Advanced HIV: diagnosis, treatment, and prevention

Prabhu, Sandeep; Harwell, Joseph I.; Kumarasamy, Nagalingeswaran

doi:10.1016/s2352-3018(19)30189-4

Cited by 53 publications

(44 citation statements)

References 75 publications

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“…Patients with advanced HIV disease should be screened for TB and cryptococcus and provided with prophylaxis, given the high mortality rates associated with these coinfections. Future guidance should consider whether additional interventions should be included, especially to reduce the risk of mortality associated with severe bacterial infections [17,60] and to identify potentially serious coinfection at an earlier stage before symptoms develop [61].…”

Section: Managing Advanced Hiv Diseasementioning

confidence: 99%

Emerging priorities for HIV service delivery

Ford

Geng²,

Ellman

et al. 2020

PLoS Med

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Section: Managing Advanced Hiv Diseasementioning

confidence: 99%

Emerging priorities for HIV service delivery

Ford

Geng²,

Ellman

et al. 2020

PLoS Med

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“…It has been 32 years since the first antiretroviral drug, zidovudine (ZDV, formerly called AZT), was introduced to treat HIV infection. The increasing accessibility and use of antiretroviral therapy (ART) can suppress the HIV viral load to undetectable levels and to increase the CD4 + T‐cell counts; therefore, the acquired immunodeficiency syndrome (AIDS)‐related morbidity and mortality in HIV‐1‐infected individuals is sharply diminished . However, in some patients, optimal treatment and persistent suppression of viral replication fail to restore their CD4 + T‐cell counts.…”

Section: Introductionmentioning

confidence: 99%

Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders

Yang

Zhang

et al. 2020

Journal of Leukocyte Biology

212

214

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The morbidity and mortality of HIV type‐1 (HIV‐1)‐related diseases were dramatically diminished by the grounds of the introduction of potent antiretroviral therapy, which induces persistent suppression of HIV‐1 replication and gradual recovery of CD4+ T‐cell counts. However, ∼10–40% of HIV‐1‐infected individuals fail to achieve normalization of CD4+ T‐cell counts despite persistent virological suppression. These patients are referred to as “inadequate immunological responders,” “immunodiscordant responders,” or “immunological non‐responders (INRs)” who show severe immunological dysfunction. Indeed, INRs are at an increased risk of clinical progression to AIDS and non‐AIDS events and present higher rates of mortality than HIV‐1‐infected individuals with adequate immune reconstitution. To date, the underlying mechanism of incomplete immune reconstitution in HIV‐1‐infected patients has not been fully elucidated. In light of this limitation, it is of substantial practical significance to deeply understand the mechanism of immune reconstitution and design effective individualized treatment strategies. Therefore, in this review, we aim to highlight the mechanism and risk factors of incomplete immune reconstitution and strategies to intervene.

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“…The results obtained suggest that LPV/r-based ART has a good efficacy and adverse event profile for the Chinese treatment naïve patients with HIV-1 infection. ART greatly improves the prognosis of HIV-infected patients, but factors such as adverse drug reactions, inadequate compliance, and drug resistance increase the likelihood of clinical and virological failure (Ghosn et al, 2018;Prabhu et al, 2019). LPV/r still plays a key role in treatment in developing countries, despite being an old drug that is no longer recommended for first-line treatment in Western countries, in which it is more widely used as a second-line therapy (Developed by the DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents, 2019).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Tolerability of Lopinavir/Ritonavir- and Efavirenz-Based Initial Antiretroviral Therapy in HIV-1-Infected Patients in a Tertiary Care Hospital in Beijing, China

Wang

Zhou

et al. 2019

Front. Pharmacol.

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Background: Lopinavir/ritonavir (LPV/r) is a major antiretroviral treatment in China, but little is known about the performance of first-line LPV/r-based regimen in treatment-naïve patients with human immunodeficiency virus type 1 (HIV-1) infection. This study aims to assess the efficacy and adverse effect events of LPV/r plus lamivudine and tenofovir or zidovudine as an initial antiretroviral treatment in HIV-1-infected individuals for whom cannot take efavirenz (EFV) or is allergic to EFV. Methods:We performed a retrospective study of patients registering with the China's National Free Antiretroviral Treatment Program from July 2012 to January 2017, followed at a tertiary care hospital in Beijing, China. The primary outcome was the proportion of subjects with HIV-1 RNA ≤40 copies/ml at 6 and 24 months of treatment. We assessed the immunological response and adverse events.Results: In total, 4,862 patients were enrolled in the study and 237 were eligible for analysis in each study arm. During the first six months, virological suppression was better with the LPV/r-based regimen than with the EFV-based regimen (93.80 vs 87.80% for P < 0.05). Viral suppression rates continued to increase until 12 months, remain steady thereafter until 24 months, for both groups. The multilevel analysis revealed that patients in the LPV/r group were more likely to display improvements in CD4 T-cell count over time than those in the EFV group (P < 0.001). Grade 3 or 4 laboratory adverse events were observed in 14 patients (5.91%) from the LPV/r group and three patients (1.20%) in EFV group.Conclusion: Our findings demonstrate that LPV/r-containing regimens are effective and well-tolerated in Chinese treatment-naïve patients with HIV-1 infection.

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Advanced HIV: diagnosis, treatment, and prevention

Cited by 53 publications

References 75 publications

Emerging priorities for HIV service delivery

Emerging priorities for HIV service delivery

Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders

Efficacy and Tolerability of Lopinavir/Ritonavir- and Efavirenz-Based Initial Antiretroviral Therapy in HIV-1-Infected Patients in a Tertiary Care Hospital in Beijing, China

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