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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 of the most commonly used medications include stavudine (d4T) 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 nine randomised controlled trials. Overall, these studies showed no critical difference between d4T 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

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

The primary objective of this review was to evaluate the antiviral efficacy of co‐formulated abacavir‐lamivudine‐zidovudine 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‐lamivudine‐zidovudine 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: 2016

Zidovudine (AZT) was the first antiretroviral drug used in HIV and AIDS. It is expensive and has several adverse effects including nausea, vomiting, blood problems (anaemia and neutropenia) and myopathy (muscle weakness). The next two drugs developed for HIV were didanosine (ddI) and zalcitabine (ddC). The adverse effects of ddI include nausea, vomiting, diarrhoea and problems with the pancreas (pancreatitis) and nerves in the arms and legs (peripheral neuropathy). Adverse effects of ddC are mouth ulcers and peripheral neuropathy. The review of trials found that both HIV disease progression and death are delayed by ddI, and perhaps also by ddC, at least when used with AZT.

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

Version: 2010

Zidovudine (AZT) was the first antiretroviral drug used in HIV and AIDS. It is expensive and has several adverse effects including nausea, vomiting, blood problems (anaemia and neutropenia) and myopathy (muscle weakness). The review of trials found that AZT does delay the early progression of HIV disease, but this improvement is not sustained. AZT alone does not increase survival for people without AIDS.

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

Version: 2010

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‐zidovudine‐lamivudine) 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

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

Mother‐to‐child transmission (MTCT) of HIV is the primary way that children become infected with HIV.  Such transmission can take place when the child is still in the mother’s womb, around the time of birth, or through breastfeeding after birth.  Hundreds of thousands of children are infected this way every year, with most of them in developing countries.  Major progress has been made in preventing MTCT when the baby is still in the mother’s womb, or around the time the baby is born.  In many resource‐rich settings, mothers with HIV infection are counseled not to breastfeed their children, and there are feasible and affordable alternatives to breastfeeding.  However, in parts of the world where the vast majority of mothers with HIV infection live, complete avoidance of breastfeeding is often not feasible (for example, because of the lack of availability of clean water and of affordable replacement feeding).  Therefore, interventions to prevent transmission of HIV infection through breast milk are urgently needed.  The authors found that, in addition to complete avoidance of breastfeeding if safe and affordable, exclusive breastfeeding (where the baby receives only breast milk) for the first few months of life helps prevent transmission (as compared to breastfeeding supplemented by feeding the baby other liquids or solids).  Another intervention, giving the baby an anti‐HIV medicine (antiretroviral) while breastfeeding, decreases the risk of transmission of HIV from mother to child. Implementation of such interventions, as well as developing more and better interventions, is essential.

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

Version: 2010

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

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

Cesarean section before labor and before ruptured membranes (also called "elective cesarean section," or ECS) has been introduced as an intervention for the prevention of MTCT of HIV. The objectives of this review were to assess the efficacy (for prevention of MTCT of HIV) and the safety of ECS among HIV‐infected women.

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

Version: 2011

This review evaluated the effects of antiretroviral post‐exposure prophylaxis (PEP) for preventing HIV infection following occupational exposure. No randomized controlled trials were identified. Only one case‐control study provides evidence for using zidovudine monotherapy. The study found that, in the occupational setting, HIV transmission was significantly associated with deep injury, visible blood on the sharp instrument, procedures involving a needle placed in the source patient's blood vessel, and terminal illness in the source patient. After taking these into account, it was found that those who became infected with HIV had significantly lower odds of having taken zidovudine after exposure, compared to those who did not seroconvert. There is no direct evidence to support the use of multi‐drug antiretroviral regimens following occupational exposure to HIV. However, due to the success of combination therapies in treating HIV‐infected individuals, a combination of drugs should be used for PEP. Eight reports from other studies confirmed the findings that adverse events were higher with a three‐drug regimen; however, discontinuation rates were not significantly different. A four‐week regimen of post‐exposure prophylaxis should be initiated as soon as possible after exposure, depending on the risk of seroconversion. Healthcare workers should be counseled about expected adverse events and given strategies for managing these events. They should also be advised that PEP is not 100% effective in preventing HIV seroconversion.

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

Version: 2012

Patients starting their first HIV treatment are often given efavirenz in combination with two other drugs. Emtricitabine and tenofovir are one of several pairs of drugs that can be used in this way.In early 2012, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of rilpivirine as a single drug (trade name: Edurant) taken together with two other drugs, compared with efavirenz in combination with two other drugs. The results of 815 patients were analyzed. Almost three quarters of them took rilpivirine with emtricitabine and tenofovir, and about one quarter took rilpivirine with zidovudine and lamivudine. Only a few had used rilpivirine plus abacavir and lamivudine.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 20, 2017

Dolutegravir (trade name: Tivicay) has been approved in Germany since January 2014 in combination with other antiretroviral drugs for the treatment of human immunodeficiency virus (HIV) infection in adults and children over 12 years of age.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 27, 2017

Rilpivirine has been approved in Germany since November 2011 as a single agent (trade name: Edurant) and in a fixed-dose combination with emtricitabine and tenofovir (trade name: Eviplera) for the treatment of HIV type 1 in some adults.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 29, 2017

Antiretroviral therapy (ART) has been shown to be effective in slowing down the progression of AIDS and in reducing HIV‐related illnesses and death. Traditionally, therapy is administered based on a patient’s CD4 cell count, where the number of CD4 cells reflects the body’s immune (defense) system.  An HIV‐infected individual with a CD4 cell count of 500 cells/µL is considered healthy enough not to need ART. When a patient’s cell count reaches 200 cells/ µL, however, the immune system is severely weakened and ART is necessary. A patient with advanced symptoms receives treatment regardless of CD4 count.

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

Version: 2011

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

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