There

is currently insufficient evidence selleck chemical to recommend the long-term or routine use of GH axis drugs for the treatment of HIV-associated lipodystrophy. However, our review shows that these drugs can be effective in producing substantial reductions in VAT mass and significant increases in LBM. This may result in short- or long-term improvements in metabolic derangements and/or self-perceptions of body image. Thus, clinicians may consider using this category of drugs in the treatment of individual patients whom they feel may benefit. Generally, the GH axis drugs were well tolerated, as the overall number of side effects was not significantly different between the intervention and placebo groups. However, subgroup analysis revealed that patients receiving GH axis drugs experienced a higher rate of arthralgias and peripheral oedema. The beneficial effect of this category of drugs on VAT mass and LBM provides insights into the

pathophysiology of HIV-associated lipodystrophy and its relation to the GH axis. These results may instigate further research into both the pathogenesis of this disorder and other potential treatments for this condition along this axis. Because negative perception of body habitus is a common cause of noncompliance with HAART, future studies should examine the effects of GH axis treatments on compliance with HAART and the effect of these treatments on body image perception. Few studies evaluated the retention of the benefits of treatment after discontinuation of the drug, and further studies need to examine the long-term benefits of treatment. Finally, long-term studies are needed to GSK458 price evaluate adverse events many associated with prolonged use of these drugs. We would like to thank Dr. Robin Larson for her invaluable assistance in the preparation of this systematic review. “
“Surrogate markers of HIV disease progression are HIV RNA in plasma viral load (VL) and CD4 cell count (immune function). Despite improved international access to antiretrovirals, surrogate marker diagnostics are not routinely available in resource-limited settings. Therefore, the objective was to assess effects

of economic and diagnostic resourcing on patient treatment outcomes. Analyses were based on 2333 patients initiating highly active antiretroviral therapy (HAART) from 2000 onwards. Sites were categorized by World Bank country income criteria (high/low) and annual frequency of VL (≥3, 1–2 or <1) or CD4 (≥3 or <3) testing. Endpoints were time to AIDS/death and change in CD4 cell count and VL suppression (<400 HIV-1 RNA copies/mL) at 12 months. Demographics, Centers for Disease Control and Prevention (CDC) classification, baseline VL/CD4 cell counts, hepatitis B/C coinfections and HAART regimen were covariates. Time to AIDS/death was analysed by proportional hazards models. CD4 and VL endpoints were analysed using linear and logistic regression, respectively.