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Complications à long terme des traitements antirétroviraux : observance, résistances et troubles métaboliques

Abstract : The therapeutic advance in the field of the Virus of the Human Immunodeficiency (HIV) infection transformed the prognostic of this pathology. The HIV-positive persons experience the same difficulties met in the other chronic diseases: difficulties following a treatment regularly, side effects of treatments and loss of efficiency of drugs. To improve the care of these individuals, new drugs such as non-nucleoside reverse transcriptase inhibitors (NNRTI), have been developed as an alternative to protease inhibitors. We analyzed the predictors of virologic failure and resistance in a prospective cohort of subjects receiving NNRTI based antiretroviral combination. Regarding long term complications, we randomly compared the lipid profile of the two main NNRTI drugs, namely efavirenz and nevirapine. We assessed the effect of once-daily versus twicedaily dosage on electronic monitors defined adherence in a randomized trial. Finally, we conducted a systematic review to assessed the methodologic quality of noninferiority randomized trials in the field of antiretroviral therapy. We identified treatment interruptions for more than 48 hours as an independent risk factor for virologic failure and resistance to NNRTI and confirmed the impact of depression on the risk of virologic failure to NNRTI. The switch from efavirenz to nevirapine was associated with a 20% decrease in the 10-year relative risk for major cardiac events, according to the Framingham equation. The switch from twice to once-daily nevirapine was well tolerated but did not increase adherence significantly compared to twice-a-day. Methodologic standards were scarcely complied with, leaving space for improvements. Overall, our work contributed to improve the knowledge of long term complications associated with HIV by investigating the complex interactions between virologic dynamics, pharmacological properties of drugs and human behaviours
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  • HAL Id : tel-00812668, version 1

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Jean-Jacques Parienti. Complications à long terme des traitements antirétroviraux : observance, résistances et troubles métaboliques. Maladies infectieuses. Université Pierre et Marie Curie - Paris VI, 2008. Français. ⟨NNT : 2008PA066212⟩. ⟨tel-00812668⟩

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