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This paper presents our long-term (1992–2000) treatment of pediatric Acquired Immune Deficiency Syndrome (AIDS) patients (maximum 100 children, last three years 65) using native herbal remedies in a voluntary medical assistance program in Constanta, Romania. We primarily report the progress of 10 children at a facility called the "House of Tomorrow" and three other facilities. The long-term (8 years and 8 months) treatment contributed to a drop of the amount of Human Immunodeficiency Virus Ribonucleic Acids (HIV-RNA) below the measurable level for 9 out of 10 patients at the "House of Tomorrow." Furthermore, the treatment led to preservation and increase of the cluster of differentiation (CD4) count, a remarkable decrease in mortality rate, as well as the maintenance of a good quality of life. It took one to three years for the beneficial effects of the treatment to emerge. No side-effects were recognized either clinically or biochemically, nor was there any emergence of drug-resistant strains of HIV as seen with anti-HIV chemical treatments.This paper also refers to which herbal remedies were used and their general mechanism of action.

In more than 20 years of medical practice, a surprising phenomenon has often occurred: some patients with acquired immunodeficiency syndrome (AIDS) decide not to go to the hospital and they do not let others know that they are suffering from the disease unless they believe that they are dieing. Zhang Shan (a pseudonym) is one such patient with human immunodeficiency virus (HIV)/AIDS who was reluctant to receive antiviral therapy as soon as possible, and this paper shares Zhang's story as he related it. Clearly, there are numerous views as to why patients in China behave as Zhang did. Presented here are several reasons, including society, history, morality and ideology, family, and education. Although all of these reasons do play a role, the patient's mindset and behavior is the most significant reason for a patient's reluctance to seek treatment or disclose his/her status. If the individual patient's mindset and behavior are not dealt with effectively, then HIV/AIDS can continue to spread and threaten additional lives and even the fabric of society. This paper analyzes the reasons why patients are hesitant to receive antiviral therapy, but this paper also suggests steps healthcare personnel can take to encourage patients to seek treatment. Such steps can save the lives of current patients with HIV/AIDS. In addition, sound public health measures and a rational approach to treatment are important to helping potential patients with HIV/AIDS.

Progress towards data sharing but many battles still to fight This week sees the publication of the updated Cochrane systematic review on the neuraminidase inhibitors oseltamivir and zanamivir.1 The review, which is also reported in two papers published in The BMJ ,2 3 provides the most complete analysis so far of what is known from randomised trials about the effectiveness and safety of these antiviral drugs. It is also the culmination of a four and a half year battle for access to the raw data from industry funded trials of oseltamivir, a drug on which the world has spent billions of dollars.4 Through their exhaustive scrutiny of the data contained in clinical study reports (the lengthy documents held by the drug’s manufacturer Roche and previously seen only in part by drug regulators), the Cochrane authors have set exacting new standards for systematic reviewers and decision makers. Their fight for the data has also shown us, in more detail than ever, that the entire ecosystem of drug evaluation and regulation is deeply flawed. The Cochrane review and BMJ papers represent a huge amount of work. The authors—Tom Jefferson, Carl Heneghan, and colleagues—are among just a handful of systematic reviewers who have made use of clinical study reports (CSRs) to reach their conclusions. CSRs are intended to provide regulatory authorities with a structured detailed report of a clinical trial.5 In contrast to the abbreviated information about a trial contained in a journal article, one CSR can extend to hundreds of pages. The “compression factor”—the length (in pages) of the CSR of a trial compared with the length of the corresponding journal article—has been found to range from one to an astonishing 8805.6 7 It is a formidable task to sift through this amount of information, which is …

The past five years have seen a revolution in the treatment of chronic hepatitis C, as short duration oral regimens of direct-acting antiviral drugs (DAAs), with nearly 100% cure rates for all genotypes, have replaced longer courses of ribavirin and injected interferon. Although initially very expensive, these DAAs are now becoming available in generic equivalents in countries with large numbers of chronically infected people, such as India. However, a number of obstacles may hinder the delivery of these drugs in resource-limited settings, including lack of access to diagnostic testing and the restriction of treatment to a small number of medical specialists. New approaches are therefore needed to make DAAs available to the estimated 71 million infected people, many of whom disproportionately live in low- or middle-income countries. A recent pilot study (ASCEND) of hepatitis C management in a low-income population in Washington, D.C., demonstrated that trained nurse practitioners, primary care physicians and hepatologists were equally successful in diagnosing and treating patients, indicating that such an approach might be successful in resource-limited regions of the world. Members of the Global Virus Network have received funding to carry out a similar training project in a region of India with a high prevalence of hepatitis C. This paper reviews the challenges of delivering DAA therapy in low- and middle-income countries, describes plans for performing and evaluating the effectiveness of a training program in India, and discusses future needs for the eventual elimination of hepatitis C.

Introduction: We used published literature from 2013–2016, to review data regarding the new all oral interferon and ribavirin free direct acting antiviral (DAA’s) treatment regimens.Areas covered: Specifically, this paper will address DAA’s clinical efficacy, their associated patient reported outcomes, their adherence to treatment, and their cost-effectiveness of treatment using studies from the United States.Expert commentary: The current data suggest that cure and elimination of HCV appears to be on the horizon; however, more research is needed to verify similar results from real world practices. Further, research is also needed to overcome the barriers to treatment (lack of education and awareness of HCV, inadequate diagnosis technology, and lack of access and link to care) in order for the elimination of HCV to be obtained.

Hepatitis B virus (HBV) infection causes a tremendous clinical burden across the world with more than half a million people dying annually from HBV related disease. Significant advances have been made in HBV treatment in the past decade and several guidelines have been published by professional societies and expert panels. Although these recommendations have been valuable to help optimize HBV treatment, there is discordance in treatment criteria and many patients infected with HBV may fall outside of these recommendations. This paper systematically reviews the natural history of the disease and compares and contrasts the recommendations for initiation of treatment from the various societies. There is also discussion of special groups that require particular consideration and some of the open research questions and future research directions within the field.

The randomised controlled trial (RCT) constitutes a quantitative, comparative, controlled study of a particular treatment, and provides invaluable evidence regarding its pharmacotherapeutic efficacy. These studies are generally predicated upon the ethical principle of clinical equipoise. However, this may be insufficient to justify withholding treatment from a control group while assessing drug therapy in a potentially fatal disease. Thus, the criteria for randomisation, informed consent methodology and timing, and consideration of treatment options in such a scenario remain the province of medical ethics. This paper addresses the need for an RCT of ribavirin in the treatment of Crimean Congo haemorrhagic fever, and highlights underlying ethical concerns in light of the current medical, virological and ethical literature.

HIV/AIDS has associated cultural and social meanings which shape communication. The disease is closely linked to the concepts of life and death. Antiretroviral therapy (ART) has brought hope and life, but its success is heavily dependent on strict adherence. Research has shown that patients and health professionals often find it difficult to talk about these topics. However, there is little research available which focuses on health professionals' and patients' discussion of ART. This paper thus presents some exploratory discussion of extracts from pharmacy interactions in an HIV context which illustrate how pharmacists talk about antiretrovirals (ARVs) with patients with particular reference to the concepts of life and death. Data are taken from 26 video pharmacist-patient interactions recorded in a South African HIV/AIDS pharmacy. A hybrid qualitative analytic approach enabled identification of three types of references to ART, including the need to take ART "for the rest of your life", ART as "saving your life" and ART as "making you better". Explicit references to death were infrequent. These references were often emphatic and there are several potential reasons for this. The pharmacists' communication appears to be influenced by the urgency of the disease, a desire to give patients hope and a need to "normalise" discussions of death and HIV. The importance of ensuring understanding of ARV dosage instructions and discouraging patients from seeking traditional healing also appears to affect communication. The disease, societal and cultural contexts are thus shown to be significant influences which shape discussions of ART. This study has a number of practical implications, which are discussed.

In this paper we review current guidelines in assuring the rights of study participants and review the experiences in three randomized placebo-controlled double-blinded clinical trials of potential new HIV prevention technologies. The education of study participants to obtain informed consent reducing and monitoring risky behavior during a trial and the role of community participation are discussed. Recommendations are made based on the authors own observations and do not represent official recommendations of their organizations. (excerpt)

This paper reviews the definitions of complementary and alternative medicine (CAM) and adopts the definition, "Complementary and alternative medicine is defined through a social process as those practices that do not form part of the dominant system for managing health and disease" (Jonas, 1996, p.1). The authors review the literature on CAM usage in the general and HIV/AIDS populations, and the impact of CAM on modern Western medicine and the allied health professions. Host-virus factors in HIV/AIDS are examined from the perspectives of both Western medicine and complementary and alternative medicine. Methodological issues and the historical argument over the relative importance of host and microbe are explored in relation to HIV/AIDS and the CAM and Western approaches to HIV/AIDS care.

In this paper, we argue that circulating metaphors and beliefs can create an environment in which particular biomedical treatments make cultural sense, even if they seem to be ineffective or are associated with unpleasant side effects. We develop this argument in relation to interferon combined therapy. An innovative methodology combining the collection and deconstructive analysis of visual and narrative texts produced by people with hepatitis C is used to demonstrate links between a predisposition towards Western biomedical practice, discomfort with uncertainty, a desire to reassert control, and adoption of conflict metaphors associated with the tropes of invasion and eradication.