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Results: 19

Co‐formulated abacavir‐lamivudinezidovudine for treating HIV infection and AIDS

The primary objective of this review was to evaluate the antiviral efficacy of co‐formulated abacavir‐lamivudinezidovudine for initial treatment of HIV infection. The secondary objectives were to evaluate the safety and tolerability of the triple drug combination. We identified 15 potentially eligible studies, four of which met our inclusion criteria. Our findings indicate that co‐formulated abacavir‐lamivudinezidovudine remains a viable option for initiating antiretroviral therapy, especially in HIV‐infected patients with pre‐existing hyperlipidaemia and those who do not tolerate ritonavir.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Comparing initial antiretroviral regimens tenofovir or zidovudine as part of three‐drug combinations for treatment of HIV infection

The introduction of highly active antiretroviral therapy (ART) as treatment for HIV infection has greatly improved mortality and morbidity for adults and adolescents living with HIV around the world. Deciding which treatment regimen to begin for first‐line treatment in ART‐naïve patients, however, remains a significant challenge. Two commonly used medications are tenofovir (TDF) and zidovudine (AZT). The purpose of this review was to assess which of these two medications was the best for initial treatment for people living with HIV, and through our search we identified two randomised controlled trials. We did not find any critical difference between the two medications in regards to serious adverse events or virologic response, but did find that TDF is superior to AZT in terms of immunologic response and adherence and more frequent emergence of resistance. However, these two studies are not directly comparable because they used two related different drugs in addition to TDF and AZT. Future studies and recommendations should focus on specific toxicities and tolerability when comparing these two medications.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Hydroxyurea for the Treatment of Sickle Cell Disease

To synthesize the published literature on the efficacy, effectiveness, and toxicity of hydroxyurea (HU) when used for treatment of sickle cell disease (SCD); and to review the evidence regarding barriers to its use.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: February 2008
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Closing the Quality Gap: Revisiting the State of the Science (Vol. 4: Medication Adherence Interventions: Comparative Effectiveness)

To assess the effectiveness of patient, provider, and systems interventions (Key Question [KQ] 1) or policy interventions (KQ 2) in improving medication adherence for an array of chronic health conditions. For interventions that are effective in improving adherence, we then assessed their effectiveness in improving health, health care utilization, and adverse events.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: September 2012
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Management of Chronic Hepatitis B

Synthesize evidence of the natural history of chronic hepatitis B (CHB) and effects and harms of antiviral drugs on clinical, virological, histological, and biochemical outcomes.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: October 2008
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Systematic review of the efficacy of antiretroviral therapies for reducing the risk of mother-to-child transmission of HIV infection

This review found that zidovudine alone or combined with lamivudine and nevirapine monotherapy can prevent mother-to-child transmission of the human immunodeficiency virus. Different antiretroviral regimens are comparable in their ability to prevent transmission. The conclusions are likely to be reliable, but should be interpreted with some caution given the small number of included studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Reducing the number of drugs in combination antiretroviral therapy for HIV after initial virologic response reduces the effectiveness of the treatment

Combination antiretroviral therapy can lower the amount of HIV in the blood, improve immune system function, and slow the progress of HIV. It is thought these drugs will need to be used for life. Keeping up this therapy, though, is difficult, and there are concerns about the adverse effects of the drugs and the development of resistance to the drugs over time. Therefore, attempting to use fewer drugs has been tried. However, the review of trials comparing combinations of three or four drugs, in patients who successfully completed initial therapy, with using fewer drugs found that a reduced number of drugs could not suppress the virus as well.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Effects of first-line use of nucleoside analogues, efavirenz, and ritonavir-boosted protease inhibitors on lipid levels

This review found that there was a wide range of lipid elevations during 48 weeks of ritonavir-boosted protease inhibitors or efavirenz in antiretroviral-naive patients, depending on the type of antiretrovirals used. The reliability of the conclusions is unclear due to a lack of reporting of the review process, lack of validity assessment, and unclear suitability of the data synthesis methods.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Using antiretroviral medication to prevent transmission of HIV from mother‐to‐child during breastfeeding

Worldwide, the primary cause of human immunodeficiency virus (HIV) infection in children is mother‐to‐child transmission (MTCT). MTCT of HIV can occur during pregnancy, around the time of delivery, or through breastfeeding. Great strides have been made in reducing MTCT during pregnancy and around the time of delivery. However, without intervention, a significant proportion of children born to HIV–infected mothers acquire HIV through breastfeeding.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

A systematic review of a single-class maintenance strategy with nucleoside reverse transcriptase inhibitors in HIV/AIDS

BACKGROUND: Single drug class regimens with nucleotide reverse transcriptase inhibitors (NRTIs) are generally not recommended as initial therapy, because they were inferior compared to therapy with 2 NRTIs plus efavirenz. However triple-NRTI combinations can be useful in specific circumstances such as in tuberculosis co-infection, pregnancy, or dyslipidemia. Here, we review the potential of such combinations to maintain viral suppression after induction of suppression by standard combination antiretroviral therapy (cART), and to evaluate the trade-off of NRTI-only regimens for metabolic control.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Abacavir‐based triple nucleoside regimens for maintenance therapy in patients with HIV

Regimen simplification can be defined as a change in established effective therapy to reduce pill burden and dosing frequency, to enhance tolerability, or to decrease specific food and fluid requirements. Many patients on suppressive antiretroviral therapy may be considered candidates for a simplification strategy and, among them, those who have achieved virologic suppression. We have reviewed clinical trials evaluating the efficacy and safety of abacavir‐containing triple nucleoside combination as a simplification therapy in HIV‐infected adult patients treated with a Protease‐Inhibitor (PI)‐containing regimen and  with undetectable viral load. Patients on a PI‐containing regimen had three possibilities: continue the PI regimen or switch to a simplification maintenance regimen with triple nucleoside combination (abacavir‐zidovudinelamivudine) or with non‐nucleoside (efavirenz or nevirapine) containing regimens. The review included 8 RCTs and 1675 HIV infected patients. Simplification with triple nucleoside regimen showed an overall failure rate comparable to that of  continuing  PI regimen or  to simplification with non‐nucleoside regimens. Rates of failure due to adverse events with triple nucleoside combinations were lower compared to controls, but the difference was not statistically significant. By contrast, rates of virologic failures   were more frequent with  triple nucleoside combination that with PI or NNRTI, but in both the comparisons the differences were  not statistically significant. Simplification with abacavir had a favourable and significant impact on lipid metabolism compared to control group. Simplification with triple nucleoside regimens should be still considered for individuals who are unable to tolerate or have contraindications to NNRTI or PI based regimens

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Impact of baseline HIV-1 RNA levels on initial highly active antiretroviral therapy outcome: a meta-analysis of 12,370 patients in 21 clinical trials

BACKGROUND: Individual randomized trials of first-line antiretroviral treatment do not consistently show an association between higher baseline HIV-1 RNA and lower efficacy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Emergence of drug resistance in HIV type 1-infected patients after receipt of first-line highly active antiretroviral therapy: a systematic review of clinical trials

This review compared drug resistance profiles of patients with HIV type 1 infection after treatment with first-line antiretroviral therapy. The authors concluded that initial treatment with a boosted protease inhibitor-based regimen was associated with less resistance within and across drug classes. The reliability of this conclusion is unclear due to potential methodological weaknesses and gaps in the reporting process.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Screening for HIV in Pregnant Women: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation [Internet]

A 2005 U.S. Preventive Services Task Force (USPSTF) review found good evidence that prenatal HIV screening is accurate and can lead to interventions that reduce the risk of mother-to-child transmission.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: November 2012
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Antiretrovirals for reducing the risk of mother‐to‐child transmission of HIV infection

At the end of 2009, 2.5 million children under the age of 15 years were estimated to be living with HIV/AIDS (WHO 2011). The majority of these children acquired their infections as a result of mother‐to‐child transmission during pregnancy, labor, or breastfeeding. Antiretroviral drugs administered to the HIV‐infected mother and/or to her child during pregnancy, labor, or breastfeeding can reduce mother‐to‐child transmission of HIV. The objective of this review is to determine whether a regimen of antiretroviral drugs leads to a significant reduction in HIV transmission during pregnancy and labor without serious side‐effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Therapy for treating HIV infection in pregnant women who require treatment for their own health

Pregnant human immunodeficiency virus‐infected (HIV)‐infected women often need treatment with antiretroviral therapy (ART) for their own health. Mother‐to‐child transmission (MTCT) is the most common way that children worldwide become HIV infected. Treatment of HIV‐infected pregnant women with ART decreases the risk of HIV MTCT. It is possible to decrease the risk of MTCT to 1‐2% with the use of antiretroviral medications, caesarean section before labour begins, and avoiding breastfeeding. When women who require HIV treatment for the benefit of their own health become pregnant, we need to know the most effective therapy, the impact of the drug on the MTCT of HIV, and what the potential complications of the therapy might be for both the mother and her unborn child.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Antenatal Care: Routine Care for the Healthy Pregnant Woman

The original antenatal care guideline was published by NICE in 2003. Since then a number of important pieces of evidence have become available, particularly concerning gestational diabetes, haemoglobinopathy and ultrasound, so that the update was initiated. This update has also provided an opportunity to look at a number of aspects of antenatal care: the development of a method to assess women for whom additional care is necessary (the ‘antenatal assessment tool’), information giving to women, lifestyle (vitamin D supplementation, alcohol consumption), screening for the baby (use of ultrasound for gestational age assessment and screening for fetal abnormalities, methods for determining normal fetal growth, placenta praevia), and screening for the mother (haemoglobinopathy screening, gestational diabetes, pre-eclampsia and preterm labour, chlamydia).

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: March 2008
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Screening for HIV: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation [Internet]

A 2005 U.S. Preventive Services Task Force (USPSTF) review found good evidence that HIV screening tests are accurate and that identification of undiagnosed HIV infection and treatment of immunologically advanced disease is associated with substantial clinical benefits. However, it found insufficient evidence to estimate effects of diagnosis and subsequent interventions on transmission risks, or to estimate clinical benefits of antiretroviral treatment in patients with less immunologically advanced disease.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: November 2012
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Caesarean Section

This guidance is a partial update of NICE clinical guideline 13 (published April 2004) and will replace it.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: November 2011
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