Efficacy Of HAART Research Articles

HIV screening in men and women in Senegal: coverage and associated factors; analysis of the 2017 demographic and health survey

BackgroundDespite the adoption of the provider-initiated HIV testing strategy, the rate of HIV testing is still very low in sub-Saharan Africa. The aim of this study was to assess the factors associated with HIV testing among sexually active women and men in Senegal. Knowledge of HIV status is the gateway to antiretroviral treatment.MethodsA secondary analysis of the 2017 Senegal Demographic and Health Survey (DHS) was performed, using data on sexually active women aged 15–49 and men aged 15–59. The outcome variable was the proportion of women and men who reported ever being tested for HIV in the last 12 months before the survey. Descriptive, bivariate, and multivariable logistic regression analyses were performed to identify the socio-demographic, HIV-knowledge, media exposure, and behavioral factors associated with HIV testing in Senegal.ResultsThe study found that 61.1% (95%CI: 59.2–62.9) of women and 26.2% (95%CI: 24.2–28.3) of men were tested for HIV at the last 12 months. In multivariate analysis, among men the factors independently associated with being tested for HIV were: age groups 20–24 to 40–44 and age group 50–54; a higher level of education; being in the richest household wealth quintile; being married; knowing about the efficacy of HAART during pregnancy; having 2 or more lifetime sex partners and owning a mobile phone. Among women factors independently associated with HIV testing were: being in any age groups versus 15–19; a higher level of education; being in the richest household wealth quintile; being married; knowing about the efficacy of HAART during pregnancy; having any STI in last 12 months; fearing stigma; owning a mobile phone; and having any number of ANC visits, versus none.ConclusionAlthough HIV remains a public health threat, HIV testing’s prevalence is still low in Senegal, making it difficult to interrupt the transmission chain within the community and to reach the UNAIDS goal for 2020 of “90–90-90”. Innovative community-based strategies are needed to address barriers and improve access to HIV testing in Senegal, particularly for men and for the youngest and poorest populations.

Persistent But Not Replicating HIV-1 Cell-Associated DNA in Semen of Long-Term ART Experienced Men

The semen of HIV-1 infected men represents the main vector of HIV-1 spread following sexual transmission of cell-free or cell-associated virions. The present study aimed to assess the impact of HAART on HIV-1 RNA/DNA and on inflammatory environment in the semen of long-term HAART-experienced men. Forty-five paired samples of semen and blood were obtained from 37 consenting men, 10 untreated and 27 under HAART. Blood and seminal HIV RNA and DNA loads were quantified by the Abbott RealTime m2000rt assay and an inhouse real-time PCR protocol, respectively. Tat/rev/nef intra-cellular mRNA was tested by qualitative PCR. Interleukin (IL)- 1β, IL-2, IL-6, IL-7, IL-8, IL-10, GM-CSF and TNFα were quantified in 20 paired samples by Bio-plex® assay. No semen was found HIV RNA positive in men under HAART. Twenty-six percent of semen samples from HAART-experienced men remained positive for HIV DNA. Seminal HIV DNA was significantly associated with the duration of infection and the HIV DNA load in blood. No seminal mononuclear cells were found positive for intracellular HIV RNA in HAART experienced men. All the tested chemokines exhibited significantly higher concentration in semen than in blood in both treated and untreated men. No effect of HAART on cytokines/chimiokines loads was observed. These results demonstrate the efficacy of HAART on the reduction of seminal RNA HIV-1 loads despite the persistence of local inflammation. Moreover, in our hands the seminal cell-associated virus reservoir was not reactivated in an inflammatory environment was not productive and its reactivation seems unlikely.

The child and adolescent with HIV in resource poor countries.

Although sub-Saharan Africa caries the burden of paediatric and adult HIV/AIDS infections, the epidemic is spreading most rapidly in the Middle East and North Africa Region where between 2005 and 2013, AIDS-related deaths increased by 66% in comparison with a worldwide fall of 35%. For the first time, in 2011, more than half of people in need of antiretroviral drugs were receiving them, with coverage reaching 54%; yet only28% of children have access to HIV treatment. This review sought to provide an update of paediatric and adolescent oral HIV/AIDS issues in resource poor countries. To review the literature on paediatric & adolescent HIV with a focus on oral lesions as predictors of HIV infection; as markers of the efficacy of HAART and quality of life; caries risk; management of oral lesions; and epidemiological tests for clinical significance of oral lesions. A search strategy was developed for PubMed to identify papers on paediatric oral HIV. Publications in English were selected on the basis that their titles and abstracts were relevant to the review objectives. The reference lists of included papers were screened for additional articles. The time-search for publications was limited from 2009 to 15 October 2014. Papers on the prevalence of oral lesions lacked standardization in diagnostic criteria and the introduction of HAART had significantly reduced prevalence; oral lesions remain useful predictors for HIV infection and as markers for the efficacy of HAART. Evidence suggest that caries risk is increased with HIV infection; management of oral lesions is inconsistent with available resources and surprisingly little recent information has been published in the past 5 years. Revised case definitions are proposed for large-scale epidemiologic studies with the development of an oral lesion index showing promise. Oral health quality of life indicators for children and adolescents are becoming important as more of these indicators are being developed and their negative oral impacts in individuals with oral lesions are now well established. Paediatric and adolescent oral HIV research needs to be prioritized as current studies are few and are characterized by poor quality study designs, small study samples and a lack of multicentre collaborations. There is a lack of high quality evidence for a number of interventions available for management of oral lesions.

Acquired Immunodeficiency Syndrome - A Pedodontist's Perspective

AIDS was believed to be associated with a certain group of people, later the belief changed when the disease start encroaching other set of people. As science evolved, the knowledge about transmission of the virus grew and the evidences for the maternal transmission of the virus were found. Among children, most cases of infection by HIV are transmitted vertically, i.e., from mother to child. As they have an immature immune system, which may cause the rapid and severe progression. Children who are vertically infected present considerable weight loss, delayed development, delayed dental eruption, fewer permanent teeth, prolonged retention of primary teeth and various number of dental anomalies. The most important comeback by the science was by the establishment of antiretroviral protocols which has reduced the occurrence of oral changes. There been a decline in the rate of HIV-related oral manifestations following the introduction of HAART. Many studies evaluating the efficacy of HAART demonstrated positive results and better lifestyle of the infected children. It is clearly known fact that there are considerable regional variations in the oral manifestations of HIV infection, depending both on the populations studied and on the clinical expertise available, among other factors. This review article explains the manifestations, dental implications and the various treatment regimens to be followed in pediatric patients.

Acquired Immunodeficiency Syndrome – A Pedodontist's Perspective

AIDS was believed to be associated with a certain group of people, later the belief changed when the disease start encroaching other set of people. As science evolved, the knowledge about transmission of the virus grew and the evidences for the maternal transmission of the virus were found. Among children, most cases of infection by HIV are transmitted vertically, i.e., from mother to child. As they have an immature immune system, which may cause the rapid and severe progression. Children who are vertically infected present considerable weight loss, delayed development, delayed dental eruption, fewer permanent teeth, prolonged retention of primary teeth and various number of dental anomalies. The most important comeback by the science was by the establishment of antiretroviral protocols which has reduced the occurrence of oral changes. There been a decline in the rate of HIV-related oral manifestations following the introduction of HAART. Many studies evaluating the efficacy of HAART demonstrated positive results and better lifestyle of the infected children. It is clearly known fact that there are considerable regional variations in the oral manifestations of HIV infection, depending both on the populations studied and on the clinical expertise available, among other factors. This review article explains the manifestations, dental implications and the various treatment regimens to be followed in pediatric patients.

Assessment of Level of Adherence to Anti Retroviral Therapy among Adult HIV Infected Patients in Mekelle Hospital, Northern Ethiopia

Introduction: HIV/AIDS is one of the most destructive epidemics the world has ever witnessed. Non-adherence to the proposed antiretroviral regimen is considered to be one of the greatest dangers to the response to treatment on an individual level and the dissemination of resistant viruses on the community level. An adherent patient is defined as one who takes > 95% of the prescribed doses. Objective: To assess the level of adherence and associated factors among adult HIV/AIDS patients receiving Highly Active Antiretroviral Therapy in Mekelle Hospital, Northern Ethiopia. Methods: A cross sectional study was carried out from January 1, 2013 to July 30, 2013 among 382 adult PLWHA (>=18 years) attending HAART clinic at Mekelle Hospital. Data was collected by a combination of structured questionnaire and document review. The data was entered and cleaned using Epi-Info; transported to SPSS 16.0 version for final analysis. Bivariate and multivariate analyses were performed to identify factors associated with adherence. Results: The rate of self reported adherence in the study based on the Schedule and indicator of the dose, time measurement in the last 7 days was (78.3%). Females were more adhered than males (185(87.7%)). Alcohol users have poor adherence than non alcohol users with 70.5% and 82.2% level of adherence respectively. Sex and educational status of the study participants were significantly associated with level of adherence with AOR (95% CI) of 3.81(2.18, 6.69) and 2.60(1.43, 4.71) respectively. Conclusion: The level adherence we found, 78.2%, is still very low considering the WHO recommendation of 95%. Sex and educational status of the study participants were significantly associated with level of adherence with AOR (95% CI) of 3.81(2.18,6.69) and 2.60(1.43,4.71) respectively. More focus should be given to males and individuals with low educational status to improve level of adherence and to assure the efficacy of HAART in prolonging the life of PLWHA. Adherence is a process, not a single event, and adherence support must, therefore, be integrated into regular clinical follow up. Investigation of factors related with long-term adherence would require longer follow-up than the present study.

P6.067 Five Year Survival of Adult HIV-Infected Patients Initiated on HAART at the AIDS Support Organisation(TASO), Uganda

BackgroundThe AIDS Support Organization (TASO) Antiretroviral Program was rolled out in November 2004. The study aimed to assess adherence status of adult patients surviving for 60 months after HAART initiation...

Transmitted HIV drug resistance in treatment‐naive Romanian patients

Transmitted HIV drug resistance (TDR) remains an important concern for individuals unexposed to antiretroviral treatment. Data on the prevalence of TDR, available mainly for HIV-1 subtype B, are now also emerging for other subtypes. In Romania, a steady predominance of subtype F was reported among both long-term survivor children and newly infected adults. The pol gene of 61 drug-naïve patients infected with HIV, diagnosed between 1997 and 2011 was sequenced in order to analyze the prevalence of primary resistance mutations and to correlate these with the infecting genotype. Only 5/61 specimens were classified as infected recently using the BED-Capture Enzyme Immunoassay. Subtype F1 was prevalent (80.3%), however, other HIV-1 clades are increasingly identified, especially in the group of subjects infected recently. An HIV transmission cluster, associated to injecting drug use was identified by phylogenetic analysis. The overall prevalence of TDR was 14.75%, mainly associated with NRTI resistance (13.11%), TAMs and M184V being the most common mutations. A declining trend of TDR was recorded from 26.08% in 1997-2004 to 7.89% in 2005-2011. No primary resistance was identified among recent seroconvertors. All HIV-1 strains had minor mutations in the protease and RT genes, often detected at polymorphic positions. The declining rates of TDR might be related to the high efficacy of HAART and to the increasing number of treated patients with virological success who have a low risk of transmission. The recent increase of HIV-1 infections which involve other subtypes impose a continuous surveillance of the genetic composition of the epidemic.

Cost‐effectiveness analysis of first‐line HAART

Combining various antiretroviral agents into one single pill (STR, single‐tablet regimen) is a strategy to reduce pill burden, enhance adherence and improve efficacy of HAART. We evaluated STR from a cost‐effectiveness point of view in a large, unselected cohort of patients starting their first HAART. The incremental cost‐effectiveness analysis was carried out by means of a Markov model simulating QoL and costs for a patient, according to the given regimen, through 1‐year cycles. The considered outcome measure was quality‐adjusted life years (QALYs) and all direct health costs were computed. From January 2006 to January 2012, 793 naïve patients started their first regimen at our center and were included in the analysis. They were mostly males (74.5%) with a mean age of 39 years, a baseline mean HIV‐RNA of 200K copies/ml and a mean baseline CD4 count of 292 cells/µL. We adopted several definitions to describe STR use trying to reflect the clinical indications of single‐tablet regimens: a) any EFV‐based regimen followed by STR treatment; b) TDF + FTC + EFV followed by STR; c) any HAART regimen followed by STR; d) use since the beginning of STR. We run the analysis for each of these different STR treatment definitions and compared the results with those of two different control groups: patients receiving a PI‐based OD treatment or patients receiving a PI‐based BID treatment. For the considered definitions of STR, the mean year‐cost per patient ranged from 6,766 to 7,083€ with a mean per patient QALYs ranging from 0.955 to 0.973. In the case of OD PI‐based regimens the cost range was from 8,484 to 8,532€ and the QALYs mean varied from 0.923 to 0.925. The same values for BID PI‐based regimens were from 8,040 to 8,303€ and from 0.930 to 0.931. In all cases STR dominated (i.e. was more effective and less costly) any comparator HAART regimen. The incremental cost‐effectiveness ratio (ICER) values comparing the different STR definitions are reported in the table. STR compared to boosted PI‐based regimens either OD or BID resulted highly cost‐effective showing in any case the lowest cost and the best efficacy as measured by QALYs. The comparison of different strategies including STR use revealed that starting with an STR regimen is cost‐effective compared to simplification strategies, assuming a commonly internationally accepted threshold of 50.000€ to define cost‐effectiveness. Treatment C Mean cost per patient E Mean QALYs per patient Delta C Delta Cost Delta E Delta QALYs DC/DE ICER QALYs OD EFV ‐ based HAART? switch STR €6.766 0,960 Start with STR €7.083 0.973 317 0,013 €23.770 TDF+FTC+EFV? switch STR €6.867 0,961 Start with STR €7.083 0,973 216 0.012 €17.783 Any HAART? switch STR €6.947 0,955 Start with STR €7.083 0,973 136 0,018 €7.555

Adherence, appropriateness and effectiveness of HAART in HIV patients treated at the ‘Amedeo di Savoia’ Hospital

Background‘Amedeo di Savoia’ Hospital is the regional centre in Piedmont for HIV infection diagnosis and treatment. A multidisciplinary team, Infectiologists, Pharmacists, Nurses, and Psychologists are working to optimise the clinical...

5-year survival of adult HIV-infected patients initiated on HAART in Uganda

Background: The AIDS Support Organization (TASO) Antiretroviral Program was rolled out in November 2004. The study aimed to assess adherence status of adult patients surviving for 60 months after HAART initiation in a resource-poor setting. Methodology: Retrospective cohort study of adult patients who initiated HAART 60 months prior to the date of data abstraction at TASO Soroti, Eastern Uganda. Participants included in the study were male and female adult (≥14 years) patients who initiated HAART at TASO Soroti (between 1st August 2005 to 31st March 2012). Among the 5317 HIV-infected patients who initiated HAART through 31 March 2012, 4827 adults who started HAART prior to data abstraction were included in the analysis. Since 2005 TASO Soroti has been providing HAART free of charge to patients either at World Health Organization (WHO) stage III or IV irrespective of CD4 cell count, or at any WHO stage with CD4 cell counts ≤350 cells/μl. HAART initiation began with pre-HAART counseling visits for psychosocial assessment. Follow-up visits were performed for the first 2 weeks and 1 month at the facility and thereafter patients were attached to community drug distribution points (CDDPs). At CDDPs patients were given two-monthly refills and thereafter with CD4 counts review at 6-month intervals and adherence support counseling at each visit. The primary outcomes were survival, continuation of HAART, and adherence at 60 months. Results: Of the 4827 adult patients included in the analysis, 32.1% were male and the median age was 43 years. 67.9% were female and the median age was 41 years. 94.9% of patient were HAART-naive, 5.1% were transfer-in. 3913 (81.1%) of 4827 patients were still on HAART after 5 years of follow-up. 18.9% difference is attributed to lost to follow-up, patient transferred out and reported deaths. Among the patients with adherence assessment reported, 96.6% of patients had adherence level >95%, 1.5% had adherence level of 85%-95% and 1% had adherence <85%. 74.5% patients received their HAART refills at the CDDP, 23.8% received refills at the facility, and 1.4% received refills at their homes. Conclusions: These positive results after 5 years of initiating HAART in patients with advanced HIV disease demonstrate efficacy of HAART in resource-limited settings. Additional support is required to ensure timely HAART among adults.

Impact of the efficacy of HAART for AIDS combined of oral fungal infections

Objective To explore the efficacy of HAART for AIDS combined of oral fungal infection. Methods 60 AIDS patients combined with fungal infection were selected and divided into therapy group (n =30) and control group (n = 30) by HAART criteria. Individuals in control group were treated with routine care, including washing mouth by 2％ sodium bicarbonate, Smearing glycerol reducing mold on local skin, and taking fluconazole or itraconazole capsules 100 mg orally, and all above were taken twice a day, meanwhile nutrition therapy and oral nursing were strengthened. Therapy group were treated with HAART on the base of routine care. Results Effect rate between the two groups was significantly different (X2 = 6. 667, P ＜ 0. 05). Cure rate and recurrence rate were also different (X2 = 4. 286,4. 356; P ＜ 0. 05). Conclusions Application of HAART on the basis of routine care for AIDS combined of oral fungal infections has better efficacy and lower recurrence rate and improve the clinical symptom and raise the life quality of the patients. Key words: HAART; Highly effect; AIDS; Fungal; Infection control

Mother-to-Child Transmission (MTCT) of HIV and Drugs of Abuse in Post-Highly Active Antiretroviral Therapy (HAART) Era

In the pre-highly active antiretroviral therapy (HAART) era, prenatal "vertical" mother-to-child transmission (MTCT) of HIV was about 25% and exposure of pregnant mothers to drugs of abuse (illicit drugs and tobacco smoking) was a significant contributory factor of MTCT. However, with the introduction of HAART, the rate of MTCT of HIV has decreased to less that 2%. But, it is estimated that currently about 5.1% of pregnant women use illicit drugs and 16.4% smoke tobacco. The residual prevalence of MTCT is of concern and may be related to this continued prevalence of substance use among pregnant mothers. In this report, we review and present evidence that supports the hypothesis that drugs of abuse do have the potential to increase MTCT of HIV in the presence of HAART. Exposure to drugs of abuse during pregnancy may increase MTCT of HIV through a variety of mechanisms that are addressed in detail including possible damage to the placenta, induction of preterm birth, and increasing maternal plasma viral load though a variety of putative mechanisms such as: (a) promoting HIV replication in monocyte/macrophages; (b) increasing the expression of CCR5 receptors; (c) decreasing the expression of CCR5 receptor ligands; (d) increasing the expression of CXCR4 receptors; (e) increasing the expression of DC-SIGN; (f) impairing the efficacy of HAART through drug-drug interaction; and (g) promoting HIV mutation and replication through non-adherence to HAART.

Tolerability of antiretroviral therapy (HAART) in elderly age

Background The median age of people living with HIV/AIDS is increasing: while efficacy of HAART has reduced mortality and prolonged the life of patients, low perception of risk and new late diagnosis are related to infection in an elderly age. Most new late diagnosis are performed in older hardly immuno-compromised subjects; the development of opportunistic diseases complicates management of therapeutic strategies (drugs interactions, cumulative toxicities, hypersensitivity reaction), mainly in presence of comorbities. Most randomized clinical trials with new drugs tend to avoid the enrolment of >50 years patients with proper comorbities of old age. So the few data we can analyze come from observational cohorts. While it is well defined that older people are more adherent to treatment and achieved an adequate control of HIV-RNA viremia more frequently than younger although an incomplete immuno-reconstitution, the development of drug toxicity with higher frequency is controversial. Elderly people are more frequent to show reduced hepatic and kidney function, frequently have comorbities requesting new therapies with a higher pill burden and higher risk of drug interactions. Most antiretroviral drugs are metabolized by cytochrome system. Treatment may accelerate mitochondrial dysfunction, nucleoside reverse transcriptase inhibitors may contribute to muscle wasting. Some typical side effects of HAART such as body change and facial lypoatrophy could be more evident when associated with natural facial changes occurring with aging and modify negatively self perceived body image and relationship capacity. Age was also shown to increase the risk of renal tubular disease in association with tenofovir. Age is one of the major cardio-vascular disease (CVD) risk factors and the inflammatory component may contribute to this increased risk despite HAART efficacy. The risk of myocardial infarctions is increased in older treated HIV+ patients: metabolic abnormalities are more frequent at baseline and the treatment could increase the cumulative risk of CVD.

The effect of HAART to serum soluble interleukin-2 receptors in AIDS patients

To approach the effect of HAART to serum soluble interleukin-2 receptors in AIDS patients. 90 cases of AIDS patients were chosen for detection of their slL-2R levels by enzyme-linked immunosorbent assay (ELISA), peripheral blood CD4 T cell counts by flow cytometry and viral load by Branch DNA amplification. The slL-2R levels were (3154 +/- 905) m9icrog/ml before HAART and (2216 +/- 884) pg/ml after( P < 0.001), After HAART, the sIL-2R levels were(2846 +/- 963) microg/ml in ineffective HAART group and (1879 +/- 875) pg/ml in effective HAART group (P < 0.001). The serum sIL-2R levels of AIDS patients were lowered by effective HAART, and it could judge the efficacy of HAART in same extent.

Efficacy and safety of TDF/FTC-containing first-line HAART in clinical practice – 2-year data from the German Outpatient Cohort

Poster presentation: Purpose of the study First-line HAART with tenofovir DF (TDF) and FTC in pivotal trials has been associated with high efficacy and good tolerability. However, real-life clinical practice often differs from clinical trials due to co-morbidities, co-infections, and less intensive clinical monitoring. To evaluate efficacy and safety of first-line HAART in a day-to-day setting, this Gilead-sponsored non-interventional cohort was established. Methods Between July 2005 and August 2006, 533 HIV-1 infected antiretroviral-naive patients from 50 German centres enrolled in this non-interventional cohort. All patients were followed every 3 months for 3 years to monitor efficacy (viral load [VL], CD4), tolerability, renal safety, regimen changes and resistance profile. All patients received TDF+FTC as a single tablet (Truvada, TVD) in combination with either an NNRTI or PI/r as their first antiretroviral regimen. Summary of results As of June 2008, 2 years of therapy have been documented for 330/533 (62%) patients. At treatment initiation, 81% were male; median age was 39 years; clinical AIDS diagnosis was documented in 22%; 47% started therapy with CD4 <200 cells/mm3. TVD was combined with an NNRTI (43%) or a PI/r (57%). After 24 months, in an As-Treated (AT) analysis, 85% patients achieved a VL <50 copies/ml (VL <500 copies/ml: 97%), median CD4 count increased from 217 at baseline to 450 cells/mm3 (IQR: 325–608). Truvada showed a good safety profile; 76 adverse events (AEs) of any grade were reported in 66/533 patients (12%); six of these were judged serious. Fourteen (2.6%) patients discontinued TVD due to AEs. Renal abnormalities of any grade were reported in 10 patients (1.9%). Virological failure was documented in nine patients, of which eight were genotyped; M184V/I was detected in three, K65R in two patients. Conclusion During 2 years of follow-up, the overall safety of TVD was good; renal AEs of any grade were reported in 1.9% of patients. K65R was detected in two patients. First-line HAART with TVD plus an NNRTI or PI/r in clinical practice showed comparable efficacy to that observed in controlled clinical trials.

HAART in HIV+ naive elderly patients: immuno-virological response and clinical outcome

Purpose of the study Elderly patients (≥50 years) are increasing in the HIV population; HAART-related prolonged survival and late diagnosis of new HIV infections are possible reasons of this findings. It is debated whether older patients have a different response to HAART. The aim of this retrospective study was to evaluate efficacy of HAART and clinical outcome in a group of patients ≥50 year in comparison to a control group (<50 years-old).

Positive outcomes of HAART at 24 months in HIV-infected patients in Cambodia

African and Asian cohort studies have demonstrated the feasibility and efficacy of HAART in resource-poor settings. The long-term virological outcome and clinico-immunological criteria of success remain important questions. We report the outcomes at 24 months of antiretroviral therapy (ART) in patients treated in a Médecins Sans Frontières/Ministry of Health programme in Cambodia. Adults who started HAART 24 +/- 2 months ago were included. Plasma HIV-RNA levels were assessed by real-time polymerase chain reaction. Factors associated with virological failure were analysed using logistic regression. Of 416 patients, 59.2% were men; the median age was 33.6 years. At baseline, 95.2% were ART naive, 48.9% were at WHO stage IV, and 41.6% had a body mass index less than 18 kg/m. The median CD4 cell count was 11 cells/microl. A stavudine-lamivudine-efavirenz-containing regimen was initiated predominantly (81.0%). At follow-up (median 23.8 months), 350 (84.1%) were still on HAART, 53 (12.7%) had died, six (1.4%) were transferred, and seven (1.7%) were lost to follow-up. Estimates of survival were 85.5% at 24 months. Of 346 tested patients, 259 (74.1%) had CD4 cell counts greater than 200 cells/microl and 306 (88.4%) had viral loads of less than 400 copies/ml. Factors associated with virological failure at 24 months were non-antiretroviral naive, an insufficient CD4 cell gain of less than 350 cells/microl or a low trough plasma ART concentration. In an intention-to-treat analysis, 73.6% of patients were successfully treated. Positive results after 2 years of advanced HIV further demonstrate the efficacy of HAART in the medium term in resource-limited settings.

HIV, infant feeding, and survival: old wine in new bottles, but brimming with promise

A string of new studies most of which have been presented at international meetings and are as yet unpublished have resulted in a gathering momentum of interest in HIV and infant feeding. In rich and some middle-income countries transmission of HIV antenatally and during labour and delivery has been substantially reduced by antiretrovirals and other interventions. Postnatal transmission was prevented by advising against breastfeeding; the alternative was replacement feeding with formula milks as these could be safely prepared were affordable and were culturally acceptable. The discourse on formula feeding or breastfeeding by HIV-positive mothers in developing countries has been mired in confusion or locked in robust disagreement. WHO/UNICEF/UNAIDS guidelines offered a framework for making choices based on socioeconomic conditions and household capability to prepare formula hygienically. The difficulty in the field was to offer an optimum balance of choices between the two types of milk feeding. Exclusive breastfeeding for 6 months is the recommendation for those choosing breastfeeding. Recent data from ongoing and completed studies in Africa have suggested that the effects of avoidance of breastfeeding or cessation even at 6 months by HIV-positive mothers can be disastrous. This finding repeats what has been and remains the bedrock of public health policy for infants and children well before the HIV epidemic and recognized through centuries of human experience. The new findings have led to the WHO refining its Guidelines on HIV and Infant Feeding in late 2006. (excerpt)

The nephrologist in the HAART era

The nephrologist in the HAART era