After the initial diagnosis of HIV infection and establishment of a care plan, ongoing regular engagement with HIV treatment services is known as “retention in care” and has been defined as having at least two monitoring visits with an HIV medical provider spaced at least three months apart within 1 year. Retention in care has …
Mark Bloch1, Craig Rodgers2 Holdsworth House Medical Practice and East Sydney Doctors, Sydney NSW St Vincent’s Hospital, Sydney NSW Last reviewed: March 2016 Next review due: December 2019 Initiation of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) in the naïve patient centres around two main questions: When to start therapy and what to therapy …
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In the Australian context, ASHM Sub-Committee for Guidance on HIV Management recommends that antiretroviral therapy should be initiated in all people with HIV, irrespective of CD4 count, taking into account the following principles:[15] ART is recommended for all individuals with HIV infection, irrespective of CD4 count, to reduce the risk of disease progression. The decision …
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When selecting a regimen for an individual patient, a number of patient- and regimen-specific characteristics should be considered, with the goal of providing a potent, safe, tolerable and easy to adhere to regimen for the patient in order to achieve sustained virological control. Some of the factors can be grouped into the following categories: Initial …
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Acute or primary HIV infection Improved recognition of the clinical syndrome suggestive of acute HIV or primary HIV infection combined with use of newer diagnostic tests enables early identification of this group of individuals and thus consideration of antiretroviral therapy. The SPARTAC study randomised patients with primary HIV infection to 48 weeks vs 12 weeks …
HIV and hepatitis C co-infection HIV-hepatitis C virus (HCV) co-infection is increasingly prevalent in Australia, affecting approximately 10% of those with HIV, and with clinical consequences for both diseases. The rate of progression of liver disease from hepatitis C has long been known to be accelerated in the setting of co-infection and a recent meta-analysis …
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The INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med 2015;373:795-807 The TEMPRANO ANRS 12136 Study Group. A trial of early antiretrovirals and isoniazid preventive therapy in Africa. N Engl J Med 2015;373:808-22 Lee FJ, Amin J, Carr A. Efficacy of initial antiretroviral therapy for HIV-1 infection …
Nicholas Medland1, Vincent Cornelisse2, Don Smith3 The Kirby Institute, University of NSW, Sydney, NSW Kirketon Road Centre, Sydney, NSW The Albion Centre, Surry Hills, Sydney, NSW Last reviewed: November 2019 Antiretroviral drug classes The six classes of antiretroviral drugs currently licensed for use in Australia are: Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs); Non-nucleoside reverse transcriptase inhibitors …
The four regimens currently recommended for the initial treatment of most people with HIV infection combine a two-drug NRTI backbone with a third antiretroviral drug from the INSTI class, as follows: Dolutegravir/abacavir/lamivudine (if HLA-B*5701 negative) Dolutegravir + emtricitabine/tenofovir alafenamide (tenofovir AF) or tenofovir disoproxil fumarate (tenofovir DF) Raltegravir + emtricitabine/tenofovir AF or tenofovir DF Bictegravir/emtracitabine/tenofovir AF …
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NRTIs inhibit HIV RNA-dependent DNA polymerase (reverse transcriptase) by acting as structural analogues for thymidine or adenosine when DNA is reverse transcribed inside cells leading to premature DNA chain termination and inhibition of viral replication. All NRTIs also have the potential to inhibit human intracellular DNA polymerases, including those necessary for mitochondria to replicate. Mitochondrial …
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