Darunavir and acute HIV-related demyelinating polyneuropathy: a new possible treatment?


ABSTRACT
At this moment the role of new protease inhibitors in the onset of HIV-related demyelinating polyneuropathy remains a controversial topic. We describe the improvement of AIDP after introduction of boosted Darunavir plus Tenofovir/ Emtricitabine in a HIV positive patient naïve for antiretroviral therapy. The regression of the neurological symptoms was associated with the introduction of protease inhibitors in absence of traditional treatment strategies for demyelinating polyneuropathy. Further studies are needed to establish their potential use in the treatment of HIV-1 related demyelinating polyneuropathy.

Keywords: Generic drug; Co-formulation; Antiretroviral therapy.


Articolo presente in – HAART and correlated pathologies n. 11

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Generic Drugs: What Antiretroviral Scenario is Expecting?

ABSTRACT

The prevalence of HIV-infected patients in antiretroviral treatment is continuously increasing in western world due to longer survival, changes in guidelines for initiation of treatment and immigration from poor resources countries: the cost of drugs will inevitably drive the future choices. Since for an always larger number of antiretroviral drugs the patent is going to expire in the next few years, the generic drugs may let great cost reduction. One of the immediate issues that the clinicians are going to face, is the “disruption” of the actual drugs co-formulations (that is >1 drug in one pill) for economic reasons. However, the patent expiration of the antiretroviral drugs might allow in the next years different coformulations with respect to those currently available. The role of the generic drugs in antiretroviral therapy is still well undefined but probably they will occupy a larger and larger market share: the implications of this change for clinical practice are not fully understandable at the present time, but clinicians and authorities should evaluate advantages and disadvantages, avoiding opportunistic choices or defensive positions, in order to offer the best cost-effective treatment to the largest number of HIV patients.
Keywords: Generic drug; Co-formulation; Antiretroviral therapy.


Articolo presente in – HAART and correlated pathologies n. 11

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Endothelial inflammatory disease and cardiovascular risk in HIV patients


ABSTRACT
Several reports have indicated that HIV-positive patients have an increased risk of cardiovascular disease (CVD). Some studies have demonstrated a relationship between antiretroviral use and increased risk of cardiovascular events. More recent studies disclosed that the use of abacavir was associated with an excess risk of CVD, and patients with low CD4+ cell count could be at higher risk of subclinical arterial lesions or CVD. This prompted the hypothesis that mechanisms other that those linked to lipid changes and “classic” risk factors for atheroma may be at work in HIV-positive patients. Atherogenesis is mainly an inflammatory disease, so it is not surprising that endothelial injury is associated with the progression and severity of HIV infection. Another question is: do antiretroviral drugs increase or reduce endothelial injury? Various studies support the hypothesis that highly active antiretroviral therapy (HAART) does stimulate endothelial function. Thus, the HIV virus together with immune reconstitution and HAART itself promote premature endothelial activation. Such a prominent role played by the inflammatory events also seems to affect the structure of the arterial lesions in HIV patients that could differ from classical atheroma. We hypothesize that the atherosclerotic lesions in HIV patients develop in two distinct phases: the first characterized by an inflammation of the vascular wall, the second in which the lesions could evolve towards the classic feature of atheroma. The initial lesions are probably determined by immune deficiency, immune reconstitution, and the effect of HAART, whereas subsequent lesions could be maintained by the classic risk factors.
Keywords: Atherosclerosis; HIV; Antiretroviral therapy; Endothelium; Arteritis.


Articolo presente in – HAART and correlated pathologies n. 1

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