Use of antiretroviral therapy in resource-limited countries in 2006: distribution and uptake of first- and second-line regimens

Abstract

This survey has provided valuable information on the uptake of ARTs in developing countries and will help forecast future demand. Reporting for second-line and pediatric antiretroviral therapy should improve as national programs gain more experience. The current availability of active pharmaceutical ingredients appears to be sufficient to meet current demand. Further work is needed for an understanding of switching rates.

A Prospective Study to Evaluate Prescription Pattern of Second Line Antiretroviral Therapy Given to HIV Patients

“…23 A multi country survey by the WHO found highly variable rates of switching to second-line regimens. 24 It seems unlikely that this variability is explained by differences in primary resistance to NRTIs or NNRTIs. In another study which was held in Cambodia includes 70 patients, shows that the most frequent second-line regimen used was ddI+3TC+LPV/r [n = 46, 65.7%].…”

Rapid Development of Antiretroviral Drug Resistance Mutations in HIV-Infected Children Less Than Two Years of Age Initiating Protease Inhibitor-Based Therapy in South Africa

“…Children are one-third as likely to receive ART as adults, 1 and treatment selections are limited by a lack of pediatric formulations, the instability of some liquid formulations at room temperature, and drug interactions during treatment for tuberculosis and bacilli Calmette-Guérin (BCG) coinfections. [2][3][4][5] HIV-infected infants in resource-limited settings are also more likely to have been exposed to short-course or single-dose nevirapine (sdNVP) for prevention of mother-to-child transmission (PMTCT). This exposure may lead to poor virologic outcomes in infants initiating ART with NVP-based regimens, the most common first-line ART regimen in resource-limited settings, as a result of persistent nevirapine-associated resistance mutations.…”

Integrating HIV-1 Pharmacogenomics into the Universal Coverage Health- Care System in Thailand: From Scientific Evidence to Policy

“…In Thailand, the Government Pharmaceutical Organization (GPO) has manufactured a generic fixed-dose combination of stavudine, lamivudine and nevirapine (GPO-VIR S) since 2002 for treating HIV infection [34]. These antiretroviral drugs have been also recommended by the WHO as a first-line regimen, which remains on the list of alternative second line regimens [35]. GPO-VIR S is an inexpensive and effective antiretroviral drug regimen for initiating treatment of naïve patients, but careful assessment for nevirapine-induced skin rash and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/ TEN) [36][37][38], and stavudine-associated lipodystrophy are mandatory [39].…”