Le Loup G.,University Pierre and Marie Curie |
Le Loup G.,Tropical and Infectious Diseases Unit |
Fleury S.,Fundacao Getulio Vargas |
Camargo K.,Federal University of Rio de Janeiro |
Larouze B.,University Pierre and Marie Curie
Tropical Medicine and International Health | Year: 2010
The sustainability of successful public health programmes remains a challenge in low and middle income settings. These programmes are often subjected to mobilization-demobilization cycle. Indeed, political and organizational factors are of major importance to ensure this sustainability. The cooperation between the World Bank and the Brazilian AIDS programme highlights the role of international institutions and global health initiatives (GHI), not only to scale up programmes but also to guarantee their stability and sustainability, at a time when advocacy is diminishing and vertical programmes are integrated within health systems. This role is critical at the local level, particularly when economic crisis may hamper the future of public health programmes. Political and organizational evolution should be monitored and warnings should trigger interventions of GHI before the decline of these programmes. © 2009 Blackwell Publishing Ltd.
Ratcliffe L.,North Manchester General Hospital |
Beadsworth M.B.J.,Tropical and Infectious Diseases Unit |
Pennell A.,North Manchester General Hospital |
Phillips M.,North Manchester General Hospital |
Vilar F.J.,North Manchester General Hospital
AIDS | Year: 2011
Background: Combination emtricitabine (FTC) or lamivudine (LAM) with tenofovir disoproxil (TDF) is the recommended first-line regime for treatment in chronic hepatitis B virus (HBV)/HIV co-infection. However, in those failing to suppress, few data exist regarding further management. In HBV/HIV co-infection, there are no published data describing outcomes when entecavir (ETV) is then added to TDF-based regimes in patients no longer suppressing their HBV. We report the first series of patients using ETV with truvada-based HAART in HBV/HIV co-infected patients with previous HBV therapy failure, including inadequate suppression. Methods: A prospective observational study. Results: Thirteen HIV/HBV co-infected patients (all male, hepatitis B e antigen positive and hepatitis B e antibody negative) were commenced on ETV in addition to background truvada. All patients were previously exposed to LAM or FTC and TDF (median 53 months, range 6-123). Seven patients had LAM monotherapy prior to TDF/LAM or FTC combination; the remaining six patients were exposed to FTC or LAM and TDF combination. Median time of follow-up was 74 weeks (range 16-159) and median HBV decline was 2.53 log10 IU/ml (range 1.28-7.36). Thirty-eight percent of patients achieved undetectable HBV DNA level by the end of the study and eight of 13 (62%) achieved normal alanine aminotransferase (ALT) levels with median reduction -28 U/l (range -152 to 37). TDF was stopped in one patient because of renal toxicity. ETV was well tolerated with no change of estimated glomerular filtration rate during the study. Conclusion: Entecavir can be considered in addition to TDF/FTC in HBV/HIV co-infected treatment-experienced patients failing to fully suppress their HBV viral load. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.