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Julian Gold

Publications and source records attributed to Julian Gold.

6 recordsLinked to original sources
PubMed2006

Early clinical experience with atazanavir in treatment-experienced patients.

BACKGROUND: Atazanavir (ATV) is a newly approved protease inhibitor following successful clinical trials in naive and treatment-experienced patients. We describe early experience with ATV in treatment-experienced patients attending a single ambulatory care clinic in Sydney. METHODS: Patients commencing ATV between February 2003 and May 2004 in an expanded access program were identified from the clinic pharmacy's database. Data were retrospectively collected from patients' medical records. RESULTS: Data from 30 patients were analysed. Reasons for commencing ATV were: virological failure in six patients (20%); toxicity to previous regimen in 13 patients (43%); simplification strategy in two patients (7%); and recommencing therapy in nine patients (30%) following treatment interruption. Six patients (20%) discontinued ATV. One patient discontinued ATV due to virological failure, two patients discontinued due to toxicity to concomitant antiretrovirals, two as a result of the patient's choice and one as a result of the physician's decision. Eighteen patients commenced ATV in combination therapy with a detectable viral load (VL). From a baseline VL of 4.3 +/- 1.1 log10 copies mL(-1), 15 (83%) had > 1.0 log decrease in VL with 11 (61%) achieving viral suppression (<50 copies mL(-1)). Three (16%) failures were recorded in this group. Twelve subjects commenced ATV with an undetectable VL. One failure was recorded in this group. Bilirubin increased by 22.7 micromol L(-1) (P < 0.001), with significant decreases in cholesterol (1.4 mmol L(-1), P = 0.01) and triglycerides (1.5 mmol L(-1), P = 0.01) in 12 patients on ritonavir-boosted ATV. CONCLUSION: This audit found ATV to be safe, well tolerated and had good potency in treatment-experienced patients. However caution should be exercised in switching to ATV in heavily pre-treated patients.

Adult↗
PubMed2006

Antiretroviral therapy and HIV prevention in India: modeling costs and consequences of policy options.

OBJECTIVES: The objective of this study is to assess the costs, cost-effectiveness, and HIV epidemic impact of 3 antiretroviral therapy (ART) policy options. STUDY DESIGN: We constructed an epidemiologic model to predict the course of the HIV epidemic in the absence of expanded ART availability. Based on background studies of the willingness to pay for ART among patients with AIDS, of the costs to the government of the alternative treatment interventions, and of ART's likely effects on HIV transmission, we simulated the consequences of 3 possible alternative government ART policies. RESULTS: A program to reduce the negative consequences of the currently unstructured private-sector provision of ART is the most cost-effective of the 3 options at a 10% discount rate and least cost-effective at a 3% rate. The costs and cost-effectiveness of all options are highly sensitive to the effect of ART on condom use. CONCLUSION: The design of ART policy should capitalize on the potential of ART to decrease HIV transmission through institutional arrangements that reward effective prevention programs, thereby raising the likelihood that treatment has beneficial rather than negative external effects.

Antiviral Agents↗
PubMed2003

Altered lymphocyte heat shock protein 70 expression in patients with HIV disease.

Heat shock protein (HSP) expression in lymphocytes isolated from 20 patients with HIV disease and 15 age-matched controls was determined. Fold increases in lymphocyte hsp70 expression after heat shock were 4.52 +/- 2.97 in HIV-positive individuals compared with 2.60 +/- 1.29 for HIV-negative controls (P= 0.001). Given clear roles for HSP in the cross-presentation of antigens, alpha-defensin internalization and pro-inflammatory cytokine production, a further investigation of HSP in HIV patients is merited.

Adult↗
PubMed2002

Support required for antiretroviral uptake in developing countries.

It is evident from the current global debate on improving care and treatment for people living with HIV that antiretroviral therapy will become increasingly available in resource-poor countries. As this happens, there is an imperative to determine which factors will promote optimal use of these complex therapies to minimise the potentially serious consequences of poor adherence and the development of a worse epidemic of multidrug-resistant HIV (MDRHIV). In parallel with the process of allocating funds to purchase drugs, there needs to be a pro-active scaling up of healthcare worker training and infrastructure support systems and development of continuity of care from healthcare services into the community. The engagement of healthcare workers in the HIV epidemic has been largely ignored in favour of a focus on prevention which, understandably, works through the non-government sector as the vehicle for implementation. This upscaling and recruitment of healthcare workers needs involvement not only from our more eminent clinicians as spokespeople but also from experienced field workers, who will be caring for the majority of patients as they become ill. This article identifies the multidimensional approach necessary to implement a broad initiative for care and treatment and discusses the possible strategies and consequences of each factor.

AIDS-Related Opportunistic Infections↗