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    • pdgf receptor The treatment target which aims at

    2021-09-08

    The “90-90-90 treatment target” which aims at diagnosing 90% of HIV-infected individuals, treating 90% of those diagnosed and achieve viral suppression for 90% of treated individuals, is a key strategy to achieve one of the sustainable development goals (SDG) of ending AIDS as a public health threat by 2030 (UNAIDS, 2014). However, low level of treatment adherence, loss to follow-up, and drug resistance needs to be addressed to achieve the SDG goals. ART should be taken for life with adequate level of adherence to get the desired benefit. However, asymptomatic individuals with a high level of CD4 count might have poor adherence and be less motivated to continue treatment (Nachega et al., 2014). For example, a study in Malawi reported that 73% of women continued ART treatment three months after initiation but only 56% were adherent to treatment (Hauser et al., 2017). Drug resistance is another problem that should be taken into account. The 2017 WHO HIV drug resistance report showed that the level of HIV drug resistance among the first line drugs used in most low and middle income countries was very high; three of the four sub-Saharan African countries included in the report had greater than 10% pretreatment resistance for non-nucleoside reverse transcriptase inhibitors (NNRTIs) (ranging from 8.1% to 15.4%) (WHO, 2017). Mathematical modeling estimates showed that if NNRTI pretreatment resistance exceeds 10%, and NNRTI-based ART continue to be a first-line treatment in the next 15 years, NNRTI pretreatment resistance could become responsible for 16% of AIDS deaths (n=890000) and 9% of new HIV infections (n=450000) in sub-Saharan Africa alone (Phillips et al., 2017). Notably, early pdgf receptor of treatment is found to reduce the risk of HIV drug resistance compared to delaying treatment (Hamers et al., 2012, Fogel et al., 2016). Our findings should be understood in the light of the following limitations. Because of the observational nature of the study, different confounding factors could bias the findings; but we were able to adjust for a broad range of known potential confounders. We also explore influence calendar year at the start of ART but we found no association between calendar year at the start of ART and treatment outcome. The study was conducted in resource limited urban settings which might limit its generalizability to other settings. Moreover, our study was limited by exclusion of a substantial number of women due to missing information, although our comparison of characteristics of those excluded and those included showed that the two groups were very similar. More women with lower CD4 counts were started on other ART types compared to TDF-3TC-EFV. This is because of evolution of the treatment guideline. Before 2013, efavirenz was not recommended during early pregnancy for fear of side effects; meanwhile eligibility for ART was based on CD4 count (<350cell/mm3) or disease progression. Viral load and CD4 to CD8 ratio which are important clinical indicators of treatment success were not measured. Our study was also limited by short follow-up period; as a result we could not evaluate the long term trend of CD4 count and clinical outcomes. Notably, previous studies indicated that most of the CD4 gains in patients on ART were achieved within one year of treatment (Lifson et al., 2011, Gezie, 2016). In conclusion, initiation of ART for asymptomatic HIV-infected pregnant women with CD4 count ≥500cells/mm3 was beneficial to preserve or recover immunity after 12 months of treatment in resource limited settings. Our finding supports the recent WHO recommendations of universal ART for HIV-infected individuals including pregnant women as early as possible. A large-scale study on drug toxicity and drug resistance in resource-limited settings among men and women who initiate ART at different CD4 counts is warranted.
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