Effective treatment of HIV disease uses anti-retroviral therapy (ART). Why are s

Question

Effective treatment of HIV disease uses anti-retroviral therapy (ART). Why are social issues and factors important to how we think about HIV treatment? What social factors are important in considering when someone who is HIV should start or change ART? Discuss how these are important in considering an ART regimen. What are some of the most Important considerations for advancing the biomedical options (vaccine, microbicide, PrEP) for HIV prevention? What do you think is the greatest challenge for each of these biomedical prevention options?

Explanation / Answer

1. There are a number of key issues in the study of adherence to antiretroviral theray. The important factors are 1) patient sel-reports, 2) patient's reports on missing pills, 3) assays of drug levels have been used in clinical trials to measure the last dose taken, 4) electronic monitoring systems (medication event monitoring system).

2. Patient's factors : active substance abuse, male sex, youth, active depression, lower level of education, lack of self-efficacy, extreme anxiety, extreme pain,

medication factors: dose frequency of more than twice a day, pill burden, type of drug, food requirement, side effects, poor doctor-health-care provider relationship.

system of care : dissatisfaction with past experience of health care system, leading to avoidance.

3. Vaccine : VaxGen studies used antigens that mimicked the GP120 outer membrane of HIV in an effort to produce broadly neutralizing antibodies, but the trials failed to demonstrate protection. The Step study was to produce cytotoxic T-lymphocytes did not result against HIV seroconversion.

microbicides : Nonoxynol-9 (N-9), the spermicidal agent was shown neither safe nor effective. C31g were shown to be ineffective in protecting against HIV transmission. PRO2000, a microbicide inhibits HIV entry with an acidifying agent buffergel suggesting 30% decreased risk of HIV transmission.

PrEP: antiretrovirals may considerably prevent HIV transmission by either reducing HIV concentrations in people or acting as pre-exposure prophylaxis (PrEP).

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