scholarly journals Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand

2017 ◽  
Vol 66 (4) ◽  
pp. 594-603 ◽  
Author(s):  
◽  
Intira Jeannie Collins ◽  
Luminita Ene ◽  
Caroline Foster ◽  
Christian Kahlert ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Second Line ◽  
Immunodeficiency Virus ◽  
Second Line Antiretroviral Therapy

scholarly journals Diverse Human Immunodeficiency Virus–1 Drug Resistance Profiles at Screening for ACTG A5288: A Study of People Experiencing Virologic Failure on Second-line Antiretroviral Therapy in Resource-limited Settings

2019 ◽  
Vol 71 (7) ◽  
pp. e170-e177 ◽  
Author(s):  
Carole L Wallis ◽  
Michael D Hughes ◽  
Justin Ritz ◽  
Raquel Viana ◽  
Carlos Silva de Jesus ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Drug Resistance ◽  
Antiretroviral Therapy ◽  
Virologic Failure ◽  
Cd4 T Cell ◽  
Second Line ◽  
Drug Classes ◽  
Immunodeficiency Virus ◽  
Third Line ◽  
Second Line Antiretroviral Therapy

Abstract Background Human immunodeficiency virus (HIV) drug resistance profiles are needed to optimize individual patient management and to develop treatment guidelines. Resistance profiles are not well defined among individuals on failing second-line antiretroviral therapy (ART) in low- and middle-income countries (LMIC). Methods Resistance genotypes were performed during screening for enrollment into a trial of third-line ART (AIDS Clinical Trials Group protocol 5288). Prior exposure to both nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs and confirmed virologic failure on a protease inhibitor–containing regimen were required. Associations of drug resistance with sex, age, treatment history, plasma HIV RNA, nadir CD4+T-cell count, HIV subtype, and country were investigated. Results Plasma HIV genotypes were analyzed for 653 screened candidates; most had resistance (508 of 653; 78%) to 1 or more drugs. Genotypes from 133 (20%) showed resistance to at least 1 drug in a drug class, from 206 (32%) showed resistance to at least 1 drug in 2 drug classes, and from 169 (26%) showed resistance to at least 1 drug in all 3 commonly available drug classes. Susceptibility to at least 1 second-line regimen was preserved in 59%, as were susceptibility to etravirine (78%) and darunavir/ritonavir (97%). Susceptibility to a second-line regimen was significantly higher among women, younger individuals, those with higher nadir CD4+ T-cell counts, and those who had received lopinavir/ritonavir, but was lower among prior nevirapine recipients. Conclusions Highly divergent HIV drug resistance profiles were observed among candidates screened for third-line ART in LMIC, ranging from no resistance to resistance to 3 drug classes. These findings underscore the need for access to resistance testing and newer antiretrovirals for the optimal management of third-line ART in LMIC.

scholarly journals Human Immunodeficiency Virus-1 Drug Resistance Patterns Among Adult Patients Failing Second-Line Protease Inhibitor-Containing Regimens in Namibia, 2010–2015

2018 ◽  
Vol 5 (2) ◽  
Author(s):  
Souleymane Sawadogo ◽  
Andreas Shiningavamwe ◽  
Clay Roscoe ◽  
Andrew L Baughman ◽  
Taffa Negussie ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Adult Patients ◽  
Second Line ◽  
Viral Load Monitoring ◽  
Immunodeficiency Virus ◽  
Load Monitoring ◽  
Resistance Patterns ◽  
Third Line ◽  
Emergence Of Resistance ◽  
Second Line Antiretroviral Therapy

Abstract Three hundred sixty-six adult patients in Namibia with second-line virologic failures were evaluated for human immunodeficiency virus drug-resistant (HIVDR) mutations. Less than half (41.5%) harbored ≥1 HIVDR mutations to standardized second-line antiretroviral therapy (ART) regimen. Optimizing adherence, viral load monitoring, and genotyping are critical to prevent emergence of resistance, as well as unnecessary switching to costly third-line ART regimens.

scholarly journals Human Immunodeficiency Virus and Leprosy Coinfection: Challenges in Resource-Limited Setups

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Charles M. Kwobah ◽  
Kara K. Wools-Kaloustian ◽  
Jane N. Gitau ◽  
Abraham M. Siika
Keyword(s):  
Antiretroviral Therapy ◽  
Antiretroviral Drugs ◽  
Second Line ◽  
Resource Limited ◽  
Hiv Coinfection ◽  
Immunodeficiency Virus ◽  
Public Health Challenge ◽  
Low Prevalence ◽  
Adult Male Patient ◽  
Second Line Antiretroviral Therapy

Mycobacteria leprae(leprosy)and HIV coinfection are rare in Kenya. This is likely related to the low prevalence (1 per 10,000 of population) of leprosy. Because leprosy is no longer a public health challenge there is generally a low index of suspicion amongst clinicians for its diagnosis. Management of a HIV-1-leprosy-coinfected individual in a resource-constrained setting is challenging. Some of these challenges include difficulties in establishing a diagnosis of leprosy; the high pill burden of cotreatment with both antileprosy and antiretroviral drugs (ARVs); medications’ side effects; drug interactions; scarcity of drug choices for both diseases. This challenge is more profound when managing a patient who requires second-line antiretroviral therapy (ART). We present an adult male patient coinfected with HIV and leprosy, who failed first-line antiretroviral therapy (ART) and required second-line treatment. Due to limited choices in antileprosy drugs available, the patient received monthly rifampicin and daily lopinavir-/ritonavir-based antileprosy and ART regimens, respectively. Six months into his cotreatment, he seemed to have adequate virological control. This case report highlights the challenges of managing such a patient.

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