatment becomes more complex, generic competition emerges, and newer patented drugs become available. PMID:19601776

Dhamija, P; Bansal, D; Medhi, B

2009-07-01

231

Factors Influencing Adherence to Antiretroviral Treatment in Nepal: A Mixed-Methods Study  

PubMed Central

Background Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal. Methods A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts. Results A total of 282 (85.5%) respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR?=?17.99, p?=? 0.014); alcohol use (OR?=?12.89, p?=?<0.001), being female (OR?=?6.91, p?=?0.001), being illiterate (OR?=?4.58, p?=?0.015), side-effects (OR?=?6.04, p?=?0.025), ART started ?24 months (OR?=?3.18, p?=?0.009), travel time to hospital >1 hour (OR?=?2.84, p?=?0.035). Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription), followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence. Conclusion Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients’ lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients. PMID:22563464

Wasti, Sharada P.; Simkhada, Padam; Randall, Julian; Freeman, Jennifer V.; van Teijlingen, Edwin

2012-01-01

232

A three-tier framework for monitoring antiretroviral therapy in high HIV burden settings  

PubMed Central

The provision of antiretroviral therapy (ART) in low and middle-income countries is a chronic disease intervention of unprecedented magnitude and is the dominant health systems challenge for high-burden countries, many of which rank among the poorest in the world. Substantial external investment, together with the requirement for service evolution to adapt to changing needs, including the constant shift to earlier ART initiation, makes outcome monitoring and reporting particularly important. However, there is growing concern at the inability of many high-burden countries to report on the outcomes of patients who have been in care for various durations, or even the number of patients in care at a particular point in time. In many instances, countries can only report on the number of patients ever started on ART. Despite paper register systems coming under increasing strain, the evolution from paper directly to complex electronic medical record solutions is not viable in many contexts. Implementing a bridging solution, such as a simple offline electronic version of the paper register, can be a pragmatic alternative. This paper describes and recommends a three-tiered monitoring approach in low- and middle-income countries based on the experience implementing such a system in the Western Cape province of South Africa. A three-tier approach allows Ministries of Health to strategically implement one of the tiers in each facility offering ART services. Each tier produces the same nationally required monthly enrolment and quarterly cohort reports so that outputs from the three tiers can be aggregated into a single database at any level of the health system. The choice of tier is based on context and resources at the time of implementation. As resources and infrastructure improve, more facilities will transition to the next highest and more technologically sophisticated tier. Implementing a three-tier monitoring system at country level for pre-antiretroviral wellness, ART, tuberculosis and mother and child health services can be an efficient approach to ensuring system-wide harmonization and accurate monitoring of services, including long term retention in care, during the scale-up of electronic monitoring solutions. PMID:24780511

Osler, Meg; Hilderbrand, Katherine; Hennessey, Claudine; Arendse, Juanita; Goemaere, Eric; Ford, Nathan; Boulle, Andrew

2014-01-01

233

Broadening the use of antiretroviral therapy: the case for feline leukemia virus  

PubMed Central

Antiretroviral drugs have saved and extended the lives of millions of individuals infected with HIV. The major classes of anti-HIV drugs include reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors, and entry/fusion inhibitors. While antiretroviral drug regimens are not commonly used to treat other types of retroviral infections, there are instances where there is a perceived need for re-evaluation of the benefits of antiretroviral therapy. One case in point is that of feline leukemia virus (FeLV), an infection of companion felines. While vaccines exist to prevent FeLV infection and spread, they have not eliminated FeLV infection. For FeLV-infected felines and their human companions, antiretroviral therapy would be desirable and of practical importance if good options were available. Here, we discuss FeLV biology and current treatment options, and propose that there is a need for antiretroviral treatment options for FeLV infection. The comparative use and analysis of antiretroviral therapy can provide new insights into the mechanism of antiretroviral drug action. PMID:21479142

Greggs, Willie M; Clouser, Christine L; Patterson, Steven E; Mansky, Louis M

2011-01-01

234

Monitoring of HAART regime antiretrovirals in serum of acquired immunodeficiency syndrome patients by micellar liquid chromatography.  

PubMed

A methodology based on micellar liquid chromatography to monitor five antiretroviral drugs (lamivudine, stavudine, tenofovir, zidovudine and efavirenz) was proposed. Antiretrovirals were studied in sets of three, corresponding to each highly active antiretroviral therapy (HAART) regime, prescribed to acquired immunodeficiency syndrome (AIDS)-infected patients. Four aqueous micellar mobile phases buffered at pH 7 were optimized to separate these compounds, using sodium dodecyl sulfate as the tensioactive, and 1-propanol or 1-pentanol as the organic modifier. The composition of each mobile phase was optimized for each antiretroviral. The common separation conditions were: C18 apolar column (125 × 4.6 mm, 5 ?m particle size), UV detection set at 214 nm, and mobile phase running at 1 mL min(-1) without controlling the temperature. The finally suggested method was validated for five analysed antiretroviral drugs following the US Food and Drug Administration guidelines in terms of: linearity between 0.5 and 50 ppm (r(2) > 0.9995), sensitivity (LOD lower than 0.25 ppm), intra- and inter-day precision (<7.1 and <5.2%, respectively) and accuracy (recovery 88.5-105.3% and 93.5-101.3%, respectively), as well as robustness (<6.5%). The proposed method was used to monitor the level of antiretrovirals in the serum of AIDS patients. The suggested methodology was found to be useful in the routine analysis of antiretrovirals in serum samples. PMID:22858583

Casas-Breva, I; Peris-Vicente, J; Rambla-Alegre, M; Carda-Broch, S; Esteve-Romero, J

2012-09-21

235

Insurability of HIV-positive people treated with antiretroviral therapy in Europe: collaborative analysis of HIV cohort studies  

PubMed Central

Objective: To increase equitable access to life insurance for HIV-positive individuals by identifying subgroups with lower relative mortality. Design: Collaborative analysis of cohort studies. Methods: We estimated relative mortality from 6 months after starting antiretroviral therapy (ART), compared with the insured population in each country, among adult patients from European cohorts participating in the ART Cohort Collaboration (ART-CC) who were not infected via injection drug use, had not tested positive for hepatitis C, and started triple ART between 1996–2008. We used Poisson models for mortality, with the expected number of deaths according to age, sex and country specified as offset. Results: There were 1236 deaths recorded among 34?680 patients followed for 174?906 person-years. Relative mortality was lower in patients with higher CD4 cell count and lower HIV-1 RNA 6 months after starting ART, without prior AIDS, who were older, and who started ART after 2000. Compared with insured HIV-negative lives, estimated relative mortality of patients aged 20–39 from France, Italy, United Kingdom, Spain and Switzerland, who started ART after 2000 had 6-month CD4 cell count at least 350?cells/?l and HIV-1 RNA less than104?copies/ml and without prior AIDS was 459%. The proportion of exposure time with relative mortality below 300, 400, 500 and 600% was 28, 43, 61 and 64%, respectively, suggesting that more than 50% of patients (those with lower relative mortality) could be insurable. Conclusion: The continuing long-term effectiveness of ART implies that life insurance with sufficiently long duration to cover a mortgage is feasible for many HIV-positive people successfully treated with ART for more than 6 months. PMID:23449349

Kaulich-Bartz, Josee; Dam, Wayne; May, Margaret T.; Lederberger, Bruno; Widmer, Urs; Phillips, Andrew N.; Grabar, Sophie; Mocroft, Amanda; Vilaro, Josep; van Sighem, Ard; Moreno, Santiago; Dabis, Francois; Monforte, Antonella D'Arminio; Teira, Ramon; Ingle, Suzanne M.; Sterne, Jonathan A.C.

2013-01-01

236

Ways to Start a Support Group  

MedlinePLUS

... Here are ways the Amputee Coalition of America (ACA) suggests you get started: • Find the right people • ... group of people. Ways to Learn More The ACA can help you get your support group started. ...

237

The Association of Adherence to Antiretroviral Therapy with Healthcare Utilization and Costs for Medical Care  

PubMed Central

Background The association between antiretroviral adherence, healthcare utilization and medical costs has not been well studied. Objective To examine the relationship of adherence to antiretroviral medications to healthcare utilization and healthcare costs. Methods A retrospective cohort study was conducted using data from 325 previously antiretroviral medication-naive HIV-infected individuals initiating first antiretroviral therapy from 1997 through 2003. The setting was an inner-city safety net hospital and HIV clinic in the US. Adherence was assessed using pharmacy refill data. The average wholesale price was used for prescription costs. Healthcare utilization data and medical costs were obtained from the hospital billing database, and differences according to quartile of adherence were compared using analysis of variance (ANOVA). Multivariate logistic regression was used to assess predictors of higher annual medical costs. Sensitivity analyses were used to examine alternative antiretroviral pricing schemes. The perspective was that of the healthcare provider, and costs were in year 2005 values. Results In 325 patients followed for a mean (± SD) 3.2 (1.9) years, better adherence was associated with lower healthcare utilization but higher total medical costs. Annual non-antiretroviral medical costs were $US7612 in the highest adherence quartile versus $US10 190 in the lowest adherence quartile. However, antiretroviral costs were significantly higher in the highest adherence quartile ($US17 513 vs $US8690), and therefore the total annual medical costs were also significantly higher in the highest versus lowest adherence quartile ($US25 125 vs $US18 880). In multivariate analysis, for every 10% increase in adherence, the odds of having annual medical costs in the highest versus lowest quartile increased by 87% (odds ratio 1.87; 95% CI 1.45, 2.40). In sensitivity analyses, very low antiretroviral prices (as seen in resource-limited settings) inverted this relationship – excellent adherence was cost saving. Conclusion Better adherence to antiretroviral medication was associated with decreased healthcare utilization and associated costs; however, because of the high cost of antiretroviral therapy, total medical costs were increased. Combination antiretroviral therapy is known to be cost effective; lower antiretroviral costs may make it cost saving as well. PMID:19231907

Gardner, Edward M.; Maravi, Moises E.; Rietmeijer, Cornelis; Davidson, Arthur J.; Burman, William J.

2009-01-01

238

Alaska Head Start. Annual Report for 1998.  

ERIC Educational Resources Information Center

This annual report details the accomplishments of the Alaska Head Start Program for fiscal year 1998. The report begins with a graphic presentation of the locations of Alaska Head Start programs and a table delineating the administrative and program partners of Head Start, its service population, eligibility requirements, funding sources, service…

Alaska State Dept. of Community and Regional Affairs, Juneau.

239

JumpStart III Final Report.  

ERIC Educational Resources Information Center

This final report for the JumpStart III program presents a summary of the entrepreneurship training programs developed by each of the four JumpStart III partners selected in March 1997. Grants for the colleges totaled $354,546 over 2 years. The Jumpstart funding has been only a starting point for these and the other 12 Jumpstart partners in…

Cohen, Arthur M.; Brawer, Florence B.; Kozeracki, Carol A.

240

Exploration into the Head Start Fade Phenomenon  

Microsoft Academic Search

The Head Start fade effect, documented since the 1970s, finds that students who make gains in I.Q. and social skills in the Head Start program later see those positive effects diminish in the early years of schooling and disappear altogether by the end of third grade. The hypothesis proposed in this study was as follows: Group I Head Start students

Deborah Tenjeras Clarke

2007-01-01

241

Behcet's disease with HIV infection: response to antiretroviral therapy.  

PubMed

The differential diagnosis of oral ulcerations in a patient with AIDS/HIV infection is often challenging to the clinician. While old diseases have appeared in a new garb, many new ones are also being recognized. The association of Behetaet's disease and AIDS/HIV infection has been recently recognized. We present an HIV-positive patient having oro-genital aphthosis conforming to the diagnostic criteria for Behetaet's disease. Erythema nodosum, periphlebitis, erythematous papulopustular lesions, half and half nails, ocular congestion, raised ESR and dimorphic anemia were some other features present. He had low CD4+/CD8+ counts. He had no other HIV-related disease. He responded well to triple anti-retroviral treatment alone. The possible pathomechanism of the occurrence of both diseases is also discussed. PMID:16394440

Mahajan, Vikram K; Sharma, Nand Lal; Sharma, Vikas C; Sharma, Ramesh Chander; Sarin, Sandip

2005-01-01

242

Immune reconstitution disease associated with parasitic infections following antiretroviral treatment  

PubMed Central

HIV-associated immune reconstitution disease (IRD) is the clinical presentation or deterioration of opportunistic infections that results from enhancement of pathogen-specific immune responses among patients responding to antiretroviral treatment (ART). The vast majority of reported cases of IRD have been associated with mycobacterial, chronic viral and invasive fungal infections; such cases result from dysregulated augmentation of cell-mediated type 1 cytokine-secreting host immune responses. However, the spectrum of infections now recognized as associated with IRD is expanding and includes a number of parasitic infections, which may be mediated by different immunopathological mechanisms. These include leishmaniasis (visceral, cutaneous, mucosal and post kala azar dermal leishmaniasis), schistosomiasis and strongyloidiasis. Since the major burden of HIV lies in resource-limited countries where access to ART is now rapidly expanding, increased awareness and knowledge of these phenomena is important. Here we review the clinical spectrum and pathogenesis of IRD associated with parasitic infections. PMID:17042934

LAWN, S D; WILKINSON, R J

2006-01-01

243

Antiretroviral therapy adherence among transgender women living with HIV.  

PubMed

Despite disproportionate rates of HIV among transgender women and evidence that medication adherence is necessary for treatment success and increased likelihood of survival, there has been little investigation into antiretroviral therapy (ART) adherence issues among transgender women. This study examined rates of self-reported ART adherence among transgender women on ART (n = 35) and well-established correlates of nonadherence, including depression, adherence self-efficacy, patient perceptions of interactions with their providers, and perceived adverse side effects of ART compared to other respondents (n = 2,770). Transgender women on ART were less likely to report 90% adherence rates or higher and reported less confidence in their abilities to integrate treatment regimens into their daily lives. When transgender women were compared to other respondents, regardless of the current medication regimen, they reported significantly fewer positive interactions with their health care providers. Training for providers and integration of hormone therapy into HIV care is recommended. PMID:20347342

Sevelius, Jae M; Carrico, Adam; Johnson, Mallory O

2010-01-01

244

[Policy dilemmas in providing antiretroviral treatment in Brazil].  

PubMed

This paper addresses institutional constraints that have affected Brazilian politics regarding provision of anti-retroviral treatment (ART) to HIV/Aids patients. We analyzed the normative conflict resulting from international agreements on intellectual property rights, especially patent protection, and the constitutional rights of Brazilian patients to universal and free access to ART. These constraints have not substantially changed the Brazilian public policy yet, but they may impact the future sustainability of this policy. As the main barrier to the production of patented drugs is not technological but institutional, Brazilian government faces a dilemma. It may either abide by existing monopolistic restrictions or it may incite competitiveness of domestic industries and developing countries in the pharmaceutical market. PMID:21120341

do Lago, Regina Ferro; Costa, Nilson do Rosário

2010-11-01

245

Pharmacokinetic interactions between etravirine and non-antiretroviral drugs.  

PubMed

Etravirine (formerly TMC125) is a non-nucleoside reverse transcriptase inhibitor (NNRTI) with activity against wild-type and NNRTI-resistant strains of HIV-1. Etravirine has been approved in several countries for use as part of highly active antiretroviral therapy in treatment-experienced patients. In vivo, etravirine is a substrate for, and weak inducer of, the hepatic cytochrome P450 (CYP) isoenzyme 3A4 and a substrate and weak inhibitor of CYP2C9 and CYP2C19. Etravirine is also a weak inhibitor of P-glycoprotein. An extensive drug-drug interaction programme in HIV-negative subjects has been carried out to assess the potential for pharmacokinetic interactions between etravirine and a variety of non-antiretroviral drugs. Effects of atorvastatin, clarithromycin, methadone, omeprazole, oral contraceptives, paroxetine, ranitidine and sildenafil on the pharmacokinetic disposition of etravirine were of no clinical relevance. Likewise, etravirine had no clinically significant effect on the pharmacokinetics of fluconazole, methadone, oral contraceptives, paroxetine or voriconazole. No clinically relevant interactions are expected between etravirine and azithromycin or ribavirin, therefore, etravirine can be combined with these agents without dose adjustment. Fluconazole and voriconazole increased etravirine exposure 1.9- and 1.4-fold, respectively, in healthy subjects, however, no increase in the incidence of adverse effects was observed in patients receiving etravirine and fluconazole during clinical trials, therefore, etravirine can be combined with these antifungals although caution is advised. Digoxin plasma exposure was slightly increased when co-administered with etravirine. No dose adjustments of digoxin are needed when used in combination with etravirine, however, it is recommended that digoxin levels should be monitored. Caution should be exercised in combining rifabutin with etravirine in the presence of certain boosted HIV protease inhibitors due to the risk of decreased exposure to etravirine. Although adjustments to the dose of clarithromycin are unnecessary for the treatment of most infections, the use of an alternative macrolide (e.g. azithromycin) is recommended for the treatment of Mycobacterium avium complex infection since the overall activity of clarithromycin against this pathogen may be altered when co-administered with etravirine. Dosage adjustments based on clinical response are recommended for clopidogrel, HMG-CoA reductase inhibitors (e.g. atorvastatin) and for phosphodiesterase type-5 inhibitors (e.g. sildenafil) because changes in the exposure of these medications in the presence of co-administered etravirine may occur. When co-administered with etravirine, a dose reduction or alternative to diazepam is recommended. When combining etravirine with warfarin, the international normalized ratio (INR) should be monitored. Systemic dexamethasone should be co-administered with caution, or an alternative to dexamethasone be found as dexamethasone induces CYP3A4. Caution is also warranted when co-administering etravirine with some antiarrhythmics, calcineurin inhibitors (e.g. ciclosporin) and antidepressants (e.g. citalopram). Co-administration of etravirine with some antiepileptics (e.g. carbamazepine and phenytoin), rifampicin (rifampin), rifapentine or preparations containing St John's wort (Hypericum perforatum) is currently not recommended as these are potent inducers of CYP3A and/or CYP2C and may potentially decrease etravirine exposure. Antiepileptics that are less likely to interact based on their known pharmacological properties include gabapentin, lamotrigine, levetiracetam and pregabalin. Overall, pharmacokinetic and clinical data show etravirine to be well tolerated and generally safe when given in combination with non-antiretroviral agents, with minimal clinically significant drug interactions and no need for dosage adjustments of etravirine in any of the cases, or of the non-antiretroviral agent in the majority of cases studied. PMID:21142266

Kakuda, Thomas N; Schöller-Gyüre, Monika; Hoetelmans, Richard M W

2011-01-01

246

Initiating antiretrovirals during tuberculosis treatment: a drug safety review  

PubMed Central

Introduction Integrating HIV and TB treatment can reduce mortality substantially. Practical barriers to treatment integration still exist and include safety concerns related to concomitant drug use because of drug interactions and additive toxicities. Altered therapeutic concentrations may influence the chances of treatment success or toxicity. Areas covered The available data on drug-drug interactions between the rifamycin class of anti-mycobacterials and the non-nucleoside reverse transcriptase inhibitor and the protease inhibitor classes of anti-retrovirals are discussed with recommendations for integrated use. Additive drug toxicities, the impact of immune reconstitution inflammatory syndrome (IRIS) and the latest data on survival benefits of integrating treatment are elucidated. Expert opinion Deferring treatment of HIV to avoid drug-interactions with TB treatment or the occurrence of IRIS is not necessary. In the integrated management of TB/HIV co-infection, rational drug combinations aimed at reducing toxicities while effecting TB cure and suppressing HIV viral load are possible. PMID:21204737

Gengiah, Tanuja N.; Gray, Andrew L.; Naidoo, Kogieleum; Karim, Quarraisha Abdool

2011-01-01

247

Limitations of current antiretroviral agents and opportunities for development.  

PubMed

Significant progress has been made in the field of human immunodeficiency virus (HIV) pharmacotherapy. This is a remarkable achievement given that the virus was first recognized in the United States in 1981 and the first antiretroviral (ARV) agent became available in 1987. There are now 20 medications in 4 different classes approved by the Food and Drug Administration (FDA) for the treatment of HIV and the carefully orchestrated use of these agents has dramatically decreased HIV mortality. However, the currently available agents have concerning limitations. These include potentially life-threatening side effects, drug interactions, loss of effectiveness over time due to resistance and the need for an extremely high level of medication adherence to achieve viral suppression. In the following review, important features of the presently available agents are described, and the characteristics of an ideal ARV agent defined. PMID:16515486

Jain, R; Clark, N M; Diaz-Linares, M; Grim, S A

2006-01-01

248

46 CFR 112.50-5 - Electric starting.  

Code of Federal Regulations, 2010 CFR

...Electric starting. An electric starting system must have a starting battery with sufficient capacity for at least six consecutive starts. A second, separate source of starting energy may provide three of the required six starts. If a second...

2010-10-01

249

Gender Differences in Factors Associated with Adherence to Antiretroviral Therapy  

PubMed Central

OBJECTIVE To identify gender differences in social and behavioral factors associated with antiretroviral adherence. DESIGN Prospective cohort study. SETTING Methadone maintenance program. PARTICIPANTS One hundred thirteen HIV-seropositive current or former opioid users. MEASUREMENTS AND MAIN RESULTS Participants were surveyed at baseline about social and behavioral characteristics and at monthly research visits about drug and alcohol use and medication side effects. Electronic monitors (MEMS) were used to measure antiretroviral adherence. Median adherence among women was 27% lower than among men (46% vs. 73%; P < .05). In gender-stratified multivariate models, factors associated with worse adherence in men included not belonging to an HIV support group (P < .0001), crack/cocaine use (P < .005), and medication side effects (P = .01). Among women, alcohol use (P = .005), heroin use (P < .05), and significant medication side effects (P < .005) were independently associated with worse adherence. In a model including both men and women, worse adherence was associated with lack of long-term housing (P < .005), not belonging to any HIV support groups (P < .0005), crack or cocaine use (P < .01), and medication side effects (P < .0005). In addition, worse adherence was associated with the interaction between female gender and alcohol use (P ? .05). CONCLUSIONS In this cohort of current and former opioid users, gender-stratified analysis demonstrated that different social and behavioral factors are associated with adherence in men and women. Among both men and women, worse adherence was associated with lack of long-term housing, not belonging to an HIV support group, crack/cocaine use, and medication side effects. Among women only, alcohol use was associated with worse adherence. PMID:15566440

Berg, Karina M; Demas, Penelope A; Howard, Andrea A; Schoenbaum, Ellie E; Gourevitch, Marc N; Arnsten, Julia H

2004-01-01

250

Cohort profile: Antiretroviral Therapy Cohort Collaboration (ART-CC).  

PubMed

The advent of effective combination antiretroviral therapy (ART) in 1996 resulted in fewer patients experiencing clinical events, so that some prognostic analyses of individual cohort studies of human immunodeficiency virus-infected individuals had low statistical power. Because of this, the Antiretroviral Therapy Cohort Collaboration (ART-CC) of HIV cohort studies in Europe and North America was established in 2000, with the aim of studying the prognosis for clinical events in acquired immune deficiency syndrome (AIDS) and the mortality of adult patients treated for HIV-1 infection. In 2002, the ART-CC collected data on more than 12,000 patients in 13 cohorts who had begun combination ART between 1995 and 2001. Subsequent updates took place in 2004, 2006, 2008, and 2010. The ART-CC data base now includes data on more than 70,000 patients participating in 19 cohorts who began treatment before the end of 2009. Data are collected on patient demographics (e.g. sex, age, assumed transmission group, race/ethnicity, geographical origin), HIV biomarkers (e.g. CD4 cell count, plasma viral load of HIV-1), ART regimen, dates and types of AIDS events, and dates and causes of death. In recent years, additional data on co-infections such as hepatitis C; risk factors such as smoking, alcohol and drug use; non-HIV biomarkers such as haemoglobin and liver enzymes; and adherence to ART have been collected whenever available. The data remain the property of the contributing cohorts, whose representatives manage the ART-CC via the steering committee of the Collaboration. External collaboration is welcomed. Details of contacts are given on the ART-CC website (www.art-cohort-collaboration.org). PMID:23599235

May, Margaret T; Ingle, Suzanne M; Costagliola, Dominique; Justice, Amy C; de Wolf, Frank; Cavassini, Matthias; D'Arminio Monforte, Antonella; Casabona, Jordi; Hogg, Robert S; Mocroft, Amanda; Lampe, Fiona C; Dabis, François; Fätkenheuer, Gerd; Sterling, Timothy R; del Amo, Julia; Gill, M John; Crane, Heidi M; Saag, Michael S; Guest, Jodie; Brodt, Hans-Reinhard; Sterne, Jonathan A C

2014-06-01

251

Novel Antiretroviral Drugs and Renal Function Monitoring of HIV Patients.  

PubMed

Chronic kidney disease is a major comorbidity in patients affected by HIV infection. In addition, the introduction of new antiretroviral agents that interact with creatinine transporters is raising some concerns. In this review we analyze the currently available data about three new antiretroviral drugs and one new pharmacokinetic enhancer. Three of them (rilpivirine, cobicistat, dolutegravir) have shown some interactions with renal function, while tenofovir alafenamide fumarate reduces the plasmatic concentration of the parent drug. The future use of tenofovir alafenamide seems to be encouraging in order to reduce the renal interaction of tenofovir. Rilpivirine, cobicistat, and dolutegravir reduce the tubular secretion of creatinine, inducing a decrease of estimated glomerular filtration rate according to creatinine. Rilpivirine and dolutegravir block the uptake of creatinine from the blood, inhibiting organic cation transporter 2, and cobicistat interacts with the efflux inhibiting multidrug and toxin extrusion protein 1. This effect can then be considered a "reset" of the estimated glomerular filtration rate according to creatinine. However, clinicians should carefully monitor renal function in order to identify possible alterations suggestive of a true renal functional impairment. Owing to the interference of these drugs with creatinine secretion, an alternative way of estimation of glomerular filtration rate would be desirable. However, at the moment, other methods of direct glomerular filtration rate measurement have a high impact on the patient, are not readily available, or are not reliable in HIV patients. Consequently, use of classic formulas to estimate glomerular filtration rate is still recommended. Also, tubular function needs to be carefully monitored with simple tests such as proteinuria, phosphatemia, urinary excretion of phosphate, normoglycemic glycosuria, and excretion of uric acid. PMID:25102336

Maggi, Paolo; Montinaro, Vincenzo; Mussini, Cristina; Di Biagio, Antonio; Bellagamba, Rita; Bonfanti, Paolo; Calza, Leonardo; Cherubini, Chiara; Corsi, Paola; Gargiulo, Miriam; Montella, Francesco; Rusconi, Stefano

2014-01-01

252

Initiation of Antiretroviral Treatment in Women After Delivery Can Induce Multiclass Drug Resistance in Breastfeeding HIV-Infected Infants  

PubMed Central

Background.?The World Health Organization currently recommends initiation of highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV)–infected lactating women with CD4+ cell counts <350 cells/?L or stage 3 or 4 disease. We analyzed antiretroviral drug resistance in HIV-infected infants in the Post Exposure Prophylaxis of Infants trial whose mothers initiated HAART postpartum (with a regimen of nevirapine [NVP], stavudine, and lamivudine). Infants in the trial received single-dose NVP and a week of zidovudine (ZDV) at birth; some infants also received extended daily NVP prophylaxis, with or without extended ZDV prophylaxis. Methods.?We analyzed drug resistance in plasma samples collected from all HIV-infected infants whose mothers started HAART in the first postpartum year. Resistance testing was performed using the first plasma sample collected within 6 months after maternal HAART initiation. Categorical variables were compared by exact or trend tests; continuous variables were compared using rank-sum tests. Results.?Multiclass resistance (MCR) was detected in HIV from 11 (29.7%) of 37 infants. Infants were more likely to develop MCR infection if their mothers initiated HAART earlier in the postpartum period (by 14 weeks vs after 14 weeks and up to 6 months vs after 6 months, P = .0009), or if the mother was exclusively breastfeeding at the time of HAART initiation (exclusive breastfeeding vs mixed feeding vs no breastfeeding, P = .003). Conclusions.?postpartum maternal HAART initiation was associated with acquisition of MCR in HIV-infected breastfeeding infants. The risk was higher among infants whose mothers initiated HAART closer to the time of delivery or were still exclusively breastfeeding when they first reported HAART use. PMID:21460326

Fogel, Jessica; Li, Qing; Taha, Taha E.; Hoover, Donald R.; Kumwenda, Newton I.; Mofenson, Lynne M.; Kumwenda, Johnstone J.; Fowler, Mary Glenn; Thigpen, Michael C.

2011-01-01

253

The Association between Yang-Deficient Constitution and Clinical Outcome of Highly Active Antiretroviral Therapy on People Living with HIV  

PubMed Central

Objective. To determine the association between Yang-Deficient Constitution and the clinical outcomes of HIV/AIDS patients who have initiated highly active antiretroviral therapy (HAART). Method. A total of 197 antiretroviral-naive adults who initiated HAART between 2009 and 2011 were recruited. The participants were asked to complete a questionnaire twice to assess their Yang-Deficient Constitution status before HAART. During the study, signs and symptoms and CD4 or CD8 T cell counts were recorded. Routine blood and biochemical tests were conducted. For the patients who were found to have infections, pathologic examination was performed. Statistical test of association of clinical attributes and demographic factors with Yang-Deficient Constitution was conducted. Result. Good test-retest reliability was observed for Yang-Deficient Constitution scoring. The median Yang-Deficient Constitution score of 142 eligible participants was 25. Female (score = 32.14, P < 0.05), hepatotoxicity (32.14, P < 0.1), nephrotoxicity (37.50, P < 0.1), total number of adverse events (P < 0.1), and mortality (39.29, P < 0.05) were associated with Yang-Deficient Consitution, while annual changes or nadir values of CD4 or CD8 T lymphocytes, and newly acquired infections after starting HAART were not. Mortality was also associated with total number of adverse events (P < 0.05), hepatotoxicity (P < 0.05), and nephrotoxicity (P < 0.05). Conclusion. Yang-Deficient Constitution score has a potential to be developed as a predictor for early HIV-related mortality and side effects. The interrelation and underlying mechanisms should be further investigated for evidence-based design of a more appropriate treatment strategy. PMID:24489581

Leung, Ross Ka-kit; Zhang, Fuchun; Jia, Weidong; Zhang, Jiansheng; Tan, Xinghua; Xu, Feilong

2013-01-01

254

Higher rates of AIDS during the first year of antiretroviral therapy among migrants: the importance of tuberculosis  

PubMed Central

Objective In lower-income countries rates of AIDS-defining events (ADEs) and death are high during the first year of combination antiretroviral therapy (ART). We investigated differences between foreign-born (migrant) and native-born (nonmigrant) patients initiating ART in Europe, the US and Canada, and examined rates of the most common ADEs and mortality during the first year of ART. Design Observational cohort study. Methods We studied HIV-positive adults participating in one of 12 cohorts in the Antiretroviral Therapy Cohort Collaboration (ART-CC). Results Of 48 854 patients, 25.6% were migrants: 16.1% from sub-Saharan Africa, 5.6% Latin America, 2.3% North Africa/Middle East, and 1.6% Asia. Incidence of ADEs during the first year of ART was 60.8 per 1000 person-years: 69.9 for migrants and 57.7 for nonmigrants [crude hazard ratio (HR) 1.18; 95% confidence interval (CI) 1.08–1.29], adjusted HR (for sex, age, CD4, HIV-1 RNA, ART regimen, prior ADE, probable route of infection and year of initiation, and stratified by cohort) 1.21 (95% CI 1.09–1.34). Rates of tuberculosis were substantially higher in migrants than nonmigrants (14.3 vs. 6.3; adjusted HR 1.94; 95% CI 1.53–2.46). In contrast, mortality was higher among nonmigrants than migrants (crude HR 0.71; 95% CI 0.61–0.84), although excess mortality was partially explained by patient characteristics at start of ART (adjusted HR 0.91; 95% CI 0.76–1.09). Conclusions During the first year of ART, HIV-positive migrants had higher rates of ADEs than nonmigrants. Tuberculosis was the most common ADE among migrants, highlighting the importance of screening for tuberculosis prior to ART initiation in this population. PMID:23925379

2014-01-01

255

Long-term virological outcome in children on antiretroviral therapy in the UK and Ireland  

PubMed Central

Objective: To assess factors at the start of antiretroviral therapy (ART) associated with long-term virological response in children. Design: Multicentre national cohort. Methods: Factors associated with viral load below 400?copies/ml by 12 months and virologic failure among children starting 3/4-drug ART in the UK/Irish Collaborative HIV Paediatric Study were assessed using Poisson models. Results: Nine hundred and ninety-seven children started ART at a median age of 7.7 years (inter-quartile range 2.9–11.7), 251 (25%) below 3 years: 411 (41%) with efavirenz and two nucleoside reverse transcriptase inhibitors (EFV?+?2NRTIs), 264 (26%) with nevirapine and two NRTIs (NVP?+?2NRTIs), 119 (12%; 106 NVP, 13 EFV) with non-nucleoside reverse transcriptase inhibitor and three NRTIs (NNRTI?+?3NRTIs), and 203 (20%) with boosted protease inhibitor-based regimens. Median follow-up after ART initiation was 5.7 (3.0–8.8) years. Viral load was less than 400?copies/ml by 12 months in 92% [95% confidence interval (CI) 91–94%] of the children. Time to suppression was similar across regimens (P?=?0.10), but faster over calendar time, with older age and lower baseline viral load. Three hundred and thirty-nine (34%) children experienced virological failure. Although progression to failure varied by regimen (P?

Duong, Trinh; Judd, Ali; Collins, Intira Jeannie; Doerholt, Katja; Lyall, Hermione; Foster, Caroline; Butler, Karina; Tookey, Pat; Shingadia, Delane; Menson, Esse; Dunn, David T.; Gibb, Di M.

2014-01-01

256

CD8+ Cell Anti-HIV Activity Rapidly Increases Upon Discontinuation of Early Antiretroviral Therapy  

E-print Network

of initiating antiretroviral therapy (ART) very early in thetherapies that can preserve CNAR activity during early ART,therapy, for each of the 16 subjects studied, CNAR activity was measured during ART and

Killian, M. Scott; Roop, Jeremy; Ng, Sharon; Hecht, Frederick M.; Levy, Jay A.

2009-01-01

257

Ocular Syphilis in HIV-Positive Patients Receiving Highly Active Antiretroviral Therapy  

Microsoft Academic Search

BackgroundFrom October 2001 to October 2002, we have observed a surprisingly high incidence of ocular syphilis in human immunodeficiency virus-positive (HIV+) patients receiving highly active antiretroviral therapy at our clinic.

Gayle P. Balba; Princy N. Kumar; Andrea N. James; Anurag Malani; Allan G. Palestine; James N. Welch; Joseph G. Timpone

2006-01-01

258

Understanding the facilitators and barriers of antiretroviral adherence in Peru: A qualitative study  

Microsoft Academic Search

BACKGROUND: Antiretroviral scale-up is increasing in resource-constrained settings. To date, few studies have explored the barriers and facilitators of adherence to ART in these settings. Facilitators and barriers of antiretroviral adherence in Peru are not completely understood. METHODS: At two clinics that serve a large number of HIV-positive individuals in Lima, Peru, 31 in-depth interviews were carried out in 2006

Walter H Curioso; Deanna Kepka; Robinson Cabello; Patricia Segura; Ann E Kurth

2010-01-01

259

Simultaneous determination of nine antiretroviral compounds in human plasma using liquid chromatography  

Microsoft Academic Search

A rapid, sensitive and specific high-performance liquid chromatographic (HPLC) method using UV detection was developed for the determination of nine antiretroviral compounds commonly found in plasma from patients receiving antiretroviral therapy. Analytes include indinavir, saquinavir, ritonavir, amprenavir, lopinavir, delavirdine, efavirenz, nelfinavir and its M8 metabolite. Analytes were isolated from plasma using tert.-butyl methyl ether and separation achieved via reversed-phase liquid

Michele L Turner; Kedria Reed-Walker; Jennifer R King; Edward P Acosta

2003-01-01

260

Prevalence of Potential Drug-Drug Interactions Involving Antiretroviral Drugs in a Large Kenyan Cohort  

Microsoft Academic Search

BackgroundClinically significant drug-drug interactions (CSDIs) involving antiretrovirals are frequent and under-recognized in developed countries, but data are lacking for developing countries.Methodology and Principal FindingsTo investigate the prevalence of CSDIs between antiretrovirals and coadministered drugs, we surveyed prescriptions dispensed in a large HIV clinic in Kenya. Of 1040 consecutive patients screened, 996 were eligible for inclusion. CSDIs were defined as ‘major’

Gabriel Kigen; Sylvester Kimaiyo; Winstone Nyandiko; Brian Faragher; Edwin Sang; Beatrice Jakait; Andrew Owen; David Back; Sara Gibbons; Kay Seden; Saye H. Khoo; Gary Maartens

2011-01-01

261

Factors affecting antiretroviral pharmacokinetics in HIV-infected women with virologic suppression on combination antiretroviral therapy: a cross-sectional study  

PubMed Central

Background Although some studies show higher antiretroviral concentrations in women compared to men, data are limited. We conducted a cross-sectional study of HIV-positive women to determine if protease inhibitor (PI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) Cmin and Cmax values were significantly different than historical general population (predominantly male) averages and to evaluate correlates of higher concentrations. Methods HIV-positive women with virologic suppression (viral load < 50copies/mL) on their first antiretroviral regimen were enrolled. Timed blood samples for Cmin and Cmax were drawn weekly for 3 weeks. The ratio of each individual’s median Cmin and Cmax to the published population mean values for their PI or NNRTI was calculated and assessed using Wilcoxon sign-rank. Intra- and inter-patient variability of antiretroviral drug levels was assessed using coefficient of variation and intra-class correlation. Linear regression was used to identify correlates of the square root-transformed Cmin and Cmax ratios. Results Data from 82 women were analyzed. Their median age was 41 years (IQR=36-48) and duration of antiretrovirals was 20 months (IQR=9-45). Median antiretroviral Cmin and Cmax ratios were 1.21 (IQR=0.72-1.89, p=0.003) (highest ratios for nevirapine and lopinavir) and 0.82 (IQR=0.59-1.14, p=0.004), respectively. Nevirapine and efavirenz showed the least and unboosted atazanavir showed the most intra- and inter-patient variability. Higher CD4+ count correlated with higher Cmin. No significant correlates for Cmax were found. Conclusions Compared to historical control data, Cmin in the women enrolled was significantly higher whereas Cmax was significantly lower. Antiretroviral Cmin ratios were highly variable within and between participants. There were no clinically relevant correlates of drug concentrations. Trial registration NCT00433979 PMID:23732043

2013-01-01

262

Survey of physician knowledge regarding antiretroviral medications in hospitalized HIV-infected patients  

PubMed Central

Background Antiretroviral prescribing errors are common among hospitalized patients. Inadequate medical knowledge is likely one of the factors leading to these errors. Our objective was to determine the proportion of hospital physicians with knowledge gaps about prescribing antiretroviral medications for hospitalized HIV-infected patients and to correlate knowledge with length and type of medical training and experience. Methods We conducted an electronic survey comprising of ten clinical scenarios based on antiretroviral-prescribing errors seen at two community teaching hospitals. It also contained demographic questions regarding length and type of medical training and antiretroviral prescribing experience. Three hundred and forty three physicians at both hospitals were asked to anonymously complete the survey between February 2007 and April 2007. Results One hundred and fifty-seven physicians (46%) completed at least one question. The mean percentage of correct responses was 33% for resident physicians, 37% for attending physicians, and 93% for Infectious Diseases or HIV (ID/HIV) specialist physicians. Higher scores were independently associated with ID/HIV specialty, number of outpatients seen per month and physician reported comfort level in managing HIV patients (P < .001). Conclusion Non-ID/HIV physicians had uniformly poor knowledge of common antiretroviral medication regimens. Involvement of ID/HIV specialists in the prescribing of antiretrovirals in hospitalized patients might mitigate prescribing errors stemming from knowledge deficits. PMID:19183506

2009-01-01

263

Sex after ART: sexual partnerships established by HIV-infected persons taking anti-retroviral therapy in Eastern Uganda.  

PubMed

This paper explores the social contexts that influence the formation and nature of sexual partnerships among people on anti-retroviral therapy (ART). We draw on the findings of a qualitative, longitudinal study of 70 people (36 women and 34 men) who have been participating in a home-based ART programme for over three years in Eastern Uganda. Since initiating ART, 32 (18 men and 14 women) participants reported having had a new partner. Five participants (4 men and 1 woman) renewed relationships with spouses with whom they had been prior to starting ART. Overall, 37 of the 70 participants had had a sexual partner after starting ART. Companionship, material support, social and cultural norms, as well as a desire for sex and children, are drivers of new relationships. The opportunity that ART brings for people to get on with their lives brings with it a reinstatement into a social world that places a value on marriage and child-bearing. The sexual rights of those living with HIV and on ART need to be taken seriously and safer sex facilitated. PMID:19544115

Seeley, Janet; Russell, Steven; Khana, Kenneth; Ezati, Enoch; King, Rachel; Bunnell, Rebecca

2009-10-01

264

The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals  

PubMed Central

Objective To estimate the effect of combined antiretroviral therapy (cART) on mortality among HIV-infected individuals after appropriate adjustment for time-varying confounding by indication. Design A collaboration of 12 prospective cohort studies from Europe and the United States (the HIV-CAUSAL Collaboration) that includes 62,760 HIV-infected, therapy-naïve individuals followed for an average of 3.3 years. Inverse probability weighting of marginal structural models was used to adjust for measured confounding by indication. Results 2039 individuals died during the follow-up. The mortality hazard ratio was 0.48 (95% confidence interval: 0.41, 0.57) for cART initiation versus no initiation. In analyses stratified by CD4 cell count at baseline, the corresponding hazard ratios were 0.29 (0.22, 0.37) for <100 cells/?L, 0.33 (0.25, 0.44) for 100-<200 cells/?L, 0.38 (0.28, 0.52) for 200-<350 cells/?L, 0.55 (0.41, 0.74) for 350-<500 cells/?L, and 0.77 (0.58, 1.01) for ?500 cells/?L. The estimated hazard ratio varied with years since initiation of cART from 0.57 (0.49, 0.67) for <1 year since initiation to 0.21 (0.14, 0.31) for ? 5 years (p-value for trend<0.001). Conclusions We estimated that cART halved the average mortality rate in HIV-infected individuals. The mortality reduction was greater in those with worse prognosis at the start of follow-up. PMID:19770621

2010-01-01

265

HLA B?5701 status, disease progression, and response to antiretroviral therapy  

PubMed Central

Objective: In addition to hypersensitivity reactions to abacavir, HLA B?5701 has been associated with slow or nonprogression of HIV infection. We explored the effect of HLA B?5701 on CD4+ cell count and viral load in untreated patients and on responses to nonabacavir-containing combination antiretroviral therapy (cART) in a large UK-based cohort. Design: Analysis of a cohort of HIV-infected adults. Methods: In untreated patients, CD4+ cell count and viral load at study entry were compared in HLAB?5701-positive and HLAB?5701-negative individuals and linear regression tested for an interaction effect of viral load and HLA B?5701 on CD4+ cell count. In patients starting a nonabacavir cART regimen, Cox proportional hazards models compared virological responses to cART among HLA B?5701-negative, HLA B?5701-positive, and those not tested. Six-month and 12-month changes in CD4+ cell count were used as outcomes in linear regression to compare immunological response to cART in these groups. Results: ART-naive HLA B?5701-positive individuals had higher CD4+ cell count (P?<0.0001) and lower viral load (P?<0.0001) at study entry than negatives; however, HLA B?5701 status was not found to effect the association between viral load and CD4+ cell count (interaction P value?=?0.09). HLA B?5701-positive patients were more likely to achieve viral suppression than negative patients on a nonabacavir regimen [hazard ratio?=?1.29, 95% confidence interval, CI (1.15–1.54)] and less likely to experience viral rebound [hazard ratio?=?0.61, 95% CI (0.37–0.99)]. Conclusion: Better virological but not immunological responses to cART were seen in HLA B?5701-positive patients on nonabacavir regimens. This study provides further evidence of the potentially beneficial effect of HLA B?5701 on HIV progression. PMID:23921616

2013-01-01

266

Prevalence of Congenital Anomalies in Infants with in Utero Exposure to Antiretrovirals  

PubMed Central

Background While use of efficacious interventions, including antiretrovirals (ARVs), has reduced dramatically the rate of mother-to-child transmission (MTCT) of HIV, the safety of in utero ARV exposure remains of concern. Methods Data regarding 1112 infants enrolled in the International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) protocol P1025 born between 2002 and 2007 were analyzed for this study. Congenital anomalies were classified based on the Metropolitan Atlanta Congenital Defects Program (MACDP) guidelines. Associations between congenital anomalies and timing of first in utero exposure to ARVs were evaluated by logistic regression analysis. Results 61 of the 1112 infants had congenital anomalies identified and confirmed, resulting in a prevalence of 5.49/100 live births (95%CI: 4.22–6.99). Among the 80 anomalies identified, the organ systems involved included: cardiovascular (n=33), musculoskeletal (n=15), renal (n=9), genitourinary (n=6), craniofacial (n=4), and central nervous system (n=2). First trimester exposure to efavirenz was associated with a significantly increased risk of congenital anomalies (OR 2.84, 95%CI: 1.13–7.16). No significant associations were observed between exposure to other individual ARVs or classes of ARVs started at any time during pregnancy and infant congenital anomalies. Conclusions The observed rate of congenital anomalies in this cohort is higher than previously reported for the general population, but is consistent with rates observed in other recent studies of children born to HIV-infected women. Cardiovascular anomalies occurred most frequently. With the exception of a known teratogen (efavirenz), no statistically significant associations between in utero exposure to ARVs and congenital anomalies were identified. PMID:21983213

KNAPP, KATHERINE M.; BROGLY, SUSAN B.; MUENZ, DANIEL G.; SPIEGEL, HANS M.; CONWAY, DANIEL H.; SCOTT, GWENDOLYN B.; TALBOT, JEFFREY T.; SHAPIRO, DAVID E.; READ, JENNIFER S.

2011-01-01

267

Microcomputer controlled soft start of motor  

NASA Astrophysics Data System (ADS)

Improving the starting characteristics of a motor is an important part of the motor control. An intelligent soft starting technique was adopted in the starter and used in the present study because of its many advantages compared with conventional starting processes. The core of the soft starter was a single chip (Atmel 8098), its soul was the software and its control object was a Silicon Controlled Rectifier (SCR). The starter achieved not only current-limit starting, but also closed-loop control with a stator current detection circuit. In conclusion, as a result of digital control, starting characteristic can be conveniently chosen according to the load. In addition the starter is of small size, and starting is smooth and reliable due to current feedback.

Gao, Miao; Wang, Yanpeng; Li, Shian

2005-12-01

268

Head start teaching center: Evaluation of a new approach to head start staff development  

Microsoft Academic Search

Head Start Teaching Centers are a national demonstration project designed to provide participatory training in all Head Start component areas within the context of an exemplary Head Start program. Each Teaching Center employs an independent evaluation to study this alternative approach to Head Start staff development. This paper presents the results of the outcome evaluation for the first year of

Diane M. Horm-Wingerd; David A. Caruso; Sheryl Gomes-Atwood; Julianna Golas

1997-01-01

269

Family Connections: Helping Early Head Start/Head Start Staff and Parents Address Mental Health Challenges  

ERIC Educational Resources Information Center

Early Head Start/Head Start teachers and staff encounter parents who have wrestled with depression and other adversities every day. This article describes an innovative program of trainings for and consultation to Early Head Start/Head Start staff to help them effectively deal with mental heath challenges faced by parents and children. The program…

Beardslee, William R.; Avery, Mary Watson; Ayoub, Catherine; Watts, Caroline L.

2009-01-01

270

Antiretroviral regimens containing a single protease inhibitor increase risk of virologic failure in young HIV-infected children.  

PubMed

Rifampin-based tuberculosis treatment can cause subtherapeutic concentrations of protease inhibitors and virologic failure in children receiving antiretroviral therapy. Among 217 children on antiretroviral therapy, tuberculosis cotreatment (in 78) was associated with virologic failure. Ritonavir-based single protease inhibitor antiretroviral therapy regimen predicted virologic failure (adjusted odds ratio 3.7, 95% confidence interval 1.5-8.9, P = 0.004) on multivariate analysis. PMID:23114373

Walters, Elisabetta; Reichmuth, Kirsten; Dramowski, Angela; Marais, Ben J; Cotton, Mark F; Rabie, Helena

2013-04-01

271

Antiretroviral Treatment for Children with Peripartum Nevirapine Exposure  

PubMed Central

BACKGROUND Single-dose nevirapine is the cornerstone of the regimen for prevention of mother-to-child transmission of human immunodeficiency virus (HIV) in resource-limited settings, but nevirapine frequently selects for resistant virus in mothers and children who become infected despite prophylaxis. The optimal antiretroviral treatment strategy for children who have had prior exposure to single-dose nevirapine is unknown. METHODS We conducted a randomized trial of initial therapy with zidovudine and lamivudine plus either nevirapine or ritonavir-boosted lopinavir in HIV-infected children 6 to 36 months of age, in six African countries, who qualified for treatment according to World Health Organization (WHO) criteria. Results are reported for the cohort that included children exposed to single-dose nevirapine prophylaxis. The primary end point was virologic failure or discontinuation of treatment by study week 24. Enrollment in this cohort was terminated early on the recommendation of the data and safety monitoring board. RESULTS A total of 164 children were enrolled. The median percentage of CD4+ lymphocytes was 19%; a total of 56% of the children had WHO stage 3 or 4 disease. More children in the nevirapine group than in the ritonavir-boosted lopinavir group reached a primary end point (39.6% vs. 21.7%; weighted difference, 18.6 percentage-points; 95% confidence interval, 3.7 to 33.6; nominal P = 0.02). Baseline resistance to nevirapine was detected in 18 of 148 children (12%) and was predictive of treatment failure. No significant between-group differences were seen in the rate of adverse events. CONCLUSIONS Among children with prior exposure to single-dose nevirapine for perinatal prevention of HIV transmission, antiretroviral treatment consisting of zidovudine and lamivudine plus ritonavir-boosted lopinavir resulted in better outcomes than did treatment with zidovudine and lamivudine plus nevirapine. Since nevirapine is used for both treatment and perinatal prevention of HIV infection in resource-limited settings, alternative strategies for the prevention of HIV transmission from mother to child, as well as for the treatment of HIV infection, are urgently required. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT00307151.) PMID:20942667

Palumbo, Paul; Lindsey, Jane C.; Hughes, Michael D.; Cotton, Mark F.; Bobat, Raziya; Meyers, Tammy; Bwakura-Dangarembizi, Mutsawashe; Chi, Benjamin H.; Musoke, Philippa; Kamthunzi, Portia; Schimana, Werner; Purdue, Lynette; Eshleman, Susan H.; Abrams, Elaine J.; Millar, Linda; Petzold, Elizabeth; Mofenson, Lynne M.; Jean-Philippe, Patrick; Violari, Avy

2010-01-01

272

When Do Start-Ups Make Sense?  

ERIC Educational Resources Information Center

The start-up has received considerable attention in the last few years. While the National Research Council of Canada has generated many start-ups over its 88-year history, the creation of a formal entrepreneurship programme in the mid-1990s dramatically accelerated the pace at which they were created. Many factors come into play in the decision…

Langemeyer, Clement J.

2005-01-01

273

JobStart: The Road to Independence.  

ERIC Educational Resources Information Center

Family Friends is an intergenerational program that brings senior volunteers into the lives of children with disabilities or chronic illnesses. JobStart is a training program in which volunteers help children with disabilities who are 10 years of age or older prepare to enter the world of work. A JobStart team is formed for each child in the…

National Council on the Aging, Inc., Washington, DC.

274

Head Start Impact Study. Final Report  

ERIC Educational Resources Information Center

This report addresses the following four questions by reporting on the impacts of Head Start on children and families during the children's preschool, kindergarten, and 1st grade years: (1) What difference does Head Start make to key outcomes of development and learning (and in particular, the multiple domains of school readiness) for low-income…

Puma, Michael; Bell, Stephen; Cook, Ronna; Heid, Camilla; Shapiro, Gary; Broene, Pam; Jenkins, Frank; Fletcher, Philip; Quinn, Liz; Friedman, Janet; Ciarico, Janet; Rohacek, Monica; Adams, Gina; Spier, Elizabeth

2010-01-01

275

Starting Total Quality Management from ISO 9000  

Microsoft Academic Search

Some 20,000 companies have been registered as working to the International Quality Management Standard ISO 9000, but many have not achieved the improvements in their operations that can be obtained from managing on total quality management principles. ISO 9000 can be an excellent start to TQM, if it is interpreted in a way that encourages the company to start on

Michael Bradley

1994-01-01

276

Head Start Home-Based Resource Directory.  

ERIC Educational Resources Information Center

A revision of the 1989 publication, this directory was compiled in order to help parents and professionals involved with Head Start home-based programming in meeting the needs of young children and families. The directory lists a broad range of guides and resources on topics related to Head Start home-based programs. Each listing provides the…

Trans-Management Systems, Inc.

277

Head Start Impact Study. Technical Report  

ERIC Educational Resources Information Center

This Technical Report is designed to provide technical detail to support the analysis and findings presented in the "Head Start Impact Study Final Report" (U.S. Department of Health and Human Services, January 2010). Chapter 1 provides an overview of the Head Start Impact Study and its findings. Chapter 2 provides technical information on the…

Puma, Michael; Bell, Stephen; Cook, Ronna; Heid, Camilla; Shapiro, Gary; Broene, Pam; Jenkins, Frank; Fletcher, Philip; Quinn, Liz; Friedman, Janet; Ciarico, Janet; Rohacek, Monica; Adams, Gina; Spier, Elizabeth

2010-01-01

278

The impact of HBV or HCV infection in a cohort of HIV-infected pregnant women receiving a nevirapine-based antiretroviral regimen in Malawi  

PubMed Central

Background Coinfection with the hepatitis viruses is common in the HIV population in sub-Saharan Africa. The aim of this study was to assess, in a cohort of HIV-infected pregnant women receiving antiretroviral drugs (ARVs), the prevalence of HBV and HCV infections and to determine the impact of these infections on the occurrence of liver toxicity and on the viro-immunological response. Methods Women were screened for HBsAg and HCV-RNA before starting, at week 25 of gestational age, an antiretroviral regimen consisting of lamivudine and nevirapine plus either stavudine or zidovudine. Women with CD4+??250/mm3 (P?=?0.030). In HBV-infected women a baseline HBV-DNA level above 10,000 IU/ml was significantly associated to the development of liver toxicity of grade???1 (P?=?0.040). Coinfections had no impact on the immunological and virological response to antiretroviral drugs up to 2 years after delivery. Conclusions In this cohort of nevirapine-treated women the presence of HBV or HCV was associated only to the development of mild liver toxicity, while the occurrence of moderate or severe hepatoxicity was correlated to a baseline CD4+ count?>?250/mm3. No statistically significant effect of the coinfections was observed on the efficacy of antiretroviral therapy. PMID:24708626

2014-01-01

279

How Qualitative Methods Contribute to Understanding Combination Antiretroviral Therapy Adherence  

PubMed Central

Summary Strict adherence to medication regimens is generally required to obtain optimal response to combination antiretroviral therapy (ART). Yet, we have made limited progress in developing strategies to decrease the prevalence of nonadherence. As we work to understand adherence in developed countries, the introduction of ART in resource-poor settings raises novel challenges. Qualitative research is a scientific approach that uses methods such as observation, interviews, and verbal interactions to gather rich in-depth information about how something is experienced. It seeks to understand the beliefs, values, and processes underlying behavioral patterns. Qualitative methods provide powerful tools for understanding adherence. Culture-specific influences, medication beliefs, access, stigma, reasons for nonadherence, patterns of medication taking, and intervention fidelity and measurement development are areas ripe for qualitative inquiry. A disregard for the social and cultural context of adherence or the imposition of adherence models inconsistent with local values and practices is likely to produce irrelevant or ineffective interventions. Qualitative methods remain underused in adherence research. We review appropriate qualitative methods for and provide an overview of the qualitative research on ART nonadherence. We discuss the rationales for using qualitative methods, present 2 case examples illustrating their use, and discuss possible institutional barriers to their acceptance. PMID:17133205

Sankar, Andrea; Golin, Carol; Simoni, Jane M.; Luborsky, Mark; Pearson, Cynthia

2014-01-01

280

Namibian prisoners describe barriers to HIV antiretroviral therapy adherence.  

PubMed

Little is available in scholarly literature about how HIV-positive prisoners, especially in low-income countries, access antiretroviral therapy (ART) medication. We interviewed 18 prisoners at a large prison in Namibia to identify barriers to medication adherence. The lead nurse researcher was a long-standing clinic employee at the prison, which afforded her access to the population. We identified six significant barriers to adherence, including (1) the desire for privacy and anonymity in a setting where HIV is strongly stigmatized; (2) the lack of simple supports for adherence, such as availability of clocks; (3) insufficient access to food to support the toll on the body of ingesting taxing ART medications; (4) commodification of ART medication; (5) the brutality and despair in the prison setting, generally leading to discouragement and a lack of motivation to strive for optimum health; and (6) the lack of understanding about HIV, how it is transmitted, and how it is best managed. Because most prisoners eventually transition back to communitysettings when their sentences are served, investments in prison health represent important investments in public health. PMID:24499371

Shalihu, Nauyele; Pretorius, Louise; van Dyk, Agnes; Vander Stoep, Ann; Hagopian, Amy

2014-01-01

281

HIV recombination: what is the impact on antiretroviral therapy?  

PubMed Central

Retroviral recombination is a potential mechanism for the development of multiply drug resistant viral strains but the impact on the clinical outcomes of antiretroviral therapy in HIV-infected patients is unclear. Recombination can favour resistance by combining single-point mutations into a multiply resistant genome but can also hinder resistance by breaking up associations between mutations. Previous analyses, based on population genetic models, have suggested that whether recombination is favoured or hindered depends on the fitness interactions between loci, or epistasis. In this paper, a mathematical model is developed that includes viral dynamics during therapy and shows that population dynamics interact non-trivially with population genetics. The outcome of therapy depends critically on the changes to the frequency of cell co-infection and I review the evidence available. Where recombination does have an effect on therapy, it is always to slow or even halt the emergence of multiply resistant strains. I also find that for patients newly infected with multiply resistant strains, recombination can act to prevent reversion to wild-type virus. The analysis suggests that treatment targeted at multiple parts of the viral life-cycle may be less prone to drug resistance due to the genetic barrier caused by recombination but that, once selected, mutants resistant to such regimens may be better able to persist in the population. PMID:16849208

Fraser, Christophe

2005-01-01

282

Novel drug delivery approaches on antiviral and antiretroviral agents  

PubMed Central

Viruses have the property to replicate very fast in host cell. It can attack any part of host cell. Therefore, the clinical efficacy of antiviral drugs and its bioavailability is more important concern taken into account to treat viral infections. The oral and parenteral routes of drug administration have several shortcomings, however, which could lead to the search for formulating better delivery systems. Now, a day's novel drug delivery systems (NDDS) proved to be a better approach to enhance the effectiveness of the antivirals and improve the patient compliance and decrease the adverse effect. The NDDS have reduced the dosing frequency and shorten the duration of treatment, thus, which could lead the treatment more cost-effective. The development of NDDS for antiviral and antiretroviral therapy aims to deliver the drug devoid of toxicity, with high compatibility and biodegradability, targeting the drug to specific sites for viral infection and in some instances it also avoid the first pass metabolism effect. This article aims to discuss the usefulness of novel delivery approaches of antiviral agents such as niosomes, microspheres, microemulsions, nanoparticles that are used in the treatment of various Herpes viruses and in human immunodeficiency virus (HIV) infections. PMID:23057001

Sharma, Pooja; Chawla, Anuj; Arora, Sandeep; Pawar, Pravin

2012-01-01

283

Continuing or adding IL-2 in patients treated with antiretroviral therapy (ACTG Protocol A5051, a rollover trial of ACTG Protocol A328)  

E-print Network

to antiretroviral therapy (ART) alone or ART followed by IL-continue antiretroviral therapy (ART) alone or with eithertherapy and IL-2 in a pre- vious study, patients newly exposed to IL-2 after initial ART

Bosch, Ronald J; Pollard, Richard B; Landay, Alan; Aga, Evgenia; Fox, Lawrence; Mitsuyasu, Ronald

2010-01-01

284

Self-reported adverse reactions among patients initiating antiretroviral therapy in Brazil.  

PubMed

A cross-sectional analysis was carried out to describe adverse reactions to antiretroviral therapy (ART) reported by HIV-infected patients initiating treatment at two public health AIDS referral centers in Belo Horizonte, Brazil, 2001-2003 and to verify their association with selected variables. Adverse reactions were obtained through interview at the first follow-up visit (first month) after the antiretroviral prescription. Socio-demographic and behavioral variables related to ART were obtained from baseline and follow-up interviews and clinical variables from medical charts. Patients with four or more reactions were compared to those with less than four. Odds ratio with 95% confidence interval were estimated using logistic regression model for both univariate and multivariate analyses. At least one adverse reaction was reported by 92.2% of the participants while 56.2% reported four or more different reactions. Antiretroviral regimens including indinavir/ritonavir, irregular use of antiretrovirals and switch in regimens were independently associated with four or more adverse reactions (OR=7.92, 5.73 and 2.03, respectively). The initial period of ARV treatment is crucial and patients' perception of adverse reactions should be carefully taken into account. Strategies for monitoring and management of adverse reactions including the choice of regimens and the prevention of irregular ART should be developed in AIDS/HIV referral centers in Brazil to promote better adherence to antiretroviral therapy. PMID:17625721

Pádua, Cristiane A Menezes de; César, Cibele C; Bonolo, Palmira F; Acurcio, Francisco A; Guimarães, Mark Drew C

2007-02-01

285

Head start teaching center: Describing the initiation of a new approach to head start staff development  

Microsoft Academic Search

This paper provides a description of the program and formative evaluation of the New England Head Start Teaching Center, one\\u000a of fourteen funded nationally to study alternative approaches to Head Start staff development. Head Start Teaching Centers\\u000a are a national demonstration project created to provide participatory training in all Head Start component areas within the\\u000a context of an exemplary Head

David A. Caruso; Diane M. Horm-Wingerd; Lynda Dickinson

1996-01-01

286

Four-drugs regimen containing raltegravir is highly effective in HIV patients starting therapy with >500,000 copies/mL viral load  

PubMed Central

Introduction Assessing virological response of four-drugs antiretroviral regimen that include raltegravir (RAL) in naïve patients with high viral load (>500,000 copies/mL) selected from a multicentre Italian database. Methods Naïve patients with HIV RNA>500,000 copies/mL, who began standard antiretroviral regimens either based on non-nucleoside reverse transcriptase inhibitors (NNRTI) or boosted-PI (PI/r), or a standard regimen plus RAL between 2008 and 2013 were analyzed. Observation was censored at 12 months and the percentage of patients who achieved a viral load below the limit of detection (BLD) was calculated. Virological failure was defined as two consecutive viral loads>40 copies/mL. Results Overall, 179 patients were included (13% with primary HIV infection (PHI), and 42.5% with AIDS diagnosis). Of them, 156 started standard three-drugs antiretroviral regimen (75.6% PI/r-based, 24.4% NNRTI-based. Among patients with PHI, 23 patients (12.8%), 6 (25%) started a four-drugs antiretroviral regimen containing both RAL and PI/r. Patients’ characteristics were as follows: males 74%, median age 42 years (IQR 35–51), sexually transmission 75.1%, median CD4 count 156 cells/µL (IQR 47–368) and median HIV-RNA 6.1 log10 copies/mL (IQR 5.8–6.4). 91 of 179 patients (50.8%) reached BLD viral load during the twelve months of observation. Three patients (1.7%) who began regimens PI/r-based with three-drugs had virological rebound after reaching BLD viral load. By use of survival analysis, we show that those patients who added RAL to the standard regimen have reached the primary end point faster (mean 8.4 months (95% CI 7.2–9.6) vs 11.4 (95% CI 11.0–11.8) in PI group and 10.3 (95% CI 9.4–11.1) in NNRTI group; p<0.001, Figure 1). In the adjusted analysis, the choice of a standard regimen versus a four-drugs regimen was driven only by higher baseline viral load (OR. 9.05; 95% CI 2.41–37.41; p=0.001). Conclusions Only half of the naïve patients who began antiretroviral therapy having >500,000 copies/mL HIV-RNA had virological success at 12 months. The success was reached faster using the RAL-containing four-drugs regimen, suggesting that strengthening the initial regimen could be an option in patients with very high viral load to improve virological response.

Sterrantino, Gaetana; Zaccarelli, Mauro; Prati, Francesca; Boschi, Andrea; Sighinolfi, Laura; Borghi, Vanni

2014-01-01

287

A Review of Head Start Research Since 1970. Head Start Evaluation, Synthesis and Utilization Project.  

ERIC Educational Resources Information Center

This review attempts to summarize the major findings concerning the impact of Head Start that have been reported in the literature published since 1970, and to communicate these results to policymakers, researchers, Head Start program staff, and others. The review constitutes an update of "A Review of Head Start Research since 1969 and an…

Hubbell, Ruth

288

START-UPS 2012profiles number of start-ups formed  

E-print Network

- nies. In addition to licensing technology from the university, start-ups attract venture capital university technology 149 number of start-ups, since FY-1988, founded in the state of California 122 number with current technology licenses with UC San Diego 26 number of start-ups acquired by other companies $3

Fainman, Yeshaiahu

289

34 CFR 200.16 - Starting points.  

Code of Federal Regulations, 2013 CFR

...Using data from the 2001-2002 school year, each State must establish starting points in reading/language arts and in mathematics for measuring the percentage of students meeting or exceeding the State's proficient level of academic...

2013-07-01

290

34 CFR 200.16 - Starting points.  

...Using data from the 2001-2002 school year, each State must establish starting points in reading/language arts and in mathematics for measuring the percentage of students meeting or exceeding the State's proficient level of academic...

2014-07-01

291

34 CFR 200.16 - Starting points.  

Code of Federal Regulations, 2012 CFR

...Using data from the 2001-2002 school year, each State must establish starting points in reading/language arts and in mathematics for measuring the percentage of students meeting or exceeding the State's proficient level of academic...

2012-07-01

292

The Physics of Tokamak Start-up  

SciTech Connect

Tokamak start-up on present-day devices usually relies on inductively induced voltage from a central solenoid. In some cases inductive startup is assisted with auxiliary power from electron cyclotron radio frequency heating. ITER, the National Spherical Torus eXperiment Upgrade and JT60, now under construction, will make use of the understanding gained from present-day devices to ensure successful start-up. Design of a spherical tokamak (ST) with DT capability for nuclear component testing would require an alternative to a central solenoid because the small central column in an ST has insufficient space to provide shielding for the insulators in the solenoid. Alternative start-up techniques such as induction using outer poloidal field coils, electron Bernstein wave start-up, coaxial helicity injection and point source helicity injection have been used with success, but require demonstration of scaling to higher plasma current.

D. Mueller

2012-11-13

293

Start Date for Lectures GSFS Common Lectures  

E-print Network

Semester DayHours Start Date for Lectures () Place Ocean Technology, Policy and Enviroment 47230/15 Env.Build.3rd Floor Lecture room 3 Ocean Technology, Policy and Enviroment 47233-12 Exercises on Ocean

Yamamoto, Hirosuke

294

75 FR 57704 - Head Start Program  

Federal Register 2010, 2011, 2012, 2013

...proposes seven conditions in three critical areas of Head Start program administration...impact of this new system and the critical need to ensure high-quality...Support domain develop children's critical thinking skills, provide ongoing...

2010-09-22

295

A Head Start in the Nursery.  

ERIC Educational Resources Information Center

In an interview, J. McVicker Hunt discusses the role of children's interactions with their environments in raising intelligence, the general effects of Head Start, and the role of mothers in affecting their children's intelligence. (MH)

Pines, Maya

1979-01-01

296

Getting Started Computing at the AI Lab  

E-print Network

This document describes the computing facilities at M.I.T. Artificial Intelligence Laboratory, and explains how to get started using them. It is intended as an orientation document for newcomers to the lab, and will be ...

Stacy, Christopher C.

1982-09-07

297

76 FR 70009 - Head Start Program  

Federal Register 2010, 2011, 2012, 2013

...rating instruments (e.g., the Early Childhood Environmental Rating Scale, Infant and Toddler Environment Rating Scale, and the Family Child Care Environment Rating Scale) into the Head Start monitoring review system. Some of the...

2011-11-09

298

Delivering Sure Start in rural communities  

Microsoft Academic Search

This paper explores and questions some of the evidence used to support early childhood interventions in the UK, and reports on discussions with three rural Mini Sure Start project leaders in Devon. Sure Start funding in the UK has been repeatedly increased to provide more centres for 0–3?year?olds and their parents. It is increasingly linked to welfare to work policies

Jenny Willan

2007-01-01

299

Antiretroviral Drug Therapy in Benue State, Nigeria: A Follow-up of 20 PLWA in a Private Hospital in Gboko  

Microsoft Academic Search

KEYWORDS Antiretroviral. Drug. AIDS. Benue. Nigeria. Follow-Up ABSTRACT The need for a drug policy on HIV\\/AIDS was investigated through a pilot clinical study of 20 Persons Living With AIDS (PLWA), (8 males and 12 females) who took combivir antiretroviral drugs (ARV). Their age range was between 11 and 60 years with those between 11 and 40 years presenting most for

Fred Iornongo Tamen; John Kpamor; Nyitor Alexander Shenge

300

Multi-Scale Modeling of HIV Infection in vitro and APOBEC3G-Based Anti-Retroviral Therapy  

E-print Network

Multi-Scale Modeling of HIV Infection in vitro and APOBEC3G-Based Anti-Retroviral Therapy Iraj Infection in vitro and APOBEC3G-Based Anti-Retroviral Therapy. PLoS Comput Biol 8(2): e1002371. doi:10. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which

Levin, Judith G.

301

S. Blower, et al.: Forecasting the Future of HIV Epidemics: the Impact of Antiretroviral Therapies & Imperfect Vaccines AIDSREVIEWS  

E-print Network

S. Blower, et al.: Forecasting the Future of HIV Epidemics: the Impact of Antiretroviral Therapies & Imperfect Vaccines AIDSREVIEWS 113 Forecasting the Future of HIV Epidemics: the Impact of Antiretroviral of specific epidemic control strategies and to design epidemic control strategies. We review how models have

Blower, Sally

302

The Financial Burden of Morbidity in HIV-Infected Adults on Antiretroviral Therapy in Co^te d'Ivoire  

E-print Network

antiretroviral therapy (ART) in Co^te d'Ivoire. Methodology/Principal Findings: We conducted a crossThe Financial Burden of Morbidity in HIV-Infected Adults on Antiretroviral Therapy in Co^te d-sectional survey. After obtaining informed consent, we interviewed HIV-infected adults taking ART who had

Paris-Sud XI, Université de

303

Building capacity for antiretroviral delivery in South Africa: A qualitative evaluation of the PALSA PLUS nurse training programme  

Microsoft Academic Search

BACKGROUND: South Africa recently launched a national antiretroviral treatment programme. This has created an urgent need for nurse-training in antiretroviral treatment (ART) delivery. The PALSA PLUS programme provides guidelines and training for primary health care (PHC) nurses in the management of adult lung diseases and HIV\\/AIDS, including ART. A process evaluation was undertaken to document the training, explore perceptions regarding

J Stein; S Lewin; L Fairall; P Mayers; R English; A Bheekie; E Bateman; M Zwarenstein

2008-01-01

304

Community-based treatment of advanced HIV disease: introducing DOT-HAART (directly observed therapy with highly active antiretroviral therapy)  

Microsoft Academic Search

In 2000, acquired immunodeficiency syndrome (AIDS) overtook tuberculosis (TB) as the world's leading infectious cause of adult deaths. In affluent countries, however, AIDS mortality has dropped sharply, largely because of the use of highly active antiretroviral therapy (HAART). Antiretroviral agents are not yet considered essential medications by international public health experts and are not widely used in the poor countries

Paul Farmer; Fernet Leandre; Joia Mukherjee; Rajesh Gupta; Laura Tarter; Jim Yong Kim

305

Determination of 19 antiretroviral agents in pharmaceuticals or suspected products with two methods using high-performance liquid chromatography  

Microsoft Academic Search

Three classes of antiretroviral agents are usually available for the treatment of HIV infection: nucleoside reverse transcriptase inhibitors (IN), non-nucleoside reverse transcriptase inhibitors (INN) and protease inhibitors (IP). Two methods by reversed-phase liquid chromatography were developed for the analysis of 19 antiretroviral molecules belonging to these three therapeutic classes and used in medicinal products. Both of these HPLC techniques use

Hervé Rebiere; Bernard Mazel; Corinne Civade; Pierre-Antoine Bonnet

2007-01-01

306

Cellular HIV-1 DNA load predicts HIV-RNA rebound and the outcome of highly active antiretroviral therapy  

E-print Network

Cellular HIV-1 DNA load predicts HIV-RNA rebound and the outcome of highly active antiretroviral HIV-1 DNA prior to highly active antiretroviral therapy (HAART) initiation predicts its outcome initiation were available. Cellular HIV-1 DNA quantification was performed by a molecular beacon-based real

307

Response to antiretroviral therapy (ART): comparing women with previous use of zidovudine monotherapy (ZDVm) in pregnancy with ART na?ve women  

PubMed Central

Background 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. Methods 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. Results In adjusted analyses, ART-naïve (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. Conclusions In this setting, antenatal ZDVm exposure did not adversely impact on outcomes once ART was initiated for the woman’s health. PMID:24593018

2014-01-01

308

Antiretroviral Therapy for HIV-2 Infection: Recommendations for Management in Low-Resource Settings  

PubMed Central

HIV-2 contributes approximately a third to the prevalence of HIV in West Africa and is present in significant amounts in several low-income countries outside of West Africa with historical ties to Portugal. It complicates HIV diagnosis, requiring more expensive and technically demanding testing algorithms. Natural polymorphisms and patterns in the development of resistance to antiretrovirals are reviewed, along with their implications for antiretroviral therapy. Nonnucleoside reverse transcriptase inhibitors, crucial in standard first-line regimens for HIV-1 in many low-income settings, have no effect on HIV-2. Nucleoside analogues alone are not sufficiently potent enough to achieve durable virologic control. Some protease inhibitors, in particular those without ritonavir boosting, are not sufficiently effective against HIV-2. Following review of the available evidence and taking the structure and challenges of antiretroviral care in West Africa into consideration, the authors make recommendations and highlight the needs of special populations. PMID:21490779

Peterson, Kevin; Jallow, Sabelle; Rowland-Jones, Sarah L.; de Silva, Thushan I.

2011-01-01

309

Simultaneous determination of nine antiretroviral compounds in human plasma using liquid chromatography.  

PubMed

A rapid, sensitive and specific high-performance liquid chromatographic (HPLC) method using UV detection was developed for the determination of nine antiretroviral compounds commonly found in plasma from patients receiving antiretroviral therapy. Analytes include indinavir, saquinavir, ritonavir, amprenavir, lopinavir, delavirdine, efavirenz, nelfinavir and its M8 metabolite. Analytes were isolated from plasma using tert.-butyl methyl ether and separation achieved via reversed-phase liquid chromatography on a C(8) column with a gradient mobile phase. Detection at 210 nm provided adequate sensitivity. Limit of quantification is 50 ng/ml and all analytes demonstrated linearity across 50-10000 ng/ml from a single 200-microliter plasma sample. Recovery from plasma was consistently high (>80%). This novel HPLC methodology allows us to simultaneously determine plasma concentrations of nine antiretrovirals, including lopinavir, in HIV-infected patients on a single HPLC system. PMID:12505781

Turner, Michele L; Reed-Walker, Kedria; King, Jennifer R; Acosta, Edward P

2003-02-01

310

Impact of immune reconstitution inflammatory syndrome on antiretroviral therapy adherence  

PubMed Central

Objective We determined the impact of immune reconstitution inflammatory syndrome (IRIS) on antiretroviral therapy (ART) adherence in a cohort of 274 human immunodeficiency virus (HIV)-infected South African adults initiating ART. Methods We carried out a secondary analysis of data from a randomized controlled trial of partially supervised ART in Cape Town, South Africa. Monthly pill count adherence, viral suppression (HIV viral load < 50 c/mL), and IRIS events were documented. Poisson regression was used to identify variables associated with ART adherence below the median in the first 6 months of ART. Results We enrolled 274 patients: 58% women, median age 34 years, median CD4 count 98 cells/?L, 46% World Health Organization clinical stage IV, and 40% on treatment for tuberculosis (TB). IRIS and TB-IRIS developed in 8.4% and 6.6% of patients, respectively. The median cumulative adherence at 6 months for those with an IRIS event vs no IRIS was 95.5% vs 98.2% (P = 0.04). Although not statistically significant, patients developing IRIS had a lower 6-month viral load suppression than those without IRIS (68% vs 80%, P = 0.32). ART adherence below the median of 98% was independently associated with alcohol abuse (relative risk [RR] 1.5; 95% confidence interval [CI] 1.2–1.9; P = 0.003) and IRIS events (RR 1.7; 95% CI 1.2–2.2; P = 0.001). Conclusion Although IRIS events were associated with slightly lower adherence rates, overall adherence to ART remained high in this study population. Concerns about IRIS should not deter clinicians from early ART initiation. PMID:23271897

Nachega, Jean B; Morroni, Chelsea; Chaisson, Richard E; Goliath, Rene; Efron, Anne; Ram, Malathi; Maartens, Gary

2012-01-01

311

Reforming antiretroviral price negotiations and public procurement: the Mexican experience.  

PubMed

Since antiretroviral (ARV) medicines represent one of the most costly components of therapy for HIV in middle-income countries, ensuring their efficient procurement is highly relevant. In 2008, Mexico created a national commission for the negotiation of ARV prices to achieve price reductions for their public HIV treatment programmes. The objective of this study is to assess the immediate impact of the creation of the Mexican Commission for Price Negotiation on ARV prices and expenditures. A longitudinal retrospective analysis of procurement prices, volumes and type of the most commonly prescribed ARVs procured by the two largest providers of HIV/AIDS care in Mexico between 2004 and 2009 was carried out. These analyses were combined with 26 semi-structured key informant interviews to identify changes in the procurement process. Prices for ARVs dropped by an average of 38% after the first round of negotiations, indicating that the Commission was successful in price negotiations. However, when compared with other upper-middle-income countries, Mexico continues to pay an average of six times more for ARVs. The Commission's negotiations were successful in achieving lower ARV prices. However, price reduction in upper-middle-income countries suggests that the price decrease in Mexico cannot be entirely attributed to the Commission's first round of negotiations. In addition, key informants identified inefficiencies in the forecasting and procurement processes possibly affecting the efficiency of the negotiation process. A comprehensive approach to improving efficiency in the purchasing and delivery of ARVs is necessary, including a better clarification in the roles and responsibilities of the Commission, improving supply data collection and integration in forecasting and procurement, and the creation of a support system to monitor and provide feedback on patient ARV use. PMID:22375026

Adesina, Adebiyi; Wirtz, Veronika J; Dratler, Sandra

2013-01-01

312

Alcohol use disorders and antiretroviral therapy among prisoners in Argentina  

PubMed Central

Purpose While Argentina has significantly improved access to HIV care and antiretroviral therapy (ART) for both the general population and prisoners, the prevalence of alcohol use disorders (AUDs) among HIV-infected prisoners and their relationship to accessing ART in Argentina is currently unknown. This study aims to characterize the substance abuse patterns of HIV-infected prisoners in Argentina and to assess the independent correlates of receipt of pre-incarceration ART. Design/methodology/approach An anonymous, cross-sectional survey of 100 HIV-infected federal prisoners was conducted in the Buenos Aires municipality from July–December 2010. AUDs were assessed using the AUDIT scale. Findings A majority (63 per cent) of participants met criteria for AUDs, 45 per cent of subjects were diagnosed with HIV in prison and one-quarter had initiated ART during the current incarceration. In addition, over one-third (35 per cent) of participants did not receive ART during the pre-incarceration period despite receiving it upon incarceration. This correlated significantly with the presence of having an AUD (AOR 0.20, 95 per cent CI 0.06–0.74, p = 0.016). Practical implications AUDs are prevalent among HIV-infected prisoners in Argentina and are significantly related to negative secondary HIV prevention and treatment outcomes. While Argentina has provided an exemplary model of HIV-related health care reform within its prisons, future efforts to provide screening and treatment for AUDs are needed to improve the health of the nation’s incarcerated population. Originality/value This paper is the first to describe pre-incarceration drug and alcohol use disorders and issues related to access to ART among prisoners in Argentina. PMID:24772187

Alpert, Michael; Wickersham, Jeffrey A.; Vazquez, Mariana; Altice, Frederick L.

2013-01-01

313

The HIV Antiretroviral Drug Efavirenz has LSD-Like Properties  

PubMed Central

Anecdotal reports have surfaced concerning misuse of the HIV antiretroviral medication efavirenz ((4S)-6-chloro-4-(2-cyclopropylethynyl)-4-(trifluoromethyl)-2,4-dihydro-1H-3,1-benzoxazin-2-one) by HIV patients and non-infected teens who crush the pills and smoke the powder for its psychoactive effects. Molecular profiling of the receptor pharmacology of efavirenz pinpointed interactions with multiple established sites of action for other known drugs of abuse including catecholamine and indolamine transporters, and GABAA and 5-HT2A receptors. In rodents, interaction with the 5-HT2A receptor, a primary site of action of lysergic acid diethylamine (LSD), appears to dominate efavirenz's behavioral profile. Both LSD and efavirenz reduce ambulation in a novel open-field environment. Efavirenz occasions drug-lever responding in rats discriminating LSD from saline, and this effect is abolished by selective blockade of the 5-HT2A receptor. Similar to LSD, efavirenz induces head-twitch responses in wild-type, but not in 5-HT2A-knockout, mice. Despite having GABAA-potentiating effects (like benzodiazepines and barbiturates), and interactions with dopamine transporter, serotonin transporter, and vesicular monoamine transporter 2 (like cocaine and methamphetamine), efavirenz fails to maintain responding in rats that self-administer cocaine, and it fails to produce a conditioned place preference. Although its molecular pharmacology is multifarious, efavirenz's prevailing behavioral effect in rodents is consistent with LSD-like activity mediated via the 5-HT2A receptor. This finding correlates, in part, with the subjective experiences in humans who abuse efavirenz and with specific dose-dependent adverse neuropsychiatric events, such as hallucinations and night terrors, reported by HIV patients taking it as a medication. PMID:23702798

Gatch, Michael B; Kozlenkov, Alexey; Huang, Ren-Qi; Yang, Wenjuan; Nguyen, Jacques D; Gonzalez-Maeso, Javier; Rice, Kenner C; France, Charles P; Dillon, Glenn H; Forster, Michael J; Schetz, John A

2013-01-01

314

The HIV antiretroviral drug efavirenz has LSD-like properties.  

PubMed

Anecdotal reports have surfaced concerning misuse of the HIV antiretroviral medication efavirenz ((4S)-6-chloro-4-(2-cyclopropylethynyl)-4-(trifluoromethyl)-2,4-dihydro-1H-3,1-benzoxazin-2-one) by HIV patients and non-infected teens who crush the pills and smoke the powder for its psychoactive effects. Molecular profiling of the receptor pharmacology of efavirenz pinpointed interactions with multiple established sites of action for other known drugs of abuse including catecholamine and indolamine transporters, and GABAA and 5-HT(2A) receptors. In rodents, interaction with the 5-HT(2A) receptor, a primary site of action of lysergic acid diethylamine (LSD), appears to dominate efavirenz's behavioral profile. Both LSD and efavirenz reduce ambulation in a novel open-field environment. Efavirenz occasions drug-lever responding in rats discriminating LSD from saline, and this effect is abolished by selective blockade of the 5-HT(2A) receptor. Similar to LSD, efavirenz induces head-twitch responses in wild-type, but not in 5-HT(2A)-knockout, mice. Despite having GABAA-potentiating effects (like benzodiazepines and barbiturates), and interactions with dopamine transporter, serotonin transporter, and vesicular monoamine transporter 2 (like cocaine and methamphetamine), efavirenz fails to maintain responding in rats that self-administer cocaine, and it fails to produce a conditioned place preference. Although its molecular pharmacology is multifarious, efavirenz's prevailing behavioral effect in rodents is consistent with LSD-like activity mediated via the 5-HT(2A) receptor. This finding correlates, in part, with the subjective experiences in humans who abuse efavirenz and with specific dose-dependent adverse neuropsychiatric events, such as hallucinations and night terrors, reported by HIV patients taking it as a medication. PMID:23702798

Gatch, Michael B; Kozlenkov, Alexey; Huang, Ren-Qi; Yang, Wenjuan; Nguyen, Jacques D; González-Maeso, Javier; Rice, Kenner C; France, Charles P; Dillon, Glenn H; Forster, Michael J; Schetz, John A

2013-11-01

315

Timing of Initiation of Antiretroviral Drugs during Tuberculosis Therapy  

PubMed Central

Despite high mortality rates in tuberculosis patients with HIV co-infection, there is continued controversy on when to initiate antiretroviral therapy (ART) in these patients. Methods We conducted an open-label randomized controlled trial in Durban, South Africa to determine optimal timing of ART initiation in relation to TB treatment. Acid-fast bacilli (AFB) smear positive tuberculosis patients with HIV infection and CD4+ counts <500 cells/mm3 (n=642) were randomized to one of two integrated treatment arms (ART initiation during tuberculosis treatment) or to a sequential treatment arm (ART initiation upon tuberculosis treatment completion). Participants received standard tuberculosis therapy, cotrimoxazole prophylaxis and once daily didanosine, lamivudine and efavirenz ART regimen. The primary endpoint was all-cause mortality. Results This analysis compares data from the sequential treatment arm and the combined integrated treatment arms up to 1 September 2008, when the Safety Monitoring Committee recommended halting the sequential treatment arm. Demographic, clinical and laboratory characteristics at baseline and adverse event rates during follow-up were similar in the study arms. Mortality was 56% lower (hazard ratio: 0.44; 95% Confidence Interval: 21% to 75%; p = 0.003) in the integrated arm (5.4 per 100 person-years (25 deaths; n=429)) compared to sequential arm (12.1 per 100 person-years (27 deaths; n=213)). Mortality rates were lower regardless of CD4+ count level. Conclusions Initiating ART during tuberculosis treatment in AFB positive patients with HIV co-infection and CD4+ counts <500 cells/mm3 significantly improves survival and provides further impetus for the integration of tuberculosis and AIDS services. PMID:20181971

Abdool Karim, Salim S.; Naidoo, Kogieleum; Grobler, Anneke; Padayatchi, Nesri; Baxter, Cheryl; Gray, Andrew; Gengiah, Tanuja; Nair, Gonasagrie; Bamber, Sheila; Singh, Aarthi; Khan, Munira; Pienaar, Jacqueline; El-Sadr, Wafaa; Friedland, Gerald; Karim, Quarraisha Abdool

2010-01-01

316

Pharmacokinetic optimisation of antiretroviral therapy in patients with HIV infection.  

PubMed

More than 7 years after the introduction of zidovudine for treatment of HIV infection, little use has been made of the pharmacokinetic properties of this or any of the subsequently approved antiretroviral agents to optimise therapy. This is partly because of the limits of technologies developed to measure clinically relevant forms and concentrations of these drugs, and partly because the clinical community has been slow to recognise the potential benefits of pharmacokinetic optimisation of nucleoside analogue therapy in any disease. Nonetheless, for some of these agents, progress in understanding the relationship between pharmacokinetics and pharmacodynamics has been made. With zidovudine, for example, even though plasma concentrations have little clinical utility, evidence suggests that concentrations of active phosphorylated forms of zidovudine inside target cells are related to disease progression and toxicity. Furthermore, a decreased ability to phosphorylate zidovudine might be a prerequisite for the emergence of zidovudine-resistant HIV strains. Measurements of phosphorylated zidovudine inside cells similarly suggest that 100 mg of oral zidovudine every 8 hours approximates the optimal initial dosage regimen in asymptomatic patients. Increased plasma didanosine concentrations have been associated with several measures of clinical improvement in patients, and may be associated with an increased risk of toxicity as well. For zalcitabine and stavudine, however, the picture is much less clear. Their pharmacokinetic and pharmacodynamic relationships have not been studied in patients. Furthermore, there is insufficient data on the effects of age, gender, race and concurrent underlying conditions on the pharmacokinetics of all of these agents. Mounting evidence suggests that monitoring of these compounds could lead to individually optimised intervention strategies. Given the marginal benefits of therapy with these agents, their proven toxic effects and the lack of proven alternatives, it is critical that the clinical community strive to make the most effective use of these agents in the treatment of their patients. PMID:7586898

Stretcher, B N

1995-07-01

317

Drug-Resistant Tuberculosis Treatment Complicated by Antiretroviral Resistance in HIV Coinfected Patients: A Report of Six Cases in Lesotho  

PubMed Central

Treating drug-resistant tuberculosis (DR-TB) is particularly challenging in high human immunodeficiency virus (HIV) prevalence settings. Neither antiretroviral resistance testing nor viral load monitoring is widely available in sub-Saharan Africa, and antiretroviral resistance can complicate the clinical management for DR-TB/HIV coinfected patients. We describe six cases of antiretroviral resistance in DR-TB patients with HIV coinfection in Lesotho. Two patients died before or immediately after antiretroviral resistance was detected by genotyping; the remaining four patients were switched to effective antiretroviral therapy (ART) regimens. Favorable DR-TB treatment outcomes in coinfected patients require successful management of their HIV infection, including treatment with an effective ART regimen. Coinfected patients undergoing DR-TB treatment may require closer monitoring of their response to ART, including routine viral load testing, to ensure that they receive an effective ART regimen concurrent with DR-TB treatment. PMID:23669229

Satti, Hind; McLaughlin, Megan M.; Seung, Kwonjune J.

2013-01-01

318

Are They Really Lost? “True” Status and Reasons for Treatment Discontinuation among HIV Infected Patients on Antiretroviral Therapy Considered Lost to Follow Up in Urban Malawi  

PubMed Central

Introduction Patients who are lost to follow-up (LTFU) while on antiretroviral therapy (ART) pose challenges to the long-term success of ART programs. We describe the extent to which patients considered LTFU are misclassified as true disengagement from care when they are still alive on ART and explain reasons for ART discontinuation using our active tracing program to further improve ART retention programs and policies. Methods We identified adult ART patients who missed clinic appointment by more than 3 weeks between January 2006 and December 2010, assuming that such patients would miss their doses of antiretroviral drugs. Patients considered LTFU who consented during ART registration were traced by phone or home visits; true ART status after tracing was documented. Reasons for ART discontinuation were also recorded for those who stopped ART. Results Of the 4,560 suspected LTFU cases, 1,384 (30%) could not be traced. Of the 3,176 successfully traced patients, 952 (30%) were dead and 2,224 (70%) were alive, of which 2,183 (99.5%) started ART according to phone-based self-reports or physical verification during in-person interviews. Of those who started ART, 957 (44%) stopped ART and 1,226 (56%) reported still taking ART at the time of interview by sourcing drugs from another clinic, using alternative ART sources or making brief ART interruptions. Among 940 cases with reasons for ART discontinuations, failure to remember (17%), too weak/sick (12%), travel (46%), and lack of transport to the clinic (16%) were frequently cited; reasons differed by gender. Conclusion The LTFU category comprises sizeable proportions of patients still taking ART that may potentially bias retention estimates and misdirect resources at the clinic and national levels if not properly accounted for. Clinics should consider further decentralization efforts, increasing drug allocations for frequent travels, and improving communication on patient transfers between clinics to increase retention and adherence. PMID:24086627

Tweya, Hannock; Feldacker, Caryl; Estill, Janne; Jahn, Andreas; Ng’ambi, Wingston; Ben-Smith, Anne; Keiser, Olivia; Bokosi, Mphatso; Egger, Matthias; Speight, Colin; Gumulira, Joe; Phiri, Sam

2013-01-01

319

Prospective predictors of unprotected anal intercourse among HIV-seropositive men who have sex with men initiating antiretroviral therapy.  

PubMed

Contemporary HIV prevention efforts are increasingly focused on those already living with HIV/AIDS (i.e., "prevention with positives"). Key to these initiatives is research identifying the most risky behavioral targets. Using a longitudinal design, we examined socio-demographic and psychosocial factors that prospectively predicted unprotected anal intercourse (UAI) in a sample of 134 HIV-seropositive men who have sex with men (MSM) initiating, changing, or re-starting an antiretroviral therapy regimen as part of a behavioral intervention study. Computer-based questionnaires were given at baseline and 6 months. In a sequential logistic regression, baseline measures of UAI (step 1), socio-demographic factors such as Latino ethnicity (step 2), and psychosocial factors such as crystal methamphetamine use, greater life stress, and lower trait anxiety (step 3) were predictors of UAI at 6 months. Problem drinking was not a significant predictor. Prevention efforts among MSM living with HIV/AIDS might focus on multiple psychosocial targets, like decreasing their crystal methamphetamine use and teaching coping skills to deal with life stress. PMID:23640652

Pantalone, David W; Huh, David; Nelson, Kimberly M; Pearson, Cynthia R; Simoni, Jane M

2014-01-01

320

Impact of highly effective antiretroviral therapy on the risk for Hodgkin lymphoma among people with human immunodeficiency virus infection  

PubMed Central

Purpose of review To estimate the impact of highly effective antiretroviral therapy (ART) on the incidence and prognosis of Hodgkin lymphoma among people with human immunodeficiency virus infection or AIDS (PWHA). Recent findings Age-adjusted incidence of Hodgkin lymphoma in PWHA is unchanged and is still five-fold to fifteen-fold higher than in the general population. Aging of the PWHA population with ART may account for increasing numbers of Hodgkin lymphoma cases. CD4 cell count has a complex relationship to Hodgkin lymphoma risk in PWHA. Depending on the time of measurement, Hodgkin lymphoma risk is highest with 50–249 CD4cells/µl, and falling CD4 count on ART may be a harbinger of Hodgkin lymphoma onset. HIV load appears irrelevant to Hodgkin lymphoma. For obscure reasons, Hodgkin lymphoma risk may be elevated soon after starting ART, but the risk is probably modestly reduced with 6 or more months on ART. For PWHA who develop Hodgkin lymphoma, ART and ABVD chemotherapy can be administered safely, with one recent study demonstrating equivalent outcomes for HIV-positive and HIV-negative Hodgkin lymphoma patients. Summary Vigilance for Hodgkin lymphoma is needed for immune-deficient PWHA, including those on ART. ART with opportunistic infection prophylaxis enables the delivery of effective chemotherapy for Hodgkin lymphoma, leading to a good prognosis. PMID:22729154

Goedert, James J.; Bower, Mark

2013-01-01

321

Incidence and Associated Factors of HIV Drug Resistance in Chinese HIV-Infected Patients Receiving Antiretroviral Treatment  

PubMed Central

Background A critical indicator of the future success of highly active antiretroviral therapy (HAART) is the incidence of HIV drug resistance, which has not been studied in China on the national scale. Methods HIV drug resistance baseline survey was conducted in the eight provinces with the largest numbers of patients on HAART in 2009, and a prospective cohort study with 12-month follow-up was completed in 2010. Patients completed an interviewer-administrated questionnaire and provided blood for CD4+ T-lymphocyte count (CD4 count), HIV viral load (VL), and HIV drug resistance genotyping. Factors associated with incidence of HIVDR were identified by Cox regression analysis. Results The overall prevalence of HIV RNA ?1000 copies/ml and HIVDR at baseline was 12.4% and 5.6%, respectively. Incidence of HIVDR in the one year follow-up was 3.5 per 100 person years. Independently associated factors were started treatment with a didanosine-based regimen, received care at township hospital or village clinic, low baseline CD4 counts, and high baseline VL. Conclusions The incidence of HIVDR in China was higher than that of some developed countries. China urgently needs to provide comprehensive education and training to doctors at village clinics and township hospitals to improve quality community-based care and treatment. PMID:23638072

Xing, Hui; Wang, Xia; Liao, Lingjie; Ma, Yanling; Su, Bin; Fu, Jihua; He, Jianmei; Chen, Lin; Pan, Xiaohong; Dong, Yonghui; Liu, Wei; Hsi, Jenny H.; Yang, Liting; Ruan, Yuhua; Shao, Yiming

2013-01-01

322

Characterization of peripheral and mucosal immune responses in rhesus macaques on long-term tenofovir and emtricitabine combination antiretroviral therapy  

PubMed Central

Background The goal of antiretroviral therapy (ART) is to suppress virus replication to limit immune system damage. Some have proposed combining ART with immune therapies to boost antiviral immunity. For this to be successful, ART must not impair physiological immune function. Methods We studied the impact of ART (tenofovir and emtricitabine) on systemic and mucosal immunity in uninfected and SIV-infected Chinese rhesus macaques. Subcutaneous ART was initiated 2 weeks after tonsillar inoculation with SIVmac239. Results There was no evidence of immune dysregulation as a result of ART in either infected or uninfected animals. Early virus-induced alterations in circulating immune cell populations (decreased central memory T cells and myeloid dendritic cells) were detected, but normalized shortly after ART initiation. ART-treated animals showed marginal SIV-specific T cell responses during treatment, which increased after ART discontinuation. Elevated expression of CXCL10 in oral, rectal and blood samples and APOBEC3G mRNA in oral and rectal tissues was observed during acute infection and was down-regulated after starting ART. ART did not impact the ability of the animals to respond to tonsillar application of polyICLC with increased CXCL10 expression in oral fluids and CD80 expression on blood myeloid dendritic cells. Conclusion Early initiation of ART prevented virus induced damage and did not impede mucosal or systemic immune functions. PMID:22820802

Jasny, E.; Geer, S.; Frank, I.; Vagenas, P.; Aravantinou, M.; Salazar, A.M.; Lifson, J.D.; Piatak, M; Gettie, A.; Blanchard, J.; Robbiani, M.

2012-01-01

323

Methadone induced torsade de pointes in a patient receiving antiretroviral therapy.  

PubMed

Adverse drug reactions account for approximately 5% of acute medical admissions. A 34-year-old male patient receiving antiretroviral therapy, methadone and flurazepam presented to the emergency room following collapse with associated loss of consciousness. Cardiac monitoring demonstrated marked Q-T prolongation followed by the cardiac arrhythmia, torsade de pointes. The patient made a full recovery following withdrawal of the antiretroviral therapy and a reduction in methadone dose. Methadone is a recognised cause of this potentially fatal cardiac arrhythmia which is more likely to occur when methadone metabolism is inhibited by drugs such as HIV tease inhibitors. PMID:18277734

Falconer, M; Molloy, D; Ingerhaug, J; Barry, M

2007-01-01

324

Subacute hypersensitivity pneumonitis in an HIV infected patient receiving antiretroviral therapy  

PubMed Central

Abnormal pulmonary immune response to various antigens can lead to hypersensitivity pneumonitis. This disease has not previously been reported in HIV infected patients. This case report describes an HIV infected woman who developed subacute hypersensitivity pneumonitis in response to bird exposure. The disease manifested itself only after the patient experienced an improvement in her CD4 positive T lymphocyte count secondary to antiretroviral therapy. This case emphasises the need to consider non-HIV associated diseases in patients with HIV and suggests that diseases in which host immune response plays an essential role in pathogenesis may become more prevalent in HIV infected patients receiving effective antiretroviral therapy.?? PMID:10856327

Morris, A.; Nishimura, S.; Huang, L.

2000-01-01

325

Hospitalized HIV-Infected Patients in the Era of Highly Active Antiretroviral Therapy  

PubMed Central

We interviewed 1038 HIV-positive inpatients in public hospitals in Miami, Florida, and Atlanta, Georgia, to examine patient factors associated with use of HIV care, use of antiretroviral therapy, and unprotected sexual intercourse. Multivariate analyses and multiple logistic regression models showed that use of crack cocaine and heavy drinking were associated with never having had an HIV-care provider, high-risk sexual behavior, and not receiving antiretroviral therapy. Inpatient interventions that link and retain HIV-positive persons in primary care services could prevent HIV transmission and unnecessary hospitalizations. PMID:19372520

Bell, Christine; Pereyra, Margaret; Cardenas, Gabriel; Sullivan, Tanisha; Rodriguez, Allan; Gooden, Lauren; Khoury, Nayla; Kuper, Tamy; Brewer, Toye; del Rio, Carlos

2009-01-01

326

Macrophage Folate Receptor-Targeted Antiretroviral Therapy Facilitates Drug Entry, Retention, Antiretroviral Activities and Biodistribution for Reduction of Human Immunodeficiency Virus Infections  

PubMed Central

Macrophages serve as vehicles for the carriage and delivery of polymer-coated nanoformulated antiretroviral therapy (nanoART). Although superior to native drug, high drug concentrations are required for viral inhibition. Herein, folate-modified atazanavir/ritonavir (ATV/r)-encased polymers facilitated macrophage receptor targeting for optimizing drug dosing. Folate coating of nanoART ATV/r significantly enhanced cell uptake, retention and antiretroviral activities without altering cell viability. Enhanced retentions of folate-coated nanoART within recycling endosomes provided a stable subcellular drug depot. Importantly, five-fold enhanced plasma and tissue drug levels followed folate-coated formulation injection in mice. Folate polymer encased ATV/r improves nanoART pharmacokinetics bringing the technology one step closer to human use. PMID:23680933

Puligujja, Pavan; McMillan, JoEllyn; Kendrick, Lindsey; Li, Tianyuzi; Balkundi, Shantanu; Smith, Nathan; Veerubhotla, Ram S.; Edagwa, Benson J.; Kabanov, Alexander V.; Bronich, Tatiana; Gendelman, Howard E.; Liu, Xin-Ming

2013-01-01

327

Disengagement of HIV-positive pregnant and postpartum women from antiretroviral therapy services: a cohort study  

PubMed Central

Introduction Recent international guidelines call for expanded access to triple-drug antiretroviral therapy (ART) in HIV-positive women during pregnancy and postpartum. However, high levels of non-adherence and/or disengagement from care may attenuate the benefits of ART for HIV transmission and maternal health. We examined the frequency and predictors of disengagement from care among women initiating ART during pregnancy in Cape Town, South Africa. Methods We used routine medical records to follow-up pregnant women initiating ART within prevention of mother-to-child transmission of HIV services in Cape Town, South Africa. Outcomes assessed through six months postpartum were (1) disengagement (no attendance within 56 days of a scheduled visit) and (2) missed visits (returning to care 14–56 days late for a scheduled visit). Results A total of 358 women (median age, 28 years; median gestational age, 26 weeks) initiated ART during pregnancy. By six months postpartum, 24% of women (n=86) had missed at least one visit and an additional 32% (n=115) had disengaged from care; together, 49% of women had either missed a visit or had disengaged by six months postpartum. Disengagement was more than twice as frequent postpartum compared to in the antenatal period (6.2 vs. 2.4 per 100 woman-months, respectively; p<0.0001). In a proportional hazards model, later gestational age at initiation (HR: 1.04; 95% CI: 1.00–1.07; p=0.030) and being newly diagnosed with HIV (HR: 1.57; 95% CI: 1.07–2.33; p=0.022) were significant predictors of disengagement after adjusting for patient age, starting CD4 cell count and site of ART initiation. Conclusions These results demonstrate that missed visits and disengagement from care occur frequently, particularly post-delivery, among HIV-positive women initiating ART during pregnancy. Women who are newly diagnosed with HIV may be particularly vulnerable and there is an urgent need for interventions both to promote retention overall, as well as targeting women newly diagnosed with HIV during pregnancy. PMID:25301494

Phillips, Tamsin; Thebus, Elizabeth; Bekker, Linda-Gail; Mcintyre, James; Abrams, Elaine J; Myer, Landon

2014-01-01

328

Masculine attitudes of superiority deter men from accessing antiretroviral therapy in Dar es Salaam, Tanzania  

PubMed Central

Background This article presents part of the findings from a larger study that sought to assess the role that gender relations play in influencing equity regarding access and adherence to antiretroviral therapy (ART). Review of the literature has indicated that, in Southern and Eastern Africa, fewer men than women have been accessing ART, and the former start using ART late, after HIV has already been allowed to advance. The main causes for this gender gap have not yet been fully explained. Objective To explore how masculinity norms limit men's access to ART in Dar es Salaam. Design This article is based on a qualitative study that involved the use of focus group discussions (FGDs). The study employed a stratified purposive sampling technique to recruit respondents. The study also employed a thematic analysis approach. Results Overall, the study's findings revealed that men's hesitation to visit the care and treatment clinics signifies the superiority norm of masculinity that requires men to avoid displaying weakness. Since men are the heads of families and have higher social status, they reported feeling embarrassed at having to visit the care and treatment clinics. Specifically, male respondents indicated that going to a care and treatment clinic may raise suspicion about their status of living with HIV, which in turn may compromise their leadership position and cause family instability. Because of this tendency towards ‘hiding’, the few men who register at the public care and treatment clinics do so late, when HIV-related signs and symptoms are already far advanced. Conclusion This study suggests that the superiority norm of masculinity affects men's access to ART. Societal expectations of a ‘real man’ to be fearless, resilient, and emotionally stable are in direct conflict with expectations of the treatment programme that one has to demonstrate health-promoting behaviour, such as promptness in attending the care and treatment clinic, agreeing to take HIV tests, and disclosing one's status of living with HIV to at least one's spouse or partner. Hence, there is a need for HIV control agencies to design community-based programmes that will stimulate dialogue on the deconstruction of masculinity notions. PMID:24152373

Nyamhanga, Tumaini M.; Muhondwa, Eustace P.Y.; Shayo, Rose

2013-01-01

329

Clinical Mentorship of Nurse Initiated Antiretroviral Therapy in Khayelitsha, South Africa: A Quality of Care Assessment  

PubMed Central

Introduction To combat the AIDS epidemic and increase HIV treatment access, the South African government implemented a nurse-based, doctor-supported model of care that decentralizes administration of antiretroviral treatment (ART) for HIV positive patients through nurse initiated and managed ART. Médecins Sans Frontières (MSF) implemented a mentorship programme to ensure successful task-shifting, subsequently assessing the quality of clinical care provided by nurses. Methods A before-after cross-sectional study was conducted on nurses completing the mentorship programme in Khayelitsha, South Africa, from February 2011-September 2012. Routine clinical data from 229 patient folders and 21 self-assessment questionnaires was collected to determine the number of patients initiated on ART by nurses; quality of ART management before-after mentorship; patient characteristics for doctor and nurse ART initiations; and nurse self-assessments after mentorship. Results Twenty one nurses were authorized by one nurse mentor with one part-time medical officer's support, resulting in nurses initiating 77% of ART eligible patients. Improvements in ART management were found for drawing required bloods (91% vs 99%, p?=?0.03), assessing adherence (50% vs 78%, p<0.001) and WHO staging (63% vs 91%, p<0.001). Nurse ART initiation indicators were successfully completed at 95–100% for 11 of 16 indicators: clinical presentation; patient weight; baseline blood work (CD4, creatinine, haemoglobin); STI screening; WHO stage, correlating medical history; medications prescribed appropriately; ART start date; and documented return date. Doctors initiated more patients with TB/HIV co-infection and WHO Stage 3 and 4 disease than nurses. Nurse confidence improved for managing HIV-infected children and pregnant women, blood result interpretation and long-term side effects. Conclusions Implementation of a clinical mentorship programme in Khayelitsha led to nurse initiation of a majority of eligible patients, enabling medical officers to manage complex cases. As mentorship can increase clinical confidence and enhance professional development, it should be considered essential for universal ART access in resource limited settings. PMID:24887260

Green, Ann; de Azevedo, Virginia; Patten, Gabriela; Davies, Mary-Ann; Ibeto, Mary; Cox, Vivian

2014-01-01

330

Starting Point: Teaching Entry Level Geoscience  

NSDL National Science Digital Library

The Starting Point collection consists of resources found within the Starting Point website to support teaching entry-level undergraduate geoscience of all types. The collection includes modules on instructional methods that make up the Starting Point site. Examples demonstrate ways of using these methods in geoscience courses and laboratories, and the websites referenced in the site that provide additional information and resources. The collection includes resources that span the needs of faculty and graduate students in designing, developing, and delivering entry-level undergraduate courses in the geosciences. It consists primarily of instructional materials and activities, annotations and materials supporting the use of instructional materials and activities, information on instructional methods and issues in teaching customized for geoscientists, primary sources, review articles, summaries and bibliographies pertaining to pedagogy, assessment, issues in teaching, course development and management, and learning science.

2003-09-02

331

Prevalence of transmitted HIV-1 antiretroviral resistance among patients initiating antiretroviral therapy in Brazil: a surveillance study using dried blood spots  

PubMed Central

Introduction In Brazil, the use of antiretrovirals is widespread: more than 260,000 individuals are currently undergoing treatment. We conducted a survey targeting antiretroviral-naïve individuals who were initiating antiretroviral therapy (ART) according to local guidelines. This survey covered five Brazilian regions. Methods The HIV Threshold Survey methodology (HIV-THS) of the World Health Organization was utilized, and subjects were selected from seven highly populated cities representative of all Brazilian macro-regions. Dried blood spots (DBS) were collected on SS903 collection cards and were transported by regular mail at room temperature to a single central laboratory for genotyping. Results We analysed samples from 329 individuals initiating highly active antiretroviral therapy (HAART), 39 (11.8%) of whom were harbouring transmitted drug resistance (TDR). The mean CD4+ T cell count was 253 cells/µL, and the mean viral load was 142,044 copies/mL. The regional prevalence of resistance was 17.0% in the Northeast, 12.8% in the Southeast, 10.6% in the Central region, 8.5% in the North and 8.5% in the South. The inhibitor-specific TDR prevalence was 6.9% for nucleoside reverse transcriptase inhibitors, 4.9% for non-nucleoside reverse transcriptase inhibitors and 3.9% for protease inhibitors; 3.6% of individuals presented resistance to more than one class of inhibitors. Overall, there were trends towards higher prevalences of subtype C towards the South and subtype F towards the North. Of the DBS samples collected, 9.3% failed to provide reliable results. Discussion We identified variable TDR prevalence, ranging from intermediate to high levels, among individuals in whom HIV disease progressed, thus implying that resistance testing before initiating ART could be effective in Brazil. Our results also indicate that the use of DBS might be especially valuable for providing access to testing in resource-limited and remote settings.

de Moraes Soares, Celina M P; Vergara, Tania R C; Brites, Carlos; Brito, Jose D U; Grinberg, Gorki; Caseiro, Marcos M; Correa, Carlos; Suffert, Theodoro A; Pereira, Flavio R; Camargo, Michelle; Janini, Luiz M; Komninakis, Shirley; Sucupira, Maria C A; Diaz, Ricardo S

2014-01-01

332

Alcohol cold starting - A theoretical study  

NASA Technical Reports Server (NTRS)

Two theoretical computer models have been developed to study cold starting problems with alcohol fuels. The first model, a droplet fall-out and sling-out model, shows that droplets must be smaller than 50 microns to enter the cylinder under cranking conditions without being slung-out in the intake manifold. The second model, which examines the fate of droplets during the compression process, shows that the heat of compression can be used to vaporize small droplets (less than 50 microns) producing flammable mixtures below freezing ambient temperatures. While droplet size has the greater effect on startability, a very high compression ratio can also aid cold starting.

Browning, L. H.

1983-01-01

333

Psychosocial Factors Affecting Medication Adherence Among HIV-1 Infected Adults Receiving Combination Antiretroviral Therapy (cART) in Botswana  

PubMed Central

Abstract As increasing numbers of persons are placed on potentially life-saving combination antiretroviral therapy (cART) in sub-Saharan Africa, it is imperative to identify the psychosocial and social factors that may influence antiretroviral (ARV) medication adherence. Using an 87 question survey, the following data were collected from patients on cART in Botswana: demographics, performance (Karnofsky) score, perceived stigma and level of HIV disclosure, attitudes and beliefs concerning HIV/AIDS, substance and/or drug use, depression, and pharmacy and healthcare provider-related factors. Overall adherence rates were determined by patient self-report, institutional adherence, and a culturally modified Morisky scale. Three hundred adult patients were recruited between April and May 2005. The overall cART adherence rate was 81.3% based on 4 day and 1 month patient recall and on clinic attendance for ARV medication refills during the previous 3 months. Adults receiving cART for 1–6 months were the least adherent (77%) followed by those receiving cART for greater than 12 months (79%). Alcohol use, depression, and nondisclosure of positive HIV status to their partner were predictive of poor adherence rates (p value <0.02). A significant proportion (81.3%) of cART-treated adults were adherent to their prescribed treatment, with rates superior to those reported in resource-rich settings. Adherence rates were poorest among those just starting cART, most likely due to the presence of ARV-related toxicity. Adherence was lower among those who have been treated for longer periods of time (greater than 1 year), suggesting complacency, which may become a significant problem, especially among these long-term cART-treated patients who return to improved physical and mental functioning and may be less motivated to adhere to their ARV medications. Healthcare providers should encourage HIV disclosure to “at-risk” partners and provide ongoing counseling and education to help patients recognize and overcome HIV-associated stigma, alcohol abuse, and depression. PMID:20518649

Do, Natalie T.; Phiri, Kelesitse; Bussmann, Hermann; Gaolathe, Tendani; Marlink, Richard G.

2010-01-01

334

Financing equitable access to antiretroviral treatment in South Africa  

PubMed Central

Background While South Africa spends approximately 7.4% of GDP on healthcare, only 43% of these funds are spent in the public system, which is tasked with the provision of care to the majority of the population including a large proportion of those in need of antiretroviral treatment (ART). South Africa is currently debating the introduction of a National Health Insurance (NHI) system. Because such a universal health system could mean increased public healthcare funding and improved access to human resources, it could improve the sustainability of ART provision. This paper considers the minimum resources that would be required to achieve the proposed universal health system and contrasts these with the costs of scaled up access to ART between 2010 and 2020. Methods The costs of ART and universal coverage (UC) are assessed through multiplying unit costs, utilization and estimates of the population in need during each year of the planning cycle. Costs are from the provider’s perspective reflected in real 2007 prices. Results The annual costs of providing ART increase from US$1 billion in 2010 to US$3.6 billion in 2020. If increases in funding to public healthcare only keep pace with projected real GDP growth, then close to 30% of these resources would be required for ART by 2020. However, an increase in the public healthcare resource envelope from 3.2% to 5%-6% of GDP would be sufficient to finance both ART and other services under a universal system (if based on a largely public sector model) and the annual costs of ART would not exceed 15% of the universal health system budget. Conclusions Responding to the HIV-epidemic is one of the many challenges currently facing South Africa. Whether this response becomes a “resource for democracy” or whether it undermines social cohesiveness within poor communities and between rich and poor communities will be partially determined by the steps that are taken during the next ten years. While the introduction of a universal system will be complex, it could generate a health system responsive to the needs of all South Africans. PMID:20594368

2010-01-01

335

Maximizing the benefits of antiretroviral therapy for key affected populations  

PubMed Central

Introduction Scientific research has demonstrated the clinical benefits of earlier initiation of antiretroviral treatment (ART), and that ART can markedly reduce HIV transmission to sexual partners. Ensuring universal access to ART for those who need it has long been a core principle of the HIV response, and extending the benefits of ART to key populations is critical to increasing the impact of ART and the overall effectiveness of the HIV response. However, this can only be achieved through coordinated efforts to address political, social, legal and economic barriers that key populations face in accessing HIV services. Discussion Recent analyses show that HIV prevalence levels among key populations are far higher than among the general population, and they experience a range of biological and behavioural factors, and social, legal and economic barriers that increase their vulnerability to HIV and have resulted in alarmingly low ART coverage. World Health Organization 2014 consolidated guidance on HIV among key populations offers the potential for increased access to ART by key populations, following the same principles as for the general adult population. However, it should not be assumed that key populations will achieve greater access to ART unless stigma, discrimination and punitive laws, policies and practices that limit access to ART and other HIV interventions in many countries are addressed. Conclusions Rights-based approaches and investments in critical enablers, such as supportive legal and policy environments, are essential to enable wider access to ART and other HIV interventions for key populations. The primary objective of ART should always be to treat the person living with HIV; prevention is an important, additional benefit. ART should be provided only with informed consent. The preventive benefits of treatment must not be used as a pretext for failure to provide other necessary HIV programming for key populations, including comprehensive harm reduction and other prevention interventions tailored to meet the needs of key populations. An end to AIDS is only possible if we overcome the barriers of criminalization, stigma and discrimination that remain key drivers of the HIV epidemics among key populations. PMID:25043380

Grubb, Ian R; Beckham, Sarah W; Kazatchkine, Michel; Thomas, Ruth M; Albers, Eliot R; Cabral, Mauro; Lange, Joep; Vella, Stefano; Kurian, Manoj; Beyrer, Chris

2014-01-01

336

Stigma trajectories among people living with HIV (PLHIV) embarking on a life time journey with antiretroviral drugs in Jinja, Uganda  

PubMed Central

Background Stigma is a barrier to HIV prevention and treatment. There is a limited understanding of the types of stigma facing people living with HIV (PLHIV) on antiretroviral therapy (ART). We describe the stigma trajectories of PLHIV over a 5-year period from the time they started ART. Methods Longitudinal qualitative in-depth interviews were conducted with 41 members of The AIDS Support Organisation (TASO) from 2005 to 2008 in Jinja, Uganda, who were part of a pragmatic cluster-randomised trial comparing two different modes of ART delivery (facility and home). Participants were stratified by gender, ART delivery arm and HIV stage (early or advanced) and interviewed at enrolment on to ART and then after 3, 6, 18 and 30 months. Interviews focused on stigma and ART experiences. In 2011, follow-up interviews were conducted with 24 of the participants who could be traced. Transcribed texts were translated, coded and analyzed thematically. Results Stigma was reported to be very high prior to starting ART, explained by visible signs of long-term illnesses and experiences of discrimination and abuse. Early coping strategies included: withdrawal from public life, leaving work due to ill health and moving in with relatives. Starting ART led to a steady decline in stigma and allowed the participants to take control of their illness and manage their social lives. Better health led to resumption of work and having sex but led to reduced disclosure to employers, colleagues and new sexual partners. Some participants mentioned sero-sorting in order to avoid questions around HIV sero-status. A rise in stigma levels during the 18 and 30 month interviews may be correlated with decreased disclosure. By 2011, ART-related stigma was even more pronounced particularly among those who had started new sexual relationships, gained employment and those who had bodily signs from ART side-effects. Conclusion This study has shown that while ART comes with health benefits which help individuals to get rid of previously stigmatising visible signs, an increase in stigma may be noticed after about five years on ART, leading to reduced disclosure. ART adherence counselling should reflect changing causes and manifestations of stigma over time. PMID:24010761

2013-01-01

337

Getting Started Webinar for International Parents & Families  

E-print Network

Getting Started Webinar for International Parents & Families Dulce Amor L. Dorado Director University of California San Diego Webinar ­ April 24, 2013 istudents@ucsd.edu | (858) 534-3730 #12;#12;Meet Amor L. Dorado Director International Students & Programs Office http://istudents.ucsd.edu #12;Webinar

Russell, Lynn

338

Start Your Own Business. Interim Guide.  

ERIC Educational Resources Information Center

This guide is designed for use by instructors teaching a 12-unit course in starting a business. Presented first is a diagram illustrating the place of the course in Manitoba's business education curriculum. The academic, personal management, and teamwork skills that have been deemed critical employability skills required of the Canadian work force…

Manitoba Dept. of Education and Training, Winnipeg.

339

The Prickly Politics of School Starting Times.  

ERIC Educational Resources Information Center

Tinkering with school schedules to accommodate adolescents' sleep patterns is politically risky. A University of Minnesota study analyzing stakeholders' attitudes toward later high school starting times showed that changing a school's schedule provokes as emotional a reaction as that of closing a school or changing its attendance area. Open…

Wahlstrom, Kyla L.

1999-01-01

340

Where innovation starts Eindhoven University of Technology  

E-print Network

diagnosis, and more effective treatment of diseases, as well as to promoting healthy lifestyles and living.tue.nl/health Where innovation starts Healthy Solutions from Excellent Science #12;2 | Health - Healthy Solutions from Content 04 Healthy Solutions from Excellent Science 08 Research themes 10 Successful projects 14 Education

Franssen, Michael

341

Magic Tutorial #1: Getting Started John Ousterhout  

E-print Network

Magic Tutorial #1: Getting Started John Ousterhout (updated by others, too) Computer Science This tutorial corresponds to Magic version 6. 1. What is Magic? Magic is an interactive system for creating tutorials, of which this is the first. Each tutorial introduces a particular set of facilities in Magic

Martin, Alain

342

Electric arc heater is self starting  

NASA Technical Reports Server (NTRS)

Remote method initiates an electric arc over a large range of gaps between two water-cooled electrodes of an arc-heated wind tunnel without disassembling the arc unit. This type of starting system can be used on both three-phase ac arc heaters and dc arc heaters.

Brown, R. D.

1966-01-01

343

How to Start a Day Care Center.  

ERIC Educational Resources Information Center

This publication describes the necessary steps a day care planner should follow from his or her initial thoughts of starting a day care center through to opening the door to care for children. The following steps are suggested: (1) consult appropriate offices to obtain licensing regulations, and zoning codes, as well as information on major…

Day Care and Child Development Council of America, Inc., Washington, DC.

344

Addressing Tooth Decay in Head Start Children  

Microsoft Academic Search

Tooth decay is the most prevalent chronic disease of childhood. Oral health education and dental services are crucial to reducing the number of children afflicted with dental cavities. Due to limited access to preventative care, Head Start children are particularly vulnerable to tooth decay. This article outlines practical implications of a research study (Knowlden, Hill, Alles-White, & Cottrell, 2012\\/this issue)

Adam P. Knowlden; Lawrence F. Hill; Monica L. Alles-White; Randall R. Cottrell

2012-01-01

345

Addressing Tooth Decay in Head Start Children  

ERIC Educational Resources Information Center

Tooth decay is the most prevalent chronic disease of childhood. Oral health education and dental services are crucial to reducing the number of children afflicted with dental cavities. Due to limited access to preventative care, Head Start children are particularly vulnerable to tooth decay. This article outlines practical implications of a…

Knowlden, Adam P.; Hill, Lawrence F.; Alles-White, Monica L.; Cottrell, Randall R.

2012-01-01

346

Exploring start-up event sequences  

Microsoft Academic Search

This research analyzed new venture start-up activities undertaken by 71 nascent entrepreneurs. Nascent entrepreneurs are individuals who were identified as taking steps to found a new business but who had not yet succeeded in making the transition to new business ownership. Longitudinal data for the study comes from a secondary data analysis of two representative samples, one of 683 adult

Paul D. Reynolds; William B. Gartner

1996-01-01

347

CRITICAL THINKING GETTING STARTED Other Handouts  

E-print Network

CRITICAL THINKING ­ GETTING STARTED Other Handouts: Analysing an Essay Question Improve Your Reading of Academic Texts What is critical thinking? Frequently asked questions by first year university students are: Why is critical thinking emphasised at university? How does it differ from the thinking I

348

Head Start: Making “quality” a national priority  

Microsoft Academic Search

The recurrent debate in the Federal budget and appropriations processes will continue to make financing of early childhood education programs problematic. Should money be allocated to broaden access or to improve upon program quality? As a competitor for scarce resources, Head Start represents a case in point. An analysis of issues surrounding its funding has implications forall early childhood programs.

Judith A. Chafel

1992-01-01

349

Desert Gardening 101: Steps to Starting a  

E-print Network

Desert Gardening 101: Steps to Starting a Vegetable Garden Tuesday, September 27, 2011 9:00 ­ 10 Alliance Permaculture Design Course just recently. She is keenly interested in food forests, native food garden in the Southwest desert. Also, Evan from Sunizona Family Farms will offer samples of their organic

Hall, Sharon J.

350

Health&Safety PreventionStartsHere  

E-print Network

Health&Safety atWork PreventionStartsHere Workers have the right to: · Know about workplace hazards and what to do about them. · Participate in solving workplace health and safety problems. · Refuse work they believe is unsafe. Workers must: · Follow the law and workplace health and safety policies and procedures

Czarnecki, Krzysztof

351

Evaluation of Hawaii's Healthy Start Program  

Microsoft Academic Search

Hawaii's Healthy Start Program (HSP) is designed to prevent child abuse and neglect and to promote child health and development in newborns of families at risk for poor child outcomes. The program operates statewide in Hawaii and has inspired national and international adaptations, including Healthy Families America. This article describes HSP, its ongoing evaluation study, and evaluation findings at the

Anne K. Duggan; Elizabeth C. McFarlane; Amy M. Windham; Charles A. Rohde; David S. Salkever; Loretta Fuddy; Leon A. Rosenberg; Sharon B. Buchbinder; Calvin C. J. Sia

1999-01-01

352

Apps for Assessment: A Starting Point  

Microsoft Academic Search

Many mobile applications, also known as apps, are excellent instruments for gathering qualitative and quantitative data. This article is a starting point for those interested in gathering assessment data using mobile tools and provides assessment app type overviews and examples. With relatively little effort, libraries can take advantage of mobile apps and gather compelling assessment data more easily than ever

Rachel Besara

2012-01-01

353

talk start all talks talk index ASTROPHYSICS  

E-print Network

talk start all talks talk index MASTER ASTROPHYSICS · content ­ evolution of stars and stellar populations ­ high-energy astrophysics and space research ­ solar physics · requirements ­ 1st year: 8 Advanced Astrophysics Courses ­ 2nd year: MSc thesis research, seminars ­ options: other courses

Rutten, Rob

354

"Even Start" Improves Literacy in Colorado  

ERIC Educational Resources Information Center

Through a grant from the U.S. Department of Education, the staff and faculty of Colorado State University and the Poudre School District collaborated to implement an "Even Start" family literacy project to reduce the level of poverty and illiteracy for families in the Poudre Valley Mobile Home Park. To truly establish a partnership based on trust…

Love, Cathleen T.; Thayer, Marilyn

2004-01-01

355

Getting Started with Microsoft Azure Virtual Machines  

E-print Network

Getting Started with Microsoft Azure Virtual Machines Introduction You can use a Microsoft Azure Virtual Machine when you need a scalable, cloud-based server running a Windows or Linux operating system (IaaS), you can run a virtual machine on an ongoing basis, or you can stop and restart it later

Narasayya, Vivek

356

GREAT START! ... GREAT Connecting Policy to  

E-print Network

GREAT START! ... GREAT FINISH? Connecting Policy to Developmental Issues of Early Childhood Hiram E distinguish the mother's smell from others Taste � Newborns prefer sweet, but taste preferences influenced Family System Exogenous Influences Boundaries Transitions Stories Codes Rituals Roles Father Mother

357

Arcjet power supply and start circuit  

NASA Technical Reports Server (NTRS)

A dc power supply for spacecraft arcjet thrusters has an integral automatic starting circuit and an output averaging inductor. The output averaging inductor, in series with the load, provides instantaneous current control, and ignition pulse and an isolated signal proportional to the arc voltage. A pulse width modulated converter, close loop configured, is also incorporated to give fast response output current control.

Gruber, Robert P. (inventor)

1988-01-01

358

Starting Salary Outcomes of Cooperative Education Graduates.  

ERIC Educational Resources Information Center

Comparison of 370 engineering co-op graduates with 1,037 nonco-op engineering graduates showed that co-op participants had higher starting salaries; 5 or fewer terms of co-op had better effects. Women, especially electrical, mechanical, or chemical majors, had substantially better salaries with co-op experience. (SK)

Gardner, Philip D.; And Others

1992-01-01

359

Quick Tips: Making Healthy Snacks Get started  

E-print Network

that you get plenty of these nutritious foods every day. Use these ideas to get started. Make smart snack, it's less likely that you'll pick a candy bar or bag of chips instead. Foods that make quick, healthy-serving containers · Raisins and other dried fruit · Whole wheat crackers · Pretzels · Flavored rice cakes · Unsalted

Burke, Peter

360

How to Start Intergenerational Programs in Communities.  

ERIC Educational Resources Information Center

This document is designed for use by community organizers in creating, developing and maintaining an intergenerational program. Starting with a brief overview of the Maryland Intergenerational Coalition, the document describes (in short, bulleted entries) the activities and accomplishments of various intergenerational programs in Maryland, such as…

2002

361

Housing Starts: December 1998. Current Construction Reports.  

National Technical Information Service (NTIS)

Privately owned housing starts in December 1998 were at a seasonally adjusted annual rate of 1,720,000; this is 3(+ or - 6) percent above the revised November rate of 1,662,000, but 12(+ or - 7) percent above the December 1997 rate of 1,540,000. Single-fa...

1999-01-01

362

Housing Starts: April 1998. Current Construction Reports.  

National Technical Information Service (NTIS)

Privately owned housing starts in April were at a seasonally adjusted annual rate of 1,538,000. This is 2 (+ or - 5) percent below the revised March rate of 1,575,000, but 4 (+ or - 6) percent above the April 1997 rate of 1,480,000. Single-family housing ...

1998-01-01

363

Philadelphia's Independence Starts Here: Disability Arts Festival  

ERIC Educational Resources Information Center

In tribute to Philadelphia's world-changing past, Festival partners dubbed the month-long Disability Arts Festival "Independence Starts Here." Through it, they hoped to begin to change the future for over 675,000 people with disabilities in the area and their families. Led by Amaryllis Theatre Company, which now also serves as VSA arts of…

Smith, Mimi Kenney

2008-01-01

364

Health Coaching Available Starting November 20th  

E-print Network

Health Coaching Available Starting November 20th ! If you've completed your health survey and printed your report, which explains what you are doing well and what you can do better, health coaches are now available. . Our health coaches can work with you to help you take your health to the next level

Marsh, David

365

Technology in a Head Start Parent Center.  

ERIC Educational Resources Information Center

Unless children and parents have training and access to computers and the power they offer, computers create a barrier for them as they navigate a society that depends on computers for information and occupational advancement. This paper describes a program developed by North Shore Head Start in Beverly, Massachusetts and CAST (Center for Applied…

Hughes, Bob; Coyne, Peggy; Waddell, Sandy

366

STARTING A NEW FOOD BUSINESS IN GEORGIA  

E-print Network

approved · Meeting GDA and FDA regulations · Product testing for safety (pH, temp) · Proper canning it? L What federal and state food safety regulations will I have to meet? L How do I get started Preservation, and representatives from the Georgia Department of Agriculture and FDA will address topics

Arnold, Jonathan

367

Starting Up after 50. CELCEE Digest.  

ERIC Educational Resources Information Center

Researchers are finding that older entrepreneurs are an increasing population in many Western countries. It is important to distinguish between entrepreneurs who have simply reached the age of 50 versus those who start up businesses after this age. The latter group is of particular interest because these people have presumably never faced the…

Seymour, Nicole

368

Advanced Research Computing Before We Start  

E-print Network

Advanced Research Computing Before We Start · Sign in · Copy files from the MIC directory Computing March 4, 2014 #12;Advanced Research Computing Outline · Background · The Intel Xeon Phi · Native Mode · Offloading ­ Automatic ­ Directives ­ Multiple MICs · MPI #12;Advanced Research Computing 4

Crawford, T. Daniel

369

High starting torque for AC SCR controller  

Microsoft Academic Search

A control strategy is proposed for AC thyristor controllers. The main feature of the proposed technique is that motors can start with high torque, while using an economical design. This allows the use of AC thyristor controllers for a wide range of applications, where they have not been used before. The method employs the AC thyristor controller as a discrete

Antonio Ginart; Rosana Esteller; A. Maduro; R. Piiiero; R. Moncada

1999-01-01

370

Analysis of False Starts in Spontaneous Speech.  

ERIC Educational Resources Information Center

A primary difference between spontaneous speech and read speech concerns the use of false starts, where a speaker interrupts the flow of speech to restart his or her utterance. A study examined the acoustic aspects of such restarts in a widely-used speech database, examining approximately 1000 utterances, about 10% of which contained a restart.…

O'Shaughnessy, Douglas

371

Start the New Year in the Spring.  

ERIC Educational Resources Information Center

Most schools need to review and revise disciplinary rules each year, but good administrator never publishes list of rules that have not been endorsed by "significant others" on staff or in community. By starting process in April or May, instead of August, the principal has several months to secure the necessary endorsements and involve parents.…

Curtis, Vernon B.; Smith, Steven H.

1994-01-01

372

Using cost-effectiveness analyses to inform policy: the case of antiretroviral therapy in Thailand  

Microsoft Academic Search

BACKGROUND:: Much emphasis is put on providing evidence to assist policymakers in priority setting and investment decisions. Assessing the cost-effectiveness of interventions is one technique used by policymakers in their decisions around the allocation of scarce resources. However, even where such evidence is available, other considerations may also be taken into account, and even over-ride technical evidence. Antiretroviral therapy (ART)

Sripen Tantivess; Gill Walt

2006-01-01

373

Detection of lipoatrophy in human immunodeficiency virus-1-infected children treated with highly active antiretroviral therapy  

Microsoft Academic Search

BACKGROUND: Highly active antiretroviral therapy has been associated with lipodystrophy in adults. Much is unknown about its characteristics, especially in children. OBJECTIVE: To obtain an objective case definition of the lipodystrophy syndrome. METHODS: This was a cross-sectional study. One investigator rated clinical lipodystrophy. Body composition was measured using body mass index, skin fold thickness and circumference of arm, leg, waist

Karin Hartman; Gwenda Verweel; Ronald de Groot; Nico G. Hartwig

2006-01-01

374

HIV antiretroviral drug combination induces endothelial mitochondrial dysfunction and reactive oxygen species production, but not apoptosis  

Microsoft Academic Search

Numerous reports now indicate that HIV patients administered long-term antiretroviral therapy (ART) are at a greater risk for developing cardiovascular diseases. Endothelial dysfunction is an initiating event in atherogenesis and may contribute to HIV-associated atherosclerosis. We previously reported that ART induces direct endothelial dysfunction in rodents. In vitro treatment of human umbilical vein endothelial cells (HUVEC) with ART indicated endothelial

Bo Jiang; Valeria Y. Hebert; Yuchi Li; J. Michael Mathis; J. Steven Alexander; Tammy R. Dugas

2007-01-01

375

Atazanavir/ritonavir-based combination antiretroviral therapy for treatment of HIV-1 infection in adults  

PubMed Central

In the past 15 years, improvements in the management of HIV infection have dramatically reduced morbidity and mortality. Similarly, rapid advances in antiretroviral medications have resulted in the possibility of life-long therapy with simple and tolerable regimens. Protease inhibitors have been important medications in regimens of combination antiretroviral therapy for the treatment of HIV. One of the recommended and commonly used therapies in this class is once-daily-administered atazanavir, pharmacologically boosted with ritonavir (atazanavir/r). Clinical studies and practice have shown these drugs, in combination with other antiretroviral agents, to be potent, safe and easy to use in a variety of settings. Atazanavir/r has minimal short-term toxicity, including benign bilirubin elevation, and has less potential for long-term complications of hyperlipidemia and insulin resistance compared with other protease inhibitors. A high genetic barrier to resistance and a favorable resistance profile make it an excellent option for initial HIV treatment or as the first drug utilized in the protease inhibitors class. Atazanavir/r is also currently being studied in novel treatment strategies, including combinations with new classes of antiretrovirals to assess nucleoside reverse transcriptase inhibitor-sparing regimens. In this article we review atazanavir/r as a treatment for HIV infection and discuss the latest information on its pharmacology, efficacy and toxicity. PMID:21731578

Achenbach, Chad J; Darin, Kristin M; Murphy, Robert L; Katlama, Christine

2011-01-01

376

Drug-induced lipotoxicity: Lipodystrophy associated with HIV1 infection and antiretroviral treatment  

Microsoft Academic Search

A subset of HIV-1-infected patients undergoing antiretroviral treatment develops a lipodystrophy syndrome. It is characterized by loss of peripheral subcutaneous adipose tissue (face, limbs, buttocks), visceral fat accumulation, and, in some cases, lipomatosis, especially in the dorsocervical area. In addition, these patients show metabolic alterations reminiscent of the metabolic syndrome, particularly dyslipidemia and insulin resistance. These alterations lead to enhanced

Francesc Villarroya; Pere Domingo; Marta Giralt

2010-01-01

377

Ultrastructural features of highly active antiretroviral therapy-associated partial lipodystrophy  

Microsoft Academic Search

Chronic treatment with highly active antiretroviral therapy (HAART) results in a novel variety of partial lipodystrophy, combining lipoatrophic and hypertrophic areas. We have previously reported the histopathological features of this disease and have also shown that adipocyte apoptosis is involved in its origin. With the aim of further elucidating the mechanisms underlying this peculiar disorder, we performed an ultrastructural study

Josep Lloreta; Pere Domingo; Ramón M. Pujol; Juan A. Arroyo; Núria Baixeras; Xavier Matias-Guiu; Montserrat Gilaberte; Maria A. Sambeat; Sergi Serrano

2002-01-01

378

Excluding pregnancy among women initiating antiretroviral therapy: efficacy of a family planning job aid  

Microsoft Academic Search

BACKGROUND: Guidelines for initiating ART recommend pregnancy testing, typically a urine test, as part of the basic laboratory package. The principal reason for this recommendation is that Efavirenz, a first-line antiretroviral medication, has the potential of causing birth defects when used in the first trimester of pregnancy and is therefore contraindicated for use by pregnant women. Unfortunately, in many African

Kwasi Torpey; Lona Mwenda; Mushota Kabaso; Thierry Malebe; Patrick Makelele; Francis Mwema; Henry Phiri; Jonathan Mukundu; Mark A Weaver; John Stanback

2010-01-01

379

AIDS. Author manuscript Early antiretroviral therapy of HIV-infected infants in resource-limited  

E-print Network

AIDS. Author manuscript Page /1 3 Early antiretroviral therapy of HIV-infected infants in resource : U897, Universit Victor Segalen - Bordeaux IIé , FR Pediatric, Adolescent, and Maternal AIDS Branch3 be adressed to: Renaud Becquet MESH Keywords Anti-HIV Agents

Boyer, Edmond

380

Psychosocial needs of HIV-positive children on antiretrovirals: A survey of South African children's homes  

Microsoft Academic Search

Although the distribution of antiretroviral therapy (ART) is still far from adequate, where such therapy is accessible, HIV has largely been transformed from a fatal to chronic infection. The South African government began a national ART rollout in 2003, providing ART free to medically qualifying individuals. Institutions caring for HIV-positive children have since seen a significant increase in the life

Gretchen J. Domek

2012-01-01

381

Reproductive Intentions and Outcomes among Women on Antiretroviral Therapy in Rural Uganda: A Prospective Cohort Study  

Microsoft Academic Search

Background: Antiretroviral therapy (ART) may influence the biological, social and behavioral determinants of pregnancy in HIV-infected women. However, there are limited longitudinal data on the reproductive intentions and outcomes among women on ART in Africa. Methodology \\/Principal Findings: Using a prospective cohort design, we analyzed trends in desire for children and predictors of pregnancy among a cohort of 733 HIV-infected

Jaco Homsy; Rebecca Bunnell; David Moore; Rachel King; Samuel Malamba; Rose Nakityo; David Glidden; Jordan Tappero; Jonathan Mermin

2009-01-01

382

Antiretroviral therapy (ART) adherence and correlates to nonadherence among people on ART in Estonia  

Microsoft Academic Search

There are little data on antiretroviral therapy (ART) adherence among patients in Eastern Europe, despite the high incidence of HIV infection and the growing number of HIV-infected individuals who are being prescribed ART. The aim of this study was to measure rates of adherence to ART and factors associated with nonadherence among patients receiving care at an outpatient HIV clinic

Anneli Uusküla; Kaja-Triin Laisaar; Mait Raag; Jelena Šmidt; Svetlana Semjonova; Juta Kogan; K. Rivet Amico; Anjali Sharma; Jack Dehovitz

2012-01-01

383

Human resource development and antiretroviral treatment in Free State province, South Africa  

Microsoft Academic Search

BACKGROUND: In common with other developing countries, South Africa's public health system is characterised by human resource shortfalls. These are likely to be exacerbated by the escalating demand for HIV care and a large-scale antiretroviral therapy (ART) programme. Focusing on professional nurses, the main front-line providers of primary health care in South Africa, we studied patterns of planning, recruitment, training

Dingie HCJ van Rensburg; Francois F Steyn; Helen H Schneider; Les L Loffstadt

2008-01-01

384

Cerebrospinal fluid signs of neuronal damage after antiretroviral treatment interruption in HIV1 infection  

Microsoft Academic Search

BACKGROUND: The neurofilament is a major structural component of myelinated axons. Increased cerebrospinal fluid (CSF) concentrations of the light chain of the neurofilament protein (NFL) can serve as a sensitive indicator of central nervous system (CNS) injury. To assess whether interrupting antiretroviral treatment of HIV infection might have a deleterious effect on the CNS, we measured NFL levels in HIV-infected

Magnus Gisslén; Lars Rosengren; Lars Hagberg; Steven G Deeks; Richard W Price

2005-01-01

385

HIV and Perceptions of Mortality Risk: Learning from the Provision of Antiretroviral Therapy  

E-print Network

studies that explicitly examine perceptions find that beliefs diverge from reality in important waysHIV and Perceptions of Mortality Risk: Learning from the Provision of Antiretroviral Therapy, this paper evalu- ates the impact of ART provision on mortality risk perceptions in Malawi. ART is associated

Mateo, Jill M.

386

Barriers to Antiretroviral Medication Adherence in Young HIV-Infected Children  

ERIC Educational Resources Information Center

The purpose of this exploratory study was to examine, from the perspectives of both HIV-infected children and such children's primary guardians, the barriers children face in adhering to combination antiretroviral therapies. Nine HIV-infected young children and 14 guardians of HIV-positive children were interviewed about what the children's lives…

Roberts, Kathleen Johnston

2005-01-01

387

Using motivational interviewing to promote adherence to antiretroviral medications: A randomized controlled study  

Microsoft Academic Search

The primary aim of this study was to test an intervention to support antiretroviral medication adherence among primarily low-income men and women with HIV. The study was a randomized controlled trial (Get Busy Living) with participants assigned to treatment (Motivational Interviewing [MI]) and control groups. Participants were recruited from an HIV\\/AIDS clinic in Atlanta, Georgia, US. Of those referred to

C. Diiorio; F. McCarty; K. Resnicow; M. McDonnell Holstad; J. Soet; K. Yeager; S. M. Sharma; D. E. Morisky; B. Lundberg

2008-01-01

388

Computed CD4 percentage as a low-cost method for determining pediatric antiretroviral treatment eligibility  

Microsoft Academic Search

BACKGROUND: The performance of the WHO recommendations for pediatric antiretroviral treatment (ART) in resource poor settings is insufficiently documented in routine care. METHODS: We compared clinical and immunological criteria in 366 children aged 0 to 12 years in Kinshasa and evaluated a simple computation to estimate CD4 percent, based on CD4 count, total white blood cell count and percentage lymphocytes.

Steven FJ Callens; Faustin Kitetele; Jean Lusiama; Nicole Shabani; Samuel Edidi; Robert Colebunders; Frieda Behets; Annelies Van Rie

2008-01-01

389

Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa  

Microsoft Academic Search

South Africa is one of the countries most severely affected by HIV\\/AIDS. At the peak of the epidemic, the government, going against consensus scientific opinion, argued that HIV was not the cause of AIDS and that antiretroviral (ARV) drugs were not useful for patients and declined to accept freely donated nevirapine and grants from the Global Fund. Using modeling, we

Pride Chigwedere; George R. Seage; Sofia Gruskin; Tun-Hou Lee; M. Essex

2008-01-01

390

Patients' Ways of Speaking about Antiretroviral Medications and Possible Implications for Adherence  

ERIC Educational Resources Information Center

The medical literature reports that antiretrovirals (ARVs) are considered attitudinal objects (Dunbar-Jacob, 1995). Drawing on the pragmatics of emotion (Caffi & Janney, 1994), this study analyzes how patients' stances about their ARTs shape their emotional relationships with their treatments. The data, collected in a public hospital in Uruguay,…

Delbene, Roxana

2012-01-01

391

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents  

E-print Network

] It is emphasized that concepts relevant to HIV management evolve rapidly. The Panel has a mechanism to update in Recommendations on Frequency of CD4 Count Monitoring This change can be found in the "Laboratory Testing: HIV-1Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents Developed

Levin, Judith G.

392

The paradoxical effects of using antiretroviral-based microbicides to control HIV epidemics  

E-print Network

, if used by HIV- positive women, ARV resistance may evolve. By analyzing a math- ematical model, we findThe paradoxical effects of using antiretroviral-based microbicides to control HIV epidemics David P. Wilson*, Paul M. Coplan , Mark A. Wainberg , and Sally M. Blower§¶ *National Centre in HIV Epidemiology

Blower, Sally

393

Gender differences in antiretroviral treatment outcomes of HIV patients in rural Uganda  

Microsoft Academic Search

Gender differences in treatment outcomes of 305 persons living with HIV receiving antiretroviral treatment (ART) in Kabarole district, western Uganda, were evaluated. The primary treatment outcome was virological suppression defined as HIV-1 RNA viral load (VL) <400 copies\\/ml and the secondary outcome measure was the increase in the CD4 cell count after six months on ART. Statistical analysis included descriptive,

Walter Kipp; Arif Alibhai; L. Duncan Saunders; Ambikaipakan Senthilselvan; Amy Kaler; Joseph Konde-Lule; Joa Okech-Ojony; Tom Rubaale

2010-01-01

394

The epidemiological impact of antiretroviral use predicted by mathematical models: a review  

Microsoft Academic Search

This review summarises theoretical studies attempting to assess the population impact of antiretroviral therapy (ART) use on mortality and HIV incidence. We describe the key parameters that determine the impact of therapy, and argue that mathematical models of disease transmission are the natural framework within which to explore the interaction between antiviral use and the dynamics of an HIV epidemic.

Rebecca F Baggaley; Neil M Ferguson; Geoff P Garnett

2005-01-01

395

Virological efficacy and emergence of drug resistance in adults on antiretroviral treatment in rural Tanzania  

Microsoft Academic Search

BACKGROUND: Virological response to antiretroviral treatment (ART) in rural Africa is poorly described. We examined virological efficacy and emergence of drug resistance in adults receiving first-line ART for up to 4 years in rural Tanzania. METHODS: Haydom Lutheran Hospital has provided ART to HIV-infected patients since October 2003. A combination of stavudine or zidovudine with lamivudine and either nevirapine or

Asgeir Johannessen; Ezra Naman; Sokoine L Kivuyo; Mabula J Kasubi; Mona Holberg-Petersen; Mecky I Matee; Svein G Gundersen; Johan N Bruun

2009-01-01

396

Supporting patient adherence to antiretrovirals using mobile phone reminders: Patient responses from South India  

Microsoft Academic Search

There has been exponential growth in the use of mobile phones in India over the last few years, and their potential benefits as a healthcare tool has raised tremendous interest. We used mobile phone reminders to help support adherence to antiretroviral therapy (ART) among HIV patients at an infectious disease clinic in a tertiary hospital in Bangalore. Between March and

Kristi Sidney; Jimmy Antony; Rashmi Rodrigues; Karthika Arumugam; Shubha Krishnamurthy; George Dsouza; Ayesha De Costa; Anita Shet

2012-01-01

397

Supporting patient adherence to antiretrovirals using mobile phone reminders: patient responses from South India  

Microsoft Academic Search

There has been exponential growth in the use of mobile phones in India over the last few years, and their potential benefits as a healthcare tool has raised tremendous interest. We used mobile phone reminders to help support adherence to antiretroviral therapy (ART) among HIV patients at an infectious disease clinic in a tertiary hospital in Bangalore. Between March and

Kristi Sidney; Jimmy Antony; Rashmi Rodrigues; Karthika Arumugam; Shubha Krishnamurthy; George Dsouza; Ayesha De Costa; Anita Shet

2011-01-01

398

Barriers and outcomes: TB patients co-infected with HIV accessing antiretroviral therapy in rural Zambia  

Microsoft Academic Search

The vulnerabilities that underlie barriers faced by the rural poor whilst trying to access and adhere to “free” antiretroviral treatment (ART) demand more attention. This paper highlights barriers that poor rural Zambians co-infected with tuberculosis (TB) and HIV and their households faced in accessing ART between September 2006 and July 2007, and accounts for patient outcomes by the end of

Muatale Chileshe; Virginia Anne Bond

2010-01-01

399

Influence of gender on receipt of guideline-based antiretroviral therapy in the era of HAART  

Microsoft Academic Search

United States HIV guidelines delineate preferred antiretroviral treatment (ART) and discourage use of sub-potent, toxic, or adversely interacting combinations. It is unclear how often patients receive guideline concordant ART and what factors are correlated with receiving guideline-inconsistent ART. The objective of this study was to assess ART reported by participants of the Women's Interagency HIV Study (WIHS) and the Multicenter

Jennifer M. Cocohoba; Keri N. Althoff; Rebecca Godfrey; Frank J. Palella; Ruth M. Greenblatt

2012-01-01

400

Influence of gender on receipt of guideline-based antiretroviral therapy in the era of HAART  

Microsoft Academic Search

United States HIV guidelines delineate preferred antiretroviral treatment (ART) and discourage use of sub-potent, toxic, or adversely interacting combinations. It is unclear how often patients receive guideline concordant ART and what factors are correlated with receiving guideline-inconsistent ART. The objective of this study was to assess ART reported by participants of the Women's Interagency HIV Study (WIHS) and the Multicenter

Jennifer M. Cocohoba; Keri N. Althoff; Rebecca Godfrey; Frank J. Palella; Ruth M. Greenblatt

2011-01-01

401

Adherence to antiretroviral treatment among pregnant and postpartum HIV-infected women  

Microsoft Academic Search

Among women with HIV infection, pregnancy is a time when maintenance of maternal health and reduction of vertical HIV transmission are primary concerns. Few studies have examined adherence to Antiretroviral Treatment (ART) during pregnancy and in the postpartum period when the demands of childcare may significantly interfere with women's self-care behaviors. This study examined ART use and adherence in HIV-infected

C. A. Mellins; C. Chu; K. Malee; S. Allison; R. Smith; L. Harris; A. Higgins; C. Zorrilla; S. Landesman; L. Serchuck; P. Larussa

2008-01-01

402

Lipid and Glucose Alterations in HIV-Infected Children Beginning or Changing Antiretroviral Therapy  

Microsoft Academic Search

Financial Disclosure: During the course of this study (PACTG 1010), Dr Hughes received grant support from Roche and had honoraria or consultancies with Abbott, Boehringer Ingelheim, Bristol Myers Squibb, Chiron, Roche, Tibotec, and Virionyx. These companies are all manufacturers of antiretroviral therapy or other therapy for HIV infection. The other authors have indicated they have no financial relationships relevant to

Caroline J. Chantry; Michael D. Hughes; Carmelita Alvero; Joseph S. Cervia; William A. Meyer; Janice Hodge; Peggy Borum; Jack Moye

2010-01-01

403

ASPD Blunts the Effects of HIV and Antiretroviral Treatment on Event-Related Brain Potentials  

Microsoft Academic Search

Several studies have demonstrated that antiretroviral therapy diminishes the adverse effects of HIV\\/AIDS on brain function. Yet, few studies have examined the role of comorbid psychiatric disorders in limiting the magnitude of recovery. The present study examined the effects of the presence versus absence of one such disorder – antisocial personality disorder (ASPD) – on brain function in an HIV-1

Lance O. Bauer; John D. Shanley

2006-01-01

404

Antiretroviral Drug Resistance Testing in Adults With HIV Infection Implications for Clinical Management  

Microsoft Academic Search

Objectives.— To review current knowledge of the biology and clinical implica- tions of human immunodeficiency virus (HIV) resistance to antiretroviral drugs, de- scribe assays for measuring resistance, and assess their use in clinical practice. Participants.— The International AIDS Society-USA assembled a panel of 13 physicians with expertise in basic science, clinical research, and patient care rel- evant to HIV resistance

Martin S. Hirsch; Brian Conway; Richard T. D'Aquila; Victoria A. Johnson; Francoise Brun-Vezinet; Bonaventura Clotet; Lisa M. Demeter; Scott M. Hammer; Donna M. Jacobsen; Daniel R. Kuritzkes; Clive Loveday; John W. Mellors; Stefano Vella; Douglas D. Richman

405

Future HIV Therapy Priority paper evaluation Antiretroviral therapy among HIV-infected breastfeeding mothers  

E-print Network

Future HIV Therapy Priority paper evaluation 1/10 Antiretroviral therapy among HIV-infected breastfeeding mothers: a promising strategy to prevent HIV transmission through breastmilk in Africa Renaud-00177039,version1-10Nov2009 Author manuscript, published in "Future HIV Therapy 2007;1(1):17-21" DOI : 10

Paris-Sud XI, Université de

406

Modelling HIV epidemics in the antiretroviral era: the UNAIDS Estimation and Projection package 2009  

E-print Network

Modelling HIV epidemics in the antiretroviral era: the UNAIDS Estimation and Projection package for country-level estimation and short-term projection of HIV/AIDS epidemics based on fitting observed HIV of ART on incidence and the resulting increases in HIV prevalence in populations with high ART coverage

Raftery, Adrian

407

Predicted savings to the UK National Health Service from switching to generic antiretrovirals, 2014-2018  

PubMed Central

Introduction In other disease areas, generic drugs are normally used after patent expiry. Patents on zidovudine, lamivudine, nevirapine and efavirenz have already expired. Patents will expire for abacavir in late 2014, lopinavir/r in 2016, and tenofovir, darunavir and atazanavir in 2017. However, patents on single-tablet regimens do not expire until after 2026. Methods The number of people taking each antiretroviral in the UK was estimated from 23,655 individuals in the UK CHIC cohort (2012 database). Costs of patented drugs were taken from the British National Formulary database, assuming a 30% discount. Costs of generic antiretrovirals were estimated using an 80% discount from patented prices, or actual costs where available. Two options were analysed: 1 – all patients use single-tablet regimens and patented versions of drugs; prices remain stable over time; 2 – all people switch from patented to generic drugs when available, after patent expiry (dates shown above). Results There were an estimated 67,000 people taking antiretrovirals in the UK in 2014, estimated to rise by 8% per year until 2018 (in line with previous rises). The most widely used antiretrovirals in the CHIC cohort were tenofovir (TDF) (75%), emtricitabine (FTC) (69%), efavirenz (EFV) (39%), lamivudine (3TC) (23%), abacavir (ABC) (18%), darunavir (DRV) (21%) and atazanavir (ATV) (16%). The predicted annual UK cost of generic ABC/3TC/EFV (three generic tablets once daily) was £1018 per person-year. Costs of patented single-tablet regimens ranged from £5000 to £7500 per person-year. Assuming continued use of patented antiretrovirals in the UK, the predicted total national costs of antiretroviral treatment were predicted to rise from £425 million in 2014 to £459 m in 2015, £495 m in 2016, £536 m in 2017 and £578 m in 2018. With a 100% switch to generics, total predicted costs were £337 m in 2014, £364 m in 2015, £382 m in 2016, £144 m in 2017 and £169 m in 2018. The total predicted saving over five years from a switch to generics was £1.1 billion. Conclusions Systematic switching from patented to generic antiretrovirals could potentially save approximately £1.1 billion in the UK over the next five years, compared with continued use of patented versions: this money could be spent on urgently needed HIV prevention programmes. Similar savings are feasible for other European countries, given parallel patent expiry dates. More detailed economic evaluation is required to show when patented single-tablet regimens provide value for money, compared to bioequivalent generic versions of 3–4 pills once daily. PMID:25394006

Hill, Andrew; Hill, Teresa; Jose, Sophie; Pozniak, Anton

2014-01-01

408

DRAFT ---PAUP* 4.0 QUICK START TUTORIAL 1/9/02 -1 Quick Start Tutorial  

E-print Network

DRAFT --- PAUP* 4.0 QUICK START TUTORIAL 1/9/02 -1 Quick Start Tutorial The following hands-on tutorial provides a very brief overview of the basic usage of PAUP* 4.0. The tutorial will take you step on the world wide web at http://paup.csit.fsu.edu/data/primate-mtDNA-interleaved.nex. This tutorial

Naylor, Gavin

409

The Effects of Head Start Health Services: Executive Summary of the Head Start Health Evaluation.  

ERIC Educational Resources Information Center

This report summarizes findings of an evaluation of Head Start health services. Chapter one presents an overview of the background of the evaluation project. Chapter two highlights findings for the major evaluation questions. These questions focus specifically on children's health status prior to entry into Head Start, health services subsequently…

Fosburg, Linda B.; And Others

410

INTRODUCTION The escape response (also called a C-start, fast-start or Mauthner  

E-print Network

3359 INTRODUCTION The escape response (also called a C-start, fast-start or Mauthner startle that is important in producing the escape behavior, which is primarily generated by large, paired reticulospinal'-bend, and stage two ­ the stroke during which the body bends out of the `C' shape (Weihs, 1973). Because escape

Lauder, George V.

411

iBuyNU History -Quick Start IBuyNUHistoryQuickStart  

E-print Network

iBuyNU History - Quick Start iBuyNU Purchasing IBuyNUHistoryQuickStart Last Updated 10/16/2014 lks for and track submitted carts, purchase orders and invoices using history. History menu (side banner) 1. Click the History menu icon in the side banner. 2. Click Search Documents. (The History menu search page appears.) 3

Shull, Kenneth R.

412

Enhanced normalisation of CD4/CD8 ratio with early antiretroviral therapy in primary HIV infection  

PubMed Central

Introduction Despite normalization of total CD4 counts, ongoing immune dysfunction is noted amongst those on antiretroviral therapy (ART). Low CD4/CD8 ratio is associated with a high risk of AIDS and non-AIDS events and may act as a marker of immune senescence [1]. This ratio is improved by ART although normalization is uncommon (~7%) [2]. The probability of normalization of CD4 count is improved with immediate ART initiation in primary HIV infection (PHI) [3]. We examined whether CD4/CD8 ratio similarly normalized in immediate vs. deferred ART at PHI. Material and Methods Using data from the SPARTAC trial and the UK Register of HIV Seroconverters, we examined the effect of ART with time (continuous) from HIV seroconversion (SC) on CD4/CD8 ratio (?1) adjusted for sex, risk group, ethnicity, enrolment from an African site and both CD4 count and age at ART initiation. We also examined that effect by dichotomizing HIV duration at ART initiation (ART started within six months of SC: early ART; ART initiated>six months after SC: deferred). We also considered time to CD4 count normalization (?900 cells/mm3). Results In total, 353 initiated ART with median (IQR) 97.9 (60.5, 384.5) days from estimated seroconversion; 253/353 early ART, 100 deferred ART. At one year after starting ART, 114/253 (45%) early ART had normalized CD4/8 ratio, compared with 11/99 (11%) in the deferred group, whilst 83/253 (33%) of early ART had normalized CD4 counts, compared with 3/99 (3%) in the deferred group. Individuals initiating within six months of PHI were significantly more likely to reach normal ratio than those initiating later (HR, 95% CI 2.96, 1.75 – 5.01, p<0.001). The longer after SC ART was initiated, the reduced likelihood of achieving normalization of CD4/CD8 ratio (HR 0.98, 95% CI 0.96 – 0.99 for each 30-day increase). CD4 count at ART initiation was also associated with normalization, as expected (HR 1.002, 95% CI 1.001 – 1.002, p<0.001). There was an association between normal CD4/CD8 ratio and being virally suppressed (<400 copies HIV RNA/ml) p<0.001. CD4 count normalization was also significantly more likely for those initiating early (HR 5.00, 95% CI 1.52 – 16.41, p=0.008). Conclusions The likelihood of achieving normalization of CD4/CD8 ratios was increased if ART was initiated within six months of PHI. Higher CD4/CD8 ratio may reflect a more “normal” immune phenotype conferring enhanced prognosis and predict post-treatment control. PMID:25393989

Thornhill, John; Inshaw, Jamie; Oomeer, Soonita; Kaleebu, Pontiano; Cooper, David; Ramjee, Gita; Schechter, Mauro; Tambussi, Giuseppe; Fox, Julie; Maria Miro, Jose; Weber, Jonathan; Babiker, Abdel; Porter, Kholoud; Fidler, Sarah

2014-01-01

413

Time to virologic failure for patients taking their first antiretroviral regimen and the subsequent resistance profiles  

PubMed Central

Introduction The resistance profiles of first-line antiretroviral therapy (ART) regimens after virologic failure have yet to be studied in a clinic setting in the modern treatment era. Time to virologic failure among three standard first-line regimens and the resistance profiles of these failures were compared. Materials and Methods All HIV-positive persons aged 16 and over starting a three-drug first-line ART regimen were retrospectively identified at a Toronto community clinic (1 January 2006–1 January 2013). The regimens included a backbone of two NRTIs and a third agent; a PI, an NNRTI, or an II. Patients must have been on treatment for at least 14 days and have at least one VL test within 6 months after starting treatment. The primary outcome was virologic failure defined as either: no suppression by 6 months, or after suppression, two consecutive, detectable VL200 copies/mL at least 14 days apart or one VL>200 copies/mL. Time to failure was compared using a proportional hazards model adjusting for demographic and clinical factors. Resistance profiles of NRTIs and third agents are described in patients with virologic failure who had both baseline and virologic failure genotypes. Results Six hundred sixty patients (93% male) were included with a mean age of 38.9 and a median follow-up period of 35.3 (32.2–39.3) months. Distribution of third agent use was: PI 37.3% (n=246), NNRTI 55.9% (n=369) and II 6.8% (n=45). Virologic failures occurred in 81/246 (33%) with PI, 87/369 (24%) with NNRTI and 11/45 (24%) with II. Compare to PIs, time to failure was longer with NNRTIs (p=0.0013) and similar for IIs (p=0.1562). No evidence that failure with NNRTIs was different from IIs (p=0.9139). Of the 660 patients, 567 (86%) had a baseline genotype. Of the 567 patients, 179 had virological failure. Of the 179, 145(81%) had a baseline genotype and only 37 (21%) had both a baseline and follow-up genotype. Upon failure, emerging ART resistance was rare. No new PI or II mutations were identified and one new NNRTI (Y181C) mutation was identified. Three patients taking PI-based regimens developed NRTI mutations (M184V, M184I, T215Y). Conclusions Time to virologic failure was significantly greater in the NNRTI group compared to the PI group. If failure did occur, ART resistance rarely developed with no PI mutations but a few NRTI mutations in those taking PI-based regimens, and NNRTI mutations in those taking NNRTI-based regimen. PMID:25397502

Crouzat, Frederic; Benoit, Anita; Kovacs, Colin; Smith, Graham; Taback, Nathan; Sandler, Ina; Brunetta, Jason; Chang, Benny; Merkley, Barry; Tilley, David; Fletcher, David; Kalaria, Dipen; Loutfy, Mona

2014-01-01

414

Tiger Tail Distillery alcohol plant starts up  

SciTech Connect

Tiger Tail Distillery plans to start construction in Jan. 1981 of an $89.9 million ethanol plant that would produce 50 million gal/yr of alcohol from 19 million bushels of corn. A $66.8 million loan guarantee from the U.S. Farmers Home Administration will aid the construction of the plant, which will be located on the Mississippi River west of Dyersburg, Tenn. The plant is scheduled for completion eight months after the start of construction. The production and marketing of the alcohol would cost an estimated $1.80/gal, and the cost of barging the alcohol to New Orleans and Memphis would be $0.01/gal and $0.0025/gal, respectively.

Not Available

1980-11-05

415

EMTH 211 Matlab tutorial 3 Getting Started  

E-print Network

be saved and used at a later date in exactly the same way that you use the in-built MATLAB functions. As usual, it's a good idea to open up a diary file in any MATLAB session to save your work. So start to be added. #12;Let us create a script file which solves the following system of linear equations. 5 2r r 3

Hickman, Mark

416

Monarch Kids Cub Run Start Times  

E-print Network

to promoting healthy eating and living in young children. The centers will have fun activities throughoutMonarch Kids Cub Run Start Times: 1 Mile Fun Run: 9 AM 5K Walk/Run: 10 AM Parking: LOT 30­ next !! To REGISTER, SPONSOR, or make a DONATION go to: http://education.odu.edu/monarch kids April 12th­ 7:30AM-5

417

Automotive anti-theft starting system  

SciTech Connect

A security starting system for a motor vehicle having a passenger compartment with an ignition switch therein and an engine compartment with an engine including a starter motor housing for protectively enclosing a starter motor controlled by a relay as part of a starter circuit for starting the engine of the motor vehicle is described comprising: transmitting means operative to transmit an electromagnetic signal in response to actuation thereof; receiving means operative to receive the electromagnetic signal transmitted by the transmitting means and to produce an electrical signal during times in which the receiving means receives the electromagnetic signal; and including a timer in the starter motor housing and an antenna connected to the receiving means in the starter motor housing and extending remotely to the starter motor housing for delivering the electromagnetic signal transmitted by the transmitting means; and switch means responsive to the electrical signal for controlling a period of time when the relay may be energized for operating the starter motor to start the engine of the motor vehicle by closing of the ignition switch.

Anderson, L.V.

1988-03-29

418

New START, Eyjafjallajökull, and Nuclear Winter  

NASA Astrophysics Data System (ADS)

On 8 April 2010, U.S. president Barack Obama and Russian president Dmitry Medvedev signed the Treaty Between the United States of America and the Russian Federation on Measures for the Further Reduction and Limitation of Strategic Offensive Arms, committing the United States and Russia to reducing their nuclear arsenals to levels less than 5% of the maximum during the height of the cold war in the 1980s. This treaty is called “New START,” as it is a follow-on to the 1991 Strategic Arms Reductions Treaty (START). On 14 April 2010 the Eyjafjallajökull volcano in Iceland began an explosive eruption phase that shut down air traffic in Europe for 6 days and continued to disrupt it for another month. What do these two events have in common? Nuclear weapons, when targeted at cities and industrial areas, would start fires, producing clouds of sooty smoke. Volcanic eruptions emit ash particles and sulfur dioxide (SO2), which forms sulfate aerosols in the atmosphere. Thus, both the use of nuclear weapons and volcanic eruptions produce particles that can be transported large distances from the source and can affect weather and climate.

Robock, Alan

2010-11-01

419

Immunomodulation of Antiretroviral Drug-Suppressed Chronic HIV-1 Infection in an Oral Probiotic Double-Blind Placebo-Controlled Trial.  

PubMed

Abstract A putative source of inappropriate immune activation that drives human immunodeficiency virus (HIV)-1 immunopathogenesis is the gastrointestinal tract. Even with effective antiretroviral treatment, residual activation persists. We hypothesized that an oral probiotic could improve the residual immune activation in chronic treated HIV-1 infection, and tested a Bacillus coagulans GBI-30, 6086 capsule probiotic in HIV-1-infected persons with suppressed viremia on stable antiretroviral therapy in a 3-month double-blind placebo-controlled trial (10 probiotic, 7 placebo). The Gastrointestinal Symptom Rating Scale (GSRS) was administered monthly. Blood was tested at the start and end of placebo/probiotic administration for viremia, CD4(+) T cell percentage/concentration, soluble (s)CD14, soluble intestinal fatty acid binding protein, sCD163, D-dimer, C-reactive protein (CRP), interleukin-8, and tumor necrosis factor-?. All participants maintained viremia <40 RNA copies/ml. The probiotic was safe and well tolerated, and appeared to improve chronic gastrointestinal symptoms. Its administration was associated with a significant increase in the percentage of blood CD4(+) T cells compared to placebo (+2.8% versus -1.8%, p=0.018) although CD4(+) T cell concentrations were generally unchanged in both groups. None of the biomarkers showed significant changes on probiotic treatment or between-group differences in change (although significance was borderline for a greater sCD163 drop in the probiotic versus placebo group, p=0.05). Some biomarkers showed significant correlations to each other, particularly D-dimer with CRP and sCD14 with tumor necrosis factor (TNF)-?. These data demonstrate the safety and possible benefit of this probiotic for residual inflammation in treated HIV-1 infection, although further study will be required to determine the immune pathways involved. PMID:25127924

Yang, Otto O; Kelesidis, Theodoros; Cordova, Robert; Khanlou, Homayoon

2014-10-01

420

Affective Correlates of Stimulant Use and Adherence to Anti-retroviral Therapy Among HIV-positive Methamphetamine Users  

E-print Network

psychological factors (like affective states) in relation to substance use and ARTpsychological correlates of substance use and adherence to anti-retroviral therapy (ART)psychological adjustment and increased physical activity, but it was unrelated to ART

Carrico, Adam W.; Johnson, Mallory O.; Colfax, Grant N.; Moskowitz, Judith Tedlie

2010-01-01

421

Illicit drug use, depression and their association with highly active antiretroviral therapy in HIV-positive women  

Microsoft Academic Search

BackgroundWe examined the interaction of illicit drug use and depressive symptoms, and how they affect the subsequent likelihood of highly active antiretroviral therapy (HAART) use among women with HIV\\/AIDS.

Judith A. Cook; Dennis D. Grey; Jane K. Burke-Miller; Mardge H. Cohen; David Vlahov; Farzana Kapadia; Tracey E. Wilson; Robert Cook; Rebecca M. Schwartz; Elizabeth T. Golub; Kathryn Anastos; Claudia Ponath; Lakshmi Goparaju; Alexandra M. Levine

2007-01-01

422

77 FR 3838 - Notice of Availability of Proposed New Starts/Small Starts Policy Guidance  

Federal Register 2010, 2011, 2012, 2013

...Administration's (FTA) Proposed Policy Guidance on New Starts...process, and the proposed policy guidance fills in the details...49, U.S. Code, FTA is making available this proposed policy guidance for public comment. Section...

2012-01-25

423

Prices of second-line antiretroviral treatment for middle-income countries inside versus outside sub-Saharan Africa  

PubMed Central

Introduction Antiretrovirals are available at low prices in sub-Saharan Africa, but these prices may not be consistently available for middle-income countries in other regions with large HIV epidemics. Over 30% of HIV infected people live in countries outside sub-Saharan Africa. Several key antiretrovirals are still on patent, with generic production restricted. We assessed price variations for key antiretroviral drugs inside versus outside sub-Saharan Africa. Methods HIV drug prices used in national programmes (2010–2014) were extracted from the WHO Global Price Reporting Mechanism database for all reporting middle-income countries as classified by the World Bank. Treatment costs (branded and generic) were compared for countries inside sub-Saharan Africa versus those outside. Five key second-line antiretrovirals were analysed: abacavir, atazanavir, darunavir, lopinavir/ritonavir, raltegravir. Results Prices of branded antiretrovirals were significantly higher outside sub-Saharan Africa (p<0.001, adjusted for year of purchase) (see Table 1). For example, the median (interquartile range) price of darunavir from Janssen was $732 (IQR $732-806) per person-year in sub-Saharan Africa versus $4689 (IQR $4075-5717) in non-African middle-income countries, an increase of 541%. However, when supplied by generic companies, most antiretrovirals were similarly priced between countries in sub-Saharan Africa and other regions. Conclusions Pharmaceutical companies are selling antiretrovirals to non-African middle-income countries at prices 74–541% higher than African countries with similar gross national incomes. However, generic companies are selling most of these drugs at similar prices across regions. Mechanisms to ensure fair pricing for patented antiretrovirals across both African and non-African middle-income countries need to be improved, to ensure sustainable treatment access. PMID:25394108

Simmons, Bryony; Hill, Andrew; Ford, Nathan; Ruxrungtham, Kiat; Ananworanich, Jintanat

2014-01-01

424

The impact of herbal remedies on adverse effects and quality of life in HIV-infected individuals on antiretroviral therapy  

PubMed Central

Introduction Use of herbal remedies among HIV-infected individuals in Africa increased in the past decade, mainly due to traditional beliefs and at times inconsistent access to antiretroviral drugs. In Zimbabwe, accessibility and availability of antiretroviral drugs has increased in recent years; however, the use of herbal remedies remains high. This study was conducted to determine the impact of concomitant use of herbal remedies with antiretroviral drugs on adverse events and on quality of life. Methodology A convenient sample of HIV positive patients at Parirenyatwa group of hospitals' Family Care Clinic (Harare, Zimbabwe) was enrolled. A questionnaire was used to collect data on the adverse event experiences of the patients using herbal remedies for their HIV, as well as the types of herbal remedy used. Quality of life index was measured using an HIV/AIDS targeted quality of life (HAT-QOL) tool developed by the World Health Organization. Results Abdominal pain (odds ratio = 2.7, p-value = 0.01) and rash (odds ratio = 2.5, p-value = 0.02) had significant associations with using herbal remedies during antiretroviral therapy. Improved quality of life index was not significantly associated with herbal remedy use during antiretroviral therapy. Conclusions There is evidence to suggest that some traditional herbal remedies used in Zimbabwe may increase incidence of certain types of adverse events when used in combination with antiretroviral drugs. Use of herbal drugs in combination with antiretroviral therapy does not significantly improve quality of life index in comparison to antiretroviral drug use only. PMID:21330740

Bepe, Nyasha; Madanhi, Nathan; Mudzviti, Tinashe; Gavi, Samuel; Maponga, Charles Chiedza; Morse, Gene D

2012-01-01

425

Novel codon insert in HIV type 1 clade B reverse transcriptase associated with low-level viremia during antiretroviral therapy.  

PubMed

We investigated the pol genotype in two phylogenetically and epidemiologically linked partners, who were both experiencing persistent low-level viremia during antiretroviral therapy. In one partner we identified a new residue insertion between codon 248 and 249 of the HIV-1 RNA reverse transcriptase (RT) coding region (HXB2 numbering). We then investigated the potential impact of identified mutations in RT and antiretroviral binding affinity using a novel computational approach. PMID:24020934

Chaillon, Antoine; Gianella, Sara; Vazquez, Homero; Ignacio, Caroline; Zweig, Adam C; Richman, Douglas D; Smith, Davey M

2014-02-01

426

Surveillance of Transmitted Antiretroviral Drug Resistance among HIV1 Infected Women Attending Antenatal Clinics in Chitungwiza, Zimbabwe  

Microsoft Academic Search

The rapid scale-up of highly active antiretroviral therapy (HAART) and use of single dose Nevirapine (SD NVP) for prevention of mother-to-child transmission (pMTCT) have raised fears about the emergence of resistance to the first line antiretroviral drug regimens. A cross-sectional study was conducted to determine the prevalence of primary drug resistance (PDR) in a cohort of young (<25 yrs) HAART-naïve

Mqondisi Tshabalala; Justen Manasa; Lynn S. Zijenah; Simbarashe Rusakaniko; Gerard Kadzirange; Mary Mucheche; Seble Kassaye; Elizabeth Johnston; David Katzenstein

2011-01-01

427

High prevalence of HIV1 drug resistance among patients on first-line antiretroviral treatment in Lomé, Togo  

Microsoft Academic Search

Background  With widespread use of antiretroviral (ARV) drugs in Africa, one of the major potential challenges is the risk of emergence\\u000a of ARV drug-resistant HIV strains. Our objective is to evaluate the virological failure and genotypic drug-resistance mutations\\u000a in patients receiving first-line highly active antiretroviral therapy (HAART) in routine clinics that use the World Health\\u000a Organization public health approach to monitor

Anoumou Y Dagnra; Nicole Vidal; Akovi Mensah; Akouda Patassi; Komi Aho; Mounerou Salou; Marjorie Monleau; Mireille Prince-David; Assétina Singo; Palokinam Pitche; Eric Delaporte; Martine Peeters

2011-01-01

428

The Financial Burden of Morbidity in HIV-Infected Adults on Antiretroviral Therapy in Côte d'Ivoire  

Microsoft Academic Search

BackgroundLarge HIV care programs frequently subsidize antiretroviral (ARV) drugs and CD4 tests, but patients must often pay for other health-related drugs and services. We estimated the financial burden of health care for households with HIV-infected adults taking antiretroviral therapy (ART) in Côte d'Ivoire.Methodology\\/Principal FindingsWe conducted a cross-sectional survey. After obtaining informed consent, we interviewed HIV-infected adults taking ART who had

Arnousse Beaulière; Siaka Touré; Pierre-Kébreau Alexandre; Koko Koné; Alex Pouhé; Bertin Kouadio; Neige Journy; Jérôme Son; Virginie Ettiègne-Traoré; François Dabis; Serge Eholié; Xavier Anglaret; Pieter H. M. van Baal

2010-01-01

429

Particle Physics at the LHC Start  

E-print Network

I present a concise review of the major issues and challenges in particle physics at the start of the LHC era. After a brief overview of the Standard Model and of QCD, I will focus on the electroweak symmetry breaking problem which plays a central role in particle physics today. The Higgs sector of the minimal Standard Model is so far just a mere conjecture that needs to be verified or discarded by the LHC. Probably the reality is more complicated. I will summarize the motivation for new physics that should accompany or even replace the Higgs discovery and a number of its possible forms that could be revealed by the LHC.

Guido Altarelli

2010-10-27

430

How you start the conversation matters.  

PubMed

Immunization rates are one of the many measures of quality care that are of interest to physicians. Immunization rates for children younger than 3 years of age in Minnesota have held steady between 80% and 90%. One reason they have not increased is because of emerging hesitancy among some parents to vaccinate their children. This article describes what research has taught us about working with vaccine-hesitant parents and how starting a conversation in a way that presumes parents will vaccinate may improve the odds of children getting immunized. PMID:24941597

Opel, Douglas J; Bahta, Lynn

2014-05-01

431

CD4 trajectory adjusting for dropout among HIV-positive patients receiving combination antiretroviral therapy in an East African HIV care centre  

PubMed Central

Objective Estimates of CD4 response to antiretroviral therapy (ART) obtained by averaging data from patients in care, overestimate population CD4 response and treatment program effectiveness because they do not consider data from patients who are deceased or not in care. We use mathematical methods to assess and adjust for this bias based on patient characteristics. Design We examined data from 25,261 HIV-positive patients from the East Africa IeDEA Consortium. Methods We used inverse probability of censoring weighting (IPCW) to represent patients not in care by patients in care with similar characteristics. We address two questions: What would the median CD4 be “had everyone starting ART remained on observation?” and “were everyone starting ART maintained on treatment?” Results Routine CD4 count estimates were higher than adjusted estimates even under the best-case scenario of maintaining all patients on treatment. Two years after starting ART, differences between estimates diverged from 30 cells/µL, assuming similar mortality and treatment access among dropouts as patients in care, to over 100 cells/µL assuming 20% lower survival and 50% lower treatment access among dropouts. When considering only patients in care, the proportion of patients with CD4 above 350 cells/µL was 50% adjusted to below 30% when accounting for patients not in care. One-year mortality diverged 6–14% from the naïve estimates depending on assumptions about access to care among lost patients. Conclusions Ignoring mortality and loss to care results in over-estimation of ART response for patients starting treatment and exaggerates the efficacy of treatment programs administering it. PMID:25131801

Kiragga, Agnes N; Lok, Judith J; Musick, Beverly S; Bosch, Ronald J; Mwangi, Ann; Wools-Kaloustian, Kara K; Yiannoutsos, Constantin T

2014-01-01

432

Lipotoxicity on the basis of metabolic syndrome and lipodystrophy in HIV-1-infected patients under antiretroviral treatment.  

PubMed

The development of efficacious antiretroviral drugs that minimize adverse effects is a current challenge in HIV-1 therapy. Metabolic alterations reminiscent of the metabolic syndrome and overt lipodystrophy appear often in HIV-1-infected patients undergoing antiretroviral treatment. The etiopathogenesis of these alterations is complex, but lipotoxicity has recently emerged as a key concept for explaining the metabolic syndrome in HIV-1-infected patients, similarly to what has been observed in diseases such as obesity and genetic lipodystrophies. Antiretroviral drugs from distinct drug families may directly elicit such lipotoxic phenomena, via increased lipolysis, enhanced adipocyte apoptosis and impaired adipogenesis, which collectively lead to a reduced capacity of subcutaneous adipose tissue to enlarge to meet fat storage requirements. Thus, fatty acids that cannot be properly stored as triglycerides in subcutaneous adipose tissue are expected to accumulate in visceral fat as well as in organs and tissues, such as the pancreas, muscle and liver, leading to the pattern of metabolic alterations associated with abnormal ectopic fat accumulation, mainly insulin resistance. Inflammatory responses, evoked by the combined effects of antiretroviral drugs and the underlying HIV-1 infection, also contribute to lipotoxicity, reflecting the action of pro-inflammatory cytokines that enhance lipolytic activity in adipose tissue and impair adipogenesis. Minimizing the lipotoxic action of antiretroviral drugs is ultimately essential in reducing metabolic alterations in treated patients. Moreover, pharmacological strategies that reduce lipotoxicity and promote adipose tissue expandability can be expected to ameliorate the overall metabolic abnormalities in HIV-1-infected, antiretroviral-treated patients. PMID:20687888

Giralt, Marta; Díaz-Delfín, Julieta; Gallego-Escuredo, José M; Villarroya, Joan; Domingo, Pere; Villarroya, Francesc

2010-10-01

433

Predictors of delayed antiretroviral therapy initiation, mortality, and loss to followup in HIV infected patients eligible for HIV treatment: data from an HIV cohort study in India.  

PubMed

Studies from Sub-Saharan Africa have shown that a substantial number of HIV patients eligible for antiretroviral therapy (ART) do not start treatment. However, data from other low- or middle-income countries are scarce. In this study, we describe the outcomes of 4105 HIV patients who became ART eligible from January 2007 to November 2011 in an HIV cohort study in India. After three years of ART eligibility, 78.4% started ART, 9.3% died before ART initiation, and 10.3% were lost to followup. Diagnosis of tuberculosis, being homeless, lower CD4 count, longer duration of pre-ART care, belonging to a disadvantaged community, being widowed, and not living near a town were associated with delayed ART initiation. Diagnosis of tuberculosis, being homeless, lower CD4 count, shorter duration of pre-ART care, belonging to a disadvantaged community, illiteracy, and age >45 years were associated with mortality. Being homeless, being single, not living near a town, having a CD4 count <150 cells/?L, and shorter duration of pre-ART care were associated with loss to followup. These results highlight the need to improve the timely initiation of ART in HIV programmes in India, especially in ART eligible patients with tuberculosis, low CD4 counts, living in rural areas, or having a low socioeconomic status. PMID:24288689

Alvarez-Uria, Gerardo; Pakam, Raghavakalyan; Midde, Manoranjan; Naik, Praveen Kumar

2013-01-01

434

Predictors of Delayed Antiretroviral Therapy Initiation, Mortality, and Loss to Followup in HIV Infected Patients Eligible for HIV Treatment: Data from an HIV Cohort Study in India  

PubMed Central

Studies from Sub-Saharan Africa have shown that a substantial number of HIV patients eligible for antiretroviral therapy (ART) do not start treatment. However, data from other low- or middle-income countries are scarce. In this study, we describe the outcomes of 4105 HIV patients who became ART eligible from January 2007 to November 2011 in an HIV cohort study in India. After three years of ART eligibility, 78.4% started ART, 9.3% died before ART initiation, and 10.3% were lost to followup. Diagnosis of tuberculosis, being homeless, lower CD4 count, longer duration of pre-ART care, belonging to a disadvantaged community, being widowed, and not living near a town were associated with delayed ART initiation. Diagnosis of tuberculosis, being homeless, lower CD4 count, shorter duration of pre-ART care, belonging to a disadvantaged community, illiteracy, and age >45 years were associated with mortality. Being homeless, being single, not living near a town, having a CD4 count <150 cells/?L, and shorter duration of pre-ART care were associated with loss to followup. These results highlight the need to improve the timely initiation of ART in HIV programmes in India, especially in ART eligible patients with tuberculosis, low CD4 counts, living in rural areas, or having a low socioeconomic status. PMID:24288689

Alvarez-Uria, Gerardo; Pakam, Raghavakalyan; Midde, Manoranjan; Naik, Praveen Kumar

2013-01-01

435

45 CFR 1308.21 - Parent participation and transition of children into Head Start and from Head Start to public...  

Code of Federal Regulations, 2012 CFR

...Parent participation and transition of children into Head Start and from Head Start to...HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, HEAD START PROGRAM...PERFORMANCE STANDARDS ON SERVICES FOR CHILDREN WITH DISABILITIES Parent...

2012-10-01

436

45 CFR 1308.21 - Parent participation and transition of children into Head Start and from Head Start to public...  

Code of Federal Regulations, 2010 CFR

...Parent participation and transition of children into Head Start and from Head Start to...HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, HEAD START PROGRAM...PERFORMANCE STANDARDS ON SERVICES FOR CHILDREN WITH DISABILITIES Parent...

2010-10-01

437

45 CFR 1308.21 - Parent participation and transition of children into Head Start and from Head Start to public...  

Code of Federal Regulations, 2011 CFR

...Parent participation and transition of children into Head Start and from Head Start to...HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, HEAD START PROGRAM...PERFORMANCE STANDARDS ON SERVICES FOR CHILDREN WITH DISABILITIES Parent...

2011-10-01

438

45 CFR 1308.21 - Parent participation and transition of children into Head Start and from Head Start to public...  

Code of Federal Regulations, 2013 CFR

...Parent participation and transition of children into Head Start and from Head Start to...HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, HEAD START PROGRAM...PERFORMANCE STANDARDS ON SERVICES FOR CHILDREN WITH DISABILITIES Parent...

2013-10-01

439

Prepermit work starts on California crude line  

SciTech Connect

This paper reports on preliminary work leading to permitting efforts for a 171 mile pipeline to move low gravity crude from giant fields of California to the Los Angeles area. The 20 in., unheated pipeline would cost $180-190 million and could go on stream in 3-3 1/2 years. The project has the backing of partners in development of giant Point Arguello field in the Santa Maria basin off Santa Barbara County, a project blocked from start-up for more than 3 years by permitting wrangles. Pipeline sponsors also have proposed moving oil production from development of Santa Ynez Unit in the Santa Barbara Channel. Point Arguello production is expected to start this year with flow limited to 20,000 b/d, moving moved by pipeline to refineries outside Los Angeles. Point Arguello partners want to ship full Arguello production of 80,000-100,00 b/d by tanker until the PPC project is complete, which the county opposes. The group has appealed the county's denial of an interim tankering permit to the California Coastal Commission, which is expected to hold a hearing on the matter this month. The controversy has been further complicated by other, competing projects designed to move Point Arguello crude to market.

Not Available

1991-04-08

440

Expansion of HIV care and treatment in Yunnan Province, China: treatment outcomes with scale up of combination antiretroviral therapy.  

PubMed

Effective health care models to scale up combination antiretroviral therapy (ART) are needed in rural southwestern China. We aimed to evaluate the ART treatment outcomes and their associations with patients' demographic characteristics and pre-treatment clinical features in a scaled-up provincial ART program serving eight heavily HIV-affected prefectures in Yunnan Province. We abstracted information from a computerized database for adults initiating ART between July 2007 and September 2008. Survival functions of mortality and treatment failure were calculated by age group, gender, transmission mode, and baseline CD4 count. Multivariable Cox regression analyses were conducted to find independent associations of various demographic and baseline clinical features with outcome variables. Of the 1967 patients in the mortality analysis, there were 110 deaths, of which 16 were coded as accidents or suicides. Adjusted hazard ratios (AHR) associated with mortality were greater for patients with baseline CD4 counts <100 cells/µl vs. patients with CD4 counts ?200 cells/µl, for male vs. female, for single vs. married, and for those acquired HIV through injection drug use (IDU) vs. other modes of transmission. Successful treatment was 81.3% at six months after treatment started. Immunologic treatment failure was associated with baseline CD4 counts but not with demographic characteristics. Overall loss to follow-up rate was 2.1%. Collaboration between clinics and community networks are distinctive features of Yunnan's model for scaling up ART across a diverse, poor, and rural population. This study finds that the strategy can succeed even if 40% of the patients have a history of IDU. PMID:24116389

Chen, Juemin; Yu, Bo; Wang, Yungshen; Tang, Michele; Hu, Yanhong; Cai, Thomas; Zhang, Fujie; von Zinkernagel, Deborah; Harwell, Joseph I; Huang, Zhihuan Jennifer

2014-01-01

First Page Previous Page 1 2 3 4 5 6 7 8 9