The challenge of HIV treatment in an era of polypharmacy

Journal of the International AIDS Society, Journal Year: 2020, Volume and Issue: 23(2)

Published: Feb. 1, 2020

The availability of potent antiretroviral therapy has transformed HIV infection into a chronic disease such that people living with (PLWH) have near normal life expectancy. However, there are continuing challenges in managing infection, particularly older patients, who often experience age-related comorbidities resulting complex polypharmacy and an increased risk for drug-drug interactions. Furthermore, physiological changes may affect the pharmacokinetics pharmacodynamics both antiretrovirals comedications thereby predisposing elderly to adverse drug reactions. This review provides overview therapeutic when treating PLWH (i.e. >65 years). Particular emphasis is placed on interactions other common prescribing issues inappropriate use, cascade, drug-disease interaction) encountered PLWH.

Language: Английский

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How health systems can adapt to a population ageing with HIV and comorbid disease

The Lancet HIV, Journal Year: 2022, Volume and Issue: 9(4), P. e281 - e292

Published: Feb. 23, 2022

Language: Английский

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New insights into gold nanoparticles in virology: A review of their applications in the prevention, detection, and treatment of viral infections

Biomedicine & Pharmacotherapy, Journal Year: 2025, Volume and Issue: 183, P. 117844 - 117844

Published: Jan. 17, 2025

Language: Английский

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Ageing with HIV: challenges and coping mechanisms of older adults 50 years and above living with HIV in Uganda

BMC Geriatrics, Journal Year: 2024, Volume and Issue: 24(1)

Published: Jan. 24, 2024

Abstract Introduction Globally, adults 50 years and older are an increasing proportion of persons living with HIV (PLHIV), accounting for 16% the patient group globally. The long-term effects antiretroviral use still being discovered have been associated several comorbidities; Stigma presents challenges those in need services health care can significantly affect mental treatment adherence. Understanding experiences PLHIV will inform development interventions to improve their care, health, quality life, which may help prevent further spread HIV. We explored aged above. Methods conducted 40 in-depth interviews elderly above who had lived more than ten years. also ageing two hospitals. analysed data thematically. Results key themes that emerged included; late diagnosis HIV, depression fear at time diagnosis, acceptance close family, stigma from community, polypharmacy, comorbidities, financial burden, resilience, mastery own care. Conclusion Older experience challenges, there is a develop special clinics providing appropriate social life. Prevention, Early geriatric essential well-being PLHIV.

Language: Английский

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DeepARV: ensemble deep learning to predict drug-drug interaction of clinical relevance with antiretroviral therapy

npj Systems Biology and Applications, Journal Year: 2024, Volume and Issue: 10(1)

Published: May 6, 2024

Abstract Drug-drug interaction (DDI) may result in clinical toxicity or treatment failure of antiretroviral therapy (ARV) comedications. Despite the high number possible drug combinations, only a limited DDI studies are conducted. Computational prediction DDIs could provide key evidence for rational management complex therapies. Our study aimed to assess potential deep learning approaches predict relevance between ARVs and severity grading 30,142 pairs was extracted from Liverpool HIV Drug Interaction database. Two feature construction techniques were employed: 1) similarity profiles by comparing Morgan fingerprints, 2) embeddings SMILES each via ChemBERTa, transformer-based model. We developed DeepARV-Sim DeepARV-ChemBERTa four categories DDI: i) Red: drugs should not be co-administered, ii) Amber: manageable monitoring/dose adjustment, iii) Yellow: weak iv) Green: no expected interaction. The imbalance distribution grades addressed undersampling applying ensemble learning. predicted clinically relevant comedications with weighted mean balanced accuracy 0.729 ± 0.012 0.776 0.011, respectively. have leverage molecular structures associated risks reduce class imbalance, effectively increasing predictive ability on DDIs. This approach identifying high-risk pairing drugs, enhancing screening process, targeting development.

Language: Английский

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<p>The Double Burden of the COVID-19 Pandemic and Polypharmacy on Geriatric Population – Public Health Implications</p>

Therapeutics and Clinical Risk Management, Journal Year: 2020, Volume and Issue: Volume 16, P. 1007 - 1022

Published: Oct. 1, 2020

Abstract: COVID-19 pandemic is inducing acute respiratory distress syndrome, multi-organ failure, and eventual death. Respiratory failure the leading cause of mortality in elderly population with pre-existing medical conditions. This group particularly vulnerable to infections due a declined immune system, comorbidities, geriatric potentially inappropriate polypharmacy. These conditions make more susceptible harmful effects medications deleterious consequences infections, including MERS-CoV, SARS-CoV, SARS-CoV-2. Chronic diseases among elderlies, diseases, hypertension, diabetes, coronary heart present significant challenge for healthcare professionals. To comply clinical guidelines, practitioner may prescribe complex medication regimen that adds up burden treatment, adverse drug reactions side-effects. Consequently, at increased risk falls, frailty, dependence enhances their susceptibility morbidity SARS-CoV-2 interstitial pneumonia. The major resides detection infection as atypical manifestations this age group. Healthy aging can be possible adequate preventive measures appropriate follow-up. Adherence guidelines recommendations WHO, CDC, other national/regional/international agencies reduce risks infection. Better training programs are needed enhance skill health care professionals patient's caregivers. review explains public implications associated polypharmacy on co-morbidities during pandemic. Keywords: elderly, COVID-19, pandemic, viral infection, polypharmacy, co-morbidity,

Language: Английский

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Influence of HIV Infection and Antiretroviral Therapy on Bone Homeostasis

Frontiers in Endocrinology, Journal Year: 2020, Volume and Issue: 11

Published: Sept. 2, 2020

The human immunodeficiency virus type 1 (HIV)/AIDS pandemic represents the most significant global health challenge in modern history. This infection leads toward an inflammatory state associated with chronic and immune dysregulation activation that tilts immune-skeletal interface its deep integration between cell types cytokines strong influence on skeletal renewal exacerbated bone loss. Hence, reduced mineral density is a complication among those HIV–infected individuals may progress to osteoporosis, thus increasing their prevalence of fractures. highly active antiretroviral therapy (HAART) can effectively control HIV replication but, regimens include tenofovir disoproxil fumarate (TDF) accelerate mass Molecular mechanisms HIV-associated disease OPG/RANKL/RANK system dysregulation. Thereby, osteoclastogenesis osteolytic activity are promoted after osteoclast precursor infection, accompanied by deleterious effect osteoblast cells, senescence mesenchymal stem cells (MSCs). review summarizes recent basic research data pathogenesis relation quality. It also sheds light HAART-related detrimental effects metabolism, providing better understanding molecular involved dysfunction damage as well how imbalance gut microbiome contribute disease.

Language: Английский

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Alleviating psychological distress and promoting mental wellbeing among adolescents living with HIV in sub-Saharan Africa, during and after COVID-19

Global Public Health, Journal Year: 2021, Volume and Issue: 16(6), P. 964 - 973

Published: April 11, 2021

COVID-19 social control measures (e.g. physical distancing and lockdowns) can have both immediate (social isolation, loneliness, anxiety, stress) long-term effects (depression, post-traumatic stress disorder) on individuals' mental health. This may be particularly true of adolescents living with HIV (ALHIV) their caregivers - populations already overburdened by intersecting stressors psychosocial, biomedical, familial, economic, social, or environmental). Addressing the adverse health sequelae among ALHIV requires a multi-dimensional approach that at once (a) economically empowers households (b) trains, mentors, supervises community members as lay services providers. Mental literacy programming also implemented to increase knowledge, reduce stigma, improve service use ALHIV. Schools care clinics offer ideal environments for increasing improving access services.

Language: Английский

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Ageing with HIV: Medicine Optimisation Challenges and Support Needs for Older People Living with HIV: A Systematic Review

Drugs & Aging, Journal Year: 2023, Volume and Issue: 40(3), P. 179 - 240

Published: Jan. 20, 2023

Older people living with HIV (PLWH) are at increased risks of co-morbidities and polypharmacy. However, little is known about factors affecting their needs concerns medicines. This systematic review aims to describe these identify interventions improve medicine optimisation outcomes in older PLWH. Multiple databases grey literature were searched from inception February 2022 including MEDLINE, CINAHL, PsycInfo, PsychArticles, the Cochrane Database Systematic Reviews Controlled Register Trials, Abstracts Social Gerontology, Academic Search Complete. Studies reporting interventions/issues PLWH (sample populations mean/median age ≥ 50 years; any aspect optimisation, or concerns). Quality assessments completed by means critical appraisal checklists for each study design. Title abstract screening was led one reviewer a sample reviewed independently two reviewers. Full-paper reviews author 20% Data extracted three independent reviewers using standardised data extraction forms synthesised according reported. summarised include key themes, concerns, summary intervention. Seventy-nine (n = 79) studies met eligibility criteria, most which originated USA 36). A few Australia 5), Canada Spain 9), UK 5). Ten Sub-Saharan Africa (Kenya n 1, South 6, Tanzania Uganda Zimbabwe 1). The rest China 1), France Germany Italy Netherlands Pakistan Switzerland Saudi Arabia 1) Ukraine Publication dates ranged 2002 2022. Sample sizes 10 15,602 across studies. PLWH's experience issues medicines co-morbidities, health-related quality life, polypharmacy, drug interactions, adverse reactions, adherence, burden, treatment stigma, social support, patient-healthcare provider relationships. Nine identified target persons, five aimed improving medication reduce self-management initiatives. Further in-depth research needed understand experiences priority issues. Adherence-focused predominant, but there scarcity this population. Multi-faceted achieve registered PROSPERO registration number: CRD42020188448.

Language: Английский

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Treatment Regimens and Care Models for Older Patients Living with HIV: Are We Doing Enough?

HIV/AIDS - Research and Palliative Care, Journal Year: 2023, Volume and Issue: Volume 15, P. 191 - 208

Published: April 1, 2023

Abstract: With improved access to antiretroviral therapy throughout the world, people are aging with HIV, and a large portion of global population HIV (PWH) is now age 50 or older. Older PWH experience more comorbidities, aging-related syndromes, mental health challenges, difficulties accessing fundamental needs than older adults without HIV. As result, ensuring that receiving comprehensive healthcare can often be overwhelming for both providers. Although there growing literature addressing this population, gaps remain in care delivery research. In paper, we suggest seven key components any program designed address HIV: management comorbidity screening treatment, primary coordination planning, attention related-syndromes, optimization functional status, support behavioral health, basic services. We review many controversies related implementation these components, which include absence guidelines challenges integration, next steps. Keywords: therapy, multimorbidity, syndromes

Language: Английский

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