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Letsios AN, Mavridoglou G, Ladopoulou D, Tsourdini D, Dedes N, Polyzos NM. Exploring the impact of clawback on pharmaceutical expenditure: A case study of public hospitals in Greece. Int J Health Plann Manage 2023; 38:1539-1554. [PMID: 37477549 DOI: 10.1002/hpm.3679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/17/2022] [Accepted: 06/26/2023] [Indexed: 07/22/2023] Open
Abstract
Several European administrations have applied various mechanisms promoting cost containment to stabilise their budgets for pharmaceutical expenditure. Since 2016, Greece has adopted the clawback as a policy to contain the NHS hospitals' pharmaceutical expenditure, which increased significantly in the 2016-2020 period. The present study reviews the impact of this policy on the operation of NHS hospitals, the uninterrupted supply and rational use of their medicines, along with the sustainability of their finances. The trend of pharmaceutical expenditure for the period 2016-2020 is combined with further analysis of detailed drug consumption data of 15 sampled NHS hospitals. The data is classified by Anatomical Therapeutic Category (ATC) and the percentage of clawback distributed to each ATC and pharmaceutical company is calculated. It was found that a large proportion of the clawback is allocated to a few therapeutic categories (ATCs) and consequently, few pharmaceutical companies are particularly burdened. The increased burden on pharmaceutical companies, due to the continuous increase in the excessive pharmaceutical expenditure of the NHS hospitals and their limited budget, endangers the uninterrupted supply of medicines to hospitals and the viability of pharmaceutical companies. This issue was discussed in a scientific consensus group*, in which participants proposed ways to keep the level of pharmaceutical expenditure in line with patients' needs, the country's economic potential, and the sustainability of pharmaceutical companies.
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Affiliation(s)
- Apostolos N Letsios
- Department of Social Work, School of Social, Political & Economical Sciences, Democritus University of Thrace, Komotini, Greece
| | - George Mavridoglou
- Department of Accounting and Finance, School of Management, University of Peloponnese, Kalamata, Greece
| | - Domniki Ladopoulou
- Department of Informatics, School of Information Sciences & Technology, Athens University of Economics and Business, Athens, Greece
| | - Despoina Tsourdini
- Department of Business Administration, School of Business, Athens University of Economics and Business, Athens, Greece
| | | | - Nikolaos M Polyzos
- Department of Social Work, School of Social, Political & Economical Sciences, Democritus University of Thrace, Komotini, Greece
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2
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Papadakos SP, Dedes N, Pergaris A, Gazouli M, Theocharis S. Exosomes in the Treatment of Pancreatic Cancer: A Moonshot to PDAC Treatment? Int J Mol Sci 2022; 23:3620. [PMID: 35408980 PMCID: PMC8998433 DOI: 10.3390/ijms23073620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 12/11/2022] Open
Abstract
Pancreatic Ductal Adenocarcinoma (PDAC) constitutes a leading cause of cancer death globally. Its mortality remains unaltered despite the considerable scientific progress made in the fields of diagnostics and treatment. Exosomes comprise of small extracellular vesicles secreted by nearly all cells; their cargo contains a vast array of biomolecules, such as proteins and microRNAs. It is currently established that their role as messengers is central to a plethora of both physiologic and pathologic processes. Accumulating data have shed light on their contributions to carcinogenesis, metastasis, and immunological response. Meanwhile, the advancement of personalized targeted therapies into everyday clinical practice necessitates the development of cost-efficient treatment approaches. The role of exosomes is currently being extensively investigated towards this direction. This review aims to summarize the current pre-clinical and clinical evidence regarding the effects of exosomal applications in the timely diagnosis, prognosis, and therapeutic management of pancreatic cancer.
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Affiliation(s)
- Stavros P. Papadakos
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.P.P.); (N.D.); (A.P.)
| | - Nikolaos Dedes
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.P.P.); (N.D.); (A.P.)
| | - Alexandros Pergaris
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.P.P.); (N.D.); (A.P.)
| | - Maria Gazouli
- Laboratory of Biology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.P.P.); (N.D.); (A.P.)
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3
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Gökengin D, Wilson-Davies E, Nazlı Zeka A, Palfreeman A, Begovac J, Dedes N, Tarashenko O, Stevanovic M, Patel R. 2021 European guideline on HIV testing in genito-urinary medicine settings. J Eur Acad Dermatol Venereol 2021; 35:1043-1057. [PMID: 33666276 DOI: 10.1111/jdv.17139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Abstract
Testing for HIV is critical for early diagnosis of HIV infection, providing long-term good health for the individual and prevention of onward transmission if antiretroviral treatment is initiated early. The main purpose of the 2021 European Guideline on HIV Testing in Genito-Urinary Settings is to provide advice on testing for HIV infection in individuals aged 16 years and older who present to sexually transmitted infection, genito-urinary or dermato-venereology clinics across Europe. The guideline presents the details of best practice and offers practical guidance to clinicians and laboratories to identify and offer HIV testing to appropriate patient groups.
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Affiliation(s)
- D Gökengin
- Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Ege University, Izmir, Turkey.,Ege University HIV/AIDS Research and Practice Center, Izmir, Turkey
| | - E Wilson-Davies
- Southampton Specialist Virology Center, University Hospitals Southampton, Southampton, UK
| | - A Nazlı Zeka
- Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Dokuz Eylül University, Izmir, Turkey
| | - A Palfreeman
- Department of Infectious Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Begovac
- Department of Infectious Diseases, University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia
| | - N Dedes
- Positive Voice, Athens, Greece
| | - O Tarashenko
- Head Center of Hygiene and Epidemiology, Federal Medical-Biological Agency (FMBA) of Russia, Moscow, Russia
| | - M Stevanovic
- Clinic for Infectious Diseases and Febrile Conditions, Skopje, Former Yugoslav Republic of Macedonia
| | - R Patel
- Solent NHS Trust, Southampton, UK
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4
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Zagouri F, Dedes N, Papatheodoridi A, Liontos M, Dimopoulos MA. Supportive medication in cancer during pregnancy. BMC Pregnancy Childbirth 2020; 20:747. [PMID: 33261562 PMCID: PMC7706269 DOI: 10.1186/s12884-020-03432-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/16/2020] [Indexed: 02/08/2023] Open
Abstract
While pregnancy-related malignancies are quite rare, their incidence is increasing and thus affecting more and more women nowadays. Their management, however, with both chemotherapy and supportive agents remains quite challenging and it seems crucial to define the optimal treatment for this special population. Concerning supportive medication, it is clinically significant to determine whether commonly used agents, including Granulocyte Colony-Stimulating Factors, Erythropoiesis-stimulating agents, Bisphosphonates, Anticoagulation agents, Antiemetics and Glucocorticoids are indeed effective in ameliorating chemotherapy side effects. Meanwhile, it is of great importance that the administration of any of these agents is safe for both mother and fetus. This review aims to provide a précis of the current literature regarding both safety and efficacy of all categories of supportive medication during pregnancy.
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Affiliation(s)
- Flora Zagouri
- Haematology - Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 80, 11528, Athens, Greece.
| | - Nikolaos Dedes
- Haematology - Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 80, 11528, Athens, Greece
| | - Alkistis Papatheodoridi
- Haematology - Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 80, 11528, Athens, Greece
| | - Michael Liontos
- Haematology - Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 80, 11528, Athens, Greece
| | - Meletios Athanasios Dimopoulos
- Haematology - Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 80, 11528, Athens, Greece
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5
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Mussini C, Antinori A, Bhagani S, Branco T, Brostrom M, Dedes N, Bereczky T, Girardi E, Gökengin D, Horban A, Lacombe K, Lundgren JD, Mendao L, Mocroft A, Oprea C, Porter K, Podlekareva D, Battegay M, d'Arminio Monforte A. European AIDS Clinical Society Standard of Care meeting on HIV and related coinfections: The Rome Statements. HIV Med 2015; 17:445-52. [PMID: 26492497 DOI: 10.1111/hiv.12347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of the 1st European AIDS Clinical Society meeting on Standard of Care in Europe was to raise awareness of the European scenario and come to an agreement on actions that could be taken in the future. METHODS Data-driven presentations were given on specific topics followed by interactive panel discussions. RESULTS In Eastern European countries, the epidemic is largely driven by injecting drug use, in contrast with Western Europe where the infection mainly occurs through heterosexual contact. A high proportion of people living with HIV remain unaware of their infection. Substantial differences exist in Eastern Europe and Central Asia with respect to treatment coverage, regimen availability and continuity of drug supply. In 2012, tuberculosis case notification rates were 5-10 times higher in Eastern Europe compared with Western Europe, with an alarming proportion of newly diagnosed multi-drug-resistant cases. Hepatitis C is widespread in selected geographical areas and risk groups. CONCLUSIONS The key conclusion from the meeting was that a high-priority group of actions could be identified, including: increasing HIV awareness and testing, improving training for health care providers, ensuring equitable patient access to treatments and diagnostics for HIV and comorbidities, and implementing best practices in infection control and treatment of HIV-infected patients coinfected with tuberculosis and hepatitis C virus, for whom direct acting antiviral treatment. should be considered.
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Affiliation(s)
- C Mussini
- University of Modena and Reggio Emilia, Modena, Italy
| | - A Antinori
- National Institute for Infectious Disease 'L. Spallanzani', Rome, Italy
| | - S Bhagani
- University College London, London, UK
| | - T Branco
- Department of Infectious Diseases, Hospital Center, Lisbon, Portugal
| | | | | | | | - E Girardi
- National Institute for Infectious Disease 'L. Spallanzani', Rome, Italy
| | | | - A Horban
- Warsaw Medical University and Hospital of Infectious Diseases, Warsaw, Poland
| | | | - J D Lundgren
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - A Mocroft
- University College London, London, UK
| | - C Oprea
- Victor Babes Hospital, Bucharest, Romania
| | - K Porter
- University College London, London, UK
| | - D Podlekareva
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - M Battegay
- University Hospital of Basel, Basel, Switzerland
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6
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Dedes N, Fotiadis M. Greece, social spending, people who use drugs and the return of HIV. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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7
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Raben D, Delpech V, de Wit J, Sullivan A, Lazarus JV, Dedes N, Coenen T, Lundgren J. Conclusions from the HIV in Europe Copenhagen 2012 Conference and ways forward: working together for optimal HIV testing and earlier care. HIV Med 2013; 14 Suppl 3:1-5. [DOI: 10.1111/hiv.12062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
- D Raben
- Copenhagen HIV Programme; University of Copenhagen; Copenhagen; Denmark
| | - V Delpech
- Public Health England; Colindale; UK
| | - J de Wit
- National Centre in HIV Social Research; The University of New South Wales; Sydney; New South Wales; Australia
| | - A Sullivan
- Directorate of Sexual Health and HIV Medicine; Chelsea and Westminster NHS Foundation Trust; London; UK
| | - JV Lazarus
- Copenhagen HIV Programme; University of Copenhagen; Copenhagen; Denmark
| | - N Dedes
- European AIDS Treatment Group (EATG); Athens; Greece
| | - T Coenen
- AIDS Action Europe; Aids Fonds & Soa Aids Nederland; Amsterdam; the Netherlands
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Jordan MR, Bennett DE, Wainberg MA, Havlir D, Hammer S, Yang C, Morris L, Peeters M, Wensing AM, Parkin N, Nachega JB, Phillips A, De Luca A, Geng E, Calmy A, Raizes E, Sandstrom P, Archibald CP, Perriëns J, McClure CM, Hong SY, McMahon JH, Dedes N, Sutherland D, Bertagnolio S. Update on World Health Organization HIV drug resistance prevention and assessment strategy: 2004-2011. Clin Infect Dis 2012; 54 Suppl 4:S245-9. [PMID: 22544182 DOI: 10.1093/cid/cis206] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The HIV drug resistance (HIVDR) prevention and assessment strategy, developed by the World Health Organization (WHO) in partnership with HIVResNet, includes monitoring of HIVDR early warning indicators, surveys to assess acquired and transmitted HIVDR, and development of an accredited HIVDR genotyping laboratory network to support survey implementation in resource-limited settings. As of June 2011, 52 countries had implemented at least 1 element of the strategy, and 27 laboratories had been accredited. As access to antiretrovirals expands under the WHO/Joint United Nations Programme on HIV/AIDS Treatment 2.0 initiative, it is essential to strengthen HIVDR surveillance efforts in the face of increasing concern about HIVDR emergence and transmission.
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Affiliation(s)
- M R Jordan
- World Health Organization, Geneva, Switzerland.
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9
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Antinori A, Coenen T, Costagiola D, Dedes N, Ellefson M, Gatell J, Girardi E, Johnson M, Kirk O, Lundgren J, Mocroft A, D'Arminio Monforte A, Phillips A, Raben D, Rockstroh JK, Sabin C, Sönnerborg A, De Wolf F. Late presentation of HIV infection: a consensus definition. HIV Med 2011; 12:61-4. [PMID: 20561080 DOI: 10.1111/j.1468-1293.2010.00857.x] [Citation(s) in RCA: 329] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Across Europe, almost a third of individuals infected with HIV do not enter health care until late in the course of their infection. Surveillance to identify the extent to which late presentation occurs remains inadequate across Europe and is further complicated by the lack of a common clinical definition of late presentation. The objective of this article is to present a consensus definition of late presentation of HIV infection. METHODS Over the past year, two initiatives have moved towards a harmonized definition. In spring 2009, they joined efforts to identify a common definition of what is meant by a 'late-presenting' patient. RESULTS Two definitions were agreed upon, as follows. Late presentation: persons presenting for care with a CD4 count below 350 cells/μL or presenting with an AIDS-defining event, regardless of the CD4 cell count. Presentation with advanced HIV disease: persons presenting for care with a CD4 count below 200 cells/μL or presenting with an AIDS-defining event, regardless of the CD4 cell count. CONCLUSION The European Late Presenter Consensus working group believe it would be beneficial if all national health agencies, institutions, and researchers were able to implement this definition (either on its own or alongside their own preferred definition) when reporting surveillance or research data relating to late presentation of HIV infection.
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Affiliation(s)
- A Antinori
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Rome, Italy
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10
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Asboe D, Catalan J, Mandalia S, Dedes N, Florence E, Schrooten W, Noestlinger C, Colebunders R. Sexual dysfunction in HIV-positive men is multi-factorial: a study of prevalence and associated factors. AIDS Care 2007; 19:955-65. [PMID: 17851990 DOI: 10.1080/09540120701209847] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
To establish the prevalence of sexual dysfunction amongst HIV-positive men and to determine the factors associated with dysfunction we conducted a cross-sectional study in seven European HIV treatment centres. Data on medical history, antiretroviral treatment and laboratory results were collected by interview and case record review. Sexual function was evaluated by the participant self-completion of a questionnaire based on the International Index of Erectile Function (IIEF) 711/929. Seventy-seven percent of participants returned the questionnaire. Data from 668 (72%) respondents were included. Thirty-three percent (95%CI: 29.4-36.5%) had moderate/severe erectile dysfunction (EDF) and 24% (95%CI: 20.9-27.3%) had moderate to severe impairment of sexual desire. Variables significantly associated with EDF in multivariable analysis were older age (greater than 40 years), heterosexual status, non-alcohol drinking status, depression, antidepressants, psychotropic medications and duration of ARV therapy. Low sexual desire (LSD) was associated with older age (greater than 40 years), depression and black African ethnicity. We establish that EDF and LSD are common in both ARV naïve and ARV experienced, HIV-positive individuals. Erectile dysfunction was associated with long duration of ARV treatment, with a significantly increased risk of dysfunction in the quartile with the longest period of exposure. No significant association was seen with specific classes of anti-retrovirals. Older age, and depression were the variables most consistently associated with both EDF and LSD.
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Affiliation(s)
- D Asboe
- Directorate of HIV/GU Medicine, Chelsea and Westminster Hospital, London, UK.
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11
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Vandamme AM, Sönnerborg A, Ait-Khaled M, Albert J, Asjo B, Bacheler L, Banhegyi D, Boucher C, Brun-Vézinet F, Camacho R, Clevenbergh P, Clumeck N, Dedes N, De Luca A, Doerr HW, Faudon JL, Gatti G, Gerstoft J, Hall WW, Hatzakis A, Hellmann N, Horban A, Lundgren JD, Kempf D, Miller M, Miller V, Myers TW, Nielsen C, Opravil M, Palmisano L, Perno CF, Phillips A, Pillay D, Pumarola T, Ruiz L, Salminen M, Schapiro J, Schmidt B, Schmit JC, Schuurman R, Shulse E, Soriano V, Staszewski S, Vella S, Youle M, Ziermann R, Perrin L. Updated European recommendations for the clinical use of HIV drug resistance testing. Antivir Ther 2004; 9:829-48. [PMID: 15651743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In most European countries, HIV drug resistance testing has become a routine clinical tool. However, its practical implementation in a clinical context is demanding. The European HIV Drug Resistance Panel was established to make recommendations to clinicians and virologists on this topic and to propose quality control measures. The panel recommends resistance testing for the following indications: i) drug-naive patients with acute or recent infection; ii) therapy failure, including suboptimal treatment response, when treatment change is considered; iii) pregnant HIV-1-infected women and paediatric patients with detectable viral load when treatment initiation or change is considered; and iv) genotype source patient when post-exposure prophylaxis is considered. In addition, for drug-naive patients with chronic infection in whom treatment is to be started, the panel suggests that resistance testing should be strongly considered and recommends testing the earliest sample for drug resistance if suspicion of resistance is high or prevalence of resistance in this population exceeds 10%. The panel does not favour genotyping over phenotype, however it is anticipated that genotyping will be used more often because of its greater accessibility, lower cost and faster turnaround time. For the interpretation of resistance data, clinically validated systems should be used to the greatest extent possible. It is mandatory that laboratories performing HIV resistance tests take regular part in quality assurance programs. Similarly, it is necessary that HIV clinicians and virologists take part in continuous education and meet regularly to discuss problematic clinical cases. Indeed, resistance test results should be used in the context of all other clinically relevant information for predicting therapy response. The panel also encourages the timely collection of epidemiological information to estimate the impact of transmission of resistant HIV and the prevalence of HIV-1 non-B subtypes in the different European countries.
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Affiliation(s)
- A M Vandamme
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Belgium.
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12
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Vandamme AM, Sönnerborg A, Ait-Khaled M, Albert J, Asjo B, Bacheler L, Banhegyi D, Boucher C, Brun-Vézinet F, Camacho R, Clevenbergh P, Clumeck N, Dedes N, Luca AD, Doerr HW, Faudon JL, Gatti G, Gerstoft J, Hall WW, Hatzakis A, Hellmann N, Horban A, Lundgren JD, Kempf D, Miller M, Miller V, Myers TW, Nielsen C, Opravil M, Palmisano L, Perno CF, Phillips A, Pillay D, Pumarola T, Ruiz L, Salminen M, Schapiro J, Schmidt B, Schmit JC, Schuurman R, Shulse E, Soriano V, Staszewski S, Vella S, Youle M, Ziermann R, Perrin L. Updated European Recommendations for the Clinical Use of HIV Drug Resistance Testing. Antivir Ther 2004. [DOI: 10.1177/135965350400900619] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In most European countries, HIV drug resistance testing has become a routine clinical tool. However, its practical implementation in a clinical context is demanding. The European HIV Drug Resistance Panel was established to make recommendations to clinicians and virologists on this topic and to propose quality control measures. The panel recommends resistance testing for the following indications: i) drug-naive patients with acute or recent infection; ii) therapy failure, including suboptimal treatment response, when treatment change is considered; iii) pregnant HIV-1-infected women and paediatric patients with detectable viral load when treatment initiation or change is considered; and iv) genotype source patient when post-exposure prophylaxis is considered. In addition, for drug-naive patients with chronic infection in whom treatment is to be started, the panel suggests that resistance testing should be strongly considered and recommends testing the earliest sample for drug resistance if suspicion of resistance is high or prevalence of resistance in this population exceeds 10%. The panel does not favour genotyping over phenotype, however it is anticipated that genotyping will be used more often because of its greater accessibility, lower cost and faster turnaround time. For the interpretation of resistance data, clinically validated systems should be used to the greatest extent possible. It is mandatory that laboratories performing HIV resistance tests take regular part in quality assurance programs. Similarly, it is necessary that HIV clinicians and virologists take part in continuous education and meet regularly to discuss problematic clinical cases. Indeed, resistance test results should be used in the context of all other clinically relevant information for predicting therapy response. The panel also encourages the timely collection of epidemiological information to estimate the impact of transmission of resistant HIV and the prevalence of HIV-1 non-B subtypes in the different European countries.
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Affiliation(s)
- A-M Vandamme
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Leuven, Belgium
| | - A Sönnerborg
- Divisions of Infectious Diseases and Clinical Virology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M Ait-Khaled
- GlaxoSmithKline, HIV Medicines Development Centre Europe, Greenford, UK
| | - J Albert
- Dept of Virology, Swedish Institute for Infectious Diease Control and Microbiology and Tumourbiology Center, Karolinska Institutet, Solna, Sweden
| | - B Asjo
- Centre for Research in Virology, Gade Institute, University of Bergen, Bergen, Norway
| | | | - D Banhegyi
- 5th Department of Medicine, Saint Laszlo Hospital, Budapest, Hungary
| | - C Boucher
- University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F Brun-Vézinet
- Department of Virology, Hôpital Bichat Claude Bernard, Paris, France
| | - R Camacho
- Hospital Egas Moniz, Serviço de Imuno-Hemoterapia, Lisboa, Portugal
| | - P Clevenbergh
- Service de Médecine Interne A, Hôpital Lariboisiere, Paris, France
| | - N Clumeck
- Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium
| | | | - A De Luca
- Istituto di Clinica delle Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - HW Doerr
- Institute for Medical Virology, University Clinic Frankfurt, Frankfurt, Germany
| | | | - G Gatti
- Vertex Pharmaceuticals, Genova, Italy
| | - J Gerstoft
- Rigshospitalet Department of Infectious Diseases, University of Copenhagen, Copenhagen, Denmark
| | - WW Hall
- University College Dublin, Department Medical Microbiology, Dublin, Ireland
| | - A Hatzakis
- National Retrovirus Reference Centre, Department of Hygiene and Epidemiology, Athens University Medical School, Athens, Greece
| | - N Hellmann
- ViroLogic, Inc., South San Francisco, Calif., USA
| | - A Horban
- Hospital of Infectious Diseases, AIDS Diagnosis and Therapy Centre, Warsaw, Poland
| | - JD Lundgren
- Copenhagen HIV Programme (CHIP) - Section 044, Hvidovre University Hospital, Hvidovre, Denmark
| | - D Kempf
- Abbott Laboratories, Abbott Park, Ill., USA
| | - M Miller
- Gilead Sciences, Foster City, Calif., USA
| | - V Miller
- Forum for Collaborative HIV Research, George Washington University, Washington DC, USA
| | - TW Myers
- Roche Molecular Systems, Alameda, Calif., USA
| | - C Nielsen
- Department of Virology, Statens Serum Institut, Copenhagen S, Denmark
| | - M Opravil
- Department of Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - CF Perno
- University of Rome Tor Vergata and INMI L. Spallanzani, Rome, Italy
| | - A Phillips
- Royal Free Centre for HIV Medicine and Department of Primary Care & Population Sciences, Royal Free and University College Medical School, London, UK
| | - D Pillay
- Royal Free and University College Medical School, University College London, London, UK
| | - T Pumarola
- Servicio de Microbiología, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - L Ruiz
- Retrovirology Lab, IRSICAIXA Foundation, Barcelona, Spain
| | - M Salminen
- Department of Infectious Disease Epidemiology, National Public Health Institute, Helsinki, Finland
| | | | - B Schmidt
- Institute of Clinical and Molecular Virology, German National Reference Centre for Retroviruses, Erlangen, Germany
| | - J-C Schmit
- National Service of Infectious Diseases, Retrovirology Laboratory Luxembourg, Centre Hospitalier de Luxembourg, Luxembourg
| | - R Schuurman
- University Medical Centre Utrecht, Department of Virology, Utrecht, The Netherlands
| | - E Shulse
- Celera Diagnostics, Alameda, Calif., USA
| | - V Soriano
- Department of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | | | - S Vella
- Istituto Superiore di Sanità, Rome, Italy
| | - M Youle
- Royal Free and University College Medical School, London, UK
| | - R Ziermann
- Bayer HealthCare – Diagnostics, Medical and Scientific Affairs, Berkeley, Calif., USA
| | - L Perrin
- Laboratoire de Virologie, Geneva University Hospital, Geneva, Switzerland
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Dreezen C, Schrooten W, de Mey I, Goebel FD, Dedes N, Florence E, Colebunders R. Self-reported signs of lipodystrophy by persons living with HIV infection. Int J STD AIDS 2002; 13:393-8. [PMID: 12015013 DOI: 10.1258/095646202760029813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify risk factors for the development of lipodystrophy in HIV infected patients on highly active antiretroviral therapy. METHODS A survey among patients with HIV infection using an anonymous questionnaire was conducted in 10 European countries between December 1998 and December 1999. Nine hundred and four people receiving antiretrovirals, were included in the analyses. RESULTS 368 (41%) people reported an increase in abdominal girth since commencing current antiretroviral treatment. Breast enlargement was reported by 106 people (12%). Lipoatrophy signs were reported by approximately one-third of the people: 291 (32%) complained about decrease in facial fat and 300 (33%) reported decrease in buttock fat. One hundred and thirty-one (15%) people reported both lipoatrophy signs and an increase in abdominal girth (mixed lipodystrophy syndrome). In multivariate analysis, the development of the mixed lipodystrophy syndrome was associated with a longer use of indinavir (OR=1.03, 95% CI: 1.00-1.06), ritonavir (OR=1.06, 1.02-1.09) and stavudine (OR=1.05, 1.02-1.08) and also with age, a longer duration of HIV seropositivity and an advanced stage of HIV infection. CONCLUSIONS This study suggests that multiple factors are associated with the occurrence of lipodystrophy, including the prolonged use of protease inhibitors.
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Affiliation(s)
- C Dreezen
- Institute of Tropical Medicine, Antwerpen, Belgium
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14
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Schrooten W, Colebunders R, Youle M, Molenberghs G, Dedes N, Koitz G, Finazzi R, de Mey I, Florence E, Dreezen C. Sexual dysfunction associated with protease inhibitor containing highly active antiretroviral treatment. AIDS 2001; 15:1019-23. [PMID: 11399984 DOI: 10.1097/00002030-200105250-00010] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A high proportion of individuals receiving highly active antiretroviral treatment (HAART) complain of sexual dysfunction (SD), encompassing a lack of desire or erectile dysfunction. OBJECTIVE To determine whether SD was associated with particular components of the HAART regimens and to identify risk factors for the development of SD in patients on HAART. METHODS A survey among patients with HIV infection using an anonymous questionnaire was conducted in 10 European countries between December 1998 and December 1999. A total of 904 individuals currently receiving antiretroviral agents were included in the analyses. RESULTS A decrease in sexual interest was significantly more frequently reported by subjects (men and women) using HAART containing protease inhibitors (PI) (308/766, 40%), compared with PI-naive patients (22/138, 16%; OR 3.55; 95% CI 2.15--5.89). In addition, a significantly larger number of PI-experienced men reported a decrease in sexual potency (216/628, 34%) compared with PI-naive men (12/99, 12%; OR 2.56; 95% CI 1.33--5.03). In multivariate analyses the following factors were associated with a decrease in sexual interest: a current PI-containing regimen, a history of a PI regimen, symptomatic HIV infection, age and homosexual contact as HIV transmission mode. Factors associated with a decrease in sexual potency were: current use of a PI-containing regimen, symptomatic HIV disease, age and the use of tranquillisers. CONCLUSION SD appears to be a common side-effect of HAART regimens containing a PI. The potential association between SD and other side-effects of HAART, such as lipodystrophy syndrome and neuropathy, should be investigated further.
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Affiliation(s)
- W Schrooten
- Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium
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