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Huang C, Hoque T, Bendayan R. Antiretroviral drugs efavirenz, dolutegravir and bictegravir dysregulate blood-brain barrier integrity and function. Front Pharmacol 2023; 14:1118580. [PMID: 36969875 PMCID: PMC10030948 DOI: 10.3389/fphar.2023.1118580] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
The implementation of combined antiretroviral therapy (cART) significantly reduces the mortality associated with human immunodeficiency virus (HIV) infection. However, complications such as HIV-associated neurocognitive disorders (HAND) remain a major health concern. We hypothesized that the toxicity of antiretroviral drugs (ARVs) may contribute to the pathogenesis of HAND in addition to cerebral viral infection. To address this question, we evaluated the impact of HIV integrase strand transfer inhibitors (dolutegravir and bictegravir), and a non-nucleoside reverse transcriptase inhibitor (efavirenz) on the integrity and permeability of various human and mouse blood-brain barrier (BBB) models, in vitro, ex vivo and in vivo. We observed a significant downregulation of tight junction proteins (TJP1/Tjp1, OCLN/Ocln and CLDN5/Cldn5), upregulation of proinflammatory cytokines (IL6/Il6, IL8/Il8, IL1β/Il1β) and NOS2/Nos2, and alteration of membrane-associated transporters (ABCB1/Abcb1a, ABCG2/Abcg2 and SLC2A1/Slc2a1) mRNA expression, in vitro, in human (hCMEC/D3) and primary cultures of mouse microvascular endothelial cells, and ex vivo in isolated mouse brain capillaries treated with efavirenz, dolutegravir, and/or bictegravir. We also observed a significant increase in BBB permeability in vivo following treatment with the selected ARVs in mice applying NaF permeability assay. Taken together, these results suggest that clinically recommended integrase strand transfer inhibitors such as dolutegravir may exacerbate HIV-associated cerebrovascular pathology, which may contribute to the associated short-term neuropsychiatric side effects and the high incidence of mild forms of HAND reported in the clinical setting.
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Meleddu R, Distinto S, Corona A, Tramontano E, Bianco G, Melis C, Cottiglia F, Maccioni E. Isatin thiazoline hybrids as dual inhibitors of HIV-1 reverse transcriptase. J Enzyme Inhib Med Chem 2016; 32:130-136. [PMID: 27766892 PMCID: PMC6010014 DOI: 10.1080/14756366.2016.1238366] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A series of 3-3-{2-[2-3-methyl-4-phenyl-2,3-dihydro-1,3-thiazol-2-ylidene]hydrazin-1-ylidene-2,3-dihydro-1H-indol-2-one derivatives has been designed and synthesized to study their activity on both HIV-1 (Human Immunodeficiency Virus type 1) RT (Reverse Transcriptase) associated functions. These derivatives are analogs of previously reported series whose biological activity and mode of action have been investigated. In this work we investigated the influence of the introduction of a methyl group in the position 3 of the dihydrothiazole ring and of a chlorine atom in the position 5 of the isatin nucleus. The new synthesized compounds are active towards both DNA polymerase and ribonuclease H in the µM range. The nature of the aromatic group in the position 4 of the thiazole was relevant in determining the biological activity.
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Affiliation(s)
- Rita Meleddu
- a Department of Life and Environmental Sciences , University of Cagliari , Cagliari , Italy
| | - Simona Distinto
- a Department of Life and Environmental Sciences , University of Cagliari , Cagliari , Italy
| | - Angela Corona
- b Department of Life and Environmental Sciences , University of Cagliari, Cittadella Universitaria di Monserrato , Cagliari , Italy
| | - Enzo Tramontano
- b Department of Life and Environmental Sciences , University of Cagliari, Cittadella Universitaria di Monserrato , Cagliari , Italy
| | - Giulia Bianco
- a Department of Life and Environmental Sciences , University of Cagliari , Cagliari , Italy
| | - Claudia Melis
- a Department of Life and Environmental Sciences , University of Cagliari , Cagliari , Italy
| | - Filippo Cottiglia
- a Department of Life and Environmental Sciences , University of Cagliari , Cagliari , Italy
| | - Elias Maccioni
- a Department of Life and Environmental Sciences , University of Cagliari , Cagliari , Italy
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Jiang F, Ma Y, Jack Lee J. A second-order semiparametric method for survival analysis, with application to an acquired immune deficiency syndrome clinical trial study. J R Stat Soc Ser C Appl Stat 2016. [DOI: 10.1111/rssc.12189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Fei Jiang
- University of Hong Kong; People's Republic of China
| | - Yanyuan Ma
- Penn State University; State College USA
| | - J. Jack Lee
- University of Texas MD Anderson Cancer Center; Houston USA
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(3Z)-3-(2-[4-(aryl)-1,3-thiazol-2-yl]hydrazin-1-ylidene)-2,3-dihydro-1H-indol-2-one derivatives as dual inhibitors of HIV-1 reverse transcriptase. Eur J Med Chem 2015; 93:452-60. [PMID: 25728026 DOI: 10.1016/j.ejmech.2015.02.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/13/2015] [Accepted: 02/19/2015] [Indexed: 11/24/2022]
Abstract
The HIV-1 Reverse Transcriptase (RT) is a validated and deeply explored biological target for the treatment of AIDS. However, only drugs targeting the RT-associated DNA polymerase (DP) function have been approved for clinical use. We designed and synthesised a new generation of HIV-1 RT inhibitors, based on the (3Z)-3-(2-[4-(aryl)-1,3-thiazol-2-yl]hydrazin-1-ylidene)-2,3-dihydro-1H-indol-2-one scaffold. These compounds are active towards both RT-associated functions, DNA polymerase and ribonuclease H. The structure, biological activity and mode of action of the new derivatives have been investigated. In particular, the nature of the aromatic group in the position 4 of the thiazole ring plays a key role in the modulation of the activity towards the two RT-associated functions.
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Effect of Ritonavir on (99m)Technetium-Mebrofenin Disposition in Humans: A Semi-PBPK Modeling and In Vitro Approach to Predict Transporter-Mediated DDIs. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2013; 2:e20. [PMID: 23887590 PMCID: PMC3600725 DOI: 10.1038/psp.2012.21] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 11/13/2012] [Indexed: 11/15/2022]
Abstract
A semiphysiologically based pharmacokinetic (semi-PBPK) model was developed to describe a unique blood, liver, and bile clinical data set for the hepatobiliary imaging agent 99mTechnetium–mebrofenin (99mTc–mebrofenin), and to simulate sites/mechanisms of a 99mTc–mebrofenin–ritonavir drug–drug interaction (DDI). The transport inhibitor ritonavir (multiple-dose: 2 × 300 mg) significantly increased systemic 99mTc–mebrofenin exposure as compared with control (4,464 ± 1,861 vs. 1,970 ± 311 nCi min/ml; mean ± SD), without affecting overall hepatic exposure or biliary recovery. A novel extrahepatic distribution compartment was required to characterize 99mTc–mebrofenin disposition. Ritonavir inhibited 99mTc–mebrofenin accumulation in human sandwich-cultured hepatocytes (SCH) (half maximal inhibitory concentration (IC50) = 3.46 ± 1.53 µmol/l). Despite ritonavir accumulation in hepatocytes, intracellular binding was extensive (97. 6%), which limited interactions with multidrug resistance protein 2 (MRP2)-mediated biliary excretion. These in vitro data supported conclusions from modeling/simulation that ritonavir inhibited 99mTc–mebrofenin hepatic uptake, but not biliary excretion, at clinically relevant concentrations. This integrated approach, utilizing modeling, clinical, and in vitro data, emphasizes the importance of hepatic and extrahepatic distribution, assessment of inhibitory potential in relevant in vitro systems, and intracellular unbound concentrations to assess transporter-mediated hepatic DDIs.
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Thompson KA, Cherry CL, Bell JE, McLean CA. Brain cell reservoirs of latent virus in presymptomatic HIV-infected individuals. THE AMERICAN JOURNAL OF PATHOLOGY 2011; 179:1623-9. [PMID: 21871429 DOI: 10.1016/j.ajpath.2011.06.039] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 06/13/2011] [Accepted: 06/28/2011] [Indexed: 10/17/2022]
Abstract
We detected HIV-1 DNA in pure populations of perivascular macrophages, parenchymal microglia, and astrocytes, isolated using laser microdissection from brain tissue of five untreated individuals who died in the presymptomatic stage of infection from non-HIV causes. HIV-1 DNA was detected in the three cell populations, most consistently in perivascular macrophages, without evidence of productive infection. The percentage of PCR reactions detecting HIV-1 DNA in perivascular macrophages correlated inversely with peripheral blood CD4 counts. These findings demonstrate that brain cell reservoirs of latent HIV-1 exist before pathological HIV encephalitis and suggest that perivascular macrophage trafficking of latent virus into the brain increases with immunosuppression.
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Affiliation(s)
- Katherine A Thompson
- Pathology Research Laboratory, Anatomical Pathology Unit, The Alfred Hospital, Department of Medicine, Monash University, Melbourne, Australia
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Torian LV, Wiewel EW. Continuity of HIV-related medical care, New York City, 2005-2009: Do patients who initiate care stay in care? AIDS Patient Care STDS 2011; 25:79-88. [PMID: 21284498 DOI: 10.1089/apc.2010.0151] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this era of effective antiretroviral therapy, early diagnosis of HIV and timely linkage to and retention in care are vital to survival and quality of life. Federal guidelines recommend regular monitoring of HIV-related laboratory parameters and initiation of antiretroviral treatment at specified thresholds. We used routinely reported laboratory data to measure intervals between visits by New York City residents newly diagnosed with HIV July 1 to September 30, 2005, and initiating care within 3 months of diagnosis. We measured regular care (≥1 visit every 6 months) and retention in care (last visit ≤6 months before close of analysis) through June 30, 2009. Patients were followed for 45-48 months. Seventy-seven percent (650/842) of patients initiated care within 3 months of diagnosis; 609 (93.7%) made at least one subsequent visit; 45.4% had regular care. Risk factors for not receiving regular care included age 13-24 versus 50+ (adjusted odds ratio [AOR] 3.0, 95% confidence interval [CI] 1.5, 6.0), black race (AOR 2.0, 95% CI 1.4,2.8), eligibility for antiretroviral treatment (AOR 1.5, 95% CI 1.1, 2.2), and injection drug use (IDU; AOR = 2.7. 95% CI 1.0, 7.1). In a time-to-event analysis, risk factors for loss to care were age 13-24 versus 50+ at diagnosis (adjusted hazard ratio [AHR] 1.9, 95% CI 1.1, 3.4), non-hospital site of care (AHR 1.4, 95% CI 1.0, 2.0) and early stage (non-AIDS) disease (AHR 1.4, 95% CI 1.0, 2.0). The analysis demonstrates how mandated reporting of HIV-related laboratory tests provides surveillance systems with the capacity to monitor utilization of care, identify deficits, and evaluate progress in programs designed to facilitate retention in care.
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Affiliation(s)
- Lucia V. Torian
- The New York City Department of Health and Mental Hygiene, New York, New York
| | - Ellen W. Wiewel
- The New York City Department of Health and Mental Hygiene, New York, New York
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Expanded Highly Active Antiretroviral Therapy Coverage Among HIV-Positive Drug Users to Improve Individual and Public Health Outcomes. J Acquir Immune Defic Syndr 2010; 55 Suppl 1:S5-9. [DOI: 10.1097/qai.0b013e3181f9c1f0] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Venkatesh KK, de Bruyn G, Lurie MN, Lentle K, Tshabangu N, Moshabela M, Martinson NA. Patient referral from nurses to doctors in a nurse-led HIV primary care clinic in South Africa: implications for training and support. AIDS Care 2010; 22:1332-9. [DOI: 10.1080/09540121003692243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kartik K. Venkatesh
- b Department of Community Health, Alpert Medical School , Brown University , Providence , RI , 02912 , USA
| | - Guy de Bruyn
- a Perinatal HIV Research Institute , University of the Witwatersrand , Soweto , South Africa
| | - Mark N. Lurie
- b Department of Community Health, Alpert Medical School , Brown University , Providence , RI , 02912 , USA
| | - Kgotso Lentle
- c Rural AIDS and Development Action Research, School of Public Health , University of the Witwatersrand , Johannesburg , South Africa
| | - Nkeko Tshabangu
- b Department of Community Health, Alpert Medical School , Brown University , Providence , RI , 02912 , USA
| | - Mosa Moshabela
- c Rural AIDS and Development Action Research, School of Public Health , University of the Witwatersrand , Johannesburg , South Africa
| | - Neil A. Martinson
- b Department of Community Health, Alpert Medical School , Brown University , Providence , RI , 02912 , USA
- d Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Venkatesh KK, Lurie MN, Mayer KH. How HIV treatment could result in effective prevention. Future Virol 2010; 5:405-415. [PMID: 20814447 DOI: 10.2217/fvl.10.38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
As the number of HIV infections continues to surpass treatment capacity, new HIV prevention strategies are imperative. Beyond individual clinical benefits, by rendering an individual less infectious, expanding access to highly active antiretroviral therapy (HAART) could also have a larger public health impact of curbing new HIV infections. Recent guidelines have moved towards initiating HAART at higher CD4 cell counts, thus increasing the number of individuals in need of treatment. A new treatment strategy is wanting that can simultaneously curb the epidemic and provide necessary treatment to those most in need. A recent debate has centered on whether an expansion of free and universal treatment, regardless of CD4 cell count, could be a means of HIV prevention. In light of the growing access to HAART in resource-limited settings and increasing evidence suggesting the clinical and prevention benefits of initiating treatment at higher CD4 cell counts, it is conceivable that, in the future, HAART will be an integral part of both individual-level clinical treatment programs as well as public health-based HIV prevention interventions.
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Affiliation(s)
- Kartik K Venkatesh
- Department of Community Health, Division of Infectious Diseases, Department of Medicine, Alpert Medical School, Brown University/Miriam Hospital, RI, USA
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Lam TTY, Hon CC, Tang JW. Use of phylogenetics in the molecular epidemiology and evolutionary studies of viral infections. Crit Rev Clin Lab Sci 2010; 47:5-49. [PMID: 20367503 DOI: 10.3109/10408361003633318] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since DNA sequencing techniques first became available almost 30 years ago, the amount of nucleic acid sequence data has increased enormously. Phylogenetics, which is widely applied to compare and analyze such data, is particularly useful for the analysis of genes from rapidly evolving viruses. It has been used extensively to describe the molecular epidemiology and transmission of the human immunodeficiency virus (HIV), the origins and subsequent evolution of the severe acute respiratory syndrome (SARS)-associated coronavirus (SCoV), and, more recently, the evolving epidemiology of avian influenza as well as seasonal and pandemic human influenza viruses. Recent advances in phylogenetic methods can infer more in-depth information about the patterns of virus emergence, adding to the conventional approaches in viral epidemiology. Examples of this information include estimations (with confidence limits) of the actual time of the origin of a new viral strain or its emergence in a new species, viral recombination and reassortment events, the rate of population size change in a viral epidemic, and how the virus spreads and evolves within a specific population and geographical region. Such sequence-derived information obtained from the phylogenetic tree can assist in the design and implementation of public health and therapeutic interventions. However, application of many of these advanced phylogenetic methods are currently limited to specialized phylogeneticists and statisticians, mainly because of their mathematical basis and their dependence on the use of a large number of computer programs. This review attempts to bridge this gap by presenting conceptual, technical, and practical aspects of applying phylogenetic methods in studies of influenza, HIV, and SCoV. It aims to provide, with minimal mathematics and statistics, a practical overview of how phylogenetic methods can be incorporated into virological studies by clinical and laboratory specialists.
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Affiliation(s)
- Tommy Tsan-Yuk Lam
- School of Biological Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Grace C, Kutzko D, Alston WK, Ramundo M, Polish L, Osler T. The Vermont Model for Rural HIV Care Delivery: Eleven Years of Outcome Data Comparing Urban and Rural Clinics. J Rural Health 2010; 26:113-9. [DOI: 10.1111/j.1748-0361.2010.00272.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Cytochrome P450 2B6 (CYP2B6) is the main metabolizing pathway for efavirenz (EFV), the prescription of which is associated with neurologic side effects. The authors conducted a study on the prevalence of CYP2B6 polymorphism, profile of side effects, and pharmacokinetics of EFV in a group of human immunodeficiency virus (HIV)-infected southern Chinese. Patients with HIV were recruited at the Shenzhen City Third People's Hospital, China. The prevalence of CYP2B6 G516T and plasma EFV concentration were determined. Pharmacokinetics was assessed using blood samples of selected patients at time 0, 1, 2, 4, 8, 12, and 24 hours after the last dose of EFV. Between October 2007 and June 2008, 79 Chinese patients with HIV were recruited. Sequencing of CYP2B6 at position 516 gave 42 GG, 34 GT, and 3 TT genotypes, with corresponding mean spot plasma EFV level of 3.4, 4.1, and 8.1 mg/L, respectively. The allelic frequency of 516 G>T was 0.25. Univariate analysis showed that plasma EFV level correlated with genotype (P = 0.02). Eighteen patients completed the pharmacokinetic study: TT genotype gave the longest half-life (t 1/2), highest plasma EFV concentration, and largest area under the curve. The volume of distribution per surface area (Vd ss), total clearance (Cltot), and elimination rate constant (ke) were the lowest. There was no association between the occurrence of side effects and the EFV concentration (chi2 test, P > 0.05). The EFV pharmacokinetics of TT genotype differed significantly from GG and GT genotypes. Accumulation of EFV may potentially occur over time, causing toxicity in TT and GT genotypes.
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Venkatesh KK, Kumarasamy N, Mayer KH. Indian manufacture of new generic antiretrovirals: implications for global access to anti-HIV drugs. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/hiv.09.55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Kartik K Venkatesh
- Departments of Medicine & Community Health, Miriam Hospital/Brown University, Providence, RI, USA
| | | | - Kenneth H Mayer
- Departments of Medicine & Community Health, Miriam Hospital/Brown University, Providence, RI, USA
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Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet 2009; 373:48-57. [PMID: 19038438 DOI: 10.1016/s0140-6736(08)61697-9] [Citation(s) in RCA: 1386] [Impact Index Per Article: 92.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Roughly 3 million people worldwide were receiving antiretroviral therapy (ART) at the end of 2007, but an estimated 6.7 million were still in need of treatment and a further 2.7 million became infected with HIV in 2007. Prevention efforts might reduce HIV incidence but are unlikely to eliminate this disease. We investigated a theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, and examined the conditions under which the HIV epidemic could be driven towards elimination. METHODS We used mathematical models to explore the effect on the case reproduction number (stochastic model) and long-term dynamics of the HIV epidemic (deterministic transmission model) of testing all people in our test-case community (aged 15 years and older) for HIV every year and starting people on ART immediately after they are diagnosed HIV positive. We used data from South Africa as the test case for a generalised epidemic, and assumed that all HIV transmission was heterosexual. FINDINGS The studied strategy could greatly accelerate the transition from the present endemic phase, in which most adults living with HIV are not receiving ART, to an elimination phase, in which most are on ART, within 5 years. It could reduce HIV incidence and mortality to less than one case per 1000 people per year by 2016, or within 10 years of full implementation of the strategy, and reduce the prevalence of HIV to less than 1% within 50 years. We estimate that in 2032, the yearly cost of the present strategy and the theoretical strategy would both be US$1.7 billion; however, after this time, the cost of the present strategy would continue to increase whereas that of the theoretical strategy would decrease. INTERPRETATION Universal voluntary HIV testing and immediate ART, combined with present prevention approaches, could have a major effect on severe generalised HIV/AIDS epidemics. This approach merits further mathematical modelling, research, and broad consultation.
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Burger H, Hoover D. HIV‐1 Tropism, Disease Progression, and Clinical Management. J Infect Dis 2008; 198:1095-7. [DOI: 10.1086/591624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Bartlett JG. Significant challenges facing HIV practitioners. J Infect Dis 2008; 197 Suppl 3:S250-1. [PMID: 18447610 DOI: 10.1086/533417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- John G Bartlett
- Johns Hopkins University, 1830 E. Monument Street, Baltimore, MD 21205, USA.
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