Clinical Management of HIV Drug Resistance

Abstract

Combination antiretroviral therapy for HIV-1 infection has resulted in profound reductions in viremia and is associated with marked improvements in morbidity and mortality. Therapy is not curative, however, and prolonged therapy is complicated by drug toxicity and the emergence of drug resistance. Management of clinical drug resistance requires in depth evaluation, and includes extensive history, physical examination and laboratory studies. Appropriate use of resistance testing provides valuable information useful in constructing regimens for treatment-experienced individuals with viremia during therapy. This review outlines the emergence of drug resistance in vivo, and describes clinical evaluation and therapeutic options of the individual with rebound viremia during therapy.

Porphyrin-based cationic amphiphilic photosensitisers as potential anticancer, antimicrobial and immunosuppressive agents

“…However, although very safe and effective, the use of target-specific drugs (e.g. specifically against cell-wall, virus polymerase or protease) has inevitably led to the emergence of resistant clones, thus becoming a global threat (Bacon et al 2003;Coen and Whitley 2011;Cortez et al 2011;Memoli et al 2011). Due to ROS-mediated targeting of microbial membranes, membrane proteins, DNA, etc., of various pathogens, PACT represents a broad-spectrum multitargeted approach with very limited, if any, chances for the development of resistant bacteria or viruses (Jori et al 2006, Tavares et al 2010Costa et al 2012b;Dosselli et al 2012;Maisch 2015).…”

Selection of an Antiretroviral Regimen Based on the Resistance Data

“…Оба вида резистентности снижают эффек-тивность терапии у отдельного человека и у популяции в целом [7]. Доступные опции АРТ многообразны, но не безграничны.…”

“…В новый список были СОЦИАЛЬНО ЗНАЧИМЫЕ ИНФЕКЦИИ Резистентность разделяют на приобретен-ную, то есть возникшую за счет мутаций ви-руса на фоне приема АРТ , и на передаваемую (первичную, трансмиссивную), то есть пере-данную ранее не инфицированному человеку. Оба вида резистентности снижают эффек-тивность терапии у отдельного человека и у популяции в целом [7]. Доступные опции АРТ многообразны, но не безграничны.…”

The emergence of drug resistant HIV variants and novel anti–retroviral therapy

“…Such clinical drug resistance arises from the residual replication of mutant viral quasi-species that have endured incomplete suppressive drug regimens [32] . In the case of most ARV agents, cumulative effects of several mutations are required to result in clinical resistance; however, single mutations could also confer resistance to certain agents such as NNRTIs and NRTIs [33] . For example, there are certain mutations that confer resistance to NNRTIs and specifically found in the binding site of the RT gene (e.g.…”

“…With this weakened immune system, opportunistic infections may easily invade the immune-deficient host during advanced stages of the HIV infection. More than 33 million people were living with HIV infection at the end 2008 [7] .…”