AIDS reviews
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HIV vaccine research has recently produced a number of efficacy results, in addition to some promising preclinical developments. Some of these have been surprising, leading to parallel calls for a better understanding of HIV pathogenesis and immunity, while accelerating the number of candidates that can be tested empirically in clinical trials. In this review, we describe the development of three HIV vaccine efficacy trials to date, and highlight some of the possible avenues available for the field of biomedical HIV prevention to proceed.
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Although the availability of antiretroviral therapy has increased rapidly to reach over three million people in low- and middle-income countries, coverage remains low as only 31% of people in need were receiving antiretroviral therapy in sub-Saharan Africa. Antiretroviral therapy scale-up needs to continue to grow exponentially to meet the need for universal access and keep pace with or exceed the new HIV infections. ⋯ In this article we highlight some of the strategies that have optimized HIV treatment outcomes within the constraints of limited resources in sub-Saharan Africa. Key strategies to optimize HIV treatment outcomes include, i) scaling up HIV testing to identify all in need of HIV treatment, ii) strengthening the links between HIV diagnosis and comprehensive HIV/AIDS care, iii) timely initiation of antiretroviral therapy, iv) optimal diagnosis and treatment of opportunistic infections and comorbidities, v) investing in laboratory tests to support clinical monitoring of patients on antiretroviral therapy, vi) maximizing adherence to antiretroviral medication and retention of patients in HIV/AIDS care, viii) improving the health infrastructure, and increasing the human resources to handle the growing numbers of people in need of HIV treatment.
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The objective of this study is to systematically review the epidemiology and the clinical and virologic aspects of multicentric Castleman's disease in HIV-positive patients and to evaluate treatment strategies and outcome, especially in relation to HAART administration. The authors have conducted a systematic review of the English literature for all cases of newly diagnosed multicentric Castleman's disease in HIV-positive patients. The 25 studies which met the selection criteria included 84 HIV-positive patients with multicentric Castleman's disease (20 pre-HAART and 64 post-HAART era). ⋯ Infection, multiorgan failure, Kaposi's sarcoma, non-Hodgkin lymphoma and progressive multicentric Castleman's disease were the most often reported causes of death. In conclusion, multicentric Castleman's disease is a lymphoproliferative disorder with an increasing prevalence in HIV-infected individuals. Even though life expectancy in multicentric Castleman's disease seems to have significantly improved in the HAART era, it remains a disease with a poor prognosis and an increased incidence of non-Hodgkin lymphoma in the HIV-context.
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Administration of standard doses of most antiretroviral drugs results in significant variations in plasma drug concentrations among different individuals, as well as different rates of drug-associated toxicity. The reasons for the large interindividual variability in drug levels are multifactorial, and involve differences in gender metabolism, concomitant medications, drug compliance, underlying diseases, and genetic factors. Pharmacogenetics is the discipline that analyses the genetic basis for the interindividual variation in the body disposition of drugs. ⋯ This variation is due to polymorphisms in the N-acetyltransferase-2 (NAT2) gene, which may split the population into three categories: slow, intermediate, and fast metabolizers. Pharmacogenetic studies conducted so far with antiretrovirals have focused on metabolizing enzymes and transporter proteins in the cell membrane. Herein, we review the genetic polymorphisms known to be associated with altered pharmacokinetics of antiretrovirals, which may influence the efficacy and toxicity of these drugs.
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Antiretroviral (ARV) drugs have become the cornerstone of care and treatment for AIDS in North America, Brazil, and Europe. Twenty years into the epidemic, and more than 10 years after the introduction of ARV's, effective global treatment of AIDS, particularly in sub-Saharan Africa where the epidemic is most concentrated, is an extraordinary challenge. ⋯ Implementation of safe, effective, and equitable access to ARV's in Africa should be cognizant of the guidelines for ARV treatment in the Northern countries. Careful observation and operational research to accrue more African data, and evaluate regional and local solutions to this daunting challenge, will identify new approaches to scaling-up of ARV treatment.