Utilization and costs of HIV antiretroviral drugs in Europe during the last ten years: Impact of generic antiretroviral drugs on cost reduction

IntroductionSimulation studies showed that generic antiretroviral (ARV) drug utilization could lead to significant cost reduction of HIV treatment in developed world. This study aimed to quantify ARV utilization and costs in European countries between 2006 and 2015. We also assessed the impact of generic ARV drug utilization on cost reduction in real-life.MethodsARV drug utilization in 14 European countries (France, Italy, Germany, Denmark, Netherlands, Norway, Sweden, Finland, Iceland, Croatia, Czech Republic, Estonia, Latvia, and Lithuania) were analysed using defined daily dose (DDD)/1000 inhabitants/year. ARV drug cost was estimated in million euro/year and euro/1000 inhabitants/year. The impact of generics on cost reduction was assessed in three countries: France, Denmark, and Czech Republic, using four parameters: expected savings, observed savings, brand price-reduction savings and overall savings.ResultsBetween 2006 and 2015, median ARV drug utilization increased from 234 DDDs per 1000 inhabitants per year (IQR 124–388) to 385 (229–670). The median cost increased from €3751/1000 inhabitants/year (1109–4681) to €9158 (3269–10,646). Between 2013 and 2015, overall savings of €0.9, €1.6, and €33.7 million were respectively observed in Denmark, Czech Republic, and France.ConclusionOverall savings observed in real-life from generic ARV drugs in Denmark were related to high rate of low-price generic utilization, contrarily to France and Czech Republic where these were more related to brand price-reduction than generic utilization itself.     

祥云县艾滋病抗病毒治疗取得明显成效原因分析

[目的]通过对祥云县艾滋病抗病毒治疗工作取得明显成效的原因进行分析，探讨出基层开展抗病毒治疗工作的有效方法，全面推进艾滋病抗病毒治疗工作。[方法]通过考察学习、召开会议、制定方案、协调部门配合、落实责任到人等一系列措施，祥云县艾滋病抗病毒治疗工作不断取得新进展。[结果]2005年开展抗病毒治疗2例；2006年开展抗病毒治疗9例；2007年开展抗病毒治疗41例，治疗覆盖面从2005年的33．33％上升到2007年的87．23％，顺利完成省级下达的任务指标。[结论]领导重视、方法得当、措施得力，是艾滋病抗病毒治疗工作不断取得新进展的关键。     

探讨艾滋病抗病毒治疗的管理及对策

[目的]探讨在艾滋病抗病毒治疗工作中存在的问题。[方法]收集了2005年9月～2007年6月底治疗的47例AIDS流行病学资料进行分析。[结果]抗病毒治疗初期面临许多问题，近年艾滋病病人逐年增加，急需加强艾滋病抗病毒治疗管理。[结论]建议为抗病毒治疗的开展提供政策和经费保障。     

HIV/AIDS患者高效抗逆转录病毒治疗依从性的研究进展

高效抗逆转录病毒治疗(HAART)可以有效地延缓HIV/AIDS患者的疾病进程,改善生活质量,但HAART要求近乎完美的依从性。其依从性的研究在西方发达国家开展较多,但在我国的相关研究不多。文章就国际上HIV/AIDS患者HAART依从性的评价方法及影响因素的研究进展进行了综述。     

云南省国家免费抗病毒治疗艾滋病病毒感染者／病人相关医疗费用及分担方式研究

调查了云南省艾滋病病人免费抗病毒治疗所需的总费用,分析总费用中供方和需方所占的比例,提出了各方付费的政策建议,为进一步落实国家的艾滋病防治政策,体现对艾滋病病人的关爱,构建和谐社会提供科学依据。     

河南省81例HCV/HIV共感染者接受艾滋病二线抗病毒治疗效果及HIV耐药性分析

目的 了解HCV/HIV共感染者在艾滋病一线抗病毒治疗病毒学失败后更换二线治疗方案一年内的效果和耐药情况.方法 招募2012年5－10月间河南省新蔡、确山和尉氏3县中HIV/HCV抗体阳性且使用一线艾滋病抗病毒治疗方案一年后病毒载量未得到抑制的患者.患者更换艾滋病二线治疗方案后6个月和12个月时进行随访和CD₄⁺T淋巴细胞计数、HIV病毒载量和HIV耐药性检测.结果 符合条件的81例HIV/HCV共感染者的CD₄⁺T淋巴细胞中位数在更换二线药物6个月、12个月后出现回升;基线、6个月和12个月的CD₄⁺T淋巴细胞中位数分别为266 cells/μl、275 cells/μl和299 cells/μl(χ²=8.214,P=0.009);HIV病毒载量得到抑制的患者比例分别上升到6个月、12个月的46.84%、50.00%.HIV耐药发生率显著下降,基线、6个月和12个月的耐药发生率分别为66.67%、26.58%和27.63%(χ²=29.362,P=0.000);同时NRTI和NNRTI耐药的发生率均下降,基线、6个月和12个月的发生率分别为51.85%、18.99%和17.11%(χ²=14.230,P=0.005).81例患者在基线时对NRTI中3TC、ABC和FTC的耐药发生率都在50%以上,对AZT、D4T和DDI的耐药发生率在41%～44%之间,对TDF的耐药发生率为33.33%,6个月和12个月后下降到12%～18%.患者基线时对NNRTI中NVP和EFV的耐药率都达到65.43%,而在更换二线药物6个月和12个月后都下降到24%～27%.结论 发生一线艾滋病抗病毒治疗病毒学失败的HIV/HCV共感染者在更换二线治疗方案6个月后状况得到了改善,但是在12个月后治疗效果改善有限.     

江苏省2013年新加入抗病毒治疗的HIV/AIDS流行病学特征分析

目的了解2013年江苏省新入组艾滋病免费抗病毒治疗HIV/AIDS患者流行病学特征。方法收集2013年新接受抗病毒治疗的HIV/AIDS入组时基本资料,用SPSS 16.0软件进行分析。结果江苏省2013年新入组治疗2 065例HIV/AIDS,87.8%为本省籍,男女比6.2∶1,平均年龄(39.8±13.2)岁,已婚有配偶者占50.0%。来源以医疗机构发现为主,感染途径主要为男男性传播和异性性传播,两者合计占95.8%,入组时CD4+T水平中位数为218个/μL,在疾控中心治疗者占50.5%。开始治疗时间与确证时间间隔中位数为3.0月,logistic回归分析显示,年龄越大、CD4+T水平越低、临床分期越高时间间隔在1年内的比例越大;性传播途径的较经血液传播的时间间隔在1年内的比例大(P0.05)。结论江苏省2013年艾滋病病人开始抗病毒治疗时机仍较晚。病人发现较晚是主要原因,HIV感染者早发现能力仍需加强。     

长沙市180例接受艾滋病抗病毒治疗患者抑郁症患病现状及影响因素研究

目的 了解目前接受艾滋病抗病毒治疗患者中抑郁症的患病率,初步探索影响抑郁症产生的因素。方法 2015年6-12月对长沙市传染病医院艾滋病门诊接受艾滋病抗病毒治疗的180例患者开展横断面研究,采用问卷调查的方法评估患者合并抑郁症的情况。利用宗氏抑郁自评量表(SDS)筛查调查对象的抑郁症状(SDS得分≥50分),应用心理疾病专家诊断系统(心理CT)确诊是否患抑郁症,并用logistic回归分析影响抑郁症产生的因素。结果 初筛检出有抑郁症状者48例(26.67%),确诊抑郁症者33例(18.33%)。多因素分析,艾滋病相关羞辱和歧视状况量表得分20~40分(OR=0.093,95%CI:0.020~0.431)是接受艾滋病抗病毒治疗患者抑郁症形成的保护因素,独居(OR=5.062,95%CI:1.626~15.764)、近3个月出现艾滋病相关的疾病(OR=3.778,95%CI:1.113~12.826)是接受艾滋病抗病毒治疗患者抑郁症形成的危险因素。结论 接受艾滋病抗病毒治疗患者抑郁症患病率应该引起关注,临床应加大对艾滋病患者的心理关怀。     

Early HIV treatment and labour outcomes: A case study of mining workers in South Africa

This study examines whether labour outcomes of HIV‐infected workers treated with antiretrovirals are associated with the stage of the disease when commencing therapy. We use data on employment separation and absenteeism from the workplace health programme of South Africa's largest coal mining company over the period of January 2009 to March 2017 in a Cox proportional hazards model. When treatment was initiated at a CD4⁺ T cell count above 350 cells/μl, the risk of separating from the company was 37% lower and the risk of absence was 20%t lower than initiating at a CD4 count below 200 cells/μl, and these differences persist over time. Also, we find that workers initiating antiretroviral therapy at CD4 ≥ 350 have an 8% lower risk of absence prior to treatment. Although many companies and the South African government have adopted universal test‐and‐treat policies aiming to initiate all HIV‐infected people as early as possible, most HIV patients still start treatment late in the disease course when their CD4 counts have fallen to low levels. Our results indicate early HIV detection and treatment could have large productivity gains.     

HIV抗病毒治疗者病毒抑制失败影响因素及耐药

目的 了解抗病毒治疗者病毒抑制失败影响因素和耐药状况.方法 2009年8月在河南省西华县整群抽取接受抗病毒治疗者371例,进行基本情况和抗病毒治疗相关因素问卷调查,同时抽取静脉血进行病毒载量检测,对病毒载量＞1 000拷贝/mL的血液样本采用逆转录-套式聚合酶链反应(RT-nested PCR)方法扩增HIV-1 POL区基因,进行耐药基因型分析.结果 371例中,病毒抑制失败87例,失败率为23.5%;多因素Logistic回归分析结果显不,男性(OR=1.8,95%CI=1.1～3.1,P=0.026 4)、最近1个月有漏服药物(OR=2.3,95%CI=1.2～4.2,P=0.009 2)和现治疗方案为早期一线治疗方案(OR=2.1,95%CI=1.2～3.9,P=0.012 4)与病毒抑制失败率的关系有统计学意义;病毒抑制失败者的耐药率为63.2%(55/87),其中非核苷类药物和核苷类药物的耐药率分别为63.2%(55/87)和49.3%(43/87),未检测到对蛋白酶类药物的耐药.结论 抗病毒治疗人群中病毒抑制失败率和耐药突变率较高,服药依从性是主要影响因素.     

陕西省HIV/AIDS患者接受抗病毒治疗后病毒载量结果及其影响因素分析

目的 分析陕西省艾滋病病毒(human immunodeficiency virus,HIV)感染者/艾滋病(acquired immune deficiency syndrome,AIDS)患者(以下简称为HIV/AIDS患者)接受抗病毒治疗后病毒载量结果及相关影响因素。 方法 对接受抗病毒治疗六个月以上的1 046例HIV/AIDS患者进行病毒载量检测,结合病例流行病学资料分析病毒载量结果及其影响因素。 结果 1 046例HIV/AIDS患者中,≥1 000 copies/ml占9.6%(100/1 046),50~999 copies/ml占9.1%(95/1 046),＜50 copies/ml占25.4%(266/1 046),TND(未检出病毒)占55.9%(585/1 046)。单因素分析显示病毒载量结果＜1 000 copies/ml与≥1 000 copies/ml HIV/AIDS患者在民族(P＜0.05)、教育程度(χ²=10.901,P＜0.05)、感染途径(χ²=14.286, P＜0.05)变量上差异有统计学意义。多因素分析显示教育程度大专及以上是病毒载量≥1 000 copies/ml的保护因素(OR=0.344,95%CI:0.121~0.979),HIV感染途径中注射吸毒是病毒载量≥1 000 copies/ml的危险因素(OR=5.237,95%CI:1.272~21.556)。 结论 陕西省HIV/AIDS患者抗病毒治疗效果较好,但需要提高患者治疗依从性,减少病毒抑制失败。     

Body–drug assemblages: theorizing the experience of side effects in the context of HIV treatment

Each of the antiretroviral drugs that are currently used to stop the progression of HIV infection causes its own specific side effects. Despite the expansion, multiplication, and simplification of treatment options over the past decade, side effects continue to affect people living with HIV. Yet, we see a clear disconnect between the way side effects are normalized, routinized, and framed in clinical practice and the way they are experienced by people living with HIV. This paper builds on the premise that new approaches are needed to understand side effects in a manner that is more reflective of the subjective accounts of people living with HIV. Drawing on the work of Deleuze and Guattari, it offers an original application of the theory of ‘assemblage’. This theory offers a new way of theorizing side effects, and ultimately the relationship between the body and antiretroviral drugs (as technologies). Combining theory with examples derived from empirical data, we examine the multiple ways in which the body connects not only to the drugs but also to people, things, and systems. Our objective is to illustrate how this theory dares us to think differently about side effects and allows us to originally (re)think the experience of taking antiretroviral drugs.     

An instrumental variables evaluation of the effect of antidepressant use on employment among HIV‐infected women using antiretroviral therapy in the United States: 1996–2004

Depression is a common condition among patients with HIV. This paper uses panel data for 1234 participants from the Women's Interagency HIV Study to estimate the effect of antidepressant use on the likelihood of being employed among women receiving highly active antiretroviral therapy (HAART) in the United States from 1996 to 2004. We show that naive regressions of antidepressant use on employment generally result in negative or non‐significant coefficients, whereas the instrumental variables (IVs) approach shows a positive and significant effect of antidepressant use on the employment probability of women living with HIV. We use IVs to predict antidepressant use independently of outcomes, thus addressing potential biases (e.g. more depressed women are more likely to receive antidepressant treatment, but they are also more likely to be unemployed). The results are consistent for linear (random and fixed effects) as well as non‐linear (bivariate probit) specifications. Among women receiving HAART, and controlling for individual and local area labor market characteristics, the use of antidepressants is associated with a 29‐percentage‐point higher probability of being employed. Improved efforts to test, diagnose and treat depression among HIV‐positive patients may improve not only clinical indicators but also labor market outcomes. Copyright © 2009 John Wiley & Sons, Ltd.     

Evaluation of the reproductive toxicity of antiretroviral drug loaded lactoferrin nanoparticles

Multiple prevention therapy has gained importance for the prevention and treatment of sexually transmitted diseases, especially HIV/AIDS. Antiretroviral drugs encapsulated in nanoparticles have been developed for efficient delivery of the drugs to the vaginal surface. Lactoferrin nanoparticles (LFNPs) encapsulating anticancer or antiretroviral drugs are found to be promising agents to specifically deliver drugs at the target sites. Recent studies indicate that the bioavailability is higher for antiretroviral drugs delivered by LFNPs than when the drugs are administered alone. Although LFNP-mediated drug delivery via the oral or vaginal route for the treatment of HIV/AIDS is promising, the effect of such administrations is not well studied. Drug-loaded LFNPs when administered to rats by the vaginal route did not show any effect on the reproductive performance, fertility, and postnatal development. Oral administration of drug-loaded LFNPs caused a significant decrease in litter size, whereas the reproductive performance and postnatal development remained normal. In our model system, the results indicate that vaginal administration of drug-loaded LFNPs appears safer and can be projected for the delivery of antiretroviral agents via the vaginal route.

Abbreviations: LFNPs: lactoferrin nanoparticles; STIs: sexually transmitted diseases infections; NPs: nanoparticles; LF: lactoferrin; DL-LFNPs: drug loaded lactoferrin nanoparticles; MPT: multiple prevention techniques     

中国艾滋病抗病毒治疗药品采购供应现状分析

目的分析我国艾滋病抗病毒治疗药品采购供应现状,为改善抗病毒药品可及性提出相应建议。方法回顾有关历史及现状,结合艾滋病抗病毒治疗特点,总结艾滋病抗病毒药品采购供应工作的特点及现存问题。结果艾滋病抗病毒治疗具有长期性、复杂性和不可预期性,药品种类及生产商均有限,各类药品短期需求量存在不确定性,药品采购的可选择范围也较小。目前我国艾滋病抗病毒药品采购供应存在采购环节多、周期长,药品品种变更可能影响病人服药依从性等问题,不能满足艾滋病治疗现况需求。结论建立高效的药品供应协调机制,缩短采购周期;改进招标方式,延长招标覆盖时间,体现政府采购导向作用;建立药品储备,应对药品紧急需求。     

2010-2014年东莞市接受艾滋病抗病毒治疗病例的 流行病学特征

摘要:目的　了解东莞市2010-2014年接受艾滋病抗病毒治疗病例入组时的流行特征,为提高抗病毒治疗工作提供依据。方法　利用东莞市2010-2014年接受艾滋病抗病毒治疗病例入组时的数据资料,分析其流行特征和变化趋势。结果　1412例治疗病例的平均年龄为（35.99±10.13）岁,80.17%为男性,已婚或者同居者占55.88%。经异性传播和同性传播比例分别为占42.14%和29.67%。入组时CD4+ T淋巴细胞计数的平均值是（218.93±123.35）个/μl,接受治疗时间与HIV确证阳性时间的间隔天数的中位数为74.5 d（P25＝32,P75＝321）。入组治疗治时,采用D4T/AZT/TDF+3TC+NVP方案的比例为70.11%。治疗病例的在访率为87.89%。结论　东莞市艾滋病抗病毒治疗时机的选择较之以前有所提前,应继续采取措施尽早发现和治疗艾滋病感染者/病人,同时加强MSM病例的治疗工作。     

2010-2012年新疆HIV感染产妇及其所生婴儿应用抗艾滋病病毒药物状况分析

目的了解新疆HIV感染产妇及其所生婴儿抗艾滋病病毒药物应用状况及变化趋势。方法对预防艾滋病母婴传播管理信息网络直报系统中报告的2010-2012年间分娩的1303例HIV感染产妇及其所生婴儿抗病毒药物应用情况进行描述性分析。结果1303例HIV感染产妇中,2010-2012年分别有72．58％、77．40％和79．55％的产妇应用了抗病毒药物,并呈逐年上升趋势（×。=6．30,P〈0．05）,HIV感染产妇孕28周及以前开始应用三联方案比例也呈逐年上升趋势（Х^2=13．81,P〈0．01）;HIV感染产妇所生婴儿抗逆转录病毒药物应用比例分别为77．63％、84．91％和84．09％,2011年比2010年上升幅度比较明显,2012年比2011年略有下降（Х^2=8．82,P〈0．01）。结论HIV感染产妇及所生婴儿抗病毒药物应用比例逐年上升,但仍有较大的上升空间,需要进一步提高HIV感染产妇及其所生婴儿抗病毒药物应用比例,从而减少母婴传播的风险。     

New forms of citizenship and socio-political inclusion: accessing antiretroviral therapy in a Rio de Janeiro favela

Brazil has received praise internationally for its national health policy against HIV. Whilst the ethical stance of the Brazilian programme has been widely applauded, there is a lack of empirical data on how the commitment to equitable and universal HIV prevention and treatment works in practice among the poorest population groups. The aim of this paper is to explore the broad ethics of the Brazilian AIDS programme by investigating how universal access to HIV treatment is being implemented within a favela (shanty town). Data collected through anthropological research show that in settings such as the favelas , the universal character of this public health programme is challenged by a number of issues such as local definitions of illness, problems related to the understanding of and adherence to treatment, structural violence, political alienation, and lack of perspectives about the future. It is also argued that such health intervention has contributed to the promotion of novel attitudes towards individual notions of socio-political participation. These are explored with reference to the notion of therapeutic citizenship, which in the context of a favela neighbourhood translates into a new set of concerns around free access to and availability of treatment, the right to health care and the sustainability of public health policies.