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Antiretroviral resistance patterns and HIV-1 subtype in mother-infant pairs after the administration of combination short-course zidovudine plus single-dose nevirapine for the prevention of mother-to-child transmission of HIV.
Clinical Infectious Diseases. 2009 Jul 15; 49(2):299-305.BACKGROUND: World Health Organization guidelines for prevention of mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) recommend administration of zidovudine and single-dose nevirapine (NVP) for HIV-1-infected women who are not receiving treatment for their own health or if complex regimens are not available. This study assessed antiretroviral resistance patterns among HIV-infected women and infants receiving single-dose NVP in Thailand, where the predominant circulating HIV-1 strains are CRF01_AE recombinants and where the minority are subtype B. METHODS: Venous blood samples were obtained from (1) HIV-infected women who received zidovudine from 34 weeks' gestation and single-dose NVP plus oral zidovudine during labor and (2) HIV-infected infants who received single-dose NVP after birth plus zidovudine for 4 weeks after delivery. HIV-1 drug resistance testing was performed using the TruGene assay (Bayer HealthCare). RESULTS: Most mothers and infants were infected with CRF01_AE. NVP resistance was detected in 34 (18%) of 190 women and 2 (20%) of 10 infants. There was a significantly higher proportion of NVP mutations in women with delivery viral loads of >50,000 copies/mL (adjusted odds ratio, 8.5; 95% confidence interval, 2.2-32.8, [Formula: see text] for linear trend) and in those with subtype B rather than CRF01_AE infections (38% vs. 16%; adjusted odds ratio, 3.6; 95% confidence interval, 1.1-11.8; P = .038). CONCLUSIONS: The lower frequency of NVP mutations among mothers infected with subtype CRF01_AE, compared with mothers infected with subtype B, suggests that individuals infected with subtype CRF01_AE may be less susceptible to the induction of NVP resistance than are individuals infected with subtype B.
Scaling up antiretroviral therapy in resource-limited settings. Guidelines for a public health approach. Executive summary.
Geneva, Switzerland, WHO, Department of HIV / AIDS, 2002 Apr. 31 p.Currently, fewer than five per cent of those who require ARV treatment can access these medicines in resource limited settings. WHO believes that at least three million people needing care should be able to get medicines by 2005—a more than ten-fold increase. These guidelines are intended to support and facilitate the proper management and scale-up of ART in the years to come by proposing a public health approach to achieve these goals. The key tenets of this approach are: 1) Scaling up of antiretroviral treatment programmes to meet the needs of people living with HIV/AIDS in resource-limited settings; 2) Standardization and simplification of ARV regimens to support the efficient implementation of treatment programmes; 3) Ensuring that ARV treatment programmes are based on the best scientific evidence, in order to avoid the use of substandard treatment protocols which compromise the treatment outcome of individual clients and create the potential for emergence of drug resistant virus. (excerpt)
Scaling up antiretroviral therapy in resource-limited settings. Guidelines for a public health approach.
Geneva, Switzerland, WHO, Department of HIV / AIDS, 2002. 163 p.These guidelines are part of the World Health Organization’s commitment to the global scale-up of antiretroviral therapy. Their development involved international consultative meetings throughout 2001, in which more than 200 clinicians, scientists, government representatives, representatives of civil society and people living with HIV/AIDS from more than 60 countries participated. The recommendations included in this document are largely based on a review of evidence and reflect the best current practices. Where the body of evidence was not conclusive, expert consensus was used as a basis for recommendations. We hope that this guidance will help Member countries as they work towards meeting the global target of having three million people on antiretroviral therapy by 2005. (excerpt)
Geneva, Switzerland, WHO, 2003. 79 p.The purposes of the HDRST include: 1) to work with the National AIDS Committee to consider the specific public health uses of HIV drug resistance surveillance in the country, and to assess feasibility of surveillance; 2) to develop an appropriate time line for resistance surveillance activities, in coordination with other important implementation plans such as expanding HIV treatment; 3) to assess the country's capacity for HIV drug resistance surveillance, to decide on the populations and groups to be targeted, and to identify additional resources and activities needed; 4) to perform HIV drug resistance threshold surveys to assess when the frequency of resistance in persons newly diagnosed with HIV has reached the 5% threshold indicating a need for resistance surveillance; 5) to implement, when appropriate, HIV drug resistance surveillance; 6) to collaborate with the National AIDS Committee and the national treatment programme; to explore the feasibility of treatment programme monitoring by adding a resistance monitoring component to other year-end programme monitoring activities; 7) after routine surveillance is established, to consider implementing other special studies for in-depth evaluation of certain aspects of drug resistance within the country; 8) to insure implementation of all activities in accordance with international ethical standards designed to promote the well- being and health of individuals and communities; 9) to insure the dissemination of results in order to promote and support the public health of the country. (excerpt)
Scaling up antiretroviral therapy in resource-limited settings: treatment guidelines for a public health approach. Rev. ed.
Geneva, Switzerland, WHO, 2003. 67 p.Currently, fewer than 5% of people in developing countries who need ART can access the medicines in question. WHO believes that at least 3 million people needing care should be able to get the medicines by 2005. This represents almost a tenfold increase. These treatment guidelines are intended to support and facilitate the proper management and scale-up of ART in the years to come by proposing a public health approach to achieve the goals. The key tenets of this approach are as follows. 1) Scaling-up of antiretroviral treatment programmes with a view to universal access, i.e. all persons requiring treatment as indicated by medical criteria should have access to it. 2) Standardization and simplification of ARV regimens so as to support the efficient implementation of treatment programmes in resource-limited settings. 3) Ensuring that ARV treatment programmes are based on scientific evidence in order to avoid the use of substandard protocols that compromise the outcomes of individual patients and create a potential for the emergence of drug-resistant virus. However, it is also important to consider the realities with respect to the availability of human resources, health system infrastructures and socioeconomic contexts so that clear and realistic recommendations can be made. (excerpt)