tailieunhanh - báo cáo hóa học:" Initiating Antiretrovirals in a Resource-Constrained Setting: Does One Size Fit All?"

Tuyển tập các báo cáo nghiên cứu về hóa học được đăng trên tạp chí sinh học quốc tế đề tài : Initiating Antiretrovirals in a Resource-Constrained Setting: Does One Size Fit All? | Journal of the International AIDS Society BioMed Central Open Access Initiating Antiretrovirals in a Resource-Constrained Setting Does One Size Fit All Ajay Wanchu Address Department of Internal Medicine Postgraduate Institute of Medical Education and Research Chandigarh India Email Ajay Wanchu - awanchu@ Published 8 August 2005 Journal of the International AIDS Society 2005 7 67 This article is available from http content 7 3 67 Introduction The World Health Organization WHO aims to provide antiretroviral therapy ART to at least 3 million patients in resource-limited settings by the end of 2005 an initiative referred to as 3 by 5. The program uses a CD4 cell count of 200 cells microliter mcL for initiating treatment as a cutoff in asymptomatic individuals. 1 Some issues need to be addressed when applying the program in resource-constrained countries such as India. Limitations of WHO-Recommended Regimen Applied in India Reduction in viral load might reduce transmission of HIV. 2 The combination of drugs primarily used in the WHO-approved regimen are nevirapine lamivudine and stavudine. This is the cheapest generic formulation in India that has the advantage of combining all 3 drugs in 1 pill. The cost of this combination is less than 1 per day. However in the free treatment program the number of patients who would require these medications worldwide will increase rapidly. Worldwide 16 000 individuals get infected daily and each would sooner rather than later require ART. In India all of the 5 million-plus patients would be candidates for treatment. Do we have resources to provide medication even at less than 1 per day It is notable that although nevirapine-based regimens have been shown to do as well as other regimens the drug has never been the most preferred in most international guidelines. 3 The other issue is one of resistance with nevirapine as a single amino acid substitution in the reverse transcriptase gene can result in .