scholarly journals Predictors of Nonadherence to Highly Active Antiretroviral Therapy Among HIV-Infected South Indians in Clinical Care: Implications for Developing Adherence Interventions in Resource-Limited Settings

2010 ◽  
Vol 24 (12) ◽  
pp. 795-803 ◽  
Author(s):  
Kartik K. Venkatesh ◽  
A.K. Srikrishnan ◽  
Kenneth H. Mayer ◽  
N. Kumarasamy ◽  
Sudha Raminani ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Clinical Care ◽  
Resource Limited Settings ◽  
Highly Active ◽  
South Indians ◽  
Resource Limited ◽  
Adherence Interventions

scholarly journals Implementing a pharmacovigilance program to evaluate cutaneous adverse drug reactions in an antiretroviral access program

2012 ◽  
Vol 6 (11) ◽  
pp. 806-808
Author(s):  
Tinashe Mudzviti ◽  
Marvelous Sibanda ◽  
Samuel Gavi ◽  
Charles Chiedza Maponga ◽  
Gene D Morse
Keyword(s):  
Antiretroviral Therapy ◽  
Adverse Drug Reactions ◽  
Highly Active Antiretroviral Therapy ◽  
Family Care ◽  
Monitoring And Evaluation ◽  
Drug Reactions ◽  
Resource Limited Settings ◽  
Drug Regulatory Authority ◽  
Highly Active ◽  
Resource Limited

Introduction: Cutaneous adverse drug reactions (cADRs) can cause significant morbidity and distress in patients, especially in the HIV-infected population on antiretroviral therapy. Adverse drug reaction monitoring and ascertaining causality in resource-limited settings remain serious challenges. This study was conducted to evaluate causality and measure the incidence of cADRs in HIV-infected patients on highly active antiretroviral therapy. The study was also designed to test a three-step approach in the monitoring and evaluation of ADRs in resource-limited settings. Methodology: A retrospective review of patient medical records was performed at the Parirenyatwa Family Care Centre, Harare, Zimbabwe. Cases of cADRs were reported to the Medicines Control Authority of Zimbabwe, the main drug regulating body in Zimbabwe, for assessment and causality classification. Results: We reviewed 221 randomly selected patient records to determine whether any diagnoses of cADRs were made by clinicians. Causality assessment revealed that 13.1% of cADRs were due to an offending agent in the antiretroviral therapy versus an initial incidence of 17.6% which had been determined by the physicians. Conclusions: cADRs had an incidence of 13.1% within the population under study due to non nucleoside reverse transcriptase inhibitors (NNRTIs). Most reactions were caused by the NNRTIs which contributed 72.4 % of all cADRs. A panel of experts from the drug regulatory authority can be used as an implementation based mechanism in ascertaining causality objectively in settings where resources are constrained.

Regression of Kaposi's sarcoma lesions following highly active antiretroviral therapy in an HIV-infected patient

2008 ◽  
Vol 19 (11) ◽  
pp. 786-788 ◽  
Author(s):  
N Kumarasamy ◽  
K K Venkatesh ◽  
B Devaleenol ◽  
S Poongulali ◽  
N Ahilasamy
Keyword(s):  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Infected Patient ◽  
Kaposi's Sarcoma ◽  
Kaposi’S Sarcoma ◽  
Chemotherapeutic Agents ◽  
Resource Limited Settings ◽  
Infected Male ◽  
Highly Active ◽  
Resource Limited

This case report documents that highly active antiretroviral therapy (HAART) can lead to the regression of Kaposi's sarcoma (KS) lesions in the auditory canal of an HIV-infected male from Chennai, India. In resource-limited settings where administering anti-KS chemotherapeutic agents may not be feasible, HAART alone can be an option in HIV-infected individuals with KS.

COST-EFFECTIVENESS OF ADHERENCE INTERVENTIONS FOR HIGHLY ACTIVE ANTIRETROVIRAL THERAPY: A SYSTEMATIC REVIEW

2013 ◽  
Vol 29 (3) ◽  
pp. 227-233 ◽  
Author(s):  
Tim Mathes ◽  
Dawid Pieper ◽  
Sunya-Lee Antoine ◽  
Michaela Eikermann
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Baseline Scenario ◽  
Highly Active ◽  
Adherence Interventions ◽  
The Cost

Objectives: The objective of this systematic review was to evaluate the cost-effectiveness of interventions aiming to increase the adherence to highly active antiretroviral therapy (HAART) in HIV-infected patients in developed countries (WHO stratum A).Methods: A systematic search for comparative health economic studies was conducted in the following databases: EMBASE, MEDLINE, NHS Economic Evaluation Database, CINAHL, HEED, and EconLit. The identified publications were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Furthermore, these were evaluated according to a standardized checklist and finally extracted, analyzed, and summarized.Results: After reviewing the abstracts and full texts four relevant studies were identified. Different educational programs were compared as well as the Directly Observed Therapy (DOT). A critical aspect to be considered in particular was the poor transparency of the cost data. In three cost-utility analyses the costs per quality-adjusted life-year (QALY) in the baseline scenario were each under USD 15,000. The sensitivity analyses with a presumed maximum threshold of USD 50,000/QALY showed a predominantly cost-effective result. In one study that examined DOT the costs add up to over USD 150,000/QALY.Conclusions: It seems that adherence interventions for HAART in HIV-infected patients can be cost-effective. Nevertheless, the quality of the included studies is deficient and only a few of the possible adherence interventions are taken into consideration. A final assessment of the cost-effectiveness of adherence interventions in general is, therefore, not possible.

scholarly journals Efficacy of first-line, WHO recommended generic HAART regimens in Indian children

2010 ◽  
Vol 7 (3) ◽  
pp. 220-225 ◽  
Author(s):  
A Parakh ◽  
AP Dubey ◽  
A Kumar ◽  
A Maheshwari ◽  
R Saxena
Keyword(s):  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Transcriptase Inhibitor ◽  
World Health ◽  
Highly Active ◽  
Resource Limited ◽  
Z Scores ◽  
Nucleotide Reverse Transcriptase Inhibitor ◽  
Health Organization ◽  
Reverse Transcriptase Inhibitor

Background: The clinical efficacy of highly active antiretroviral therapy (HAART) in children has been well documented in the developed countries, although most of the regimens are Protease Inhibitor (PI) based which are too expensive. To circumvent this problem World Health Organization (WHO) has recommended Non- Nucleotide Reverse Transcriptase Inhibitor (NNRTI) based regimen for resource-limited countries. Aim: To assess the long-term efficacy of first line World Health Organization (WHO)-recommended generic highly active antiretroviral therapy (HAART) regimens in treatment -naïve children. Materials and methods: Observational retrospective analysis was done. Thirty patients on HAART for > 6 months were included (27 on Stavudine; three on Zidovudine with Lamivudine/ Nevirapine). No protease inhibitors were used. Results: median age was seven years (Interquartile [IQR]: 5.62-8.50) and median duration on HAART was 18 months (IQR: 6-24). No new staging events were observed after six months of initiation of HAART. The median CD4% increased from 6.0 % at baseline to 15.5% at six months, 21.7% at 12 months, 25.4% at 18 months, 24.6 % at 24 months 25.3% at 30 months and 23.7% at 36 months. There was only one case of immunological failure. Stratified analysis based on baseline CD4 % show that even patients with a baseline CD4 % of <5% achieved percentage of >25% at 18-24 months and maintained it subsequently. Significant increase in the weight and body mass index Z scores was observed but significant fall in the height Z scores were observed. This sub group of patients with poor linear height velocity would require detailed endocrine evaluation after testing for viral loads. Conclusions: Non- Nucleotide Reverse Transcriptase Inhibitor based HAART regimens are feasible and effective in long term in resource-limited setting despite initiation of treatment in advanced stages. These can be continued in NACO/WHO scale up programmes at present for children. Key words: HAART in children; India; NNRTI based HAART; resource limited settings; WHO prequalified Antiretroviral therapy DOI: 10.3126/kumj.v7i3.2727 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 220-225

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