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One Month of Rifapentine plus Isoniazid to Prevent HIV-Related Tuberculosis. Tuberculosis is the leading killer of patients with human immunodeficiency virus (HIV) infection. Preventive therapy is effective, but current regimens are limited by poor implementation and low completion rates.We conducted a randomized, open-label, phase 3 noninferiority trial comparing the efficacy and safety of a 1-month regimen of daily rifapentine plus isoniazid (1-month group) with 9 months of isoniazid alone (9 (...) -month group) in HIV-infected patients who were living in areas of high tuberculosis prevalence or who had evidence of latent tuberculosis infection. The primary end point was the first diagnosis of tuberculosis or death from tuberculosis or an unknown cause. Noninferiority would be shown if the upper limit of the 95% confidence interval for the between-group difference in the number of events per 100 person-years was less than 1.25.A total of 3000 patients were enrolled and followed for a median
Does a Rehabilitation Program of Aerobic and Progressive Resisted Exercises Influence HIV-Induced Distal Neuropathic Pain? Distal symmetrical polyneuropathy is a common neurological sequela after HIV, which leads to neuropathic pain and functional limitations. Rehabilitation programs with exercises are used to augment pharmacological therapy to relieve pain but appropriate and effective exercises are unknown. This study explored the safety and effect of moderate-intensity aerobic exercises (...) and progressive resisted exercises for HIV-induced distal symmetrical polyneuropathy neuropathic pain.A randomized pretest, posttest of 12 wks of aerobic exercise or progressive resisted exercise compared with a control. Outcome measures were assessed using the subjective periphery neuropathy, brief peripheral neuropathy screening, and numeric pain rating scale. Pain was assessed at baseline, 6 and 12 wks. Data between groups were compared using Kruskal-Wallis, Mann-Whitney U test, and within-groups Friedman
Economic evaluations of pre- and post-exposure prophylaxis for HIV Economic evaluations of pre- and post-exposure prophylaxis for HIV | The Ontario HIV Treatment Network The Ontario HIV Treatment Network Economic evaluations of pre- and post-exposure prophylaxis for HIV Economic evaluations of pre- and post-exposure prophylaxis for HIV , , Questions What is the cost-effectiveness of HIV post-exposure prophylaxis? What is the cost-effectiveness of HIV pre-exposure prophylaxis? What are the gaps (...) in literature? Key take-home messages Economic evaluations of health care interventions can inform resource allocation and policy development. However, interpreting and generalizing results can be challenging (1). PrEP can be cost-effective or cost-saving depending on the local context, adherence rates, and program coverage (1). Interventions that target individuals at high risk of HIV exposure may improve the cost-effectiveness of PrEP (1–3). Non-occupational PEP may be cost-effective, or even cost-saving
HIV self-testing alone or with additional interventions, including financial incentives, and linkage to care or prevention among male partners of antenatal care clinic attendees in Malawi: An adaptive multi-arm, multi-stage cluster randomised trial Conventional HIV testing services have been less comprehensive in reaching men than in reaching women globally, but HIV self-testing (HIVST) appears to be an acceptable alternative. Measurement of linkage to post-test services following HIVST remains (...) HIVST kits for their partners; the second and third arms provided 2 HIVST kits along with a conditional fixed financial incentive of $3 or $10; the fourth arm provided 2 HIVST kits and a 10% chance of receiving $30 in a lottery; and the fifth arm provided 2 HIVST kits and a phone call reminder for the women's partners. The primary outcome was the proportion of male partners who were reported to have tested for HIV and linked into care or prevention within 28 days, with referral for antiretroviral
Association of Prescribed Opioids With Increased Risk of Community-Acquired Pneumonia Among Patients With and Without HIV Some opioids are known immunosuppressants; however, the association of prescribed opioids with clinically relevant immune-related outcomes is understudied, especially among people living with HIV.To assess the association of prescribed opioids with community-acquired pneumonia (CAP) by opioid properties and HIV status.This nested case-control study used data from patients (...) in the Veterans Aging Cohort Study (VACS) from January 1, 2000, through December 31, 2012. Participants in VACS included patients living with and without HIV who received care in Veterans Health Administration (VA) medical centers across the United States. Patients with CAP requiring hospitalization (n = 4246) were matched 1:5 with control individuals without CAP (n = 21 146) by age, sex, race/ethnicity, length of observation, and HIV status. Data were analyzed from March 15, 2017, through August 8, 2018
HIV in pregnancy: Identification of intrapartum and perinatal HIV exposures The benefits of human immunodeficiency virus (HIV) testing in pregnancy, when combined with appropriate maternal antiretroviral therapy and intrapartum and postnatal prophylaxis, are well established. The vertical rate of transmission of HIV in North America is now well below 2%. Efforts must continue to ensure that these benefits are sustained. Women who have received little or no prenatal care and those who present (...) for delivery with unknown HIV status need immediate testing. As more infants are exposed to antiretroviral agents, strategies need to be implemented to ensure adequate follow-up of these infants. Issues relating to the identification of HIV-exposed infants are highlighted. Keywords: Human immunodeficiency virus; Infant; Intrapartum transmission; Pregnancy; Screening
Routine investigation and monitoring of adult HIV-1-positive individuals (2019 interim update) BHIVA guidelines on the routine investigation and monitoring of HIV-1-positive adults 1 BHIVA guidelines for the routine investigation and monitoring of adult HIV-1-positive individuals (2019 interim update) Writing Group Brian Angus (Chair) Gary Brook (Vice-chair) Funmi Awosusi, Gary Barker, Marta Boffito, Satyajit Das, Lucy Dorrell, Esther Dixon-Williams, Charlotte Hall, Bridie Howe, Sebastian (...) Kalwij, Nashaba Matin, Eleni Nastouli, Frank Post, Melinda Tenant-Flowers, Erasmus Smit, Dan Wheals BHIVA guidelines on the routine investigation and monitoring of HIV-1-positive adults 2 Table of Contents 1. Introduction 4 2. Auditable targets 5 3. Tables summarising the monitoring of patients at different stages of their HIV care 6 3.1 Baseline/initial assessment for all newly diagnosed HIV-positive patients 6 3.2 Monitoring asymptomatic patients who currently do not want ART 7 3.3 Monitoring
British Association for Sexual Health and HIV national guideline for the management of infection with Neisseria gonorrhoeae 1 British Association for Sexual Health and HIV national guideline for the management of infection with Neisseria gonorrhoeae (2019) Helen Fifer, John Saunders, Suneeta Soni, S Tariq Sadiq, Mark FitzGerald British Association for Sexual Health and HIV national guideline for the management of infection with Mycoplasma genitalium (2018) Suneeta Soni, Paddy Horner, Michael (...) Health and HIV (BASHH), which provided funding for the literature search. No other funding was obtained. CONFLICT OF INTEREST All authors have signed BASHH conflict of interest forms. AUTHOR AFFILIATION Helen Fifer, Consultant Microbiologist, National Infection Service, Public Health England; John Saunders, Consultant in Sexual Health, National Infection Service, Public Health England and Central and North West London NHS Foundation Trust; Suneeta Soni, Consultant in Sexual Health, Brighton & Sussex
Starting antiretroviral therapy immediately after HIV diagnosis reduces transmission of the virus Starting antiretroviral therapy immediately after HIV diagnosis reduces transmission of the virus Discover Portal Discover Portal Starting antiretroviral therapy immediately after HIV diagnosis reduces transmission of the virus Published on 16 January 2018 doi: Giving antiretroviral therapy to people newly diagnosed with HIV may be an effective and cost-effective way of reducing new infections (...) . Increased HIV testing in at-risk populations may identify more people for treatment and also reduce infection rates. Using data from a number of sources including NIHR funded projects, researchers developed a computer simulation model. The model looked at the relationship between HIV infections, sexual risk behaviours and antiretroviral therapy over a 30 year period. Introduction of antiretroviral therapies and increased condom use were associated with lower rates of new cases. Most new HIV infections
Individual support of nurses using electronic medicine monitors can improve HIV treatment Individual support of nurses using electronic medicine monitors can improve HIV treatment Discover Portal Discover Portal Individual support of nurses using electronic medicine monitors can improve HIV treatment Published on 10 October 2017 doi: Use of electronic pill bottles that record when they are opened and follow-up discussion of the printed readouts with nurses improved HIV outcomes. It is thought (...) that patients became more reliable in taking the medication, which can have complicated scheduling. Overall, the HIV virus in the blood and the risk of treatment failure were lower in the group of patients who had access to this intervention compared to regular care. In addition to being more effective, the programme also reduced the estimated lifetime cost and disease burden per patient, considering quality and quantity of life lived. The readouts were used to help focus attention on any patterns
Self-testing kits increase overall HIV testing uptake in men who have sex with men Self-testing kits increase overall HIV testing uptake in men who have sex with men Discover Portal Discover Portal Self-testing kits increase overall HIV testing uptake in men who have sex with men Published on 6 February 2018 doi: Frequency of HIV testing in men who have sex with men may be increased by one additional test in a six month period when self-testing kits are used. Self-testing kits allow people (...) and support following an HIV diagnosis are of great importance and should include partner notification. Self-testing kits are available in the UK online from and are recommended by Public Health England. Share your views on the research. Why was this study needed? An estimated 89,400 people in the UK are living with HIV according to 2016 figures. The annual rate of new diagnoses is starting to decline, falling from 6,286 in 2015 to 5,164 in 2016. Over half of cases are in men who have sex with men (MSM
Single therapy an option for adults with suppressed HIV Single therapy an option for adults with suppressed HIV Discover Portal Discover Portal Single therapy an option for adults with suppressed HIV Published on 28 June 2016 doi: For adults with HIV who have achieved a low level of the HIV virus after initial treatment, further treatment with a protease inhibitor alone instead of standard triple drug therapy does not reduce future drug options. It is also cost-effective for long-term (...) management of HIV. In this large NIHR funded trial, switching to single therapy after the virus level is suppressed did not lead to treatment resistance compared to triple therapy, as earlier evidence had suggested. A return to detectable levels, called a rebound increase, was ten-fold higher on single therapy but this was managed with a change in drug regime. There was no difference between the groups in terms of quality of life, disease complications or side effects up to five years. Single therapy
Management of HIV in pregnancy and postpartum British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018 BHIVA guidelines on the management of HIV in pregnancy and postpartum 2 Guideline writing group Dr Yvonne Gilleece (Chair) Honorary Clinical Senior Lecturer and Consultant Physician in HIV and Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust Dr Shema Tariq (Vice-chair) Postdoctoral Clinical Research Fellow, University College (...) London, and Honorary Consultant Physician in HIV, Central and North West London NHS Foundation Trust Dr Alasdair Bamford Consultant in Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London Dr Sanjay Bhagani Consultant Physician in Infectious Diseases, Royal Free Hospital NHS Trust, London Dr Laura Byrne Locum Consultant in HIV Medicine, St George’s University Hospitals NHS Foundation Trust, London Dr Emily Clarke Consultant in Genitourinary Medicine
Methods to estimate the number of people living with undiagnosed HIV Methods to estimate the number of people living with undiagnosed HIV | The Ontario HIV Treatment Network The Ontario HIV Treatment Network Methods to estimate the number of people living with undiagnosed HIV Methods to estimate the number of people living with undiagnosed HIV , , , , , , , Questions How do we know how many people are living with undiagnosed HIV infection? What population groups make up people living (...) with undiagnosed HIV infection? Key take-home messages At the end of 2016, the Public Health Agency of Canada estimated that 14% of 63,110 individuals living with HIV in Canada were undiagnosed (1). Different types of data can be used across a variety of methodologies to estimate the undiagnosed proportion of people living with HIV (2, 3). The proportion of individuals living with HIV in Canada who were undiagnosed in 2016 was estimated using a complex statistical method known as “back-calculating”, which
Public health guidance on HIV, hepatitis B and C testing in the EU/EEA SCIENTIFIC AD VICE www.ecdc.europa.eu Public health guidance on HIV, hepatitis B and C testing in the EU/EEA An integrated approachECDC SCIENTIFIC ADVICE Public health guidance on HIV, hepatitis B and C testing in the EU/EEA An integrated approach ii This guidance was commissioned by the European Centre for Disease Prevention and Control (ECDC), coordinated by Andrew J Amato-Gauci and Lara Tavoschi with the support of Helena (...) , Correlation Network, Choices Support Center, Netherlands Jens Lundgren, CHIP/Region H, Denmark Jessika Deblonde, Sciensano, Belgium Jordi Casabona, Center of Epidemiological Studies on HIV and STI in Catalonia (CEEISCAT), Spain Justyna Kowalska, Medical University of Warsaw, Poland Kristi Rüütel, National Institute for Health Development, Estonia Maria Axelsson, Public Health Agency of Sweden, Sweden Maria Elena Tosti, Istituto Superiore di Sanità, Italy Matthew Hickman, University of Bristol, United
Dolutegravir/rilpivirine (Juluca) for the treatment of human immunodeficiency virus type 1 (HIV-1) AWMSG SECRETARIAT ASSESSMENT REPORT Dolutegravir/rilpivirine (Juluca ® ) 50 mg/25 mg film-coated tablet Reference number: 2850 FULL SUBMISSION This report has been prepared by the All Wales Therapeutics & Toxicology Centre (AWTTC). Please direct any queries to AWTTC: All Wales Therapeutics & Toxicology Centre (AWTTC) University Hospital Llandough Penlan Road Llandough Vale of Glamorgan CF64 2XX (...) /rilpivirine (Juluca ® ? ) 50 mg/25 mg film-coated tablet 1.0 KEY FACTS Assessment details Dolutegravir/rilpivirine (Juluca ® ? ) for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults who are virologically suppressed (HIV-1 RNA 50 copies/ml but lower than 200 copies/ml in the past 12 months 11 . Previous antiretroviral therapy regimens of two nucleoside reverse transcriptase inhibitors plus a third medicine (a non-nucleoside reverse transcriptase inhibitor, an integrase
Raltegravir-intensified initial antiretroviral therapy in advanced HIV disease in Africa: A randomised controlled trial In sub-Saharan Africa, individuals infected with HIV who are severely immunocompromised have high mortality (about 10%) shortly after starting antiretroviral therapy (ART). This group also has the greatest risk of morbidity and mortality associated with immune reconstitution inflammatory syndrome (IRIS), a paradoxical response to successful ART. Integrase inhibitors lead (...) to significantly more rapid declines in HIV viral load (VL) than all other ART classes. We hypothesised that intensifying standard triple-drug ART with the integrase inhibitor, raltegravir, would reduce HIV VL faster and hence reduce early mortality, although this strategy could also risk more IRIS events.In a 2×2×2 factorial open-label parallel-group trial, treatment-naive adults, adolescents, and children >5 years old infected with HIV, with cluster of differentiation 4 (CD4) <100 cells/mm3, from eight urban
Medical and surgical abortion for women living with HIV. The World Health Organization (WHO) guidelines for safe abortion recommend medical abortion with mifepristone and misoprostol or surgical abortion with vacuum aspiration or dilation and evacuation as safe and effective options for women. However, no specific clinical considerations are stipulated within these guidelines for women living with HIV. Concerns have been raised that women living with HIV may be at greater risk of adverse (...) abortion outcomes compared to HIV-uninfected women due to immunosuppression, high rates of co-infection with other sexually transmitted infections, and possible contraindications between medications used for medical abortion and antiretroviral therapy regimens.Our primary objective was to assess the effectiveness and safety of medical versus surgical abortion among women living with HIV. Our secondary objectives were to: (1) compare outcomes of medical and surgical abortion between women living