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Biomedical subjects

Rachael Jones

Publications and source records attributed to Rachael Jones.

8 recordsLinked to original sources
PubMed2006

The cost of antiretroviral drugs and influence on prescribing policies.

With the advent of highly active antiretroviral therapy (HAART), the prognosis for HIV-infected individuals with access has been transformed. HAART provides one of the most cost-effective treatments for any chronic disease. Immediate cost remains a legitimate factor when choosing HAART regimens, however, the cost of long-term side-effects and adherence issues must also be considered. The review examines the cost issues associated with HAART prescription and its influence on prescribing policies.

Anti-Retroviral Agents↗
PubMed2006

HIV/AIDS pathogenesis and treatment options focusing on the viral entry inhibitors.

The advent of highly active antiretroviral therapy (HAART) has revolutionized the treatment of HIV. A wide variety of antiretroviral agents are now available, allowing patients and physicians a choice of effective therapy. However, drug resistance and toxicities are emerging as major treatment challenges in the HAART era. The development of agents within existing and novel antiretroviral classes remains paramount in order to preserve the reduced morbidity and mortality we have come to expect from HAART use. This article details the development of the HIV epidemic, reviewing current and future treatment strategies, and concentrating upon the viral entry inhibitors.

Anti-Retroviral Agents↗
PubMed2004

A randomized study comparing a three- and four-drug HAART regimen in first-line therapy (QUAD study).

BACKGROUND: Evidence from randomized controlled trials supports the use of triple therapy. Research is required on the effectiveness of quadruple therapy in comparison to this and the relative effectiveness of specific highly active antiretroviral therapy (HAART) combinations. METHODS: Antiretroviral-naive individuals (n = 53) with an HIV-1 viral load >100 000 copies/mL were randomized to receive three-drug HAART with zidovudine/lamivudine (Combivir) and efavirenz or quadruple therapy with zidovudine/lamivudine/abacavir (Trizivir) and efavirenz (quad regimen). Patients continued on HAART for 48 weeks with regular clinical and immunological assessment. Standard and ultrasensitive (<5 copies/mL) viral load testing was carried out. RESULTS: A DAVG (difference in averages) analysis of the fall in viral load and increase in CD4 count showed no significant differences between regimens. Triple therapy resulted in a -4.17 log change (95% CI, -4.48 to -3.85) and quadruple therapy in a -4.36 log change (95% CI, -4.68 to -4.03) in viral load. For CD4 counts, the triple therapy arm increased by 164 cells/mm(3) (95% CI 112-217) and the quadruple arm by 185 (95% CI, 133-237). In an intent-to-treat analysis, 77% of patients in the triple therapy group reached an undetectable viral load (<50 copies/mL) compared with 84.2% of the quadruple therapy group. For ultrasensitive viral load testing, 23% and 18% of each group, respectively, reached undetectable viral loads. The hazard ratio for attaining a viral load of <5 copies/mL was 0.59 (95% CI, 0.26-1.33) for quadruple versus triple therapy. Three individuals in the triple therapy arm and nine in the quadruple therapy arm discontinued treatment. CONCLUSIONS: No differences in any analyses were observed between a standard of care regimen (zidovudine/lamivudine and efavirenz) and the quad regimen (zidovudine/lamivudine/abacavir and efavirenz).

Alkynes↗
PubMed2004

Renal dysfunction with tenofovir disoproxil fumarate-containing highly active antiretroviral therapy regimens is not observed more frequently: a cohort and case-control study.

BACKGROUND: Tenofovir disoproxil fumarate (tenofovir DF), the first nucleotide analogue reverse transcriptase inhibitor approved for the treatment of HIV infection, has been associated with renal dysfunction in isolated cases. We investigated the overall incidence and risk of renal dysfunction in individuals receiving tenofovir DF and compared this with other antiretrovirals. METHODS: Data from the Chelsea and Westminster cohort were analyzed to reveal HIV-positive individuals with a creatinine value greater than 120 micromol/L at any time, the upper limit of normal used by our reference laboratory. These individuals were classified according to antiretroviral exposure and time exposed. A matched case-control study was performed comparing patients who had received tenofovir DF and subsequently developed a creatinine value greater than 120 micromol/L against controls who had been treated with tenofovir DF and had not experienced a creatinine elevation. RESULTS: Of 4183 HIV-positive patients, 1175 were identified as having a recorded creatinine value >120 micromol/L. Comparison of antiretroviral-naive patients and patients exposed to tenofovir DF- and non-tenofovir DF-containing regimens revealed a lower rate ratio and probability of developing a creatinine value >120 micromol/L in patients exposed to tenofovir DF (rate ratio vs. no antiretrovirals = 0.22, 95% confidence interval [CI]: 0.07-0.69; P < 0.001) with no significant difference between HAART regimens, corrected for duration of exposure. Of the 1058 individuals who were exposed to tenofovir DF, 84 (8%) patients experienced a creatinine value >120 micromol/L subsequent to exposure. An alternative etiology of renal dysfunction was found in 75 (90%) of these individuals. CONCLUSIONS: Tenofovir DF is not associated with renal dysfunction more frequently than other antiretroviral drugs, and the occurrence of renal dysfunction in this context is usually attributable to other causes.

Adenine↗