Once-daily antiretroviral therapies for HIV infection: Consensus Statement of an Advisory Committee of the International Association of Physicians in AIDS Care

Alcohol consumption enhances antiretroviral painful peripheral neuropathy by mitochondrial mechanisms

A major dose-limiting side effect of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) chemotherapies, such as the nucleoside reverse transcriptase inhibitors (NRTIs), is a small-fiber painful peripheral neuropathy, mediated by its mitochondrial toxicity. Co-morbid conditions may also contribute to this dose-limiting effect of HIV/AIDS treatment. Alcohol abuse, which alone also produces painful neuropathy, is one of the most important co-morbid risk factors for peripheral neuropathy in patients with HIV/AIDS. Despite the prevalence of this problem and its serious impact on the quality of life and continued therapy in HIV/AIDS patients, the mechanisms by which alcohol abuse exacerbates highly active antiretroviral therapy (HAART)-induced neuropathic pain has not been demonstrated. In this study, performed in rats, we investigated the cellular mechanism by which consumed alcohol impacts antiretroviral-induced neuropathic pain. NRTI 2',3'-dideoxycytidine (ddC; 50 mg/kg) neuropathy was mitochondrial-dependent and PKCε-independent, and alcohol-induced painful neuropathy was PKCε-dependent and mitochondrial-independent. At low doses, ddC (5 mg/kg) and alcohol (6.5% ethanol diet for 1 week), which alone do not affect nociception, together produce profound mechanical hyperalgesia. This hyperalgesia is mitochondrial-dependent but PKCε-independent. These experiments, which provide the first model for studying the impact of co-morbidity in painful neuropathy, support the clinical impression that alcohol consumption enhances HIV/AIDS therapy neuropathy, and provide evidence for a role of mitochondrial mechanisms underlying this interaction.

Once-daily antiretroviral therapy: Spanish Consensus Statement

BACKGROUND

Administration of antiretroviral therapy (ART) once daily is creating extraordinary interest among the members of the scientific community and also among those who receive the therapy. However, in clinical practice, some doubts remain about its use.

OBJECTIVES

This document examines the characteristics and possibilities of treatment administered once daily.

METHODS

Consensus of 248 Spanish experts in the field.

RESULTS

Once-daily dosing is considered an added value which could favour adherence and, therefore, efficacy, as well as the quality of life of certain patients, however, the objective of adequate adherence in the long term is often difficult to achieve regardless of the treatment used. In theory, any patient can receive once-daily therapy, although some patients could particularly benefit from it, e.g. those with unfavourable social or personal circumstances, including drug users, patients whose treatment must be supervised, patients receiving multiple medications, or those who need rescue therapy after multiple treatment failures. At present, it is possible to design once-daily ART using some of the combinations of drugs considered as first-choice in national and international recommendations for antiretroviral therapy, but the options are still limited. The marketing of new drugs with this characteristic could allow us to increase the number and types of patient who can benefit from once-daily regimens, including those patients who need rescue therapy.

CONCLUSIONS

Once-daily ART is a good alternative to regimens administered several times each day when a potent combination of active drugs is available.

Actual medication pill burden and dosing frequency in HIV-infected patients with undetectable viral loads

Studies have shown equivalent or improved outcomes with once-daily antiretroviral (ARV) regimens, but have failed to quantify the true daily dosing frequency and pill burden of HIV-infected patients, by not considering concomitant medications. This study was conducted to describe the total daily number (pill burden) and dosing frequency for all oral medicines, and not just ARV medications in HIV-infected patients with undetectable viral loads. A retrospective chart review of patients with undetectable viral loads in an HIV primary care clinic identified dosing frequency and pill burden for all prescribed medications. These patients were divided into those with concomitant medications (WITH) and those only on ARV medications (WITHOUT). One hundred and seventeen patients qualified for the evaluation. Ninety-three were in the WITH group and 24 were in the WITHOUT group. WITH patients were older (p < 0.05), and had advanced US Centers for Disease Control and Prevention (CDC)-defined HIV disease stage (p< 0.05), a longer duration of HIV infection (p= 0.03), and a longer duration of AIDS (p= 0.02). WITH patients had a significantly greater total pill burden (p<0.01) and dosing frequency (p<0.001) when considering all medications. Assessing only ARV medications, a significant difference existed only in pill burden (mean +/- SD) (WITH = 9.91 +/- 2.1 versus WITHOUT = 6.6 +/- 1; p < 0.01), and no difference existed in ARV dosing frequency of 2.09 +/- 1.9 and 1.83 +/- 1.7, respectively (p = 0.07). Higher dosing frequencies and pill burdens were present in patients with co-morbid conditions. All patients were on more than once-daily therapies. Dosing requirements for non-ARV medications should also be considered when optimizing or simplifying ARV regimens.