ABSTRACT
Background:The introduction of the highly active antiretroviral therapy in the mid-1990s has significantly reduced morbidities and prolonged the lifespan of people living with HIV. However; the emergence of resistance to the antiretroviral drugs is becoming a major cause of treatment failure. While the problem of drug resistance is being tackled in developed countries; not much seem to be done in this regard in developing countries of Africa; Asia and Latin America. This review looked at the regional distribution of HIV groups and subtypes and how this has affected the pattern of antiretroviral resistance. Methods: The review was sourced from papers presented at international conferences on HIV/AIDS and rational drug use; relevant journals and Medline search using the keywords- Antiretroviral drugs; drug resistance; HIV subtypes and resistance testing. Results: The types; groups; subtypes; sub-subtypes and recombinant forms of HIV-1 have been identified according to their geographical distributions. The evolution of HIV viral mutations; process (es) involved in development of primary and secondary antiretroviral drug resistance; including the role of HIV genetic polymorphisms; and transmitted resistance have been discussed. Conclusion: The pitfalls in the current resistance testing based on HIV-1 subtype B have been highlighted. The design of resistance testing algorithm based on HIV-1 subtype non-B has been suggested for the developing world
Subject(s)
Acquired Immunodeficiency Syndrome , Anti-Retroviral Agents , Drug Resistance , HIV InfectionsABSTRACT
Background : Coma occurring in the course of an illness; irrespective of cause; traditionally implies a poor prognosis and many factors may determine its outcome. These factors must be identified and possibly stratified in their order of importance. This research seeks to identify these factors and how they influenced the outcome of non-traumatic coma in our environment. Methods : Two hundred consecutive patients; aged 18-79 years who met the inclusion criteria; the Glasgow coma scale (GCS) score of 8; history and physical findings suggestive of medical illness; no head trauma or sedation; were recruited into the study from August 2004 to March 2005 at the University College Hospital (UCH); Ibadan; after obtaining institutional ethical clearance and consent from patients' guardians. Detailed history of illness including the bio-data and time to present to the hospital and treatments given were noted. Thereafter; the clinical course of the patients was monitored daily for a maximum of 28 days during which the support of the family and/ or the hospital social welfare was evaluated. Results : During the 8-month period of the study; 76(152) of the patients died while 24(48) survived. The following factors were associated with high mortality rate: inability to confirm diagnosis (100); poor family support (97.1); delay in making a diagnosis within 24 h (85.4); poor family understanding of disease (84.1); need for intensive care admission and management (83.3); poor hospital social welfare support (82.4); presentation to UCH after 6 h of coma (76.7); and referral from private health facilities (75.7). Others include substance abuse (100) and seropositivity to HIV (96) and hepatitis B surface antigen (92) antibodies; among others. Conclusion : This study has demonstrated that socio-economic factors such as gender; occupation; risky lifestyle behaviors; late presentation or referral to hospital; late diagnosis and treatment; and poor family support contributed to poor outcome of nontraumatic coma. It is hoped that improvement; modification; or correction of these factors may improve coma outcome