Antiretroviral Therapy

The introduction of highly active antiretroviral therapy (also known as combination therapy) has transformed the nature of HIV infection from a severe and ultimately fatal disease to that of a manageable chronic condition. HIV drugs are highly efficacious, but their use comes at ...

A literature review of original research articles on adherence to antiretroviral therapy (ART) in developed countries, covering January 2000 to June 2011, was conducted to determine if gender differences exist in the prevalence of nonadherence to ART. Of the 1,255 articles reviewed, only 189 included data on the proportion of the study population that was adherent and only 57 (30.2%) of these reported proportional adherence values by gender. While comparing articles was challenging because of varied reporting strategies, women generally exhibit poorer adherence than men. Thirty of the 44 articles (68.2%) that reported comparative data on adherence by gender found women to be less adherent than men. Ten articles (17.5%) reported significant differences in proportional adherence by gender, nine of which showed women to be less adherent than men. These findings suggest that in multiple studies from developed countries, female gender often predicts lower adherence. The unique circumstan...

At present, the side effects associated with antiretroviral treatment are the main reasons for discontinuation of this kind of therapy, both in clinical trials and in regular clinical practise.On the other hand, due to the change of direction that our profession has suffered in recent years, we face the need to establish a different relationship with the patient, achieving direct

Approximately 36.7 million people worldwide are living with the Human
Immunodeficiency Virus (HIV). Almost 20 percent of South Africa’s adult population
(aged fifteen to forty-nine) is HIV-positive, and about one in every five people living with
HIV worldwide is in South Africa. The pandemic, and the political controversies it
elicited, have come to define both local and global understandings of the post-apartheid
nation. The history of HIV in South Africa begins in the 1980s during an era of
heightened repression by the apartheid state, in which discriminatory laws and fearful
public responses tapped into broader prejudices relating to race and sexuality. During the
1990s, as South Africa transitioned to democracy and as rates of HIV reached pandemic
levels, partnerships were built between civil society and state actors to confront the many
challenges that the HIV epidemic presented. However, from the late 1990s, corruption
and the abuse of political power within the Department of Health, together with the
government’s refusal to provide life-saving antiretroviral treatment (ART), ignited a new
era in health advocacy. While the HIV-treatment activist movement won the struggle for
public access to treatment, Jacob Zuma’s succession to President Thabo Mbeki heralded a new era of political controversies in the state’s HIV response. A copious historiography on the HIV epidemic in South Africa maps the contemporary chronology and evolution of the disease, including a focus on changing public understandings and responses

Keywords: HIV/AIDS epidemic, South Africa, apartheid, democracy, antiretroviral treatment, AIDS denialism, HIV activism

During the last decade, visceral leishmaniasis has been reconsidered in its epidemiology and strategies for diagnosis, treatment and prevention. This vectorial disease, responsible for more than 50,000 deaths each year across India, East Africa, South America, the Mediterranean area, Central Asia and China, is currently spreading over new territories. This formerly rural disease has even reached cities in South America. This spreading is caused by environmental changes due to global warming or human activity, and by the movement of workers and refugees. As a consequence, the burden of HIV/Leishmania coinfection is increasing in many developing countries even though effective antiretroviral therapy has led to a marked decrease in its incidence in Europe. The disease is now handled differently than it was 10 years ago: PCR has become the most accurate tool for diagnosis and follow-up in developed countries, and field diagnostic tools have been developed (antigenuria, rK39 dipstick). W...

Use of ‘party drugs’, a particular set of recreational drugs used in the context of ‘ChemSex’, is frequent among MSM living with HIV. A recently published observational study showed that more than half of HIV-infected MSM interviewed reported use of illicit substances in the previous 3 months, with frequent concomitant use of three or more drugs. These substances are a combination of ‘club drugs’ (methylenedioxymethamphetamine, gamma-hydroxybutyrate, ketamine, benzodiazepine) and drugs that are more specifically used in a sexualized context (methamphetamine, mephedrone, poppers and erectile dysfunction agents). Although formal data on pharmacokinetic or pharmacodynamic interactions between recreational drugs and antiretroviral agents are lacking, information regarding potentially toxic interactions can be theorized or sometimes conclusions may be drawn from case studies and cohort observational studies. However, the risk of coadministering party drugs and antiretrovirals should not be overestimated. The major risk for a drug–drug interaction is when using ritonavir-boosting or cobicistat-boosting agents, and maybe some nonnucleoside reverse transcriptase inhibitors. Knowledge of the metabolic pathways of ‘party drugs’ may help in advising patients on which illicit substances have a high potential for drug–drug interactions, as this is not the case for all.

This study examined traditional Shona beliefs and practices in light of HIV/AIDS in the rural communities of the Chipinge District in Zimbabwe. The focus of the study was to examine selected Shona traditional beliefs and practices, and evaluate how they respond to the HIV/AIDS threat. The study aimed to examine the traditional beliefs and practices that people in Chipinge rural communities still practise, have stopped practising, or have modified due to the encroachment of HIV/AIDS into the communities’ socio-moral space. It also aims to discuss the traditional beliefs and practices that are safe and those that expose people to HIV infection, in addition to the communities’ knowledge about HIV/AIDS. Grounded in the traditional Shona religious landscape, and from a phenomenological perspective, the study utilised a qualitative survey research design. Using purposive and snowball sampling procedures, 72 study participants, knowledgeable in the Shona people’s traditional beliefs and practices, were selected. The study used non-scheduled structured interviews and a questionnaire, with both closed and open-ended questions, to gather data from the participants. Most participants defined HIV/AIDS as a blend of sexually transmitted infections (STIs) that take time to treat. They believed that AIDS results from ‘pollution’ caused by sexual intercourse with ‘unclean’ women, while a few attributed it to having unprotected sex with an infected partner. Results show that kuputsa (pledged or child marriage), barika (polygamy), and kugara nhaka (wife inheritance) are harmful marriage practices that expose people to HIV infection. As old habits die hard, the study suggests modifications to such marriage practices, where people willing to be involved should take an HIV antibody test. Given that information about HIV/AIDS is communicated through posters and pamphlets written in English, it would benefit the community, if the Ministry of Health and Child Care could provide information in the Ndau language.

With the introduction of pre-exposure prophylaxis (PrEP) and preliminary findings of the PARTNER study, the lived experience of seropositivity for many (mostly gay, urban, middle-class and white) people in the Global North has been subject to rapid shifts in terms of both treatment and prevention. Whilst the corporeal boundaries between seronegative and seropositive subjects in these contexts appear to be dissipating, the broad disparity in HIV prevention and treatment options on either side of geopolitical borders is revealed, and perfectly illustrates the geocorpographies of HIV under globalised neoliberalism. As the viral inscription on bodies is recalibrated to adjust to the contemporary spatialised realities of HIV, the meaning of HIV is revealed as both volatile and ambulatory. This chapter presents a close reading of a short sequence from a Treasure Island Media pornographic film to explore the changing cultural meanings of HIV through the concepts of viral fraternity and viral corpography. Introducing the conceptual framework of e(Rx)otics - the confluence of pharmaceuticals and erotics - the geocorporeal restrictions on those who are afforded access to certain forms of sexual risk and those who are not are drawn into focus.

This is DPhil Thesis passed in 2011 submitted in Development Studies at the University of Oxford.

This doctoral project, entitled 'Displacing AIDS: Therapeutic Transitions in Northern
Uganda' examines the biosocial transitions engendered by the treatment of HIV, focusing on
antiretroviral therapy (ART/ARV) interventions, and the ways these are intertwined with the
social transitions of conflict, displacement and return. The research involved an inter- disciplinary qualitative study with internally displaced communities living with HIV in
northern Uganda, during 10 months fieldwork between 2006 and 2009. Northern Uganda has
experienced a two decade civil war between the government of Uganda and the Lord’s
Resistance Army (1987 to 2006). In 2006, after a cessation of hostilities was signed,
hundreds of thousands of the displaced began returning ‘home’. The effects of conflict and
social displacement were to significantly shape both the social and medical aspects of ART
provision. I argue that northern Uganda was significantly excluded from widespread national
community-based responses as a result of the war during the 1990s and early 2000s. Given
this background, ART interventions were to engender rapid social transformations among
those with HIV, but also in relation to the perceptions of HIV/AIDS in the broader
community. I explore these intersecting biosocial and displacement-induced transitions
through several streams: the social transitions of forced displacement and the return process;
the transitions from illness to a precarious health; from social exclusion to a contested
inclusion; transitions between local and biomedical understandings of healing; transitions in
authority and biopower; as well as continually shifting forms of identity, support and
affiliation. I give particular emphasis to forms of socio-spatial and medico -moral
transformations. I argue that ARV interventions have been nested in the social and moral
spaces of displacement. In particular the spatial configurations of encampment, involving
extreme congestion and lack of privacy, have shaped patterns of disclosure and community
and identity formation. The influence of Catholicism, shaped by missionary histories in the
region, has also had a strong impact. Themes of militarism, lack of productivity, and
encampment have shaped the language and perceptions of HIV and AIDS. Theoretically I
engage with debates around biosociality, stigmatisation and ‘clientship’ within the emerging
literature on ARVs. I trace the intersections of these questions with those in forced migration
studies regarding the social transformations of displacement and return. Furthermore, I use
this social analysis to engage with public-health perspectives on ARV provision. I argue that
community-based strategies require adaptation to the social contexts of displacement. Such
adaptations, involving attentiveness to the socio-spatial specificity of displaced contexts, are
critical for the long-term provision and sustainability of antiretroviral therapy to displaced
communities. In particular the return phase has created unexpected challenges for treatment
continuity, arising from large-scale population movements. The thesis has a strong narrative
focus and traces the experiences of several people living with HIV through the paths of
displacement and return

BACKGROUND: As the resource implications of expanding anti-retroviral therapy (ART) are likely to be large, there is a need to explore its cost-effectiveness. So far, there is no such information available from Ethiopia. OBJECTIVE: To assess the cost-effectiveness of ART for routine clinical practice in a district hospital setting in Ethiopia. METHODS: We estimated the unit cost of HIV-related care

The impact of HIV in the world especially in sub-Saharan Africa has led to an extraordinary global effort to ensure adherence to antiretroviral (ARV) therapy to treat the disease in every country where HIV is a threat including Nigeria. However, starting patients on ARVs without ensuring full adherence through an adequate support system is likely to lead to treatment failure and the emergence of drug‐resistant virus which can be transmitted to other. Factors influencing adherence to medication are both patients and service provider related. A descriptive, cross sectional study using a systematic sampling technique to select 473 young women and adolescent living with HIV in North central ART clinics in Nigeria. 77% of respondents have been on ARV regimen in the last 3 years. About 82% had good knowledge of medication adherence while 18% do not understand what adherence to medication means. Most (79%) of HIV patient’s adequate adherence to ART while others (13%) usually had stopped taking their medication when they feel better about their health. The commonest source of information about medication adherence to ARV was through the adherence counselor at during ART clinics (77%). Sixty percent of the respondents agreed that adherence to ARV medication helps in improving standard of living Factors that hindered effective adherence to treatment included poor providers’ attitude (28%) and forgetfulness to take their medication and pill burden (25%). Respondents who did not adhere to treatment were less likely to subsequently adhere to ARV medication (OR= 0.258, 95%CI= 0.1-0.5). Use of treatment supporters was the major determinant of medication adherence (OR = 4.2, 95%CI = 1.4-7.2). Majority of the respondents are knowledgeable about medication adherence.

Paediatric HIV-infected patients have higher risk of developing resistance to antiretroviral drugs, and from public health perspective, drug resistance remains a limiting factor for effective management of HIV infection in children. We reviewed the current evidences available on the antiretroviral treatment and resistance patterns in HIV-infected children. Prevalence of HIV drug resistance varied among the three main classes of antiretroviral drugs, namely nucleoside reverse transcriptase inhibitors, non-nucleoside reverse tran-scriptase inhibitors and protease inhibitors in both treatment naïve and treatment-experienced children in different countries. Most of the patients with extensive triple-class drug-resistant mutations were found to be considerably exposed to the three main classes of antiretroviral agents. Identification of genetic factors linked with susceptibility to perinatal transmission of HIV may be key in understanding the development of resistance due to waning antiviral effectiveness. Children who were less likely to achieve viral re-suppression were more likely to have resistance mutations. Newer drugs such as etravirine can be used as alternatives in case of resistance to efavirenz while newly developed diagnostic method such as next-generation sequencing is a platform for improving quality of detections especially minor variant drug resistance mutations.