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Issue No. 4 | January 23, 2009

News and Features

Long-Term Outcomes of Kidney Transplantation in HIV-Infected Patients

"In the highly active antiretroviral therapy era of improved survival for patients living with human immunodeficiency virus (HIV), chronic kidney disease now accounts for more than 10% of HIV-related deaths. ... We evaluated ... patients undergoing a renal transplant ... and found that, although long-term allograft survival is lower among HIV-positive recipients, controllable risk factors may explain this disparity. With proper donor selection and transplant recipient management, ... long-term graft survival comparable to that in HIV-negative patients can be achieved."

Nevirapine Prophylaxis in Newborns May Increase Drug-Resistant HIV

"The antiretroviral drug nevirapine may help prevent babies of HIV-positive mothers from getting the virus through breast-feeding, but it also greatly increases the odds of developing drug-resistant HIV if they are infected during the first year of life, a new study finds.

Still, the researchers consider the six-week course of the drug the best alternative available.

Given the higher chance of a baby on nevirapine acquiring treatment-resistant HIV, the authors call for the infants to also receive protease inhibitors (PIs), which can combat nevirapine-resistant HIV strains."

Impact of Mental Health on Anti-HIV Treatment Adherence

"Extensive research has demonstrated that the primary barriers to [antiretroviral therapy (ART)] adherence include mental illness, especially depression and substance abuse, as well as histories of traumatic experiences such as childhood sexual and physical abuse. These psychosocial factors are highly prevalent in people living with HIV/AIDS (PLWHA) and predict poor ART adherence, increased sexual risk behaviours, ART treatment failure, HIV disease progression and higher mortality rates. The efficacy of standard mental health interventions, such as antidepressant treatment and psychotherapy, has been well-defined, and a small but growing body of research demonstrates the potential for such interventions to improve ART adherence and reduce sexual risk behaviours. Despite this evidence, mental disorders in PLWHA frequently go undiagnosed and untreated."