Combination Antiretroviral Therapy and Recent Declines in AIDS Incidence and Mortality

Abstract

The reasons for recent declines in AIDS incidence and mortality may include advances in treatment, but these may be confounded by earlier declines in the incidence of human immunodeficiency virus (HIV) infection. To determine whether the declines in AIDS and mortality may, in part, stem from wider use of combination antiretroviral therapy, 622 HIV-positive men with well-characterized dates of seroconversion were followed. In this group, combination therapy came into widespread use in only 1996. In a Cox proportional hazards model, the 1996 calendar period was significantly associated with slower progression to AIDS (relative hazard [RH]=0. 19, 95% confidence interval [CI], 0.05-0.69, P=.01) and death (RH=0. 45, 95% CI, 0.21-0.95, P=.04). Declines in incidence of HIV infection, changes in HIV virulence, and end-point underreporting cannot fully explain the decline in AIDS and death in 1996. The introduction of combination antiretroviral therapy as the standard of care may already have had measurable effects.

Directly Observed versus Self-administered Antiretroviral Therapies: Preference of HIV-Positive Jailed Inmates in San Francisco

“…HIV treatment with ARV therapy can substantially decrease morbidity and mortality and reduce the rate of HIV transmission. [33][34][35][36][37][38][39][40] Approximately 16.9% of all HIV-positive individuals are in the U.S. criminal justice system 41 ; therefore, interventions that improve ARV uptake, as well as ARV adherence and persistence after release from jails and prisons have the potential to curtail the HIV epidemic by decreasing HIV transmission to others. This is particularly relevant given the deleterious effect of short-term incarceration and release on virologic outcomes [42][43][44] and the high frequency of self-reported HIV-related risky behaviors of newly released HIV-positive inmates.…”

Estudo da síndrome da ceratoconjuntivite seca de pacientes soropositivos para o vírus da imunodeficiência adquirida humana tipo 1 e com síndrome da imunodeficiência adquirida, em uso ou não de terapia anti-retroviral combinada (HAART)

“…As doenças associadas a AIDS apresentaram uma queda significativa no que diz respeito às manifestações oculares internas após a introdução do HAART (22) ; contudo, o mesmo não foi observado com relação às manifestações oculares externas. Neste estudo, a freqüência de olho seco foi superior a 20 %, comparável a vários estudos em pacientes com teste anti-HIV positivo, anterior ao HAART, que já relatavam a alta Grupo I -pacientes HIV+ (sem diagnóstico clínico e laboratorial de AIDS); Grupo II -pacientes com AIDS (manifestação clínica e/ou contagem de TCD4+ abaixo de 200 células/mm³).…”

Drug Interactions Between Antiretroviral Drugs and Comedicated Agents

“…[1][2][3] Antiretroviral therapy generally involves combination therapy and consists typically of three or four drugs, in most cases from different drug classes. [4] Although regimens have recently become more convenient after the reduction in dietary restrictions and pill burden due to (i) the implementation of boosting protease inhibitors (PIs) with ritonavir [4,5] and (ii) the introduction of coformulations (lopinavir and ritonavir [Kaletra 1 ]; lamivudine, zidovudine, and abacavir [Trizivir ® ]; lamivudine and zidovudine [Combivir ® ]), the treatment still requires much attention.…”