Pharmacoepidemiological Approach to the Predisposing Factors for Highly Active Antiretroviral Therapy Failure in an Hiv-Positive Cohort from Cordoba City (Argentina) 1995–2005

Abstract

Highly active antiretroviral therapy (HAART) restores immunity, avoids resistance and delays disease progression. Nonetheless, adverse medicament reactions (AMRs) and therapeutic failure (TF) are still deleterious events. Consequently, their predisposing factors should be evaluated. Data from 181 men and 28 women of an Argentinean cohort (1995-2005) were collected and analysed by logistic regression, studying 63 schemes (15 active principles). The AMRs were the main cause of scheme change, followed by TF and medicament simplification, without influence of age and sex. Twenty-nine schemes exhibited TF at least once. Compared with zidovudine-lamivudine-nevirapine (success: >75%), the following schemes fail more frequently (P < 0.01): pre-HAART (8-fold), indinavir-containing ones (30-fold) and retrotranscriptase inhibitors with > or =3 protease inhibitors (11-fold). Inadequate patient adherence preceded failure (>95%), but not successful treatments, with a strong AMR-TF association (P < 0.005). Although some schemes had inherently increased TF, low adherence, drug toxicity and TF were critically interrelated, interfering with HAART goals.

Implementation and uptake of the Conexiones y Opciones en la Argentina intervention: feasibility and acceptability

“…Such challenging patients remain a critical intervention target if the HIV epidemic is to be contained (NIH, 2015; Cohen et al, 2011; Soria et al, 2008; Ullet et al, 2009). Uptake of evidence-based interventions in the clinical setting remains the Achilles heel of HIV treatment, and to optimize treatment outcomes, studies must address feasibility and acceptability to ensure their effective implementation.…”

“…In Argentina, 31% of men and 23% of women in Argentina had delayed treatment onset (Crabtree-Ramirez et al, 2011; Ministerio de Salud, 2014), and only 51% had achieved viral suppression (Ministerio de Salud, 2014). Challenging patients, those neither adherent nor engaged in care, necessitate intervention if the HIV epidemic is to be contained (Cohen et al, 2011; NIH, 2015; Soria, Cadille, & Allende, 2008; Ullet et al, 2009).…”

Assessment of Colorectal Cancer Prognosis Through Nuclear Morphometry

“…Due to their complexity, long-term illnesses with polymorphic clinical expression need to be studied exhaustively, using integrated biological, clinical, and epidemiological data, to improve the prognostic and therapeutic assessments [21]. It is possible that morphometric nuclear evaluations may be done in samples obtained from colorectal biopsies before surgery to permit the analysis of a larger number of nuclei, identify premalignant conditions, and provide predictive data.…”

HIV-Antiretroviral Therapy Induced Liver, Gastrointestinal, and Pancreatic Injury

“…Increases in liver enzymes are also common ADRs characteristic of different ART regimens (Table 1) [20, 28–35, 66]. Increases in alanine aminotransferase (ALT) or/and aspartate aminotransferase (AST) are common symptoms of hepatotoxicity, while increases in alkaline phosphatase and γ -glutamyl transpeptidase were indicative of cholestasis in one study [66].…”

“…Nevirapine is usually substituted with efavirenz in HSR cases [42]. Dermal lesions were observed only in combinations that contained nevirapine and lamivudine in one study [66]. There was a higher incidence of severe rashes (grade ≥3) among nevirapine patients, compared to nonnevirapine patients ( P = 0.002) in another study.…”