ABSTRACT
While antiretroviral drugs, those approved for clinical use and others under evaluation, attempt in lowering viral load and boost the host immune system, antiretroviral drug resistance acts as a major impediment in the management of human immune deficiency virus type-1 (HIV-1) infection. Antiretroviral drug resistance testing has become an important tool in the therapeutic management protocol of HIV-1 infection. The reliability and clinical utilities of genotypic and phenotypic assays have been demonstrated. Understanding of complexities of interpretation of genotyping assay, along with updating of lists of mutation and algorithms and determination of clinically relevant cut-offs for phenotypic assays are of paramount importance. The assay results are to be interpreted and applied by experienced HIV practitioners, after taking into consideration the clinical profile of the patient. This review sums up the methods of assay currently available for measuring resistance to antiretroviral drugs and outlines the clinical utility and limitations of these assays.
Subject(s)
Acquired Immunodeficiency Syndrome/microbiology , Anti-HIV Agents/pharmacology , Drug Resistance, Viral/genetics , Genotype , HIV-1/drug effects , Humans , Microbial Sensitivity Tests/methods , Mutation , PhenotypeABSTRACT
BACKGROUND: The transition of human immunodeficiency virus (HIV) infection to acquired immune deficiency syndrome (AIDS) has begun in India, and an increase in AIDS-related hospitalizations and deaths is an anticipated challenge. We estimated the rates of hospitalization and inpatient care costs for HIV-1-infected patients. METHODS: Data were analysed on 381 HIV-1-infected persons enrolled in a HIV-1 discordant couples' cohort between September 2002 and March 2004. Inpatient care costs were extracted from select hospitals where the study patients were hospitalized and the average cost per hospitalization was calculated. RESULTS: A majority of the patients were in an advanced state of HIV-1 disease with the median CD4 counts being 207 cells/cmm (range: 4-1131 cells/cmm). In all, 63 participants who did not receive antiretroviral therapy required hospitalization, 53 due to HIV-1-related illnesses and the remaining 10 due to worsening of pre-existing conditions. The overall HIV-1-related hospitalization rate was 34.2 per 100 person-years (95% CI: 26.94-42.93). The median duration of HIV-1-related hospitalization was 10 days (range 2-48 days) and the median cost was Rs 17,464 (range: Rs 400-63,891). CONCLUSION: It is necessary to strengthen the inpatient care infrastructure and supporting diagnostic set-up, and work out economically optimized treatment algorithms for HIV-1-infected patients. Although this analysis does not cover all costs and may not be generalizable, these baseline data might be a useful reference while planning related studies accompanying the government-sponsored programme to roll out antiretroviral therapy to AIDS patients.
Subject(s)
Acquired Immunodeficiency Syndrome/economics , Adult , Algorithms , Disease Progression , Episode of Care , Female , HIV Infections/complications , HIV-1 , Hospital Costs/statistics & numerical data , Hospitalization/economics , Humans , India/epidemiology , Male , Middle Aged , Prospective StudiesABSTRACT
A total of 4618 tuberculosis patients attending the TB clinic at the Sassoon General Hospitals, Pune between 1991 and 1996 were screened for anti-HIV antibodies. Of these 694 were found reactive in enzyme immuno assay (EIA) and 624 were further confirmed by a second test, either rapid EIA or Western blot. HIV-1 reactivity was predominant among tuberculosis patients with HIV-2 reactivity appearing only in 1995. HIV-2 seroreactivity accounted for 0.54 and 1.02 per cent of all HIV reactive samples in 1995 and 1996. HIV-1 and HIV-2 dual reactivity accounted for 1.63 and 2.04 per cent of all infections in 1995 and 1996. The overall seroprevalence of HIV among newly diagnosed tuberculosis patients rose from 3.2 per cent in 1991 to 20.1 per cent in 1996.
Subject(s)
HIV Seroprevalence/trends , Humans , India/epidemiology , Mass Screening/methods , Tuberculosis, Pulmonary/immunologyABSTRACT
A total of 124 Indian patients with haemophilia and 185 multiple transfused patients with thalassaemia, haemoglobinopathies, patients on chronic haemodialysis and others were screened for HIV-1 infection by a commercially available competitive ELISA test and supplementary Western Blot (WB) test. The results showed that HIV-1 infection was mostly confined to the haemophiliacs where 15 (12.1%) were confirmed to be positive for HIV infection. All except one had received both foreign and Indian cryoprecipitate. However, one haemophilic seroconverted within 4 months of receiving a cryoprecipitate manufactured in India.
Subject(s)
Adolescent , Adult , Blood Transfusion , Child , HIV Antibodies/blood , HIV Infections/complications , HIV Seropositivity , HIV-1/immunology , Hemophilia A/complications , Hemophilia B/complications , Humans , Male , Middle AgedABSTRACT
In a screening of 182 vials of various commercially available blood products in the Indian market, 32 (17%) were found to contain HIV-1 antibodies. The contamination with HIV-1 antibodies was detected in all types of blood products including immunoglobulin preparations, cryoprecipitates as well as albumin. Interestingly, the contamination was seen almost exclusively in the products manufactured in the Bombay-Pune area (32 of 92, 34%). It was very low in products manufactured near Delhi (1 of 90). A single vial of imported Factor VIII concentrate tested negative.