Suchergebnisse

BackgroundLack of adherence to antiretroviral medications is one of the key challenges for paediatric HIV care and treatment programmes. There are few hands‐on opportunities for healthcare workers to gain awareness of the psychosocial and logistic challenges that caregivers face when administering daily antiretroviral therapy to children. This article describes an educational activity that allows healthcare workers to simulate this caregiver role.MethodsPaediatric formulations of several antiretroviral medications were dispensed to a convenience sample of staff at the Baylor College of Medicine‐Bristol‐Myers Squibb Children's Clinical Center of Excellence in Mbabane, Swaziland. The amounts of the medications remaining were collected and measured one week later. Adherence rates were calculated. Following the exercise, a brief questionnaire was administered to all staff participants.ResultsThe 27 clinic staff involved in the exercise had varying and low adherence rates over the week during which the exercise was conducted. Leading perceived barriers to adherence included: "family friends don't help me remember/tell me I shouldn't take it" and "forgot". Participants reported that the exercise was useful as it allowed them to better address the challenges faced by paediatric patients and caregivers.ConclusionsPromoting good adherence practices among caregivers of children on antiretrovirals is challenging but essential in the treatment of paediatric HIV. Participants in this exercise achieved poor adherence rates, but identified with many of the barriers commonly reported by caregivers. Simulations such as this have the potential to promote awareness of paediatric ARV adherence issues among healthcare staff and ultimately improve adherence support and patient outcomes.

AbstractThe advent of effective treatments for HIV has begun a new era in the worldwide HIV epidemic. Many new political, social, economic, medical, and psychological issues arise in the struggle to contain this epidemic. Mental health providers must understand the context in which people with HIV find themselves making decisions about their health care and the future directions of their lives.

Antiretroviral medications are known inhibitors and inducers of cytochrome p450 enzymes and can affect levels of non‐HIV medications. Finasteride 1 mg (Propecia), which prevents the conversion of testosterone (T) to dihydrotestosterone (DHT) is commonly prescribed for prevention of hair loss. This medication is a substrate of p450 3A4. Its efficacy may therefore be affected by HIV medications which induce or inhibit this enzyme. Levels of DHT to prevent hair loss are not well established, but likely need to be<15–20 ng/dl, or a DHT/T ratio of<0.02. Observational analysis in a private practice, measuring DHT and T levels in patients on finasteride and various antiretrovirals 21 patients were identified. 7 patients were taking protease inhibitors and had DHT levels<12 ng/dL; DHT/T<0.20. Three of these patients decreased their finasteride dose to 1 mg every‐other‐day and still have DHT <10. 8 patients were taking potent p450 inducers (efavirenz or etravirine) and had DHT levels between >20; DHT/T>0.025. Two of these patients increased the dose of finasteride to 2 mg/day and subsequently decreased DHT to 14 and 17. Two additional patients on efavirenz, however, had DHT levels of<15 without dose adjustment. Four patients taking nevirapine, a less potent inducer of p450 had DHT levels of<15, as did one patient on raltegravir, which does not affect CYP450. Antiretrovirals that affect CYP 3A4 may interact with finasteride. While it is unlikely that this interaction is dangerous, it may affect its efficacy of the finasteride. Evaluation of DHT/T levels, and/or dose adjustment of finasteride may be appropriate in men being treated for HIV.

BackgroundThe peculiarity of Romanian HIV epidemic is the high number of long‐time survivors, nosocomially infected with F subtype during early childhood. Although ART is provided for free, patients from certain regions are difficult to attain viral load (VL) and HIV resistance tests.ObjectivesTo assess the durability of first‐line antiretroviral therapy (1st ART) in Romanian HIV patients.MethodsRetrospective assessment of new HIV diagnosed patients during 2005–2010, monitored every 24 weeks (wk) in HIV clinic from Galati ‐ Romania, considering demographic data, HIV transmission pattern, immunity, HIV‐RNA blood levels, co‐morbidities, 1st ART regimen and adherence according to the national protocol. The endpoint was term on loss to follow‐up, death or 96 wk of ART.Results100 new diagnosed HIV patients since 2005 received 1st ART. Characteristics of naïve patients: median age on HIV diagnostic=22.5 years old; sex ratio M/F=53/47; living area rural/urban=55/45; low literacy 26%; HIV infection pattern paediatric/ sexual/ unknown=29/61/10; advanced late presenters 51%; TB as HIV indicator 22%; VHB co‐infection 22%; baseline av. CD4Ly=171/mm3. Experience of 1st ART: 2 NRTI+EFV 38% or LPV 27% or other protease inhibitor 35%. The reasons for 58% interrupting 1st ART: 9% dead, 17% abandoned, 18% failed, 12% developed adverse events and 2% drug‐drug interactions. While 53% patients were adherent previous to endpoint, no more than 42% kept on 1st ART>96 wk and recovered immunity with av. CD4Ly=213/mm3. Poor recovery of CD4Ly<100/mm3 was acquired by 13/48 patients with available HIV‐RNA<50 c/ml in 48 wk. The main risks below 24 weeks of 1st ART are the death (p=0.005; OR=36) and the adverse events (p=0.018; OR=24). Abandon rate (p=0.016; OR=5.14) is higher over 48 weeks. Regardless of 1st ARV regimen, adherence behaviour, immunologic benefits and ART durability were comparable. Viral failure is related to non‐adherence (p=0.03; OR=4.5) and low literacy situation (p<0.001; OR=7.5). Mortality is 4.6 times higher in TB and 2 times in HBV co‐morbidities.ConclusionsOver a half of naïve HIV patients continued 1st ART less than 96 wk. 26% patients with low literacy are a vulnerable group and require individualised educational and adherence programmes. To improve the sustainability of the 1st ART in HIV patients from Galati needs to intensify the support for earlier HIV diagnostic and current virology follow‐up.

Uganda faces major challenges to ensure the continuity and sustainability of treatment programmes for IDPs returning home. Adapted from the source document.

AbstractAccording to the 2005 United Nations Programe on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) Report, Zambia has one of the highest rates of HIV/AIDS cases in Southern Africa as well as in the world. However, it is also one of the few countries that have recorded a drop in the infection rates from an estimated 26% of the population in 2000 to just fewer than 16% in 2005. There appears to be a general consensus that the availability and free provision of antiretroviral drugs (ARVs) and treatment have raised hope that the recipients will live a longer, improved, and productive life. This paper will attempt to assess the major challenges to scaling-up antiretroviral therapy in Zambia. It argues that, while the government has made some progress in scaling-up access to ARVs, there is still much to be done.

Clinical pharmacokinetic data on antiretroviral drugs are scarce in African HIV‐1‐positive patients. Most available pharmacokinetic data are derived from ethnically distinct Caucasian research volunteers. This presentation will focus on the clinical pharmacokinetics training and research outputs of an HIV Research Trust scholarship recipient in Uganda. The work highlights the need for post‐marketing pharmacokinetic studies in the target populations in order to optimize therapy for patients in resource‐limited settings.

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK