Antiretroviral efficacy

Larder BA, Kemp SD, Harrigan PR. Potential mechanism for sustained antiretroviral efficacy of AZT-3TC combination therapy. Science 1995 269 696-699. 

Moreno S, Podzamczer D, Blazquez R, Iribarren JA, Ferrer E, Reparaz J, Pena JM, Cabrero E, Usan L. Treatment of tuberculosis in HIV-infected patients safety and antiretroviral efficacy of the concomitant use of ritonavir and rifampin. AIDS 2001 15(9) 1185-7. 

As mentioned previously, some infectious diseases pharmacists have established effective clinical practices in the outpatient setting. The most common example of this is the presence of a pharmacist in an HIV clinic. The myriad of antimicrobial drug interactions and adverse effects associated with antiretroviral therapy, the need to periodically assess antiretroviral efficacy, and the considerable potential for noncompliance literally necessitate the need for a pharmacist in any established HIV clinic. Infectious diseases pharmacists work with infectious diseases and/or immunology physicians. Pharmacists conduct medication histories and answer drug information questions. In some settings, they may act under protocol to assess patient response to antiretroviral therapy based on virologic and immunologic measures, and to make appropriate modifications in therapy. 

In addition, some Authors suggested that the antiretroviral efficacy of hypericin is associated with the inhibition of protein-kinase C-mediated phosphorylation, occurring during the viral infection of the cells [10]. 

Amprenavir levels are decreased by combined hormonal contraceptives, but the effects are modest. There appears to be no evidence to suggest that combined hormonal contraceptives decrease the antiretroviral efficacy of HAART. but evidence is preliminary and more study is needed. 

Louie M, Hogan C, Di Mascio M, Hurley A, Simon V, Rooney J, Ruiz N, Brun S, Sun E, Perelson AS, Ho DD, Markowitz M (2003) Determining the relative efficacy of highly active antiretroviral therapy. J Infect Dis 187 896-900... 

Drugs that may induce metabolism of CHC and reduce efficacy (griseofulvin, antiretroviral History of ectopic pregnancy... 

Study Design Treatment, randomized, open label, active control, parallel assignment, safety/efficacy study Official Title A Phase III, Randomized, Open-Label Study of Lopina-vir/Ritonavir Tablets 800/200mg Once-Daily Versus 400/100mg Twice-Daily When Co-administered With Nucleoside/Nucleotide Reverse Transcriptase Inhibitors in Antiretroviral-Experienced, HIV-1 Infected Subjects Primary Outcome Measures ... 

HIV infection Saquinavir mesylate in combination with ritonavir and other antiretroviral agents is indicated for the treatment of HIV infection. The twice-daily administration of saquinavir mesylate in combination with ritonavir is supported by safety data from the MaxCmin 1 study and pharmacokinetic data. The efficacy of saquinavir mesylate with ritonavir or saquinavir soft gelatin capsules (with or without ritonavir coadministration) has not been compared against the efficacy of antiretroviral regimens currently considered standard of care. 

Coinfection It is recommended that all patients with FIIV be tested for the presence of hepatitis B virus (FIBV) before initiating antiretroviral therapy. The safety and efficacy of tenofovir have not been established in patients coinfected with HBV and FIIV. Exacerbations of FIBV have been reported in patients after the discontinuation of tenofovir. Closely monitor patients coinfected with FIBV and FIIV for at least several months after stopping tenofovir treatment. 

Chiidren Safety and efficacy of delavirdine in combination with other antiretroviral agents has not been established in HIV-1-infected individuals < 16 years of age. 

Marconi P, Lorenzini P, Borrelli I, Liuzzi G, Sette P, ZaccareUi M et al. Safety and efficacy of regimens containing emtricitabine in HIV-infected patients taking highly active antiretroviral therapy. New Microbiol 2006 29(3) 169-75. 

Gallant JE, Staszewski S, Pozniak AL, DeJesus E, Suleiman JM, Miller MD, Coakley DF, Lu B, Toole JJ, Cheng AK 903 Study Group. Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients a 3-year randomized trial. JAMA 2004 292(2) 191-201. 

Sax PE, Gathe JC, Jr. Beyond efficacy the impact of combination antiretroviral therapy on quality of life. AIDS Patient Care STDS. 2005 19 563-576. 

In addition to knowledge about the clinical efficacy, adverse effect profile, and likelihood of emergence of resistance, the physician caring for an HIV-infected patient must be well versed in basic pharmacokinetics as well. Such patients are frequently taking multiple medications, including combinations of antiretroviral agents, prophylaxis or treatment for opportunistic infections, and opioid pain medications or methadone for maintenance therapy. 

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