This was comparable to the levels in many European countries and allegedly the highest in Latin America. That year the United States had physicians and 54 dentists perpopulation; the Central American isthmus had physicians and 30 dentists perThe rate is still among the highest in Latin America. In the mids, when little was known about the virus, Cuba compulsorily tested thousands of its citizens for HIV.
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Abstract Human immunodeficiency virus HIV infection is now recognized as a chronic illness. Although the success of highly active antiretroviral therapy is beyond question, several issues still persist. Since the drugs cannot eradicate the virus, cure is not yet possible, and patients have to maintain a lifelong adherence with the risk of toxic effects, drug-drug interactions and drug resistance.
A clear understanding of the viral replication and its interaction with host cell factors has led to the development of a large number of effective antiretroviral drugs ARVs.
New drugs in the existing class such as apricitabine, elvucitabine and etravirine have shown promising results against HIV isolates resistant to first line drugs. These drugs have offered a new choice for patients with drug resistant disease.
However, the impact of their long term use on safety is yet to be assessed. Novel drugs with unique mechanism of action such as CD4 receptor attachment inhibitors, maturation inhibitors, pharmacokinetic enhancers, capsid assembly inhibitors and lens epithelium derived growth factor inhibitors are still under development.
Currently, ARVs, especially tenofovir and emtricitabine, are also being evaluated for prevention of sexual transmission of HIV The initial results of an HIV prevention trial network are encouraging and have recommended the use of ARVs for pre-exposure prophylaxis.
This article discusses the challenges associated with HIV-1 treatment and updates several major advances in the development of ARVs. Antiretroviral drugs, challenges, recent advances Introduction A significant advancement in the understanding of an HIV replication and its pathogenesis has helped in the identification of different pharmacological targets.
This has resulted into availability of a large number of antiretroviral ARV drugs. The triple therapy has resulted into significant improvement in an immune status, quality of life, and reduced morbidity and mortality associated with HIV infection.
The continued search for different drug combinations, preferential change in first line drugs and identification of novel drugs has been a boon for an effective viral suppression.
However, the success of the drug treatment is achieved at the cost of life threatening adverse drug effects, drug-drug interactions and an inconvenience of lifelong therapy. Since the disease has stepped into its 3rd decade, there are several treatment-experienced patients living either with drug toxicity or facing the threat of treatment failure due to a multi-drug resistance.
Moreover, there is likelihood of newly infected untreated patients harboring HIV mutants that are already resistant to commonly used ARV drugs. In addition, a great deal of attention has also been focused on prevention of an HIV infection through sexual contact. This article is an attempt to discuss the key issues with ARV drugs, review the new agents in existing classes and also the novel drugs under development.
These factors are a major challenge for an effective long term treatment. At such a high rate of replication, the virus often commits mistakes and results into mutants.
Once infected, the virus becomes an integral part of host cell and survives the full life span of infected host cell,[ 4 ] especially in T-lymphocytes and urogenital secretions. Surprisinglydespite a complete plasma viral load suppression for months, the virus remains detectable in seminal fluid and more often than not, these are drug resistant variants.
This complicates the treatment, causes difficulty in causality assessment and may require treatment withdrawal in serious life threatening reactions.
On the other hand, the evaluation of the potential interactions during clinical trials is mostly incomplete and becomes evident only during drug therapy. Further, the drugs belonging to same class also differ in their potential to cause the interactions. For example, first licensed integrase inhibitor, raltegravir is predominantly metabolized by UGT1A1- medicated glucoronidation with little potential to interact with CYP enzymes, whereas elvitegravir is largely metabolized by CYP3A4.
The drug treatment of co-existing medical disease s and opportunistic infections can also complicate the ART. The use of over the counter drugs and herbal drugs may potentially compromise the management.
The recommended practice to combine 3 or more drugs from different classes of ART results in high pill count that, along with toxicities, may cause inconvenience to the patient and poor adherence.
Drug resistance is not only associated with rapid virologic failure but also present the daunting task in designing an effective treatment regimen.
The limited availability of ARV drugs and safe alternatives in resource poor countries further add to the problem. The lack of monitoring for adverse events and poor access to therapeutic drug monitoring facilities also interfere with effective ART management.
Host related factors Patients with pre-existing risk factors like obesity, fatty liver, psychiatric disorders, and abnormal liver and renal functions are more likely to develop ADRs and require a close monitoring.The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs in an attempt to control HIV infection.
There are several classes of antiretroviral . This article is an attempt to discuss the key issues with ARV drugs, review the new agents in existing classes and also the novel drugs under development.
Challenges with the Use of ARV Drugs The critical issues associated with ART are related to the characteristic features of the virus (HIV), ARV drugs and HIV positive patients. Moved Permanently. The document has moved here. Present National health system. Cuba's national health system is made up of multiple tiers: 1) the community containing individuals and families, 2) family doctor-and-nurse teams, 3) basic work teams, 4) community polyclinics, 5) hospitals, and 6) medical institutes.
More students apply for CAM courses: Celia Bell's defence. Sigh! The Times Higher Education Supplement (27 July ) reports an % increase in applications for 'university' courses in complementary medicine. Everything on Medicowesome searchable in one page - The contents page!