equent laboratory testing, and should therefore be a more sensitive marker of infection.7 However a study8 during the infl uenza pandemic of 2009 showed that about 10% of people whose infl uenza diagnosis was confi rmed by RT PCR had a neutralising antibody titre of less than 40 and would not have been classifi Synephrine ed as infected. Although serology is a useful diagnostic assay, it is not a perfectly sensitive marker of infection. Importantly, serology is diff erentially less sensitive in people who have received inactivated vaccines,5 and is non specifi c, with a substantial proportion of haemagglutination inhibiting antibodies to one infl uenza virus strain crossreacting with infl uenza virus strains of the same subtype.
This eff ect was noted in a study7 that identifi ed antibodies that were crossreactive with the pandemic infl uenza A H1N1 2009 , mainly in elderly JAK-STAT Signaling Pathway people. The more restrictive selection criteria for study lusion used by Osterholm and colleagues1 led to some diff erences in results from the most recent Cochrane review.Advances in antiretroviral therapy have turnedHIV into a chronic, manageable disease. Patients often require treatment for co morbid conditions as well as HIV, and consequently, pharmacokinetic interactions between antiretrovirals and other drug classes are an reasing concern. Protease inhibitors and non nucleoside reverse transcriptase inhibitors are involved in the CYP450 or other transporter systems, and may be associated with higher risk of clinically significant drug interactions.
One reverse transcriptase inhibitor, abacavir, has demonstrated weak inhibition of CYP3A4, 2D6 and 2C9 in vitro, but is not associated with any clinically significant interactions cryostat involving the CYP450 system. The integrase inhibitor raltegravir is not involved in the CYP450 system, and may be a suitable option to use when trying to minimize interactions with other drug classes. This review summarizes recently published data on clinically significant drug interactions between ARVs and other drug classes luding antineoplastics, immunosuppressant transplant drugs, directly acting antivirals for hepatitis C, antifungals, antimalarials, corticosteroids, psychotropics, hormonal contraceptives, anticoagulants, drugs for pulmonary hypertension, and herbal products. In situations of suspected or potential interactions, close monitoring is warranted, and dose adjustments or substitutions may be required.
In the past decade, there have been numerous advances in HIV therapy, and the impact of combination antiretroviral therapy on reducing HIV related morbidity and mortality is well established. For adherent patients with undetectable viral loads, HIV has become a chronic manageable disease in an aging and genetically diverse population. Although the need for primary or secondary prophylaxis of opportunistic infections has declined due to potent cART, , many patients require treatment for other concomitant conditions such as cardiovascular disease, hyperlipidemia, hypertension, diabetes, gastrointestinal conditions, osteoporosis or renal disease which may be manifestations of long term drug toxicity, reasing age, or the virus itself . Furthermore, treatment may be required for other indications luding hepatitis co infection, psychiatric illness.