scholarly journals Oral Antiretroviral Drugs as Public Health Tools for HIV Prevention: Global Implications for Adherence, Drug Resistance, and the Success of HIV Treatment Programs

2013 ◽  
Vol 207 (suppl_2) ◽  
pp. S101-S106 ◽  
Author(s):  
Ravindra K. Gupta ◽  
Mark A. Wainberg ◽  
Francoise Brun-Vezinet ◽  
Jose M. Gatell ◽  
Jan Albert ◽  
...  
Keyword(s):  
Public Health ◽  
Drug Resistance ◽  
Hiv Prevention ◽  
Antiretroviral Drugs ◽  
Hiv Treatment ◽  
Treatment Programs

Pre-treatment and acquired HIV drug resistance in Dar es Salaam, Tanzania in the era of tenofovir and routine viral load monitoring

2019 ◽  
Vol 74 (10) ◽  
pp. 3016-3020 ◽  
Author(s):  
Godfrey Barabona ◽  
Macdonald Mahiti ◽  
Salim Masoud ◽  
Peter Mbelele ◽  
Amina Shaban Mgunya ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Progressive Increase ◽  
Dar Es Salaam ◽  
Antiretroviral Drugs ◽  
Hiv Treatment ◽  
Resistance Mutations ◽  
Genetic Barrier ◽  
Hiv Drug Resistance ◽  
Pre Treatment ◽  
Treat All

Abstract Objectives We investigated the prevalence and patterns of pre-treatment and acquired HIV drug resistance mutations (DRMs) in Tanzania as a ‘treat all’ strategy, virological monitoring and the progressive increase in usage of tenofovir are being implemented in HIV treatment programmes. Methods Viral RNA was isolated from plasma of 60 ART-naive and 166 treated-but-viraemic (>400 copies/mL) HIV-1-infected adults attending a care and treatment clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania, between June and October 2017. Viral genes encoding protease and reverse transcriptase were amplified by PCR and directly sequenced. Results Viral genotyping of successfully amplified samples revealed pre-treatment DRMs in 14/47 (29.8%) ART-naive subjects. Of these, 7/47 (14.9%) harboured mutations that confer high-level resistance to at least one drug of the default first-line regimen. In treated-but-viraemic subjects, DRMs were found in 100/111 (90%), where DRMs against NNRTI, NRTI and PI were observed in 95/100 (95%), 92/100 (92%) and 13/100 (13%), respectively. Tenofovir-resistance mutations K65R and K70G/E or ≥3 thymidine analogue resistance mutations including M41L and L210W were found in 18/36 (50%) subjects on a tenofovir-containing regimen at failure. Four patients harboured multiple DRMs, which can confer resistance to all available ART regimens in Tanzania. Conclusions Taken together, pre-treatment and acquired DRMs were highly prevalent, which represents a major risk for the efficacy of ART programmes in Tanzania. Availability of a newer generation of antiretroviral drugs with a higher genetic barrier to resistance and robust treatment monitoring is warranted for effective and sustainable HIV treatment.

scholarly journals The act of telling: South African women’s narratives of HIV status disclosure to intimate partners in the HPTN 071 (PopART) HIV prevention trial

2021 ◽  
Vol 17 ◽  
pp. 174550652199820
Author(s):  
Lario Viljoen ◽  
Dillon Wademan ◽  
Graeme Hoddinott ◽  
Virginia Bond ◽  
Janet Seeley ◽  
...  
Keyword(s):  
Public Health ◽  
Hiv Prevention ◽  
Hiv Testing ◽  
Hiv Treatment ◽  
Treatment As Prevention ◽  
Hiv Status ◽  
Women Living With Hiv ◽  
Adherence Support ◽  
Hiv Status Disclosure ◽  
Status Disclosure

Background: Public health programming often frames HIV status disclosure as a means to negotiate condom- and abstinence-based prevention or to involve intimate partners in HIV care to garner treatment adherence support. HIV treatment can be used to ensure viral suppression and prevent onward transmission, which provides strong evidence to encourage disclosure. The ideological shift towards HIV treatment as prevention is expected to facilitate disclosure. Purpose: There is a lack of research on how the scale-up of universal HIV testing and treatment influences disclosure practices in high burden settings. In this manuscript, we aim to address this gap. Methods: To this end, we conducted a two-phased narrative performative analysis of the disclosure scripts of 15 women living with HIV in three communities of Western Cape, South Africa where the HPTN 071 (PopART) HIV prevention trial implemented a universal HIV testing and treatment model as part of the intervention. The women were part of a larger cohort nested in the trial. We use Goffman’s dramaturgical metaphor, which understands social interactions as ‘performances’ by ‘actors’ (people) guided by ‘scripts’ (anticipated dialogues/interactions), to explore how women living with HIV manage their status disclosure. Conclusion: We describe how these women perform HIV status disclosure (or deliberate non-disclosure) to retain, reaffirm or redefine existing social scripts with partners. Their performances reveal priorities other than those imagined by public health programmes driving HIV disclosure (or non-disclosure): establishing trust, resenting betrayal and ensuring self-preservation while simultaneously (re)constructing self-identity. None of the women engaged with the concept of treatment as prevention in their disclosure narratives, either to facilitate disclosure or to ‘justify’ non-disclosure. HIV prevention, in general, and treatment adherence support were rarely mentioned as a reason for disclosure. To date, there has been a missed opportunity to ease and support disclosure in health programmes by tapping into existing social scripts, impeding potential patient and public health benefits of universal HIV testing and treatment.

scholarly journals Paying for Prevention: Challenges to Health Insurance Coverage for Biomedical HIV Prevention in the United States

2012 ◽  
Vol 38 (4) ◽  
pp. 607-666 ◽  
Author(s):  
Kristen Underhill
Keyword(s):  
Public Health ◽  
United States ◽  
Health Insurance ◽  
Hiv Prevention ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Antiretroviral Drugs ◽  
Biomedical Hiv Prevention ◽  
Legal Grounds

Reducing the incidence of HIV infection continues to be a crucial public health priority in the United States, especially among populations at elevated risk such as men who have sex with men, transgender women, people who inject drugs, and racial and ethnic minority communities. Although most HIV prevention efforts to date have focused on changing risky behaviors, the past decade yielded efficacious new biomedical technologies designed to prevent infection, such as the prophylactic use of antiretroviral drugs and the first indications of an efficacious vaccine. Access to prevention technologies will be a significant part of the next decade's response to HIV, and advocates are mobilizing to achieve more widespread use of these interventions. These breakthroughs, however, arrive at a time of escalating healthcare costs; health insurance coverage therefore raises pressing new questions about priority-setting and the allocation of responsibility for public health. The goals of this Article are to identify legal challenges and potential solutions for expanding access to biomedical HIV prevention through health insurance coverage. This Article discusses the public policy implications of HIV prevention coverage decisions, assesses possible legal grounds on which insurers may initially deny coverage for these technologies, and evaluates the extent to which these denials may survive external and judicial review. Because several of these legal grounds may be persuasive, particularly denials on the basis of medical necessity, this Article also explores alternative strategies for financing biomedical HIV prevention efforts.

scholarly journals Challenging conventional wisdom on the evolution of resistance to multi-drug HIV treatment: Lessons from data and modeling

2019 ◽  
Author(s):  
Alison Feder ◽  
Kristin Harper ◽  
Pleuni S. Pennings
Keyword(s):  
Drug Resistance ◽  
Standard Of Care ◽  
Compartment Model ◽  
Antiretroviral Drugs ◽  
Hiv Treatment ◽  
Current Standard ◽  
Hiv Drug Resistance ◽  
Resistance Evolution ◽  
Single Drug ◽  
Evolution Of Resistance

AbstractUnder the current standard of care, individuals with HIV take three antiretroviral drugs simultaneously. Triple-drug combination therapies limit HIV drug resistance evolution, because viruses resistant to a subset of the cocktail are suppressed by the remainder of the drugs and should not complete replication and spread. Despite this, reanalysis of HIV genetic data shortly after triple drug therapies became available (1990s and 2000s) reveals ongoing drug resistance in patients on three-drug therapies. In disagreement with expected patterns of evolution in three-drug therapy-treated HIV populations, resistance usually evolves one mutation at a time in a semi-predictable order. We argue here that these surprising observations can be explained using a model that divides the human body into compartments (for example, the gut, lymph nodes and brain). If one drug reaches a compartment that the other two drugs cannot, this creates a single-drug compartment that can select for single-drug resistant viruses. Such viruses can potentially become resistant to additional drugs, if they migrate to another compartment where a second drug is present, and so on. In addition to a compartment model, for some drug combinations, an alternative model of time-heterogeneity due to short half-lives combined with sub-optimal adherence could also explain the observations. We discuss how these lessons from HIV drug resistance evolution may be useful for other systems.

Emerging Trends in the Long-acting Antiretroviral Therapy: Current Status and Therapeutic Challenges

2020 ◽  
Vol 18 ◽  
Author(s):  
Rajpushpa Labh ◽  
Rachna Gupta
Keyword(s):  
Drug Resistance ◽  
Antiretroviral Therapy ◽  
Drug Distribution ◽  
Antiretroviral Drugs ◽  
Current Status ◽  
People Living With Hiv ◽  
Viral Reservoirs ◽  
Emerging Trends ◽  
Gradual Development ◽  
Long Acting

: Antiretroviral drug therapy has significantly improved the prognosis and life expectancy of People Living with HIV over the years. But this progress comes with an important caveat that antiretroviral regimens generally require adherence to life-long, daily dosing, to keep viral multiplication under check. Non-adherence to such dosing leads to decreased efficacy and increased drug resistance against antiretroviral drugs. Besides, poor drug penetration to certain tissues like CNS and lymph nodes leads to build-up of viral reservoirs in these sites. To combat some of these challenges and improve patient compliance, long-acting antiretroviral drugs, are a new weapon in the arsenal, in fight against HIV. Few long acting preparations have been approved, and several others are in various clinical and preclinical stages of development. However, longacting formulations also have their share of clinical issues like limited drug distribution, long term adverse drug reactions, drug-drug interactions, and gradual development of drug resistance. Modern technological premises are being tested to mitigate some of these problems. One such promising approach involves nanotechnological methods, which are being used to develop ultra-long acting formulations and drug delivery systems, targeting tissues with residual HIV concentration. LongActing Slow Effective Release Antiretroviral Therapy aka LASER ART, also builds on nanotechnology and prodrug modifications to design preparations with tailor-made favorable pharmacokinetics and wider drug distribution. These recent advances are fueling the progression of antiretroviral therapy towards eliminating the disease.

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