Depuis la mise à disposition de génériques des médicaments antirétroviraux (ARV), leur utilisation dans les pays en développement a permis de réduire considérablement le coût de la trithérapie antirétrovirale et d'augmenter l'accès au traitement, contribuant à la diminution du nombre de décès liés au VIH et à l'augmentation de l'espérance de vie. Les premiers génériques ARV ont été commercialisés en Europe à partir de 2012. Cela devrait contribuer à une augmentation de la consommation d'ARV en Europe où l'incidence du VIH reste stable depuis dix ans. Cependant leur utilisation en pays développés suscite autant d'intérêt que d'interrogations. Une étude Française a souligné les réticences des médecins à prescrire et des patients à prendre des ARV génériques. Notre premier objectif a été d'estimer le niveau d'exposition aux ARV génériques en vie réelle en France depuis 2013, à partir des données du SNIIRAM, de définir le profil des patients exposés aux génériques versus ceux non-exposés mais susceptibles de l'être et déterminer les facteurs associées à cette exposition. Notre second objectif a été d'évaluer l'adhérence au régime incluant des ARV génériques et de la comparer à celle des patients non exposés aux génériques mais susceptibles de l'être. Enfin, les études de simulations ont estimé d'importantes économies réalisables grâce à la substitution de princeps par les génériques en pays développés. Notre troisième objectif a été de quantifier le niveau de consommation des ARV et les dépenses associées en Europe ces dix dernières années et de déterminer l'impact réel de l'utilisation des ARV génériques sur la réduction des dépenses. / Generic antiretroviral (ARV) drugs use in developing countries has significantly reduced the cost of and increased the access to HIV treatment which contributed to the decrease in HIV related deaths and the increase of life expectancy. WHO recommendations since 2015 suggest that antiretroviral therapy should be initiated upon discovery of HIV status, regardless of immune, virological or clinical status. Since the first generic ARVs were marketed in Europe from 2012, this should contribute to an increase in the consumption of ARVs, particularly in Europe where the incidence of HIV has remained stable for ten years. However, generic ARV drugs use in developed countries arouses as much interest as interrogations. A French study highlighted the reluctance of physicians to prescribe and patients to take generic ARVs. Our first objective was to estimate the level of exposure to generic ARVs in real life in France since their commercialization from the SNIIRAM (Système National d'Information Inter-régimes de l'Assurance Maladie) database, to define the profile of patients exposed to generics versus those likely to be exposed but who were not, and to determine the factors associated with this exposure. Substitution of brands by the available generics may increase the daily number of tablets the patient should take and consequently decrease treatment adherence, however crucial for therapeutic success. Our second objective was to assess adherence to the regimen that incorporate generic ARV drugs and compare it to that of patients likely to be switched to generic ARVs but who were not. Furthermore, simulation studies have estimated large savings due to the substitution of brand ARVs by generics in developed countries. However, this strongly depends on the level of generic use. Our third objective was to quantify the level of consumption of ARV drugs and associated expenditures in Europe over the past decade and to determine the real impact of generic ARVs use on cost reduction. This work provides new data on ARV exposure in the general population, showing the low penetration of generics since they were made available, despite treatment adherence similar to that observed under brand-names. For each study, an innovative methodological approach was developed to use the SNIIRAM databases in this area.

HIV antiretroviral therapy spans several different drug classes, meant to combat various aspects of viral infection and replication. Many authors have argued the benefits of therapeutic drug monitoring (TDM) for the HIV patient including compliance assurance and assessment of appropriate drug concentrations; however, the array of drug chemistries and combinations makes TDM an arduous task. HPLC-UV and LC-MS/MS are both frequent instruments for the quantification of HIV drugs in biological matrices with investigators striving to balance sensitivity and affordability. Plasma, the dominant matrix for these analyses, is prepared using protein precipitation, liquid-liquid extraction or solid-phase extraction depending on the specific complement of analytes. Despite the range of polarities found in drug classes relevant to HIV therapeutics, most chromatographic separations utilize a hydrophobic column (C18 ). Additionally, as the clinically relevant samples for these assays are infected with HIV, along with possible co-infections, another important aspect of sample preparation concerns viral inactivation. Although not routine in clinical practice, many published analytical methods from the previous two decades have demonstrated the ability to conduct TDM in HIV patients receiving various medicinal combinations. This review summarizes the analytical methods relevant to TDM of HIV drugs, while highlighting respective challenges.

Measles remains a major global public health problem. Attainment of high population immunity to measles through vaccination is necessary to control this disease. Children infected with HIV infection often experience secondary measles vaccine failure by 2 years of age, making them susceptible to measles. It is not clear whether HIV-infected children on Highly Active Antiretroviral Treatment (HAART), older than 2 years, have a higher risk of measles than HIV-uninfected children. This retrospective cohort study, guided by the proximate determinants framework, was conducted to compare the risk of measles between HIV-infected children on HAART (exposed) and HIV-uninfected peers (unexposed). The age group with the highest measles susceptibility in the exposed children, which could inform timing for revaccination, was investigated. The role of age at initiation of HAART, low CD4+ count, and undernutrition as predictors of the risk of measles in the exposed children was examined. Univariate, bivariate, and binomial logistic regression analytical procedures were used in data analysis. Results showed no significant difference in the risk of measles between exposed and unexposed children. The age groups 5 to 9 years and 2 to 4 years were the first and second most affected by measles among the exposed children. Undernutrition (stunting) was a significant predictor of measles in exposed children (odds ratio of 4.14, p = 0.02), while age at initiation of HAART and CD4+ count prior to measles exposure were not. The study findings provide evidence to inform vaccination policy and nutrition care for HIV-infected children on HAART in Uganda, so as to reduce their risk of measles illness and mortality, thus contributing to positive social change for the children and the country.

Developing countries like Nigeria continue to have HIV epidemic challenge due to the scarcity of evidence-based information and lack of resources to boost HIV education. The study population, Owerri, is one of the states in Nigeria with a high incidence rate of HIV. The purpose of this phenomenological study was to explore the experiences of people living with HIV/AIDS regarding the effects of nonadherence to HIV/AIDS drugs. The integrated theory of health behavior model provided the framework for the study. I collected, transcribed, and analyzed interview data to identify clusters and themes. Results showed that various factors influenced and (e.g., free drugs, fear, culture, medication side effects, discrimination, relationship/support system, poverty, belief, easy access) contributed to adherence behavior among respondents. People living with HIV/AIDS may be encouraged to adhere to drug treatments because of these research findings. This study contributed to a positive social change in that respondents were excited and open about sharing their fears, challenges, struggles and hope with the anticipation to influence others to be open about their HIV disease.

Thesis (MPH.) --Univesity of Limpopo, 2014 / Background: The main goal of HAART is to achieve maximal viral suppression. However, with poor adherence to therapy the chances of achieving and maintaining successful viral suppression are decreased, leading to virological failure. And virological failure has been recognized by WHO as one of the early warning signs of drug resistance. This operational research sought to explore virological failure as a treatment outcome to evaluate program performance at a facility level. Methods: Purposive sampling as per inclusion and exclusion criteria was used to retrospectively review clinical records of the first 700 adult HIV positive patients (350 males and 350 females) who initiated antiretroviral treatment between April 2004 and December 2007 at this adult HIV clinic, were followed up for at least 3 years and treated according to the South African government’s National Department of Health 2004 HIV treatment guidelines for adults and adolescents. Major Results: 268 clinical records, 97 (27.71%) male and 171 (58.86%) female records were eligible for inclusion in the study. The proportion of females was higher (63.8%) than males (32.8%) with an average age of 38.95 years. 24 (8.9%) patients in the study sample experienced virological failure during the study period; 11 (11.3%) males and 13 (7.6%) females. Two-thirds (66.6%) of patients who failed to suppress at their first viral load measurement proceeded to develop virological failure. Overall, there was no association of statistical significance between age, sex, baseline CD4 cell count and baseline regimen, and virological failure at various intervals, p> 0.05. Conclusion: It was a challenge to keep patients in care but those that remained in care had good treatment outcomes with only 8.9% developing virological failure. Failure to suppress at first viral load preceded virological failure in the majority of patients.

The aim of the thesis was to undertake an evaluation of the neuropsychological functioning of non-demented and demented patients with advanced HIV-infection who have been treated with Highly Active Antiretroviral Therapy (HAART) for several years. One hundred and one non-demented HIV-infected individuals and 23 patients with mild or moderate AIDS Dementia Complex (ADC), from the outpatient clinics and Neurology department at St. Vincent's Hospital, Sydney, Australia were randomly selected to participate in a prospective study of the neurological and neuropsychological complications of HIV disease. All had advanced HIV-infection and all had been on HAART for five years on average. Thirty-one seronegative controls were recruited as controls. All participants completed a standard neuropsychological examination assessing nine cognitive domains. Non-demented advanced HIV-infected individuals participated in three follow-up visits. In addition, we report the results of a multi-centre cohort of 78 patients with mild to moderate ADC on HAART (Abacavir ADC trial). The main findings of our research were that the prevalence of neuropsychological impairment in advanced HIV-infected individuals remains equivalent to the era that preceded the introduction of HAART. Moreover, while complex attention / psychomotor speed remained a marker of HIV-related neuropsychological impairment in the HAART era, impairment in learning, memory and aspects of complex attention may be new indicators of HIV-associated neurocognitive impairment. While progression of neuropsychological impairment is associated with past HIV-related history of brain involvement, we demonstrated that deterioration does not occur in a linear fashion and that over a 27 month period neuropsychological performance stabilizes in the majority. Stabilization of performance may be related to relapses in the course of HIV-associated neurocognitive impairment and HAART optimization especially with antiretrovirals that have good brain tissue penetrance. Our research showed that plasma viral load and current CD4 cell count were generally not associated with the neuropsychological performance, but rather that nadir CD4 cell count was associated with neuropsychological performance suggesting a relation between past immune deterioration and current cognitive status. Cerebrospinal markers of immune and virological activity were found to be partly dissociated from current neurological in contrast to what was observed in the pre-HAART era. Future studies will need to evaluate new factors for underlying HIV-associated neurocognitive impairment as well as factors for underlying partial recovery.

Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 130-152).

<p>The current study aimed to describe the extent and reasons for substituting and switching HAART at the Katutura Intermediate Hospital in Windhoek, Namibia</p>

<p>Sub-Saharan Africa is home to two thirds of the 33 million HIV infected individuals worldwide. In 2007 there were an estimated 1.5 million Kenyans infected with HIV, and 166 000 new infections in 2008. The introduction of antiretroviral therapy [ART] brought new hope to HIV patients. It has transformed a fatal disease to a chronic manageable condition. Kenya has made great strides in ensuring access to ART and by 2009, 308 610 patients in the country were receiving ART - which is the second highest number worldwide. The success of ART requires a sustained adherence rate to medication of more than 95% to prevent viral replication and the development of drug resistant HIV strains. Identifying the factors that influence adherence, is essential for the long-term success of public ART programmes. The current study explored patient, socio-economic, cultural, and religious and health systems factors that influence adherence to ART at the Coast Provincial General Hospital [CPGH] in Mombasa, Kenya.</p>

The HIV/AIDS pandemic has implications at every level of social functioning. It affects individuals, families, communities and organisations. The burden of caring for those exposed, affected and infected is vast, but one of the most significant developments which have the potential to reduce disease burden is antiretroviral therapy. Antiretroviral therapy (ART) is complex and difficult to administer, and requires a learning process which is mediated through a number of means. Vygotskian theory was utilised to better understand the process of adherence through mediated learning, and as a framework for explaining compliance. In this study, mediated learning occurs both in the context of the clinic staff and the clinic attendees, and the caregivers and the child. Therefore Vygotsky‟s theory offers useful insight into this process. This qualitative study aimed to research the factors which contribute to ART adherence in a small sample of HIV positive children who are attending a local clinic. Eight child-caregiver dyads were interviewed, and drawings utilised to better understand child and caregiver factors which contribute to compliance. There were a number of psychosocial factors identified which contribute to compliance, or lack thereof, including social support, stigma, medication fatigue, disclosure, access difficulties, psychoeducation, and motivation. A number of qualitative differences were also identified between children who knew their HIV status and those who did not. These differences emerged primarily through the analysis of the child participants‟ drawings and there appeared to be a number of inter- and intrapersonal benefits to disclosure. The factors identified in this study, if better understood, can inform interventions to improve compliance on ART. / Thesis (M.Soc.Sci.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.