C-C2-03: Incidence-based Costs of Multiple HAART Switches Among HIV-infected Patients in an HMO

Background: Highly active antiretroviral therapy (HAART) or combination antiretroviral (ARV) therapy is associated with reduced morbidity and mortality. Yet, many HIV-infected patients endure incomplete HIV suppression from HAART or combination ARV therapy, increasing cost and limiting effectiveness. Little is known about the direct healthcare costs of HIV+ patients requiring multiple HAART regimen switches because of incomplete HIV suppression. In an HMO-based population of HIV+ patients, we examined resource and cost implications of multiple relative to single (or no) HAART switches starting from first HAART regimen

A Randomized Controlled Trial of a Reduced Daily Dose of Zidovudine in Patients with the Acquired Immunodeficiency Syndrome

ZIDOVUDINE (3′-azido-3′-deoxythymidine; formerly azidothymidine, or AZT) is a thymidine analogue that inhibits the replication of the human immunodeficiency virus type 1 (HIV) in vitro. 1 The administration of zidovudine to patients with advanced HIV disease over a 6-to-24-month period prolongs survival, decreases the frequency and severity of opportunistic infections, improves neurologic function, transiently improves CD4 T-lymphocyte counts, and decreases the rate of HIV antigenemia. 2 3 4 5 6 7 8 Despite these benefits, zidovudine therapy is frequently associated with adverse reactions, including both anemia and neutropenia. 2 , 9 Although the serum half-life of zidovudine is one hour, the intracellular half-life of its 5′-triphosphate form approaches three hours, suggesting that . . 

The major genetic determinants of HIV-1 control affect HLA class I peptide presentation.

Infectious and inflammatory diseases have repeatedly shown strong genetic associations within the major histocompatibility complex (MHC); however, the basis for these associations remains elusive. To define host genetic effects on the outcome of a chronic viral infection, we performed genome-wide association analysis in a multiethnic cohort of HIV-1 controllers and progressors, and we analyzed the effects of individual amino acids within the classical human leukocyte antigen (HLA) proteins. We identified >300 genome-wide significant single-nucleotide polymorphisms (SNPs) within the MHC and none elsewhere. Specific amino acids in the HLA-B peptide binding groove, as well as an independent HLA-C effect, explain the SNP associations and reconcile both protective and risk HLA alleles. These results implicate the nature of the HLA-viral peptide interaction as the major factor modulating durable control of HIV infection