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Topics in Antiviral Medicine

Aroonsiri Sangarlangkarn, Jessica S Merlin, Rodney O Tucker, Amy S Kelley
In the era of antiretroviral therapy, HIV infection has become a chronic illness with associated multimorbidity, and practitioners are faced with an emerging population of HIV-infected patients with evolving needs for advance care planning (ACP), defined as communication between individuals and their proxies to plan for future health care decisions. This article provides a review of original research studies on ACP in HIV-infected adults in the era of antiretroviral therapy (1996-present) from PubMed, EMBASE, and PsycINFO...
December 2016: Topics in Antiviral Medicine
James H Stein
Current guidelines for managing cholesterol to reduce cardiovascular disease (CVD) risk focus on providing the appropriate intensity of statin therapy to reduce low-density lipoprotein cholesterol (LDL-C) level. There is very little evidence supporting the use of treatments aimed at raising high-density lipoprotein cholesterol level or reducing triglyceride levels. HIV-infected persons have excess risk of CVD compared with the general population. Statins are less effective at reducing LDL-C levels in HIV-infected persons who are also at greater risk for adverse effects from statin treatment...
December 2016: Topics in Antiviral Medicine
Steven C Johnson
Antiretroviral therapy is recommended for all patients with HIV infection. The benefit of immediate antiretroviral therapy was confirmed by results from the START (Strategic Timing of Antiretroviral Treatment) trial, which showed a 57% reduction in risk for the composite end point of AIDS-related events, serious non-AIDS-related events, or death from any cause with immediate treatment in antiretroviral therapy-naive participants with CD4+ cell counts above 500/µL. Other changes in HIV care include the widespread adoption of integrase strand transfer inhibitor-based regimens...
December 2016: Topics in Antiviral Medicine
Susan J Little
Diagnosis of acute HIV infection is important for accurate estimation of HIV incidence, identifying persons who are unaware of their HIV infection, and offering immediate treatment and risk-reduction strategies. The higher viral loads associated with acute HIV infection are associated with an increased risk of transmission. Current treatment recommendations are the same for acute and established infections. Studies of acute HIV infection indicate that initiation of antiretroviral therapy during this period may allow greater recovery of CD4+ T-cell count and function and may result in a smaller latent viral reservoir and a skewing of infection away from central memory CD4+ T cells toward shorter-lived transitional memory CD4+ T cells...
December 2016: Topics in Antiviral Medicine
Barbara S Taylor, Susan A Olender, Hong-Van Tieu, Timothy J Wilkin
The 2016 Conference on Retroviruses and Opportunistic Infections highlighted exciting advances in antiretroviral therapy, including important data on investigational antiretroviral drugs and clinical trials. Clinical trials demonstrated benefits from a long-acting injectable coformulation given as maintenance therapy, examined intravenous and subcutaneous administration of a monoclonal antibody directed at the CD4 binding site of HIV-1, and provided novel data on tenofovir alafenamide. Several studies focused on the role of HIV drug resistance, including the significance of minority variants, transmitted drug resistance, use of resistance testing, and drug class-related resistance...
May 2016: Topics in Antiviral Medicine
Anne F Luetkemeyer, David L Wyles
At the 2016 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, Massachusetts, hepatitis C virus (HCV) infection remained a major theme in the context of HIV-associated liver disease, although other causes of liver disease garnered increased attention, including fatty liver disease, hepatitis B, and the impact of HIV disease itself on the liver. Although no data from phase III studies of HCV direct-acting antiviral (DAA) drugs for the treatment of HIV/HCV coinfection were presented at CROI 2016, a broad range of HCV DAA-related topics were presented, including accumulating experience with real-world performance of DAA-based regimens outside of clinical trials, drug interactions between DAA and antiretroviral drugs, treatment of acute HCV infection, and retreatment of individuals whose DAA-based regimens failed and those in whom resistance to DAA drugs emerged...
May 2016: Topics in Antiviral Medicine
Diane V Havlir, Judith S Currier
Noncommunicable conditions such as cardiovascular disease, hypertension, renal and bone diseases, and malignancies as well as infectious complications are an ongoing concern during the course of treated HIV disease. Research in this area continues to focus on the epidemiology and risk factors for these conditions, on identifying the contributions of HIV-related immunopathology to specific and collective end-organ diseases, and on evaluating interventions to prevent or reduce the morbidity associated with these conditions...
May 2016: Topics in Antiviral Medicine
Serena S Spudich, Beau M Ances
The brain remains a major target for HIV infection and a site of potential complications for HIV-infected individuals. Emerging data presented at the 2016 Conference on Retroviruses and Opportunistic Infections suggest that during the early stages of infection, activated CD4+ cells may traffic the virus into the central nervous system (CNS). HIV is detectable in cells and tissues of the CNS in some individuals despite suppressive antiretroviral treatment. A potential source of cerebrospinal fluid HIV escape may be compartmentalized HIV replication within macrophage lineage cells...
May 2016: Topics in Antiviral Medicine
Susan P Buchbinder, Albert Y Liu
The 2016 Conference on Retroviruses and Opportunistic Infections (CROI) highlighted hot spots in HIV infection. Men who have sex with men (MSM), transgender populations, people who inject drugs, fisherfolk, migrants, adolescents, and older adults are heavily impacted in a number of regions. Stigma contributes to risk behaviors and HIV acquisition across populations. HIV testing is a crucial first step in the HIV care continuum, and several large community-based surveys are underway in Africa to increase HIV testing, linkage to care, and uptake of antiretroviral treatment...
May 2016: Topics in Antiviral Medicine
Mario Stevenson
The 2016 Conference on Retroviruses and Opportunistic Infections continued to maintain balance in the representation of different areas of research related to HIV/AIDS. The basic science category encompasses research on viral reservoirs and HIV cure, on cellular factors regulating the interplay between virus and host, and on factors that influence viral pathogenicity. Basic research on factors that influence the interaction between the virus and the host cell continues to unearth surprises with the identification of a new host antiviral factor...
May 2016: Topics in Antiviral Medicine
Jennifer M Gilbert, Kathleen V Fitch, Steven K Grinspoon
HIV infection is associated with increased cardiovascular disease (CVD), and increased rates of myocardial infarction and stroke have been observed in HIV-infected individuals. After traditional risk factors that are more common among people living with HIV infection (such as smoking and diabetes) are accounted for, the excess risk for CVD persists. Recent studies suggest that increased immune activation and inflammation may contribute to excess risk for CVD in the context of HIV infection. Imaging studies in the HIV-infected population have found inflamed, noncalcified plaque that is vulnerable to rupture...
October 2015: Topics in Antiviral Medicine
Marla J Keller
HIV-infected women have higher rates of persistence of human papillomavirus (HPV) infection, of abnormal cervical cytology results, and of cervical cancer than uninfected women. It is currently recommended that HIV-infected, sexually active women have a Papanicolaou (Pap) test performed at the time of initial diagnosis of HIV infection, followed by annual Pap testing if the previous test result is normal. Women whose test results show abnormalities greater than atypical squamous cells of undetermined significance (ASCUS) should be referred for colposcopy...
October 2015: Topics in Antiviral Medicine
Annemarie M Wensing, Vincent Calvez, Huldrych F Günthard, Victoria A Johnson, Roger Paredes, Deenan Pillay, Robert W Shafer, Douglas D Richman
The 2015 edition of the IAS-USA drug resistance mutations list updates the figures last published in July 2014. The mutations listed are those that have been identified by specific criteria for evidence and drugs described. The figures are designed to assist practitioners in identifying key mutations associated with resistance to antiretroviral drugs and, therefore, in making clinical decisions regarding antiretroviral therapy.
October 2015: Topics in Antiviral Medicine
Roy M Gulick
There is general consistency among US and European guidelines regarding the initiation of antiretroviral therapy for HIV-infected individuals. Recent and ongoing trials comparing regimens may lead to reevaluation of initial treatment choices. The choice of antiretroviral regimen will also likely be affected by development, evaluation, and availability of newer drugs. This article reviews currently recommended regimens and characteristics of selected current investigational drugs, including the nucleotide analogue reverse transcriptase inhibitor tenofovir alafenamide, the nonnucleoside reverse transcriptase inhibitor doravirine, the integrase strand transfer inhibitor cabotegravir, the HIV entry inhibitor BMS-663068, and the HIV maturation inhibitor BMS-955176...
October 2015: Topics in Antiviral Medicine
Jessica S Merlin
Chronic pain is common in individuals with HIV infection. The primary goal of treatment of chronic pain is not only to improve pain but also to improve physical and emotional function. Patients with chronic pain should be assessed for concurrent psychiatric and substance use disorders, as these conditions often coexist. Treatment of chronic pain may have limited success in the absence of treatment of psychiatric disorders. Treatments for chronic pain include nonopioid pharmacologic therapies and nonpharmacologic therapies (eg, cognitive and behavioral therapy, physical therapy), and the latter option is often the most effective for improving patient function...
August 2015: Topics in Antiviral Medicine
Henry Masur
The incidence of HIV-related opportunistic infections (OIs) has declined in the United States with the increasing use of effective antiretroviral therapy for the treatment of HIV infection. However, the absolute number of patients with OIs remains high and there continues to be considerable associated mortality. OI guidelines from the National Institutes of Health, Centers for Disease Control and Prevention, and Infectious Diseases Society of America continue to be updated on a regular basis, several times per year, as optimal strategies for prevention and therapy evolve...
August 2015: Topics in Antiviral Medicine
Kenneth E Sherman
All patients with HIV infection should be screened for hepatitis B virus (HBV) infection. Preventive HBV vaccination is less effective in HIV-infected patients than in those without HIV infection. Emtricitabine, lamivudine, and tenofovir disoproxil fumarate (tenofovir) each have activity against HIV and HBV. In HBV/HIV-coinfected patients, if HBV or HIV treatment is needed, it should be initiated with tenofovir and emtricitabine or tenofovir and lamivudine as the nucleoside analogue reverse transcriptase inhibitor backbone of a fully suppressive antiretroviral regimen...
August 2015: Topics in Antiviral Medicine
Davey M Smith
Reducing the incidence of HIV infection until there are no new infections depends on driving the number of secondary infections produced by a typical source infection in a completely susceptible population (basic reproduction number; R0) down to less than 1. Components of R0 that must be addressed are the number of sexual contacts the infectious person makes per unit of time (C), the probability of transmission per single sexual contact with the infectious person (P), and the duration that the infected person is infectious to others (D) (R0 = C × P × D)...
August 2015: Topics in Antiviral Medicine
Howard Libman
HIV infection is associated with chronic immune activation that is superimposed on immunologic senescence in older adults, resulting in the acquisition of age-related diseases at younger ages. The incidence of coronary artery disease is higher among HIV-infected persons than uninfected individuals matched for age and sex. HIV infection and its treatment have been associated with premature bone loss. Lung, hepatic, and anal cancers occur at younger ages in persons with HIV infection. HIV-infected patients are living longer, and proper attention to the management of comorbidities in this population is essential...
May 2015: Topics in Antiviral Medicine
Lucas Hill
Direct-acting antiviral (DAA) drugs exhibit considerable variability in mechanisms of metabolism and the extent to which they are substrates, inhibitors, or inducers of cytochrome P450 enzymes or P-glycoprotein and other drug transporters. Thus, potential drug-drug interactions with other commonly used therapies also vary, as do the effects of renal and hepatic impairment on DAA drug exposure. Drug-drug interaction profiles and use in cases of renal or hepatic impairment are reviewed for the DAAs simeprevir; sofosbuvir; ledipasvir; the fixed-dose combination regimen of paritaprevir, ritonavir, and ombitasvir plus dasabuvir; and the investigational drugs daclatasvir and asunaprevir...
May 2015: Topics in Antiviral Medicine
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