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Should HIV-uninfected patients with Pneumocystis pneumonia be treated with corticosteroids? Chiefs’ Inquiry Corner – March 17th, 2019 – Clinical Correlations Search Chiefs’ Inquiry Corner – March 17th, 2019 March 18, 2019 3 min read Propofol is a short-acting, intravenous sedative-hypnotic that is metabolized by the liver and excreted in the urine as conjugates of 2,6-diisopropyl-1,4 quinol. The pharmacokinetics of propofol favor its use for the induction/maintenance of anesthesia (...) with other causes of immunocompromise, especially in those with solid organ or liquid transplants, chronic steroid use, chemotherapeutics, and other immunosuppressive medications. As the use of immunosuppressive agents has increased in recent years, so has the rate of non-HIV associated Pneumocystis pneumonia (PCP). The use of steroids in HIV-infected patients with PCP has been well established, but the role of steroids in HIV-uninfected patients is much less clear. Patients with PCP who are not infected
One Month of Rifapentine plus Isoniazid to Prevent HIV-Related Tuberculosis. Tuberculosis is the leading killer of patients with humanimmunodeficiencyvirus (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
HIV in pregnancy: Identification of intrapartum and perinatal HIV exposures The benefits of humanimmunodeficiencyvirus (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: Humanimmunodeficiencyvirus; Infant; Intrapartum transmission; Pregnancy; Screening
-BHIVA guidelines on the routine investigation and monitoring of HIV-1-positive adults 15 level minority variants are detected in a UKAS accredited assay. There is currently no evidence of circulating transmitted drug resistant INSTI mutations . References 1. Castro H, Pillay D, Cane P et al. Persistence of HIV-1 transmitted drug resistance mutations. J Infect Dis 2013; 208: 1459–1463. 2. Gandhi RT, Wurcel A, Rosenberg ES et al. Progressive reversion of humanimmunodeficiencyvirus type 1 (...) for Disease Control. Compendium of evidence-based interventions and best practices for HIV prevention. Available at: http://www.cdc.gov/hiv/research/interventionresearch/compendium/lrc/index.html (accessed May 2016). 9. Aberg JA, Gallant JE, Anderson J et al. Primary care guidelines for the management of persons infected with humanimmunodeficiencyvirus: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2004; 39: 609–629. 10. Fakoya A, Lamba H
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
Doravirine/lamivudine/tenofovir disoproxil (Delstrigo) - Treatment of adults infected with humanimmunodeficiencyvirus 1 Published 11 February 2019 Statement of advice SMC2163 doravirine 100mg / lamivudine 300mg / tenofovir disoproxil 245mg film-coated tablets (Delstrigo®) Merck Sharp & Dohme Limited 11 January 2019 ADVICE: in the absence of a submission from the holder of the marketing authorisation doravirine / lamivudine / tenofovir disoproxil (Delstrigo®) is not recommended for use within (...) NHSScotland. Indication under review: Treatment of adults infected with humanimmunodeficiencyvirus 1 without past or present evidence of resistance to the non-nucleoside reverse transcriptase inhibitor class, lamivudine, or tenofovir. The holder of the marketing authorisation has not made a submission to SMC regarding this product in this indication. As a result we cannot recommend its use within NHSScotland. Advice context: No part of this advice may be used without the whole of the advice being quoted
Doravirine (Pifeltro) - treatment of adults infected with humanimmunodeficiencyvirus 1 Published 11 February 2019 Statement of advice SMC2162 doravirine 100mg film-coated tablets (Pifeltro®) Merck Sharp & Dohme Limited 11 January 2019 ADVICE: in the absence of a submission from the holder of the marketing authorisation doravirine (Pifeltro®) is not recommended for use within NHSScotland. Indication under review: In combination with other antiretroviral medicinal products, for the treatment (...) of adults infected with humanimmunodeficiencyvirus 1 without past or present evidence of resistance to the non-nucleoside reverse transcriptase inhibitor class. The holder of the marketing authorisation has not made a submission to SMC regarding this product in this indication. As a result we cannot recommend its use within NHSScotland. Advice context: No part of this advice may be used without the whole of the advice being quoted in full. This advice represents the view of the Scottish Medicines
Columbia Centre for Excellence in HIV/AIDS. HIV post-exposure prophylaxis (PEP) guidelines: May 2017. Available from: Accessed November 30, 2018. Kuhar DT, Henderson DK, Struble KA, Heneine W, Thomas V, Cheever LW, et al. Updated US Public Health Service guidelines for the management of occupational exposures to humanimmunodeficiencyvirus and recommendations for postexposure prophylaxis. Infection Control Hospital Epidemiology. 2013;34(9):875–92. Hankins C, Macklin R, Warren M. Translating PrEP (...) prophylaxis after sexual or injection-drug exposure to humanimmunodeficiencyvirus. Archives of Internal Medicine. 2004;164(1):46–54. Pinkerton SD, Martin JN, Roland ME, Katz MH, Coates TJ, Kahn JO. Cost-effectiveness of HIV postexposure prophylaxis following sexual or injection drug exposure in 96 metropolitan areas in the United States. AIDS. 2004;18(15):2065–73. Herida M, Larsen C, Lot F, Laporte A, Desenclos JC, Hamers FF. Cost-effectiveness of HIV post-exposure prophylaxis in France. AIDS. 2006;20
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
), Kogie Naidoo (CAPRISA, South Africa), Eyerusalem Negussie (Ministry of Health, Ethiopia), Cédric Nininahazwe (Global Network of Young People Living with HIV, Netherlands), Sylvia Ojoo (Institute of Human Virology of the University of Maryland, Kenya), Andrew Prendergast (Queen Mary, University of London, United Kingdom and Zvitambo Institute, Zimbabwe), Elliot Riazes (United States Centers for Disease Control and Prevention, USA), Nathan Shaffer (independent consultant), George Siberry (Office (...) informed the development of these guidelines and should guide the implementation of the recommendations. • The guidelines should contribute to realizing the Sustainable Development Goals by achieving key global and national HIV goals. • These guidelines are based on a public health approach to scaling up the use of ARV drugs along the continuum of HIV prevention, care and treatment. • Implementation of these guidelines needs to be accompanied by efforts to promote and protect the human rights of people
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
Inhibitor Monotherapy Versus Ongoing Triple Therapy (PIVOT) trial: a randomised controlled trial of a protease inhibitor monotherapy strategy for long-term management of humanimmunodeficiencyvirus infection Published on 1 March 2016 Paton NI, Stöhr W, Oddershede L, Arenas-Pinto A, Walker S, Sculpher M, Dunn DT Health Technology Assessment Volume 20 Issue 21 , 2016 Background Standard-of-care antiretroviral therapy (ART) for humanimmunodeficiencyvirus (HIV) infection uses a combination of drugs (...) 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 HIVvirus 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
. 2017;5(18). This project was funded by the National Institute for Health Research Programme Grants for Applied Research (project number RP-PG-0608-10142). Bibliography BHIVA. . London: British HIV Association; interim update 2016. Implications for a policy of initiating antiretroviral therapy in people diagnosed with humanimmunodeficiencyvirus: the CAPRA research programme Published on 14 November 2017 Miltz A, Phillips A N, Speakman A, Cambiano V, Rodger A & Lampe F C Programme Grants for Applied (...) Research Volume 5 Issue 18 , 2017 Background More than 100,000 people in the UK are living with a humanimmunodeficiencyvirus (HIV) infection. There are currently estimated to be around 4000 people newly infected in the UK per year, mostly men who have sex with men (MSM). It has become increasingly clear that antiretroviral therapy (ART) used to treat people infected with HIV also has a profound effect on infectivity. At the initiation of the programme, it was the policy in the UK to initiate ART
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
that patients became more reliable in taking the medication, which can have complicated scheduling. Overall, the HIVvirus 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 (...) 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
Motivating HIV Providers in Vietnam to Learn: A Mixed-Methods Analysis of a Mobile Health Continuing Medical Education Intervention. The Mobile Continuing Medical Education Project (mCME V.2.0) was a randomized controlled trial designed to test the efficacy of a text messaging (short message service [SMS])-based distance learning program in Vietnam that included daily quiz questions, links to readings and online courses, and performance feedback. The trial resulted in significant increases (...) their experiences with the intervention and attitudes toward continuing medical education.A total of 48 HIV specialists in the intervention group completed the endline survey, and 30 participated in the focus group discussions. Survey and focus group data suggested that most clinicians liked the daily quizzes, citing them as convenient mechanisms to convey information in a relevant manner. A total of 43 of the 48 (90%) participants reported that the daily quizzes provided motivation to study for continuing
Methods, system errors, and demographic differences in participant errors using daily text message-based short message service computer-assisted self-interview (SMS-CASI) to measure sexual risk behavior in a RCT of HIV self-test use. Assessment of sexual risk behavior is crucial to HIV prevention trials. Currently, there are no biomarkers or objective measures to detect and characterize sexual risk behavior; therefore, we must rely on self-reports. Self-report accuracy may be improved (...) by collecting data in real-time. Our objective was to demonstrate how a text message-based short message service computer-assisted self-interview (SMS-CASI) system can collect daily sexual risk behavior data.During the course of a 2-arm randomized controlled trial, confidential daily SMS-CASI was used to assess sexual risk behavior over three months for participants using only condoms in the control condition and using condoms and HIV self-tests to test themselves and their non-monogamous sexual partner
Agents of change among people living with HIV and their social networks: stepped-wedge randomised controlled trial of the NAMWEZA is a novel intervention that focuses on preventing HIV and promoting sexual and reproductive health and rights by addressing underlying factors related to vulnerability of acquiring HIV, such as depression, intimate partner violence (IPV) and stigma. The goal of the study was to evaluate the effect of the NAMWEZA intervention on risk behaviour as well as factors (...) potentially contributing to this vulnerability for people living with HIV and their network members.A stepped-wedge randomised controlled trial was conducted from November 2010 to January 2014 among people living with HIV and their network members in Dar es Salaam, Tanzania. 458 people living with HIV were randomised within age/sex-specific strata to participate in the NAMWEZA intervention at three points in time. In addition, 602 members of their social networks completed the baseline interview
Cost-Effectiveness of Three Alternative Boosted Protease Inhibitor-Based Second-Line Regimens in HIV-Infected Patients in West and Central Africa. While dolutegravir has been added by WHO as a preferred second-line option for the treatment of HIV infection, boosted protease inhibitor (bPI)-based regimens are still needed as alternative second-line options. Identifying optimal bPI-based second-line combinations is essential, given associated high costs and funding constraints in low- and middle