HIV infection – Related resources

Cochrane reviews

Drug therapy

HAART

• Initiating HIV treatment with Trizivir^® appears to have similar virological effects as the combination of efavirenz, nelfinavir, or atazanavir. Trizivir^® regimen appears to be well tolerated and has no deleterious effect on the lipid profile .
• There is not enough evidence to support routine use of therapeutic drug monitoring (TDM) of antiretrovirals (ARV) in ARV-naive or -experienced patients. TDM in treatment-naive participants on a protease inhibitor (PI)-based antiretroviral therapy regimen, particularly if unboosted by ritonavir, may improve virological outcomes .
• There is insufficient evidence to support the use of structured treatment interruptions as a standard of care in the management of chronic suppressed HIV infection .
• Structured treatment interruptions (STIs) appear not to improve outcomes in chronic unsuppressed HIV infection. On the contrary, there is evidence of harm due to the associated CD4 cell decline and the increased risk of clinical disease progression .
• The combination of nevirapine, lamivudine and stavudine appears to be as efficacious as a combination of efavirenz, lamivudine and stavudine in the treatment of HIV infection and AIDS .

Complications

• Prophylactic drug therapy is effective in reducing incidence of tuberculosis in HIV infected adults with a positive tuberculin skin test .
• Cotrimoxazole is effective in reducing mortality and preventing illness in patients with HIV infection in Africa .
• There may not be significant differences in the effects of pyrimethamine plus sulfadiazine versus pyrimethamine plus clindamycin or trimethoprim-sulfamethoxazole on mortality or cure rates in the management of toxoplasmic encephalitis in HIV-infected adults .
• There is no evidence from randomised controlled trials on the efficacy of interventions for treating AIDS-associated Hodgkin´s lymphoma in treatment-naive adults .
• There are insufficient data on the benefit of helminth eradication in HIV-1 and helminth co-infected adults on CD4 decline, clinical staging or mortality, although there may be a benefit in reducing plasma viral load .
• There is insufficient evidence for the use of antimotility agents and adsorbents in controlling diarrhoea in people with HIV/AIDS .
• Antifungal primary prophylaxis with either itraconazole or fluconazole is effective in reducing the incidence of cryptococcal disease in adults with advanced HIV disease but seems not to affect overall mortality .
• Adjunctive corticosteroids appear to reduce mortality in HIV-infected patients with Pneumocystis jiroveci pneumonia .
• Ketoconazole, fluconazole, itraconazole and clotrimazole may be effective in the treatment of oropharyngeal candidiasis in adults with HIV infection .

Other drug therapy

• Pre-exposure prophylaxis with oral tenofovir disoproxil fumarate (TDF) alone or with TDF + emtricitabine (FTC) appears to reduce the risk of acquiring HIV in high-risk individuals including people in serodiscordant relationships, men who have sex with men and other high risk men and women .
• Spermicide nonoxynol-9 is not effective in preventing vaginal acquisition of HIV infection and it may do harm by increasing the frequency of genital lesions .
• Alitretinoin gel is effective in treating cutaneous KS, PLD is effective treatment for advanced KS and radiotherapy appears effective in treating cutaneous lesions .
• Cotrimoxazole desensitization may result in fewer treatment stoppages and side effects than rechallenge in HIV-infected adult patients who had a previous mild or moderate reaction to cotrimoxazole
• Bisphosphonate therapy and testosterone in those with AIDS wasting syndrome may be safe and possibly effective methods to improve bone mineral density in HIV patients .
• There is insufficient evidence on interventions for treating anemia in persons with HIV infection .
• Vaginal disinfection may not be effective for preventing mother-to-child transmission of HIV infection .
• Herbal medicines appear ineffective in patients with HIV infection and AIDS as measured with objective disease parameters .
• Administration of anabolic steroids appears to result in a small increase in both lean body mass and body weight as compared with placebo in HIV infected individuals .
• Oral substitution treatment for injecting opioid users may reduce drug-related but not sex-related behaviours with a high risk of HIV transmission .

Surgery

• Medical male circumcision reduces the acquisition of HIV by between 38% and 66% over 24 months among heterosexual men in the general population in Africa .

Physiotherapy and rehabilitation

• Massage therapy in combination with other stress-management modalities may improve quality of life for people living with HIV/AIDS compared to massage therapy alone or to the other modalities alone .
• Aerobic exercise appears to be safe and may be beneficial for persons with HIV/AIDS .

Lifestyle and counselling

• The single study on promoting adherence to HAART showed that education by pharmacist seem to improve compliance .
• Behavioral interventions reduce unprotected sex and can thus reduce the risk of HIV infection in men who have sex with men .
• Population-based interventions may have a limited effect on the prevalence of sexually transmitted infections (STI), but little effect on HIV incidence .
• Mass media interventions have immediate and overall effects in promotion of HIV testing in the short term. This has no significant impact on detecting individuals with seropositive status .
• Abstinence-only programs may be ineffective for reducing HIV risk in high-income countries .
• Many abstinence-plus programs may reduce short-term and long-term HIV risk behavior among youth in high-income countries .
• Macronutrient supplementation appears to increase protein and energy intake in people with AIDS. However, effects on disease progression or HIV-related complications are not known .
• Interventions targeting practical medication management skills, administered to individuals or delivered over 12 weeks or more might possibly improve compliance on HAART for HIV/AIDS .

Others

• Settings of care with high volume of HIV positive patient and models of care with case management may improve patient mortality and other outcomes in persons with HIV infection .

Other evidence summaries

• Needle exchange programmes are effective in reducing HIV incidence among injecting drug users .
• Both community- and school-based interventions may have the potential to reduce sexual risk behaviours among adolescents .
• Methadone maintenance treatment appears to reduce HIV risk behaviour and prevent HIV infection .
• Interventions targeting heterosexual men on HIV sexual risk can lead to decreases in HIV risk behaviour .
• Trimethoprim-sulfamethozazole prophylaxis appears to be more effective than dapsone/pyrimethamine or aerosolised pentamidine in the prophylaxis of Pneumocystis carinii pneumonia and toxoplasma encephalitis in HIV-infected patients .
• HIV-positive participants and HIV-serodiscordant couples decrease their risk behaviour after HIV counseling and testing. However, participants who receive a negative HIV test result do not modify their behaviour .
• Antidepressant medication appears to be efficacious in treating depression in out-patient men who are HIV-positive .

Other Internet resources

• World Health Organization (WHO) Guidelines. Antiretroviral therapy for HIV infection in adults and adolescents. Recommendations for a public health approach: 2010 revision.
• US Department of Health and Human Services and US. Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV-1 transmission in the United States
• ECDC HIV Infection and AIDS website
• CDC HIV / AIDS Website
• Antiretroviraalisen hoidon ohjeistus www.arvosta.fi

Literature

• Hammer SM, Eron JJ Jr, Reiss P, Schooley RT, Thompson MA, Walmsley S, Cahn P, Fischl MA, Gatell JM, Hirsch MS, Jacobsen DM, Montaner JS, Richman DD, Yeni PG, Volberding PA, International AIDS Society-USA. Antiretroviral treatment of adult HIV infection: 2008 recommendations of the International AIDS Society-USA panel. JAMA 2008 Aug 6;300(5):555-70.
• Makadon HJ, Mayer KH, Garofalo R. Optimizing primary care for men who have sex with men. JAMA 2006 Nov 15;296(19):2362-5.