The impact of initial highly active antiretroviral therapy on future treatment sequences in HIV infection

Klein, Marina B.; Willemot, Patrick; Murphy, Tanya; Lalonde, Richard

doi:10.1097/00002030-200409240-00005

Cited by 27 publications

(15 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Cohort studies have shown that the use of NNRTI-based HAART as initial antiretroviral treatment resulted in a more durable response and lower rate of failure [9] and higher rates of viral suppression in comparison with single-PI regimens even after controlling for adherence [10]. In addition, subjects treated with NNRTI exhibited a lower risk of virological failure in comparison with PI-treated patients with comparable levels of adherence [11].…”

Section: Discussionmentioning

confidence: 99%

Residual viraemia in subjects with chronic HIV infection and viral load < 50 copies/ml: the impact of highly active antiretroviral therapy

Palmisano

Giuliano

Nicastri

et al. 2005

Aids

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Residual viraemia in subjects with chronic HIV infection and viral load < 50 copies/ml: the impact of highly active antiretroviral therapy

Palmisano

Giuliano

Nicastri

et al. 2005

Aids

View full text Add to dashboard Cite

show abstract

“…[30] Similar trends have been observed for first-line therapy, in that subjects starting NNRTI therapy remained on their initial regimens longer (median time to change 2.1 vs 1.6 years; log rank p = 0.03) compared with PI-based therapy. [31] However, such broad statements need to be interpreted with caution, given the individual toxicity profiles of drugs within both the NNRTI and PI drug classes.…”

Section: Specific Toxicity Profiles Of Nnrti Drugs: Efavirenz and Nevmentioning

confidence: 99%

Do Non-Nucleoside Reverse Transcriptase Inhibitors Contribute to Lipodystrophy?

Nolan

2005

Drug Safety

View full text Add to dashboard Cite

Abstract:Lipodystrophy complications, including lipoatrophy (pathological fat loss) and metabolic complications, have emerged as important long-term toxicities associated with antiretroviral therapy in the current era. The wealth of data that has accumulated over the past 6 years has now clarified the contribution of specific antiretroviral drugs to the risk of these clinical endpoints, with evidence that lipoatrophy is strongly associated with the choice of nucleoside reverse transcriptase inhibitor therapy (specifically, stavudine and to a lesser extent zidovudine). The aetiological basis of metabolic complications of antiretroviral therapy has proven to be complex, in that the risk appears to be modulated by a number of lifestyle factors that have made the metabolic syndrome highly prevalent in the general population, with additional contributions from HIV disease status itself, as well as from individual drugs within the HIV protease inhibitor class. The currently licensed non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs, efavirenz and nevirapine, have been proven to have a favourable safety profile in terms of lipodystrophy complications. However, it must be noted that NNRTI drugs also have individual toxicity profiles that must be accounted for when considering and/or monitoring their use in the treatment of HIV infection. Full Text:This review will focus specifically on the topic of non-nucleoside reverse transcriptase inhibitor (NNRTI) therapy and its possible association with lipodystrophy complications in patients with HIV. Given the multifactorial nature of the HIV lipodystrophy syndrome, which encompasses a number of complications including lipoatrophy and visceral and/or localised fat accumulation, as well as metabolic complications, it is gratifying to be able to provide a simple negative answer to the question under review here. In short, NNRTI drugs do not contribute to the risk of any component of lipodystrophy--indeed, nevirapine and efavirenz have emerged as having unexpected beneficial effects on lipid profiles, so that they may have a role in the management of metabolic complications that have arisen in the presence of other antiretroviral drugs.However, it remains important to consider the factors that do contribute to the various manifestations of HIV lipodystrophy in order to understand the potential benefits that may be expected with NNRTI therapy. For example, the concept of 'switching' from HIV protease inhibitors (PIs) to NNRTI drugs has been advocated for some time as a potential remedy for lipodystrophy complications. Here, we will examine the evidence suggesting that this strategy may be a rational approach to managing metabolic complications, particularly the atherogenic lipid profile characterised by reduced high-density lipoprotein (HDL)-cholesterol levels, but that lipoatrophy is unlikely to improve in this scenario. Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) Therapy and LipoatrophyEnormous progress has been made in understanding the 'lipodystrophy syndr...

show abstract

“…In addition, 91% of patients with these two response predictors had at least a 0.5 log 10 viral load reduction by week 2 with a maximum treatment response of 2.03 log 10 . Consistent with earlier studies, bevirimat was well-tolerated, with a safety profile comparable to placebo through the 14 days of treatment.…”

Section: Clinical Trials and Current Status Of Bevirimatmentioning

confidence: 98%

“…8 Introduction of highly active antiretroviral therapy (HAART), which employs a combination of drugs with different targets, was a major beneficial advance that improved both the quality and length of patient survival. 9,10 However, virus isolates resistant to the approved drugs eventually appear and reduce the choice and effectiveness of treatment options. 11 It is estimated that up to 78% of HIV-1-infected individuals harbour drug-resistant virus with a rapidly growing subgroup (5-10%) exhibiting resistance to all classes of RT and PR inhibitors.…”

Section: Introductionmentioning

confidence: 99%

“…Incremental chain lengthening significantly influenced the anti-HIV potency of the derivatives. 4 Compounds with amide side chains between aminooctanoic acid and aminododecanoic acid (7)(8)(9)(10)(11) carbons between the C-28 amide moiety and the terminal carboxylic acid group) showed much increased antiviral potency. 40 Introduction of a second aminoalkanoic acid at the end of these C-28 o-aminoalkanoic acid derivatives could further modulate the antiviral potency.…”

Section: Introduction Of C-28 Side Chain Into Bamentioning

confidence: 99%

See 1 more Smart Citation

From Natural Product to Clinical Trials: Bevirimat, a Plant-Derived Anti-AIDS Drug

Qian

Nitz²,

et al. 2009

Natural Product Chemistry for Drug Discovery

View full text Add to dashboard Cite

The impact of initial highly active antiretroviral therapy on future treatment sequences in HIV infection

Abstract: There is a high rate of treatment modification among patients initiating HAART. The initial use of NNRTI-based HAART was associated with more durable treatment and lower rates of virological failure, which may translate into a reduced need for multiple salvage therapies.

Cited by 27 publications

References 23 publications

Residual viraemia in subjects with chronic HIV infection and viral load < 50 copies/ml: the impact of highly active antiretroviral therapy

Residual viraemia in subjects with chronic HIV infection and viral load < 50 copies/ml: the impact of highly active antiretroviral therapy

Do Non-Nucleoside Reverse Transcriptase Inhibitors Contribute to Lipodystrophy?

From Natural Product to Clinical Trials: Bevirimat, a Plant-Derived Anti-AIDS Drug

Contact Info

Product

Resources

About