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Highly Active Antiretroviral Therapy

with undetectable HIV RNA levels, elective Caesarean section was associated with a

90% reduction in MTCT risk (odds ratio, 0.10; 95% CI, 0.030.33), compared with

vaginal delivery or emergency Caesarean section. Conclusions.The results suggest that

offering an elective Caesarean section delivery to all HIV-infected women, even in areas

where HAART is available, is appropriate clinical management, especially for persons

with detectable viral loads. Our results also suggest that previously identified risk factors

remain important. (Source : European Collaborative Study).

Several currently available drugs are under further development, the most

important goals being the reduction of pill burden, easier dosing and less side effects.

Three such preparations to have recently entered the market are Invirase 500,

Truvada and Kivexa. New improvements are being developed; licensing

applications for some of these are already in progress. Gilead and BMS are working on a

combination pill of FTC, tenofovir and efavirenz. However, it will be some time before

this so far one-off co-operation bears fruit.


With increasing numbers of HIV-infected pregnant women receiving highly

active antiretroviral therapy (HAART),1 concerns have been raised over the possible

teratogenic effects related to exposure in early pregnancy. It has been reported that a .4%

prevalence of congenital abnormalities in uninfected infants exposed to antiretroviral

therapy (ART; mainly monotherapy and/or dual therapy), which is similar to that seen in

those not exposed. It has not been proven that whether risk of congenital abnormalities is

increased by first-trimester exposure or by use of HAART, but there is an additional risk

of antenatal use of HAART during...
N Engl J Med 1996, 335:1081-90.
16. Mocroft A, Katlama C, Johnson AM, et al. AIDS across Europe, 1994-98: the EuroSIDA study. Lancet 2000, 356:291-6. Perelson AS, Neumann AU, Markowitz M, Leonard JM, Ho DD. HIV-1 dynamics in vivo: virion clearance rate, infected cell life-span, and viral generation time. Science 1996, 271:1582-6.
18. Volberding PA, Lagakos SW, Koch MA, et al. Zidovudine in asymptomatic HIV infection. A controlled trial in persons with fewer than 500 CD4-positive cells per cubic millimeter. N Engl J Med 1990, 322:941-9. ...Show more

Summary

2. Brinkman K, Smeitink JA, Romijn JA, Reiss P. Mitochondrial toxicity induced by nucleoside-analogue reverse-transcriptase inhibitors is a key factor in the pathogenesis of antiretroviral-therapy-related lipodystrophy. Lancet 1999, 354:1112-5.
7. Fischl MA, Parker CB, Pettinelli C, et al…
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