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

2011 ◽  
Vol 2011 ◽  
pp. 1-11 ◽  
Author(s):  
Kevin Peterson ◽  
Sabelle Jallow ◽  
Sarah L. Rowland-Jones ◽  
Thushan I. de Silva
Keyword(s):  
Antiretroviral Therapy ◽  
West Africa ◽  
Low Income ◽  
Low Income Countries ◽  
Hiv Diagnosis ◽  
Nonnucleoside Reverse Transcriptase Inhibitors ◽  
Development Of Resistance ◽  
Virologic Control ◽  
Testing Algorithms ◽  
Hiv 1

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.

scholarly journals Development of a Pain Management Protocol for a Paediatric Ward in the Gambia, West Africa

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Lisa M. Puchalski Ritchie ◽  
Stephen R. C. Howie ◽  
Pamela Collier Njai
Keyword(s):  
Health Care ◽  
Pain Management ◽  
West Africa ◽  
Low Income ◽  
The Gambia ◽  
Low Income Countries ◽  
Paediatric Ward ◽  
Health Care Settings ◽  
Management Protocol ◽  
Specific Health

Despite recent advances in our understanding of paediatric pain and its management, pain continues to be undertreated globally, particularly in children and in low income countries. This article describes the development of a paediatric analgesia and sedation protocol, tailored to the specific setting of the Medical Research Council (MRC) paediatric ward in the Gambia, West Africa. An iterative process was used throughout development, with inputs from the medical literature, local providers, and pain experts, incorporated to ensure a safe, effective, and locally appropriate protocol. We demonstrate that evidence-based published guidelines, can and should be adapted to allow for optimal pain management given the resources and capabilities of specific health care settings. It is hoped that the process and protocol described here, will not only help to improve care on the MRC ward, but serve as an example to others working toward improving pain management in similar health care settings.

scholarly journals Plasma Drug Level Validates Self-Reported Adherence but Predicts Limited Specificity for Nonadherence to Antiretroviral Therapy

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Robert Balikuddembe ◽  
Joshua Kayiwa ◽  
David Musoke ◽  
Muhammad Ntale ◽  
Steven Baveewo ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Low Income ◽  
Plasma Levels ◽  
Plasma Concentrations ◽  
Drug Level ◽  
Low Income Countries ◽  
Plasma Drug ◽  
Cross Sectional ◽  
Drug Concentrations ◽  
Emergence Of Resistance

Introduction. Adherence to antiretroviral therapy (ART) in low-income countries is mainly assessed by self-reported adherence (S-RA) without drug level determination. Nonadherence is an important factor in the emergence of resistance to ART, presenting a need for drug level determination. Objective. We set out to establish the relationship between plasma stavudine levels and S-RA and validate S-RA against the actual plasma drug concentrations. Methods. A cross-sectional investigation involving 234 patients in Uganda. Stavudine plasma levels were determined using high-performance liquid chromatography. We compared categories of plasma levels of stavudine with S-RA using multivariable logistic regression models. Results. Overall, 194/234 patients had S-RA ≥ 95% (good adherence) and 166/234 had stavudine plasma concentrations ≥ 36 nmol/L (therapeuticconcentration). Patients with good S-RA were eight times more likely to have stavudine levels within therapeutic concentration (Adjusted Odds Ratio: 7.7, 95% Confidence Interval: 3.5–7.0). However, of the 194 patients with good S-RA, 21.7% had below therapeutic concentrations. S-RA had high sensitivity for adherence (91.6%), but limited specificity for intrinsic poor adherence (38.2%). Conclusions. S-RA is a good tool for assessing adherence, but has low specificity in detecting nonadherence, which has implications for emergence of resistance.

A review on Development and Characterization of a Cost-Effective Targeted Quality-Driven Antimalarial Product with an Emphasis on Phytosomes

2021 ◽  
Vol 22 ◽  
Author(s):  
E. Bhargav ◽  
Y. Padmanabha Reddy ◽  
K.B. Koteshwara
Keyword(s):  
Low Income ◽  
Cost Effective ◽  
Low Income Countries ◽  
Development Of Resistance ◽  
Infected Rbcs ◽  
Resistant Strains ◽  
The One ◽  
The Cost ◽  
Neural Network Technology

Abstract : Malaria, a protozoan disease led to numerous deaths and several new million cases raised due to the development of resistance as per the WHO malaria report 2019. This can be overcome by the development of an effective targeted plant-based delivery system through phytosomes that are effective in permeation and bioavailability to treat infected RBCs (parasitic cells). This review article explained the development of targeted Nanophytosomes to overcome resistance, to improve efficacy. This review paper also emphasized various quality-driven developmental approaches in developing an antimalarial product at a reasonable cost. By implementing molecular modeling techniques in development, a significant phytoconstituent with the capability of acting at the target (receptor or enzymes) of the parasite and the one with the capability to overcome drug resistance against resistant strains of parasites can be identified. Absorption Distribution Metabolism Excretion and Toxicity (ADMET) studies information provide a route to the design and formulation of a potent antimalarial agent. Efficient targeted Nanophytosomal formulations can be formulated by functionalizing or conjugating with suitable targets to direct the phytoconstituent to the infected RBCs thereby achieving complete parasitic eradication. Artificial Neural Network technology (ANN), Quality by Design (QbD), molecular dynamics, and simulation studies implementation improves quality and reduces the cost of the product, as these malarial products are much utilized in low-income countries. Hence it can be concluded that targeted developmental quality-driven approaches implementation is essential for effective malarial treatment.

scholarly journals Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study

PLoS ONE ◽  
2013 ◽  
Vol 8 (6) ◽  
pp. e66135 ◽  
Author(s):  
Didier K. Ekouevi ◽  
Eric Balestre ◽  
Patrick A. Coffie ◽  
Daouda Minta ◽  
Eugene Messou ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
West Africa ◽  
Hiv 1

scholarly journals To pool or not to pool samples for Sexually Transmitted Infections detection in Men who have Sex with Men? An evaluation of a new pooling method using the GeneXpert instrument in West-Africa

2020 ◽  
Author(s):  
Irith De Baetselier ◽  
Bea Vuylsteke ◽  
Issifou Yaya ◽  
Anoumou Dagnra ◽  
Souba Diandé ◽  
...  
Keyword(s):  
West Africa ◽  
Sexually Transmitted Infections ◽  
Low Income ◽  
Low Income Countries ◽  
African Countries ◽  
Sexually Transmitted ◽  
Sample Pooling ◽  
Pooling Strategies ◽  
Sex With Men ◽  
Positive Results

AbstractBackgroundMen who have sex with Men (MSM) using Pre-exposure prophylaxis (PrEP) are at risk for Sexually Transmitted Infections (STIs). Therefore, PrEP services should include regular screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at urethra, anorectum and pharynx. However, financial and logistic challenges arise in low resource settings. We assessed a new STI sample pooling method using the GeneXpert instrument among MSM initiating PrEP in West-Africa.MethodsUrine, anorectal and pharyngeal samples were pooled per individual for analysis. Unpooled samples were analyzed in case of an invalid or positive result of the pool, to identify the infection’s biological location. The results of two different pooling strategies were compared against a gold standard.ResultsWe found a prevalence of 14.5% for chlamydia and 11.5% for gonorrhea, with a predominance of infections being extra-genital (77.6%). The majority of infections were asymptomatic (88.2%). The pooling strategy with unpooling of invalid results only, had a sensitivity, specificity and agreement for CT of 95.4%, 98.7% and 0.93, respectively; and 92.3%, 99.2% and 0.93 with additional unpooling of positive results. For NG, these figures were 88.9%, 97.7% and 0.85 for testing of invalid results, and 88.9%, 96.7% and 0.81 with unpooling of positive results.ConclusionWest-African MSM have a high prevalence of extra-genital and asymptomatic STIs. The GeneXpert method provides an opportunity to move from syndromic towards etiological STI diagnosis in low income countries, as the platform is available in all African countries for tuberculosis testing. Pooling will reduce costs of triple site testing.

scholarly journals Current Status of HIV-1 Vaccines

Vaccines ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1026
Author(s):  
Anna Hargrave ◽  
Abu Salim Mustafa ◽  
Asma Hanif ◽  
Javed H. Tunio ◽  
Shumaila Nida M. Hanif
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Global Health ◽  
Low Income ◽  
Vaccine Development ◽  
Low Income Countries ◽  
Current Status ◽  
Health Challenge ◽  
Hiv 1 ◽  
Global Health Challenge

HIV-1 infection and its progression to AIDS remains a significant global health challenge, particularly for low-income countries. Developing a vaccine to prevent HIV-1 infections has proven to be immensely challenging with complex biological acquisition and infection, unforeseen clinical trial disappointments, and funding issues. This paper discusses important landmarks of progress in HIV-1 vaccine development, various vaccine strategies, and clinical trials.

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