Re: Access to HIV drugs should be widened, says WHO
The importance of early initiation of antiretroviral therapy (ART) shouldn’t be neglected, 1 however medication non-adherence has remained a significant challenge when providing care to HIV/AIDS patients. Since long-term use of ART has been associated with increased morphological and metabolic complications,2 it adversely affects medication adherence3 and consequently high morbidity/mortality, and a HIV transmission rate result.
Protease inhibitors (PIs) have been remained the main culprit in the antiretroviral regime associated with non-adherence owing to adverse drug-related events, long-term complications (including dyslipidemia, insulin resistance and diabetes) as well as complex/frequent PI dosing schedules.3 Growing evidence advocates the role of PI-sparing antiretroviral regime linked to better treatment outcome (including less adverse events and metabolic complications) and an improved adherence to therapy.3, 4, 5PI-sparing antiretroviral regime which consists of nucleoside reverse transcriptase inhibitors (NRTIs) with/without non-nucleoside reverse transcriptase inhibitors (NNRTIs),3 are now available as a combination product within one tablet, potentially simplifying ART regime.
Replacing a PI with an NNRTI particularly nevirapine or efavirenz has remained most promising combined with sustained viral suppression and minimum PI-related toxicities.3, 4, 5 Patients’ education regarding self-care practices and self-monitoring should also be encouraged since it helps them coping better with their chronic illnesses together with minimal psychological stress.
References:
1. Gulland A. Access to HIV drugs should be widened, says WHO. BMJ. 2013;347:f4172.
2. Kalra S, Agrawal N. Diabetes and HIV: Current Understanding and Future Perspectives. Curr Diab Rep. 2013;13(3):419-27.
3. Barreiro P, García-Benayas T, Soriano V, Gallant J. Simplification of antiretroviral treatment--how to sustain success, reduce toxicity and ensure adherence avoiding PI use. AIDS Rev. 2002;4(4):233-41.
4. Tebas P, Yarasheski K, Henry K, Claxton S, Kane E, Bordenave B, et al. Evaluation of the virological and metabolic effects of switching protease inhibitor combination antiretroviral therapy to nevirapine-based therapy for the treatment of HIV infection. AIDS Res Hum Retroviruses. 2004;20(6):589-94.
5. Potard V, Chassany O, Lavignon M, Costagliola D, Spire B. Better health-related quality of life after switching from a virologically effective regimen to a regimen containing efavirenz or nevirapine. AIDS Care. 2010;22(1):54-61.
Rapid Response:
Re: Access to HIV drugs should be widened, says WHO
The importance of early initiation of antiretroviral therapy (ART) shouldn’t be neglected, 1 however medication non-adherence has remained a significant challenge when providing care to HIV/AIDS patients. Since long-term use of ART has been associated with increased morphological and metabolic complications,2 it adversely affects medication adherence3 and consequently high morbidity/mortality, and a HIV transmission rate result.
Protease inhibitors (PIs) have been remained the main culprit in the antiretroviral regime associated with non-adherence owing to adverse drug-related events, long-term complications (including dyslipidemia, insulin resistance and diabetes) as well as complex/frequent PI dosing schedules.3 Growing evidence advocates the role of PI-sparing antiretroviral regime linked to better treatment outcome (including less adverse events and metabolic complications) and an improved adherence to therapy.3, 4, 5PI-sparing antiretroviral regime which consists of nucleoside reverse transcriptase inhibitors (NRTIs) with/without non-nucleoside reverse transcriptase inhibitors (NNRTIs),3 are now available as a combination product within one tablet, potentially simplifying ART regime.
Replacing a PI with an NNRTI particularly nevirapine or efavirenz has remained most promising combined with sustained viral suppression and minimum PI-related toxicities.3, 4, 5 Patients’ education regarding self-care practices and self-monitoring should also be encouraged since it helps them coping better with their chronic illnesses together with minimal psychological stress.
References:
1. Gulland A. Access to HIV drugs should be widened, says WHO. BMJ. 2013;347:f4172.
2. Kalra S, Agrawal N. Diabetes and HIV: Current Understanding and Future Perspectives. Curr Diab Rep. 2013;13(3):419-27.
3. Barreiro P, García-Benayas T, Soriano V, Gallant J. Simplification of antiretroviral treatment--how to sustain success, reduce toxicity and ensure adherence avoiding PI use. AIDS Rev. 2002;4(4):233-41.
4. Tebas P, Yarasheski K, Henry K, Claxton S, Kane E, Bordenave B, et al. Evaluation of the virological and metabolic effects of switching protease inhibitor combination antiretroviral therapy to nevirapine-based therapy for the treatment of HIV infection. AIDS Res Hum Retroviruses. 2004;20(6):589-94.
5. Potard V, Chassany O, Lavignon M, Costagliola D, Spire B. Better health-related quality of life after switching from a virologically effective regimen to a regimen containing efavirenz or nevirapine. AIDS Care. 2010;22(1):54-61.
Competing interests: No competing interests