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The National Government HAART Program (NGP) for the provision of HAART to uninsured HIV-infected persons in Mexico began in 2001. The objective was to describe the virologic outcome of patients enrolled in the NGP in a large HIV treatment center in Mexico City. HIV-infected persons, naive or ≤6 months on HAART, who entered the NGP from 2001 to 2005 were included. Patients with virological suppression were compared to those with virologic failure (VF) during follow-up. Of 377 patients enrolled, 191 where eligible for analysis. The median age was 35.9 (18–75 years) and 85% were male. The median baseline CD4+ T cell count was 183 cells/mm3; 63.9% had <200 cells/mm3 and/or an AIDS-defining event. During follow-up (median: 17.77 months), 55 patients (28.7%) changed their first regimen: 8.3% because of VF and the remaining due to toxicity. The probability of VF at 48 months was 20%. VF was associated with age <30 years (p = 0.003, RR 4.7, IC 95% 1.5–14.4). The use of NNRTI was associated with lower risk of VF (p = 0.042, RR 0.3, IC 95% 0.12–0.99). Nadir CD4+ and AIDS-defining at baseline were not associated with VF. Implementation of NGP for HAART access in a specialized care setting in Mexico resulted in an excellent virologic response. Younger age was a significant risk factor for VF.

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

The number of people on highly active antiretroviral therapy (HAART) in South Africa has risen from ,2000 in October 2003, to almost 200,000 by the end of 2005. Yet South Africa's performance in terms of HAART coverage is poor both in comparison with other countries and the targets set by the government's own Operational Plan. The public-sector HAART ''rollout'' has been uneven across South Africa's nine provinces and the role of external assistance from NGOs and funding agencies such as the Global Fund and PEPFAR has been substantial. The National Treasury seems to have allocated sufficient funding to the Department of Health for a larger HAART rollout, but the Health Minister has not mobilized it accordingly. Failure to invest sufficiently in human resources— especially nurses—is likely to constrain the growth of HAART coverage.

The number of people on highly active antiretroviral therapy (HAART) in South Africa has risen from ,2000 in October 2003, to almost 200,000 by the end of 2005. Yet South Africa's performance in terms of HAART coverage is poor both in comparison with other countries and the targets set by the government's own Operational Plan. The public-sector HAART ''rollout'' has been uneven across South Africa's nine provinces and the role of external assistance from NGOs and funding agencies such as the Global Fund and PEPFAR has been substantial. The National Treasury seems to have allocated sufficient funding to the Department of Health for a larger HAART rollout, but the Health Minister has not mobilized it accordingly. Failure to invest sufficiently in human resources— especially nurses—is likely to constrain the growth of HAART coverage.

Background: HIV and AIDS are important global public health problems. Thai Government had declared a policy to provide medical care to patients with triple combination therapy called highly active antiretroviral therapy (HAART). These therapy decrease viral load and restore patient immune function- However these treatments also cause of adverse drug reaction and drug related problems. This study therefore assesses the outcome of pharmaceutical care in adult patients of Buriram hospital.Objective: To study drug related problems of HAART regimen in Buriram hospitalStudy Design: Descriptive prospective study.Method: Sample was 406 of HIV/AIDS patients aged between 15-70 years which were treated in Buriram hospital during March 1st 2003 to April 1st 2009.Results: It was found that 64.04% of patients were continually treated with started HAART regimen. There was 30.05% of patient had to change the regimen according to adverse drug reactions and 0.74% from drug resistance. Average CD4 before treatment (Mean+SD) was 91.00+102.93 and gradually increased by treatment throughout the study. There were 188 patients (46.31%) developed opportunistic infections before treatment, while 12 patients (2.96%) had opportunistic infection after treatment. There was 83.38% of patient had very good adherence at level of 100%-95% and 59.60% of drug related problem found in this study was adverse drug reactions.Conclusion: Pharmaceutical care in patients received HAART regimen at Burirum hospital presented increasing of average CD4, reduction of opportunistic infections but found adverse drug reactions which should be closely monitored and promote patient adherence to decrease viral load and reduce the antiretroviral drug resistance which benefit for reserving alternative regimens to patient. ; หลักการและเหตุผล: โรคติดเชื้อเอชไอวีและเอดส์ เป็นปัญหาสาธารณสุขที่สำคัญทั่วโลก ซึ่งการ ดูแลรักษาผู้ป่วยกลุ่มนี้ของไทย มีการส่งเสริมให้ผู้ป่วยเข้าถึงการบริการ ด้วยการให้ยาต้านไวรัสแบบสูตรยารวม (combination therapy) อย่างน้อย 3 ชนิดที่เรียกว่า highly active antiretroviral therapy (HAART) เพี่อ ลดจำนวนเชื้อไวรัสในกระแลเลือด ลดการทำลายและมีการฟื้นกลับมาของ ภูมิต้านทานของผู้ป่วย ซึ่งอาจพบอาการไม่พึงประสงค์และ/หรือปัญหาจาก การใช้ยาวัตถุประสงค์: เพื่อติดตามผลการรักษาและศึกษาปัญหาจากการใช้ยาต้านไวรัสเอชไอวีแบบ HAARTรูปแบบการศึกษา: การศึกษาเชิงพรรณนาแบบติดตามไปข้างหน้า (Prospective descriptive study)วิธีการศึกษา: ศึกษาในผู้ป่วยติดเชื้อเอชไอวี/เอดส์อายุระหว่าง15-70ปีที่ไต้'รับยาต้านไวรัส แบบ HAART จำนวน 406 ราย ที่มารับบริการระหว่าง 1 มีนาคม 2546 ถึง 1 เมษายน 2552ผลการศึกษา: มีผู้ป่วย 260 ราย (ร้อยละ 64.04) สามารถใช้ยาต้านไวรัสแบบ HAART สูตร แรกที่ได้รับต่อเนื่องตลอดการศึกษา และผู้ป่วยที่ต้องปรับเปลี่ยนสูตรยา เนื่องจากอาการอันไม่พึงประสงค์ร้อยละ 30.05 และจากปัญหาดื้อยา ร้อยละ 0.74 ระยะเวลารับยาเฉลี่ย (Mean)=31.92+13.85 เดือน ค่าเฉลี่ย CD4 เฉลี่ย เริ่มต้นก่อนรับยา 91.00+102.93 และทุก 6 เดือนที่มีการตรวจวัด พบว่า ค่าเฉลี่ย CD4 มีการเพิ่มขึ้นอย่างต่อเนื่องตลอดการศึกษา มีผู้ป่วยที่ ติดโรคฉวยโอกาสก่อนเริ่มยาต้านไวรัสจำนวน 188 ราย (ร้อยละ 46.31) หลังจากเริ่มยาต้านไวรัสแล้วพบลดลงเป็น 12 ราย (ร้อยละ 2.96) ผู้ป่วยจำนวน 321 ราย (ร้อยละ 83.38) มีค่าเฉลี่ย Percent Adherenceระดับ 100%-95% สำหรับปัญหาจากการใช้ยา พบว่าส่วนใหญ่มีสาเหตุจากตัวของผู้ป่วยเอง และที่สำคัญคือ ปัญหาอาการอันไม่พึงประสงค์จากยาซึ่งพบสูงถึงร้อยละ 59.60 ของปัญหาจากการใช้ยาทั้งหมดสรุป: ผลการบริบาลทางเภสัชกรรม แก่ผู้ป่วยติดเชื้อเอชไอวี/เอดส์ ที่ได้รับยาต้าน ไวรัสสูตรผสมแบบHAART ต่อเนื่องในโรงพยาบาลบุรีรัมย์ พบว่าผู้ป่วยมี ค่าเฉี่ลย CD4 Cell count เพิ่มขึ้น มีโรคติดเชื้อฉวยโอกาสน้อยลง แต่พบ ปัญหาอาการอันไม่พึงประสงค์จากยาในอัตราสูง จึงควรเฝ้าระวังและ ตรวจติดตามอย่างใกล้ชิด เสริมสร้างความร่วมมือในการใช้ยาของผู้ป่วย และติดตามผลการใช้ยา เพื่อลดปริมาณไวรัสในเลือดได้มากและนานที่สุด ซึ่งจะป้องกันการเกิดและลดการแพร่ระบาดของเชื้อเอชไอวีที่ดื้อยา เพี่อรักษาสูตรยาที่จะเป็นทางเลือกในอนาคตคำสำคัญ: การบริบาลทางเภสัชกรรม, ผู้ป่วยเอชไอวี, ยาต้านไวรัส, สูตร HAART, อาการ ไม่พึงประสงค์

Objetivo: estimar o volume de vírus circulante de HIV na população brasileira e avaliar o potencial impacto da terapia antirretroviral (HAART) na redução de novas infecções, com o propósito de construir evidências e informações para subsidiar a implementação de políticas de saúde. Métodos : Ferramentas de análise espacial foram utilizadas para descrever os padrões existentes na densidade da carga viral utilizando o método Kernel quártico. As informações da carga viral e tratamento são oriundas da base conjunta do Sistema de Controle de Exames Laboratoriais (Siscel), com informações do histórico da carga viral do indivíduo e do Sistema de Controle Logístico de Medicamentos (Siclom), que controla a dispensa dos medicamentos para a terapia antirretroviral. Resultados: Observou-se que a carga viral comunitária (CVC) apresentou redução progressiva no período de 2007 a 2011, acompanhada de uma redução da carga viral média (CVCM) superior a 32% (22.900 cópias/mL em 2007 versus 15.418 cópias/mL em 2011). Nesse período, houve redução da CVCM em todas as grandes regiões do Brasil, embora o Norte e Nordeste tenham apresentado, respectivamente, CVCM 1,7 e 1,5 vezes a registrada no Sudeste. Em uma comparação entre os indivíduos que faziam ou não uso da HAART, observou-se aumento persistente da carga viral naqueles que não faziam uso da terapia de até 3,9 vezes em 2011. Conclusão: A abordagem apresentada neste estudo aponta a existência de aglomerados no espaço com altas concentrações. O uso do Kernel na identificação de aglomerados no espaço mostrou-se um bom instrumento para análise exploratória, possibilitando a visualização do risco em determinadas áreas geográficas sem as usuais divisões político-administrativas. ; Objectives: to estimate the human immunodeficiency virus (HIV) viral load in the Brazilian population and to assess the potential impact of highly active antiretroviral therapy (HAART) in reducing new infections to build evidences and to gather information to support health policies. Methods: Spatial analysis and modeling tools were used to describe the existing patterns of the viral load density, using the Kernel method. Data on viral load and treatment were retrieved from the databases Laboratory Tests Control System (SISCEL), which contains information on the individual's history of viral load, and Medication Logistics Control System (SICLOM), which controls the dispensing of drugs used for antiretroviral therapy. Results: It was observed that the community viral load (CVL) decreased progressively from 2007 to 2011, accompanied by a decrease of more than 32% in the mean CVL (CVLM) - 22,900 copies/mL in 2007 versus 15,418 copies/mL in 2011. During this period, there was a reduction of CVLM in all regions of Brazil, although North and Northeast showed, respectively, CVLM 1.7 and 1.5 times higher than that in the Southeast region. A comparison between the individuals who underwent and who did not undergo HAART showed an increase of up to 3.9 times in 2011 in the viral load among those who did not undergo the therapy. Conclusion: The approach presented in this study indicates the existence of clusters with high concentrations. The use of Kernel in the identification of clusters proved to be a good tool for exploratory analysis, enabling the risk identification in certain geographic areas without the usual political and administrative divisions.

According to South Africa's leading demographic model, the provision of highly active antiretroviral therapy (HAART) for people living with AIDS will have positive spin-offs in terms of limiting the spread of HIV/AIDS. The ASSA2000 Interventions Model (an offshoot of the ASSA2000 demographic model of South Africa) predicts that over a million new HIV infections could be averted in the first twelve years if a HAART treatment programme was added to a set of AIDS prevention interventions. In other words, not only is HAART assumed to prolong the lives of AIDS patients, but it is also assumed to save lives by preventing a significant number of new HIV infections. See Johnson and Dorrington (2002) for a discussion of the modelling assumptions and supporting evidence. This link between AIDS treatment and AIDS prevention occurs for two reasons: firstly, HAART lowers the viral loads of AIDS patients, thereby making them less infectious. Secondly, the model assumes that voluntary counselling and testing (VCT) is an integral part of a HAART programme, and that VCT is effective in encouraging people to practice safer sex. This modelled link between AIDS treatment and prevention is, however, contentious. According to a recent Joint Health and Treasury Task Team government report (on the economic of providing HAART in South Africa), there is 'no compelling evidence that antiretrovirals would reduce numbers of new infections' (2003: 18). This is a strange comment, given that the ASSA2000 Interventions model (which, as noted above, assumes the opposite) was used by the task team in their modelling work. Nevertheless, seeing as there is wide-spread concern about the nature of the link between HAART and fewer HIV infections, the matter requires serious consideration.

South Africa's government disability grants are considered important in providing income support to low-income AIDS patients. Indeed, anecdotal evidence suggests that some individuals may opt to compromise their health by foregoing Highly Active Antiretroviral Treatment (HAART) to remain eligible for the grant. In this study, we examined the disability grant's importance to individual and household welfare, and the impact of its loss using a unique longitudinal dataset of HAART patients in Khayelitsha, Cape Town. We found that grant loss was associated with sizeable declines in income and changes in household composition. However, we found no evidence of individuals choosing poor health over grant loss. Our analysis also suggested that though the grants officially target those too sick to work, some people were able to keep grants longer than expected, and others received grants while employed. This has helped cushion people on HAART, but other welfare measures need consideration.

BackgroundThe risk of squamous intra‐epithelial lesions (SIL) is higher in HIV‐positive women. As these women begin to live longer due to highly active antiretroviral therapy (HAART), their risk of cervical cancer may increase. Few data exist regarding the effect of HAART on the incidence and progression of SIL in HIV‐positive African women. The aim of this study was to evaluate the effect of HAART on the incidence and progression of SIL in HIV‐positive women in South Africa.MethodsA prospective observational study of HIV‐seropositive women was conducted over 5 years in an HIV treatment clinic in Johannesburg, South Africa. The participants consisted of 601 women on and off HAART who had repeat Pap smears greater than 6 months apart. The effect of HAART use on incidence and progression rates of SIL was determined using multivariate Poisson regression to obtain incidence rate ratios (IRRs), adjusted for age, CD4 count and other potential confounders.ResultsMedian follow‐up time was 445 days (inter‐quartile range 383, 671). The crude rate of incidence of any SIL was 15.9 episodes (95% confidence limit (CL) 12.7, 19.9) per 100 person‐years; the crude rate of all progression of cervical dysplasia among women was 13.5 episodes (95% CL 11.3, 16.1) per 100 person‐years. HAART use was associated with a robust reduction in the rate of incidence and progression of cervical lesions, adjusted IRR=0.55 (95% CL 0.37, 0.80). Sensitivity analyses confirmed this main association held for incidence and progression when they were considered separately, and that the result was not dependent on the length of HAART exposure.ConclusionHAART use was associated with a reduction in the rate of both incidence and progression of cervical lesions among HIV‐positive women.

BackgroundUse of highly active antiretroviral therapy (HAART), a triple‐drug combination, in HIV‐infected pregnant women markedly reduces mother to child transmission of HIV and decreases maternal morbidity. However, there remains uncertainty about the effects of in utero exposure to HAART on foetal development.MethodsOur objectives were to investigate whether in utero exposure to HAART is associated with low birth weight and/or preterm birth in a population of South African women with advanced HIV disease. A retrospective observational study was performed on women with CD4 counts ≤250 cells/mm3 attending antenatal antiretroviral clinics in Johannesburg between October 2004 and March 2007. Low birth weight (<2.5 kg) and preterm birth rates (<37 weeks) were compared between those exposed and unexposed to HAART during pregnancy. Effects of different HAART regimen and duration were assessed.ResultsAmong HAART‐unexposed infants, 27% (60/224) were low birth weight compared with 23% (90/388) of early HAART‐exposed (exposed <28 weeks gestation) and 19% (76/407) of late HAART‐exposed (exposed ≥28 weeks) infants (p = 0.05). In the early HAART group, a higher CD4 cell count was protective against low birth weight (AOR 0.57 per 50 cells/mm3 increase, 95% CI 0.45‐0.71, p < 0.001) and preterm birth (AOR 0.68 per 50 cells/mm3 increase, 95% CI 0.55‐0.85, p = 0.001). HAART exposure was associated with an increased preterm birth rate (15%, or 138 of 946, versus 5%, or seven of 147, in unexposed infants, p = 0.001), with early nevirapine and efavirenz‐based regimens having the strongest associations with preterm birth (AOR 5.4, 95% CI 2.1‐13.7, p < 0.001, and AOR 5.6, 95% CI 2.1‐15.2, p = 0.001, respectively).ConclusionsIn this immunocompromised cohort, in utero HAART exposure was not associated with low birth weight. An association between NNRTI‐based HAART and preterm birth was detected, but residual confounding is plausible. More advanced immunosuppression was a risk factor for low birth weight and preterm birth, highlighting the importance of earlier HAART initiation in women to optimize maternal health and improve infant outcomes.

ObjectiveMultiple therapies are common in HIV‐infected children on highly active antiretroviral therapy (HAART). These children are at risk for clinically significant drug interactions (CSDIs). While CSDIs are under‐recognized in developed countries, data are lacking for developing African countries. We aimed to investigate the prevalence of CSDIs between antiretrovirals (ARVs) and co‐prescribed drugs for children attending a large HIV clinic in Lagos, Nigeria.MethodsWe retrospectively assessed the risk for clinically significant drug interactions in children on HAART. Of the 417 patients enrolled for treatment, 80 were eligible for inclusion. We defined CSDIs as 'major' (capable of causing severe or permanent damage, contraindicated, avoid or not recommended by the manufacturer, or requiring dose modification) or 'moderate' (manufacturers advise caution, or close monitoring, or capable of causing clinical deterioration).ResultsA total of 60 (75%) patients were at risk for a CSDI resulting in major interactions in 13 (16.3%) patients and could potentially lower the plasma concentration of antiretroviral drugs in 9 (15%) patients. Major interactions most frequently involved rifampicin in 9 (11.3%) patients and artemisinin combination therapies (ACTs) in 8 (10%) patients whereas moderate interactions frequently involved ACTs (48.8%), fluconazole (36.3%), and rifampicin (11.3%). Age (p = 0.392), gender (p = 0.813), and moderate (p = 0.692) or severe (p = 0.788) malnourished state of the children were not associated with risk for CSDIs.ConclusionsThree‐quarters of children receiving ARV drugs are at risk for CSDIs. Strategies are needed to be put in place to prevent important drug interactions and to manage unavoidable interactions.

ContextThere have been few longitudinal studies of cytokine production in neonatally acquired HIV‐1 infection and none in Asian or Chinese children.ObjectiveTo determine whether monitoring cytokine production could contribute to the better management of pediatric patients with HIV‐1 infection.SettingClinical Immunology Laboratory and Pediatrics Department, University Hospital, Hong Kong.PatientsTen Asian and 2 Eurasian children infected with HIV‐1 by mother‐to‐child transmission were followed for up to 5 years while on treatment with highly active antiretroviral therapy (HAART).Main Outcome MeasuresNumbers of unstimulated and mitogen‐activated cytokine‐secreting cells (IFN‐gamma, interleukin [IL]‐2, IL‐4, IL‐6, IL‐10, IL‐12, and TNF‐alpha) were measured by ELISPOT assay at frequent intervals, and correlations were sought with CD4+ and CD8+ cell counts and viral loads.ResultsMitogen‐stimulated IL‐2‐secreting cells were directly associated with recovery of CD4+ cells. Correlations with viral load were found for Con A‐induced IFN‐gamma, Con A‐induced IL‐4, and unstimulated IL‐10, suggesting that these cytokines were either suppressed by high virus levels or that higher cytokine levels suppressed virus. IFN‐gamma, IL‐2‐, IL‐4‐, and IL‐12‐secreting cells induced by PHA, Con A, and/or SAC tended to increase for the first 3‐4 years of treatment but declined thereafter.ConclusionAlterations in cytokine profiles were not associated with adverse clinical events and there was little evidence to indicate that monitoring cytokine enzyme‐linked immunospots (ELISPOTs) could contribute to pediatric patient management.