In the Beginning of My Life with HIV, after a coma caused by viral meningitis, there was no treatment. And therefore, no hope. I lost people, and many! Some of them just disappeared on the road, and I don't even know if they're alive or not. And as I said Martha Medeiros, the pain that hurts the most is the pain and not knowing!
About life with HIV, as far as I'm concerned, something that really bothers me is peripheral neuropathy. And look, I'm not even “so badly so"
Treatment of HIV infection continues to improve, study shows among 77.999 people
The effectiveness of first-line antiretroviral therapy (ART) continues to improve, according to an analysis of results in 78.000 people in 181 studies, published in the Journal AIDS by Professor Andrew Carr of St Vincent's Hospital in Sydney and colleagues. More than three quarters of people who started treatment between 2011 and 2015 were still on their first regimen! And they had an undetectable viral load three years later.
The results in 2011-2015 were significantly better than those recorded in people initiating therapy between 2006 and 2010, who in turn were better at results observed in people who started treatment between 2001 and 2005 and between 1994 and 2000. In addition, there was a sustained drop in the proportion of individuals who stopped their first-line regimen. In this case, there is talk of interruptions due to side effects or due to personal choices. However, the proportion of people who stopped due to virological failure was reduced by approximately 5%.
Thus, as Cazuza said: “I saw the Face of Death. And she was alive
But as good as post-2011 results are, researchers believe It is still possible to do better. They note that even with the most up-to-date ART regimens, a fifth of people experience treatment failure (interrupt or change your treatment regimen for any reason) within three years after the beginning of HIV therapy.
The So-called TARV Involved, in 1996 in a Drug Called DDI (Imagine The Devil On Tablets)
And see it here: Videx
The study contained some indications as to which regimes were likely to be most successful: treatment with tenofovir (TDF or TAF) associated with emtricitabine and integrase inhibitors were more likely to remain in first-line treatment over three years. Other findings showed that the baseline resistance test and the single daily dose were also predictors of long-term treatment success.
Five findings from the study on Treatment for HIV Infection
Five findings of particular importance are highlighted by the authors:
- The initial effectiveness of ART will continue to improve. However, more than 20% of patients on ART based on 2010 integrase inhibitors failed over 144 weeks.
- Phase 3 studies overestimate the “Real-world effectiveness”.
- There is little analysis of patient characteristics and clinical exams routinely collected to avoid failure of the routine ART regimenHIV infection and its consequences.
- The rate of ART Virological failure does not appear to have decreased by more than 20 years.
- The follow-up time of the study remains very short.
Looking Good, Antiretroviral Therapy, ART, is the guiding thread of “our lives”!
ART guidelines provide recommendations for the selection of first-line therapy based on individual randomized trials. To obtain a more accurate impression of the effectiveness and durability of first-line ART, a strategy was needed. Thus, Carr and colleagues conducted a systematic review of the results reported in 181 studies involving 77.999 people.
Explaining, the study was from 1994 to 2017.
A similar exercise performed in 2008 showed that therapy based on Tenfovir / Emtricitabine was more effective than treatment with abacavir / lamivudine when used with an enhanced protease inhibitor or a non-nucleoside reverse transcriptase inhibitor (NNRTI).
An update in 2012 showed that treatment based on an integrase inhibitor was superior to treatment, including a potentiated protease inhibitor or NNRTIs. It also showed that differences in results according to viral load were lower for the integrase inhibitors than the potentiated protease inhibitors and NNRTIs.
Studies on Improvement Against 0 Treatment of HIV Infection Has Not Evaluated “First Line” Treatments.
Only randomized studies and prospective cohort studies involving people initiating first-line HAART were included. The primary outcome was the efficacy of treatment at 48, 96 and 114 weeks. Success was defined as an undetectable viral load reported based on intent to treat. Thus, changing the treatment for any reason was therefore considered to be flawed.
Overall, patients had an average age of 37 years, 75% were men and 61% were white. At the beginning of the study, the average CD4 cell count was 262 cells / mm3. And the viral load was 63.000 copies / ml, respectively. Patients took an average of 4,8 tablets in 1,6 daily doses.
The main treatment structures were tenofovir / emtricitabine (44%), thymidine based (28%) and abacavir / lamivudine (10%). The third major drugs were NNRTIs (50%), potentiated protease inhibitors (28%) and integrase inhibitors (12%).
Anti-HIV Treatment Has Improved Quality of Life of Diagnosed People
The results at week 48 were reported for almost all participants. The average effectiveness was 71%. Significantly improved over time. The average was 57% in studies that started between 1994 and 2000. And it grew to 69% for people initiating therapy between 2001 and 2005. E for 77% for individuals in 2006 and 2010 and for 84% in post-2010.
The efficacy at week 96 was reported in 41% of studies, with an overall rate of 64%. Increased from 52% for studies prior to 2000. For 61% for studies from 2001 to 2005. And so, it grew to 65% for studies from 2006 to 2010. And finally, for 80% in recruitment studies between 2011 and 2015.
Only 14% of studies reported results at week 144 and these found an overall effectiveness of 62%. Again, this has improved over time. The effectiveness rates for the four time periods were 45%, 55%, 72% and 77%, respectively.
Predictors of efficacy included drug choice, with results favoring both tenofovir / entricibin and integrase inhibitors. Several dosing characteristics were also associated with greater effectiveness: once a day in the 48 week; dosing without food restrictions in week 96; and fewer pills in weeks 96 and 144.
HIV treatment has improved a lot. Mara, My Wife, I Believe, Is Alive Only And Only Thanks to Maraviroc, an important medication in the rescue therapy in the Treatment against HIV Infection
“The type of ART used, in particular the use of an integrase inhibitor as an anchor drug and the use of an NRTI backbone once a day [nucleoside reverse transcriptase inhibitor], had a much greater impact on effectiveness than characteristics of the patient ”, comment the authors. "The number of doses per day had a stronger relationship with effectiveness than if ART was taken as a pill or more than one pill per day."
Baseline resistance test (p = 0,0003) and higher cell count CD4 baseline (p = 0,0003) also predictors of greater efficacy.
The results in the post-licensing and "real world" studies were progressively worse than those observed in the phase three clinical trials.
In general, the results were about 10% better with the schemes recommended in the US Department of Health and Social Services guidelines compared to the regimens recommended by the World Health Organization (undetectable is equal to non-transmissible?).
Side effects continue to be the worst part of antiretroviral therapy, treatment against HIV infection
However, almost 30% of those with 144 weeks of follow-up prematurely discontinued the initial ART regimen. The most common reasons were patient choice (13%), side effects (9%) and virological failure (5%). Most of these cessations occurred in 48 week. The proportion of early cessation of treatment due to patient choice or side effects was lower in studies conducted after 2010 compared to other time periods. However, the proportion of people who discontinued therapy due to virological failure remained stable at approximately 5%.
"The initial efficacy of ART continues to improve, but more than 20% of post 2010 patients have failed in 3 years," the researchers conclude. "Real-world effectiveness is lower than in 3 phase studies. The guidelines should list the initial ART not based on integrase inhibitors as non-preferred. Strategies are needed to improve access to pre-ART genotyping and to increase the early onset of single daily ART. "
Translated by Cláudio Souza from the original HIV treatment outcomes continue to get better, says large analysis, esquito por Michael Carter, pPosted: 27 December 2018 in AIDSMAP.
My Personal Opinion
So, I would say yes, has the treatment improved since its "beginning" in 1996? Yes No doubt! And not even that would be, say, a walk to the square. If you want my opinion, I would say that if I could go back in time I would.
I would go back and tell myself everything I know. "What do I know now?" And I would tell myself to "take another route". This would certainly generate a paradox and you would not be here, "reading me".
That would not be possible. But if it were…. Well, when it comes to temporal and timeless paradoxes, it's best not to start thinking.
The great truth is that at this time, on the twenty-eighth of December of two thousand and eighteen, around 13: 00, what I can say is:
The Stupid "VontAIDS" thing
And that is stupid the placement that claims to be better die of AIDS than of Vont'AIDS
Take care. Ever
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Carr A et al. Success and failure of initial antiretroviral therapy in adults: an updated systematic review of 77.999 patients from 1994 to 2017. AIDS, online edition. DOI: 10.1097 / QAD.0000000000002077 (2018).