https://www.avert.org/professionals/hiv-programmin
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Posted On: 10/12/2019 7:28:52 PM
https://www.avert.org/professionals/hiv-progr...resistance
The emergence of HIVDR has occurred due to multiple factors, including stock-outs of drugs, poor health service quality and treatment interruptions. It limits HIV treatment options, increases treatment programme costs, and if left untreated, resistant virus can increase in the body to the extent that it can be transmitted.
On-time pill pick up/ on-time clinic appointment keeping – treatment non-adherence of just 48 hours has been linked to the development of drug resistant HIV mutations. While it is difficult to monitor patient adherence to ART, certain proxies can be used to determine if a patient is taking their medicines – such as those picking up their treatment on time, and keeping appointments at the clinic. These measure successful engagement of patients in care.
The impact on treatment options for the patient depends on which viral mutations they have. For some drugs, such as the NRTI lamivudine and all NNRTIs, just one mutation – notably the M184V or K103N mutations – can result in high-level drug resistance.9 This is clinically relevant, as NNRTIs including efavirenz and nevirapine have for many years made up the backbone of first-line treatment in low-resource settings.10
As such, the global burden of HIVDR is largely the result of NNRTI resistance. For other NRTIs and most protease inhibitors (PI), high-level drug resistance requires multiple mutations to occur simultaneously. Newer ARVs and drug classes, such as the integrase inhibitor, dolutegravir, have much higher genetic barriers to resistance.
The emergence of HIVDR has occurred due to multiple factors, including stock-outs of drugs, poor health service quality and treatment interruptions. It limits HIV treatment options, increases treatment programme costs, and if left untreated, resistant virus can increase in the body to the extent that it can be transmitted.
On-time pill pick up/ on-time clinic appointment keeping – treatment non-adherence of just 48 hours has been linked to the development of drug resistant HIV mutations. While it is difficult to monitor patient adherence to ART, certain proxies can be used to determine if a patient is taking their medicines – such as those picking up their treatment on time, and keeping appointments at the clinic. These measure successful engagement of patients in care.
The impact on treatment options for the patient depends on which viral mutations they have. For some drugs, such as the NRTI lamivudine and all NNRTIs, just one mutation – notably the M184V or K103N mutations – can result in high-level drug resistance.9 This is clinically relevant, as NNRTIs including efavirenz and nevirapine have for many years made up the backbone of first-line treatment in low-resource settings.10
As such, the global burden of HIVDR is largely the result of NNRTI resistance. For other NRTIs and most protease inhibitors (PI), high-level drug resistance requires multiple mutations to occur simultaneously. Newer ARVs and drug classes, such as the integrase inhibitor, dolutegravir, have much higher genetic barriers to resistance.
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