Talk:Management of HIV/AIDS/Archive 1

Archive 1

Is nPEP Statistics Credible?

After reading the paragraph below, which sources an article from the Centers for Disease Control, I went and read most of the article ([1]), but was unable to find any evidence that nPEP is 100% effective if taken within a 24 hour time frame, or that effectiveness falls to 52% if treated within 72 hours. I'm interested to know the source of a such a bold and definite assertion. If it is true, it would be a significant relief for those who have been exposed to HIV within a short time frame, otherwise it will be misleading at best, or raise false hopes at worse.

In 2005, the Centers for Disease Control and Prevention in the United States recommended a 28-day HIV drug regimen for those who have been exposed to HIV (HIV Postexposure Prophylaxis [PEP])[9]. The drugs have demonstrated effectiveness in preventing the virus nearly 100% of the time in those who received treatment within the initial 24 hours of exposure. The effectiveness falls to 52% of the time in those who are treated within 72 hours; those not treated within the first 72 hours are not recommended candidates for the regimen.

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Sequencing numbers

I was going through the sequencing numbers: AZT, ddI, ddC, d4T, 3TC, saquinavir, ritronavir, indinavir are the first eight. Which one is Ninth? I've been through about four times and can't find what comes between indinavir and nevirapine.

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I restructured the markup (but hopefully not the content) to use fewer levels of bullet-list indentation, and instead two levels of == wiki markup instead. I think I've gotten everything in the right place, but I'd apprciate it if someone more knowledgeble could doublecheck. I figure this was a good change to make, because:

• it allows more useful navigational information to appear in the page's table of contents
• it enables heading numbers (for those who've got that option turned on) which also help navigation
• it produces, IMHO, much more readable and attractive HTML
• the wiki markup is a bit easier to follow, too
• it creates h3 and h4 tags in the HTML output. Header tags such as these are used by the browsers and screen readers used by some disabled people, so having them instead of nested bulletlists makes for easier access for such folks.

-- Finlay McWalter 10:11, 17 Oct 2003 (UTC)

Question - we currently have a (dead) link to synergies. Is it likely that a specific medical page will later be produced for precisely this, or should we resolve the link to synergy? -- Finlay McWalter 12:14, 17 Oct 2003 (UTC)

fixed, thanks for proofing. -- Kstailey

(some talk moved to User talk:Kstailey) -- Finlay McWalter 16:03, 17 Oct 2003 (UTC)

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Should Fixed Combinations be considered new drugs in terms of them getting sequence numbers? They are just reformulations with no original medications in almost all cases (Kaletra® being the only exception.) Kstailey 15:37, 21 Oct 2003 (UTC)

If by sequence numbers you mean stuff like Third antiretroviral to be approved by FDA, then I have two comments:

• I'm not sure the details of the ordering are especially significant. It's certainly interesting that AZT was the first, and certainly interesting which drugs are the latest, but details of ordering beyond that seem (at least to me) not to be especially significant. So I don't think it matters much. The stuff you've added about how they work and what side-effects they have seems much more interesting to me (both from a clinical and a science-geek perspective).
• Secondly, I think you're by far the most knowledgable wikipedian active in this little section of the wikipedia. I think it's probably your call.

-- Finlay McWalter 16:59, 21 Oct 2003 (UTC)

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Abbott pharmaceuticals price gouging an old protease inhibitor

Permission to distribute this editoral was granted by the author:

I hereby give you permission to reprint and distribute The Center for AIDS editorial (available at the moment at www.centerforaids.org/abbott.htm). Please credit the source as "The Center for AIDS, Houston, Texas (www.centerforaids.org)."

Thanks,

Tom

Thomas Gegeny, MS, ELS Executive Director & Senior Editor

The Center for AIDS: Hope & Remembrance Project 1407 Hawthorne Houston TX 77006

www.centerforaids.org 713-527-8219 x102 (ph) 713-521-3679 (fax)

Editorial, The Center for AIDS (12/15/03)

In a move that startled healthcare professionals and community members alike, Abbott pharmaceuticals announced a price increase of almost 500% for its protease inhibitor ritonavir (Norvir). Norvir is widely being used as a pharmacokinetic "booster" for other protease inhibitors, including recently approved drugs such as fosamprenavir (Lexiva) and atazanavir (Reyataz).

Boosting protease inhibitors makes them more potent, a particular consideration for treatment-experienced or "salvage" patients with few or no treatment options left. The price increase went into effect on December 3, 2003-two days after World AIDS Day. Surprisingly, the price of another Abbott drug, Kaletra (itself Norvir-boosted protease inhibitor) has stayed the same, providing an unquestionable economic advantage to choosing Kaletra over other boosted protease inhibitor regimens, which may now increase in price by as much as double. Although negotiated prices for US government AIDS Drug Assistance Programs are locked in by law into 2005, prices negotiated after that time will be subject to increases.

Indeed, Abbott has modified its patient assistance program so that patients needing Norvir can more easily get the drug. However, this does not address the more important question of what will happen if third-party insurers are faced with footing the bill for boosted regimens that are much more expense than Kaletra. This has implications for salvage therapy research as well because potential therapies that require boosting with Norvir may be abandoned. What Abbott has done is unforgivable and will go into the history of the AIDS epidemic as a repugnant commercial manipulation that unnecessarily burdens people living with HIV/AIDS, especially those with fewer treatment options who can truly benefit from boosted protease-inhibitor therapy. Physicians, researchers, government officials, and patients should be outraged by these events and should take heed of such gross opportunism tainting the very nature and purpose of healthcare.

Working with the AIDS Treatment Activists Coalition (ATAC), The Center for AIDS will fight to make sure that this unjust act is brought to the attention of both local and national officials and that Abbott regrets the day it decided to hold salvage patients hostage through selfish profiteering. Contact ATAC if you'd like more information or to become involved. Also, contact your elected officials to inform them of this despicable development or call the office of Abbott CEO Miles White (847-937-6100) to give Abbott your thoughts on the matter directly. Other Abbott contacts can be found on the Abbot web site.

I quote from a second source below.

How much?!!

On December 3rd Abbott informed customers that the wholesale price of ritonavir had increased from $205.74 USD to $1028.71 for 120 100mg capsules – the equivalent of $515 a month if ritonavir is being dosed at 100mg twice daily with another protease inhibitor. The previous cost of the drug lay around $100 - $110 a month when dosing at 100mg twice daily.

My personal expericence is that my pharmacy raised the price from $91.55 USD to $528.76 for what is indended to be a one month supply. However, I only take antiretrovirals every other week aka Dr. Dybul

Kstailey 14:28, 20 Dec 2003 (UTC)

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Abstracts are in the public domain IIRC. Kstailey 14:28, 20 Dec 2003 (UTC)

Food-drug interaction: grapefruit juice augments drug bioavailability-mechanism, extent and relevance.

Dahan A, Altman H. Eur J Clin Nutr. 2004 Jan;58(1):1-9.

[1]Department of Pharmaceutics, School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem Israel.

More than a decade has passed since it was unintentionally discovered that grapefruit juice interacts with certain drugs. The coadministration of these drugs with grapefruit juice can markedly elevate drug bioavailability, and can alter pharmacokinetic and pharmacodynamic parameters of the drug. The predominant mechanism for this interaction is the inhibition of cytochrome P-450 3A4 in the small intestine, resulting in a significant reduction of drug presystemic metabolism. An additional mechanism is, presumably, the inhibition of P-glycoprotein, a transporter that carries drug from the enterocyte back to the gut lumen, resulting in a further increase in the fraction of drug absorbed. Some calcium channel antagonists, benzodiazepines, HMG-CoA reductase inhibitors and cyclosporine are the most affected drugs. A single exposure to one glass of the juice can usually produce the maximal magnitude of the interaction. The data available so far, concerning this interaction and its clinical implications, are reviewed in this article. It is likely that more information regarding this interaction will accumulate in the future, and awareness of such is necessary for achieving optimal drug therapy.

European Journal of Clinical Nutrition (2004) 58, 1-9. doi:10.1038/sj.ejcn.1601736

Publication Types:

   * Journal Article

PMID: 14679360 [PubMed - in process]

From PubMed

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Merke threw away combination therapy in 1993

Subject: Merck Drops Final Bid to Develop Drug For AIDS in Face of Viral Resistance 
Date: Published: 9/15/93 (66 lines)
Source: Wall Street Journal. Copyright Dow Jones & Co. Inc.

   Technology & Health:
   Merck Drops Final Bid to Develop Drug
   For AIDS in Face of Viral Resistance
   ----
   By Michael Waldholz
   Staff Reporter of The Wall Street Journal

   Merck & Co. dropped its final efforts to develop a once highly
promising AIDS drug, noting that use of the drug causes the AIDS
virus to mutate and become resistant.
   A Merck spokesman said that in recent weeks the company and
outside AIDS researchers concluded that they couldn't overcome
severe viral resistance, even when the experimental drug was used in
high doses and in combination with AZT, the drug sold by Wellcome
PLC. 
   The news is further evidence of the profound obstacles facing
researchers trying to develop new medicines against human
immunodeficiency virus, or HIV, which causes AIDS.  About a dozen
pharmaceutical companies, including Merck, are continuing to chase
after new AIDS medicines.  But viral resistance has been an
especially difficult issue to overcome.
   In composite trading on the New York Stock Exchange, Merck rose
75 cents to $32.125.
   The Merck drug, known as L661, was developed by Merck in an
unusually intense and swift research effort between 1990 and 1991.
The company then rushed the drug into human tests.  But in late 1991,
Merck's researchers were dealt a severe setback when it was
determined that the virus mutated into a resistant strain within
weeks of the drug's being administered to patients.
   Since then Merck has attempted to revive L661 by combining it
with AZT, which works against the virus through a different
mechanism, and by significantly boosting the drug's dosage.  In a
statement from its Whitehouse Station, N. J., headquarters, Merck
said recent analysis of the combination studies "concluded that the
viral resistance problem is so clinically significant ...that
development should be discontinued."
   The drug works by blocking the action of reverse transcriptase,
an enzyme crucial to viral replication.  AZT blocks the same enzyme
but in a different way.
   "It's very depressing news," said Michael Becker, a New York
lawyer and AIDS activist who closely monitors drug research efforts.
   Boehringer Ingelheim Corp., Ridgefield, Conn., is continuing to
conduct studies of a drug, called neverapine, that works in a
fashion similar to Merck's L661.  An official at the U. S. affiliate
of Boehringer Ingelheim International GmbH of Germany said its
research suggests the drug's higher potency than the Merck drug may
help it overcome viral resistance.  In another bid to surmount the
resistance issue, neverapine also is being tested in a federally
sponsored study in a so-called triple combination with AZT and DDI,
an AZT-like drug sold by Bristol-Myers Squibb Co., New York.
   Meanwhile, a dozen drug makers still are trying to find new types
of AIDS medicines.  Recently, Merck, Abbott Laboratories, Upjohn Co.,
Hoffmann-La Roche Inc., a unit of Roche Holding Ltd.  of Switzerland,
and DuPont-Merck, a joint venture of DuPont Co. and Merck, have been
testing in humans a drug that blocks another viral enzyme called
protease.  Results of those studies have yet to show whether that
class of drug will prove successful.

[This article is made available here by Dow Jones Co. for the
personal and non-commercial use of callers to this bbs, in the
hope that it will be of some help to those who are suffering
from the disease and others who are seeking to help them.]

Remeber that L661 has another name, pyridinone.

A few months earilier ATN published this article

Which I excerpt from here:

The second series of experiments detailed by Chow and others in the recent Nature paper tested combinations of two or more anti-HIV drugs, at concentrations which can be achieved in the body, to see whether they could prevent or stop an HIV infection in a laboratory culture of human cells. The combinations (1) AZT plus ddI; (2) AZT plus alpha interferon plus the Hoffmann-La Roche protease inhibitor Ro31-8959; (3) AZT plus alpha interferon plus soluble CD4; and (4) AZT plus pyridinone, all failed to do so (although AZT plus pyridinone almost worked). However, the three-drug combination AZT plus ddI plus pyridinone completely prevented the infection in the laboratory test. Even when the drugs were added at the peak of HIV infection, seven days after the virus was added, the three-drug combination of AZT plus ddI plus pyridinone stopped spread of infection in the laboratory cultures.

After 49 days of the three-drug treatment, the cells were placed in a drug-free medium for an additional 45 days, giving ideal conditions for HIV to grow. But after the 45 days, there was no evidence of the virus; nothing was found even with a PCR test so sensitive that it could detect a single copy of the HIV genetic information within DNA from 100,000 cells. This does not mean that the virus would similarly be reduced to such low levels in people -- for a number of reasons, some of which are discussed below. But it does suggest that certain combinations (for example, AZT plus ddI plus pyridinone) might work much better as antivirals than combinations now in use (for example, AZT plus ddI).

Kstailey 15:55, 17 Feb 2004 (UTC)

Drug at work?

Reading the above, I'm thinking I'm in way over my head...but I read somewhere Immune Response Corp sued when the efficacy of Remune^TM was demo zero^TM. What university did the tests? Trekphiler^TM, 15.03 22/12/05

If you want the answer, it probably wouldn't appear here. Most questions of this sort on talk pages stay unanswered. You can check somewhere else in the internet. Thanks for understanding. 173.183.79.81 (talk) 19:53, 30 April 2011 (UTC)

Split article

Since this article has grown beyond Wikipedia's size recommendations, how about we use Reverse transcriptase inhibitor and Protease inhibitor (pharmacology)? The Rod 22:04, 9 January 2006 (UTC)

Integrase Inhibitors

This article gives no mention of Integrase Inhibitors, I know little about them myself except that they exist. Someone with the time and interest might want to read up on them, I will do some reading myself but don't expect anything any time soon. Bartimaeus 21:34, 19 March 2006 (UTC)

They're still investigational, and I think we normally don't write much here about drugs under development since so many of them are dead ends (e.g. I suspect we won't be talking much about CCR5 antagonists in a few years) - but there are two that are now available in expanded-access programs, and the trials so far have been promising, so I'll try to write up something soon. Some links here: [2] ←Hob 03:57, 5 November 2006 (UTC)

MK0518 seems to be the most promising - see here and here. Trezatium 13:45, 5 November 2006 (UTC)

Very promising, but I don't think it's possible to judge "most" yet: MK0518 just happens to have reached phase II trials sooner, plus the trials were designed differently (the Gilead drug was only studied as monotherapy). ←Hob 01:19, 6 November 2006 (UTC)

OK, now there's a teeny stub for integrase inhibitor. When I get a chance I'll add some more there about the mechanism of action, how it differs from other drug classes, and a summary of the current investigational drugs. More is needed in the MK-0518 article too, since we have a good deal of data now. ←Hob 01:59, 6 November 2006 (UTC)

Page split suggestion, adverse effects

I found this article in the split form somewhat confusing in its emphasis, as it currently seems to downplay PIs, NNRTIs & nRTIs which are the main HAART components. Would anyone object if I were to split off fixed-dose combinations and synergistic enhancers into separate sections, to balance this effect? I also wondered what the point of the (incomplete) listing of adverse effects was. These vary by drug and by class and the bald listing doesn't seem to provide much info, besides leaving out the important 'lipodystrophy' class of AEs (PS I'm a relatively new Wikipedian but my background is in virology in particular HIV therapy.) Espresso Addict 23:05, 17 May 2006 (UTC)

As no-one objected, I've now split off the sections fixed dose combinations and synergistic enhancers. Espresso Addict 10:58, 30 May 2006 (UTC)

Merge suggestion

The Triple Cocktail stub contains a tiny portion of what is in this article; nothing much links to it and I think it's redundant. Any objections to merging? Trezatium 20:38, 2 November 2006 (UTC)

Looks like a perfect candidate for a merge. There's only one thing that's slightly clearer in that stub than in this article: it mentions the principle of combining drugs of different classes (NRTIs and PIs), which Antiretroviral drug doesn't really say in so many words, but that's nothing that a little editing here couldn't fix. ←Hob 02:10, 3 November 2006 (UTC)

I've performed the merger. I added one sentence about common combinations, and moved the "Classes" section so that it precedes that sentence. Trezatium 12:23, 4 November 2006 (UTC)

Hey, that looks good. Thanks. ←Hob 17:30, 4 November 2006 (UTC)

Outdated guidelines

The WHO and DHHS guidelines cited in this page are out of date. Someone with time on their hands might like to check what changes are needed. Trezatium 18:44, 4 November 2006 (UTC)

Stunning lack of perspective

"Also, providing anti-retroviral treatment is costly and resource-intensive, and the majority of the world's infected individuals cannot access treatment services." Surely the fact that millions of people who need treatment can't access it merits rather more than this casual aside. Trezatium 09:45, 17 November 2006 (UTC)

Cross-referencing to anti-AIDS programs such as the Clinton initiatives to lower drug costs is needed.Cherlin 00:10, 15 December 2006 (UTC)

Viral Load

I put in quotations from a non-copyrighted US Government publication on viral load and infectiousness for treated individuals. We need a lot more on this, because it determines how much of a drop in infections we can expect from pure treatment programs, and how much of a need for education and for prevention remains.Cherlin 00:22, 15 December 2006 (UTC)

This quotation was referenced directly in the text "reference 5", rather than using a dynamic citation. It's now out of date (it's now reference 6), and because it's essentially a block quote, I'm not sure how to best rewrite it using a dynamic citation. Further, this quote didn't specifically address the section topic (combination therapy). Rather than try to solve these problems, I simply deleted the paragraph. Noca2plus 23:07, 15 October 2007 (UTC)

Ingrown nails???

Is in-grown nails really a proven side-effect of HAART? —The preceding unsigned comment was added by 149.99.247.70 (talk • contribs).

Reference 11 in the article lists ingrown nails as a side effect of indinavir. This Google search provides more references. Trezatium 22:48, 18 February 2007 (UTC)

IMOD

I've removed IMOD as a recent development. Drugs like duranavir are recent developments. IMOD is an unfounded claim with no clincal data. If that goes in you might as well write about the cure I have locked in my garden shed. —Preceding unsigned comment added by 78.148.231.4 (talk) 12:48, 22 December 2007 (UTC)

Ggood point. but what do you mean by "the cure I have locked in my garden shed?" 173.183.79.81 (talk) 02:57, 1 May 2011 (UTC)

Definition of retrovirus

Quote "Antiretroviral drugs inhibit the reproduction of retroviruses-viruses composed of RNA rather than DNA". The sentence is in itself unclear. A virus is composed of much more than the nucleic acid. However, if the meaning is that viruses with RNA as genetic material are retroviruses, it is wrong. There are many RNA viruses that are not retroviruses! It is true that retroviruses are RNA viruses - however, what is characteristic of retroviruses is that they carry reverse transcriptase that converts the RNA code to DNA chains, that are suibsequently inserted into the host DNA, and finally re-converted to mRNA and finally viral proteins. So it is a lot more complicated than implied by this sloppy definition.Lave (talk) 17:48, 1 December 2008 (UTC)

Readers First

http://en.wikipedia.org/wiki/Wikipedia:Readers_First —Preceding unsigned comment added by Yellowlarakin (talk • contribs) 23:57, 17 May 2009 (UTC)

What do you mean by this? Also, a easier way to create links is to type

[[Wikipedia:Readers First]]

173.183.79.81 (talk) 21:56, 24 April 2011 (UTC)

Adverse effects: arrange + incl class side effects

I think the "Adverse Effects" section could benefit greatly from some restructuring. Currently it is just a long list of symptoms arranged alphabetically. Arranging the list by commonality, for, instance, could greatly add to the reader's comprehension. Furthermore, each adverse effect could be briefly expanded (i.e. nausea, especially during the first few hours after consumption). I will get on to this as soon as possible if these are not objections.

Secondly, I've noticed that the "class side/adverse effects" for ARVs are not mentioned anywhere on WP. Class adverse/side effects are those belonging to whole ARV classes. I.e. NRTIs exhibit mitochondrial toxicity and thus cause (to variable degrees) 1) hepatic steatosis, 2) hyperlactataemia/acidosis and 3) lipoatrophy. Describing class AE would also greatly aid readers in understanding AE. I would be willing to add this. However, I'm not sure whether that information should included here or on each class's page (NTRI, NNRTI etc.). Any ideas? JacoNiel (talk) 03:42, 25 April 2010 (UTC)

Historical commentary

The spate of edits today seems to be an extension of a recent discussion at the more heavily-trafficked HIV article. I agree that very early treatment approaches, e.g. prior to 1995, were not "hit early, hit hard". The few antiretroviral drugs that were available had only modest (and mostly transitory) benefits, significant side effects, and rapidly selected for resistant strains. Among the very recent edits, there are so many non-neutral and questionable edits that I'm tempted to revert them wholesale, because teasing out the verifiable statements would be very difficult. First, though, I'd like to have others weigh in so that we can arrive at some consensus. Certainly, this article needs a lot of work, but the edits over the past 24 hours or so are not, overall, an improvement. -- Scray (talk) 05:44, 13 October 2010 (UTC)

The benefits of antiretroviral therapy were only transitory when therapy was withheld until the patient developed advanced disease. This fact has been extensively debated in the literature and is now only debated by lay people, not legitimate experts. KBlott (talk) 16:35, 13 October 2010 (UTC)

The benefits were clearly transitory. For example PMID 15566811 is a review article describing the challenges faced in 1995, stating: "The in vivo antiviral effect of certain nonnucleoside RT inhibitors as monotherapy is lost coincident with emergence of a dominant population of resistant virus." That review, written by an expert, illustrates many of the lessons we've learned since then (e.g. the perils of frequent changes in antiretroviral regimens). PMID 7861022 and PMID 7614897, additional reviews from 1995 (from both sides of the pond) illustrate the bleak picture that AZT monotherapy painted (based on actual data like the Concorde trial). We've come a long way; at the time, the benefits of treatment were not clear at all. Passing judgment in retrospect is facile but misleading. -- Scray (talk) 17:15, 13 October 2010 (UTC)

The claims that you are objecting to only state that antiretroviral therapy was withheld. They do not discuss the reasons WHY they were withheld. Do you deny this claim? KBlott (talk) 23:12, 13 October 2010 (UTC)

I don't understand your question - could you be more specific? Are you suggesting you have reliable sources that clearly demonstrate the motivations of influential people who withheld antiretroviral therapy from people who clearly should have been treated based on the current scientific consensus at that time, and that these facts are both within scope of this article and notable? I'll admit that I'm a skeptic, but if you think all of these key requirements are met then I'm listening (er, reading). Remember - no original research or synthesis - just factual statements and sources. -- Scray (talk) 03:30, 14 October 2010 (UTC)

I agree with your assessment that most of the recent additions (especially the hidden commentary) was not neutral and needed to be rewritten. I have tried to rewrite it to be more neutral, but I'm not sure that section needs to be there at all, or perhaps moved to a more history oriented section. I note that one of the sources used was a letter to the editor and authored by someone named "Kenneth W. Blott" - relation to the editor who added it? It fails WP:MEDRS in either case. The second source from IRB journal did not support the statement it was purported to support, so it was removed as well. Yobol (talk) 02:13, 14 October 2010 (UTC)

I support the proposal to split the historical material onto a separate page.

Obviously, Wikipedia permits contributors to the scientific literature to contribute to Wikipedia. I acknowledge that some users do not welcome contributions from editors who can demonstrate that they understand the material they are documenting. Thank-you for your excelent revision. KBlott (talk) 04:55, 14 October 2010 (UTC)

Let’s stop rewriting history, okay?

We all know which user here was the one among those people who demanding “early” intervention before David Ho. Anyone here can confirm that fact by checking the appropriate citation. This man may be getting a little long in the tooth. But he hasn’t gone senile. He knows what happed. Please stop rewriting history. Given the immense carnage which did not need to happen, I find such behaviour very offensive.

Historical facts are based on evidence. “Consensus” is not fact. KBlott (talk) 11:14, 14 October 2010 (UTC)

Let's start writing history, okay?

There's no history section in this article? Not even a little? Well I won't get on a high horse cause I don't have time to do it, at least right now. But I'll just say that to get an impression of the magnitude of HAART in the history of AIDS, you should take one look at this CDC graph (which, by the way, belongs on this page). By 1995 AIDS was the single most common cause of death for ages 25-44. Then, by 1997 it had dropped to the bottom of the graph. Also, the page it comes from is a nice little citation for history.

--Qwerty0 (talk) 09:08, 25 March 2011 (UTC)

I agree, this article does need quite a bit on the history. 173.183.79.81 (talk) 01:38, 24 April 2011 (UTC)

Costs of production and availability

Would it be usefull to add a section on how the stuff is made, its price and the availability in different countries? — Preceding unsigned comment added by 94.212.43.51 (talk) 16:07, 11 June 2011 (UTC)

Rename or discuss non-HIV use

Despite the article being named Antiretroviral drug it only seems to discuss drug combinations against HIV. Could we rename it Antiretroviral drugs for HIV or have a section on non-HIV viruses ? - Rod57 (talk) 10:13, 22 August 2011 (UTC)

Elimination of the Virus?

This article is lacking an explicit explination why HAART and other aggressive antiretroviral treatments don't eliminate the virus altogether. — Preceding unsigned comment added by 137.43.188.170 (talk) 11:37, 26 April 2012 (UTC)

It's 2013

There are more viruses treated with drugs (rather than innoculation) today than HIV. There should be a separate Antiviral article (as noted above 2 years ago). 76.180.168.166 (talk) 19:21, 20 March 2013 (UTC)

Would an article on Antiviral drug satisfy this need? -- Scray (talk) 21:41, 20 March 2013 (UTC)

Sorry just noticed retro, still there are other retroviruses besides HIV, and therapies for them. 76.180.168.166 (talk) 00:54, 21 March 2013 (UTC)

We do have an article on Hepatitis_b#Treatment, too. If you see an opportunity to create a new page, remember: this is the encyclopedia everyone can edit! You can be bold and create WP:Your first article (lots of good advice there). If you get stuck, we have a WP:New contributors' help page. You also might ask yourself WP:Why create an account? -- Scray (talk) 02:25, 21 March 2013 (UTC)

Limiting activity to editorial comment on this. Have had a (single) named account for 7 years. 76.180.168.166 (talk) 08:38, 21 March 2013 (UTC)

If you have an account and know how to create an article, then I have no idea what you're driving at - please be more direct in asking, or just be bold. -- Scray (talk) 08:57, 21 March 2013 (UTC)

New treatment guidelines

A recent edit was malformed and did not use a particularly good reference source, but the information was accurate: http://www.who.int/mediacentre/news/releases/2013/new_hiv_recommendations_20130630/en/ I dare say a news release from the World Health Organization, linked from their own page, meets the criteria for WP:MEDRS.

I'm not sure how to work this in, as the "current guidelines" section is pretty lengthy. TechBear | Talk | Contributions 13:51, 3 July 2013 (UTC)

I agree: this should be added. Keepcalmandcarryon (talk) 13:57, 3 July 2013 (UTC)

Stem cell therapy

Why does this article not cover stem cell therapy? 16:30, 3 July 2013 (UTC)

Bone marrow transplantation is not a general HIV/AIDS management strategy. While there have been several prominent cases of individuals with HIV and cancer who have undergone apparent "functional cures" following this approach, the risks are too high for use in the general HIV+ population. Perhaps something to this effect could be said here, but it seems to me that it's covered adequately elsewhere. Keepcalmandcarryon (talk) 16:46, 3 July 2013 (UTC)

References, archiving

I have formatted all the references uniformly (last name, first 2 initials no periods, full name of journal, wl to journal, publisher, author, dates full numeric except month year dates, display authors 4). I have tried to provide links for the full text of articles whenever possible.

Of note there are several references that have received important updates (guidelines, side effects, etc) these updates are important and should be included in the article. I placed remarked out comments in article. I provided archive links to the material cited. The article should reflect the dates of the material used preferably using the template "As of". I removed one statement "current guidelines" when the guidelines cited were out of date.

I formatted the further reading section content and provided free links for full text. Are these articles the most useful and appropriate for further reading on the subject of the article? I think not.

I have set up archiving for this talk page for posts over 90 days. - - MrBill3 (talk) 15:53, 7 January 2014 (UTC)

Describing "antiretroviral"

I came to this page searching for the term "antiretroviral" which led to "antiretroviral drug". While the term is used often, it's never explicitly defined. Sure, you can make it out to be "effective against retroviri", but that should be explicit. 201.190.31.213 (talk) 04:40, 27 August 2014 (UTC)

List of symptoms

It might be useful to add the symptoms associated with HIV/AIDs when talking about the treatment associated with the disease especially since the article primarily talks about managing the disease and not just about finding a cure. (http://www.aids.gov/hiv-aids-basics/hiv-aids-101/signs-and-symptoms/)

New perspective on treatment on prevention

There might be research out there that indicates that the use of antiretroviral treatment on people that might be at high risk but do not yet have the disease can actually help to reduce their risk of contracting the disease from their sexual partner. While patients with HIV/AIDs using antiretroviral treatment may be helpful to reduce risk, the use of ART on patients without HIV could also help to reduce the risk and prevent the transmission of the disease. (http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0008829)

Difference or transition from HIV to AIDS

It might be helpful to provide the reader with an understanding of how the virus transitions from HIV to AIDS and how they are different. It may help to understand how the specific treatments listed affect the HIV virus but not the AIDs. (http://www.aids.gov/hiv-aids-basics/hiv-aids-101/what-is-hiv-aids/)

Explanation of HIV-1

It might be helpful to explain why there is a distinction between HIV and HIV-1 and explain what HIV-1 is.

HIV-1 is a type of HIV. HIV can be divided into two major types, HIV type 1 (HIV-1) and HIV type 2 (HIV-2). — Preceding unsigned comment added by 2600:8807:5582:5700:FD38:CCCD:2059:D308 (talk) 18:42, 7 June 2016 (UTC)

Infant mortality statistics

In 4.4.2 (Special Populations -> Children), this study is cited as saying that 52% of children (in Africa) infected with HIV die within 24 months.

However, see this paragraph on page 4 of the pdf document:

Overall, estimated cumulative mortality rates were 110 per 1000 livebirths at 12 months and 174 at 24 months. We estimated that by 12 months of age, 35·2% of infected children would have died, compared with an estimated 4·9% of uninfected children (figure 1). At 2 years of age, an estimated 52·5% of` infected and 7·6% of uninfected children would have died.

It looks like the maximum mortality rate is only 17.4% (174 of 1000 for 24 months). The "52·5%" figure seems to be referring to 52 children, or equivalently 5%. I'm unsure where the exact numbers for this calculation are coming from, but I believe the 52% mortality rate is off by a rather large number.

--Vixsomnis (talk) 23:37, 26 February 2015 (UTC)

Drug advertisements

I don't like the addition of section on drug advertisements by WhatamIdoing because while it is historically true, I think it gives an incorrect impression of the current state of HIV care which is the focus of this article. While 15 years ago it might have been unrealistic to show active healthy people in HIV drug ads, this is now the reality for many people I know with HIV. They live with it as a chronic disease that does not affect their lifestyle very much and they do in fact mountain climb and sail. This section seems opposite to the earlier sections on the more current discussion of "the end of AIDS" by Fauci and others. Pgcudahy (talk) 14:34, 12 January 2016 (UTC)

Can you propose a more appropriate page for documenting the very unusual marketing requirements around these drugs? There is no page about the drugs themselves; HIV medication, AIDS drug, HAART, and more than a dozen others all redirect here. Therefore, it seems to me that information about the drugs, including their political, legal, and business history needs to be on this page.

Also, I think that personal experiences probably vary. If you've got severe diarrhea from Kaletra, then you're probably not climbing any mountains, and if you've got hepatotoxicity from ritonavir, then you're probably not looking very glamorous. But regardless of what you believe is the typical patient experience, it's now actually illegal for drug companies to use athletic images in American advertisements or to misrepresent models as being patients. (There are HIV-related ads that show actual patients, just as there are for other drugs/other diseases, but they're less common than they used to be.)

I suspect that HIV ads are more criticized than any other type. If you use ads showing a happy, healthy, sexy man, then you're criticized for misrepresenting reality and causing HIV+ people to be careless about safer sex practices (PMID 12441813, etc.). If you use ads that communicate fear, then you get criticized for that, too. WhatamIdoing (talk) 01:21, 13 January 2016 (UTC)

I think your examples illustrate my point. Kaletra has not been a preferred regimen for 10 years. Even if you're having diarrhea from it, you can now boost it with cobicistat since it's the ritonavir that drives diarrhea and cobi hasn't had that issue. Same with ritonavir and hepatotoxicity, that's rare when used as a low dose booster and ritonavir hasn't been used at antiviral doses in over 15 years. Also, again we now have cobi if it does become an issue. Besides all that, we have the newer nnrtis and instis that are super well tolerated. Or even the new attachment and maturation inhibitors in phase III trials.

To me this is a historical footnote which isn't applicable to the article, let alone need its own section. In other places the history of ART is mentioned because it has bearing on the current management of disease, but I don't think this does. This isn't even the history of ART, it's the history of a regulatory issue with the marketing of ART. The FDA has been silent on the issue for 15 years since the drug companies haven't pushed it, but I highly doubt they would have the same reaction today that they did back then. To me this section reads as "The FDA thinks if you have HIV that you will be sick and not doing active things" but there is no way that I can believe that their opinion on the proper representation of HIV disease has not evolved in the last 15 years.

What article does it belong in? I don't know, but it doesn't fit here. Maybe start an article on the marketing of ART, I think that would be super interesting since it does have so many facets. Even now there are controversies with marketing PrEP which are interesting. Pgcudahy (talk) 18:39, 13 January 2016 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 1 September 2021 and 6 December 2021. Further details are available on the course page. Student editor(s): Bamba1999.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 00:28, 18 January 2022 (UTC)