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Lopinavir/ritonavir (Kaletra) - in combination with other antiretroviral medicinal products for the treatment of human immunodeficiency virus (HIV-1) infected children Published 12 February 2018 Product Update lopinavir 80mg, ritonavir 20mg oral solution (Kaletra ® ) SMC No 1302/18 AbbVie Ltd 12 January 2018 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHS Scotland (...) . The advice is summarised as follows: ADVICE: following an abbreviated submission lopinavir/ritonavir (Kaletra ® ) is accepted for use within NHS Scotland. Indication under review: in combination with other antiretroviral medicinal products for the treatment of human immunodeficiency virus (HIV-1) infected children aged from 14 days to =2 years. SMC has previously accepted lopinavir/ritonavir for use in children above the age of 2 years. Advice context: No part of this advice may be used without the whole
Elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil (as fumarate) (Stribild) - Treatment of HIV?1 infection in adolescents Published 12 February 2018 Statement of Advice elvitegravir 150mg / cobicistat 150mg / emtricitabine 200mg / tenofovir disoproxil (as fumarate) 245mg film-coated tablets (Stribild ® ) SMC No 1310/18 Gilead Sciences Ltd 12 January 2018 ADVICE: in the absence of a submission from the holder of the marketing authorisation elvitegravir / cobicistat / emtricitabine (...) / tenofovir disoproxil (as fumarate) (Stribild ® ) is not recommended for use within NHS Scotland. Indication under review: Treatment of HIV -1 infection in adolescents aged 12 to <18 years weighing =35kg who are infected with HIV -1 without known mutations associated with resistance to any of the three antiretroviral agents in Stribild ? and who have experienced toxicities which preclude the use of other regimens that do not contain tenofovir disoproxil fumarate. The holder of the marketing authorisation
Delivering comprehensive HIV services across the HIV care continuum: a comparative analysis of survival and progress towards 90-90-90 in rural Malawi 1 Wroe EB, et al. BMJ Glob Health 2018;3:e000552. doi:10.1136/bmjgh-2017-000552 Delivering comprehensive HIV services across the HIV care continuum: a comparative analysis of survival and progress towards 90-90-90 in rural Malawi Emily B Wroe, 1 Elizabeth L Dunbar, 1 Noel Kalanga, 2 Luckson Dullie, 1 Chiyembekezo Kachimanga, 1 Andrew Mganga, 3 (...) Michael Herce, 4 Jason Beste, 5 Jonas Rigodon, 6 Lawrence Nazimera, 7 Ryan K McBain 8 Research To cite: Wroe EB, Dunbar EL, Kalanga N, et al. Delivering comprehensive HIV services across the HIV care continuum: a comparative analysis of survival and progress towards 90-90-90 in rural Malawi. BMJ Glob Health 2018;3:e000552. doi:10.1136/ bmjgh-2017-000552 Handling editor Sanni Yaya Received 5 September 2017 Revised 26 November 2017 Accepted 27 November 2017 1 Partners In Health, Neno, Malawi 2 Health
Efficacy, safety, and tolerability of dolutegravir-rilpivirine for the maintenance of virological suppression in adults with HIV-1: phase 3, randomised, non-inferiority SWORD-1 and SWORD-2 studies. BACKGROUND: Lifelong HIV antiretroviral therapy (ART) has prompted an interest in two-drug regimens to minimise cumulative drug exposure and toxicities. The safety, tolerability, and efficacy of dolutegravir and rilpivirine suggest potential compatibility and effectiveness as a two-drug regimen. We (...) aimed to investigate this two-drug regimen in a phase 3 study. METHODS: We identically designed SWORD-1 and SWORD-2, which were open-label, parallel-group, multicentre, phase 3, randomised, non-inferiority studies in 12 countries evaluating efficacy and safety of once-daily dolutegravir 50 mg plus rilpivirine 25 mg versus current ART regimen (CAR). We included participants aged 18 years or older who were on first or second ART with stable plasma HIV-1 RNA (viral load <50 copies per mL) for 6
Targeted HIV Screening in Eight Emergency Departments: The DICI-VIH Cluster-Randomized Two-Period Crossover Trial 29092761 2017 11 02 1097-6760 2017 Oct 30 Annals of emergency medicine Ann Emerg Med Targeted HIV Screening in Eight Emergency Departments: The DICI-VIH Cluster-Randomized Two-Period Crossover Trial. S0196-0644(17)31660-8 10.1016/j.annemergmed.2017.09.011 This study compares the effectiveness and cost-effectiveness of nurse-driven targeted HIV screening alongside physician-directed (...) diagnostic testing (intervention strategy) with diagnostic testing alone (control strategy) in 8 emergency departments. In this cluster-randomized, 2-period, crossover trial, 18- to 64-year-old patients presenting for reasons other than potential exposure to HIV were included. The strategy applied first was randomly assigned. During both periods, diagnostic testing was prescribed by physicians following usual care. During the intervention periods, patients were asked to complete a self-administered
Challenges faced by HIV-positive youth transitioning to adult care and evidence-based practices to address them Challenges faced by HIV-positive youth transitioning to adult care and evidence-based practices to address them | The Ontario HIV Treatment Network The Ontario HIV Treatment Network Challenges faced by HIV-positive youth transitioning to adult care and evidence-based practices to address them Challenges faced by HIV-positive youth transitioning to adult care and evidence (...) -based practices to address them , , , , Questions What challenges arise when youth living with HIV transition to adult care? What evidence-based practices and resources facilitate successful transition to adult HIV care? Key take-home messages The barriers to successful transition to adult HIV care include lack of preparation, psychosocial stressors, loss of relationships, stigma, and barriers within the adult health care system (communication, distance to travel, differences from the pediatric environment
Strategies for effectively communicating the risk of HIV transmission Strategies for effectively communicating the risk of HIV transmission | The Ontario HIV Treatment Network The Ontario HIV Treatment Network Strategies for effectively communicating the risk of HIV transmission Strategies for effectively communicating the risk of HIV transmission , , , Questions What effective methods exist for communicating the risk of HIV transmission? Key take-home messages Probability information alone may (...) not be an effective way of communicating HIV risk information (1). Information about what causes a health problem, how severe the consequences of that problem will be, and what can be done to treat or prevent the problem can contextualize risk information and allow people to create a mental picture of the problem’s personal relevance (2). Adding contextual information to probability and statistical information allows it to be more reliably interpreted and more easily called to mind when needed (2). Risk scenarios
Darunavir/cobicistat/emtricitabine/tenofovir alafenamide fumarate (Symtuza) - the treatment of human immunodeficiency virus type 1 (HIV-1) infection Published 15 January 2018 Product Update: darunavir 800mg, cobicistat 150mg, emtricitabine 200mg, tenofovir alafenamide 10mg film-coated tablet (Symtuza ® ) SMC No 1290/18 Janssen-Cilag Ltd 8 December 2017 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic (...) Committees (ADTCs) on its use in NHS Scotland. The advice is summarised as follows: ADVICE: following an abbreviated submission darunavir, cobicistat, emtricitabine, tenofovir alafenamide (Symtuza ® ) is accepted for use within NHS Scotland. Indication under review: the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults and adolescents (aged 12 years and older with body weight at least 40kg). SMC has previously accepted darunavir/cobicistat (Rezolsta ® ) and emtrictabine
Assessment of HIV-related mental status changes Assessment of HIV-related mental status changes - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Assessment of HIV-related mental status changes Last reviewed: August 2018 Last updated: June 2018 Summary Altered mental status and allied cognitive disorders in HIV-infected patients have devastating consequences for patients and carers. Neuropsychological deficits also (...) have a negative impact on the quality of life. Pandya R, Krentz HB, Gill MJ, et al. HIV-related neurological syndromes reduce health-related quality of life. Can J Neurol Sci. 2005;32:201-204. http://www.ncbi.nlm.nih.gov/pubmed/16018155?tool=bestpractice.com These may arise as a direct effect of HIV infection: for example, as part of a spectrum of HIV-associated neurocognitive disorders (HAND) or as a psychiatric comorbidity (e.g., depression or alcohol/substance abuse). While HIV-related
HIV-related opportunistic infections HIV-related opportunistic infections - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search HIV-related opportunistic infections Last reviewed: August 2018 Last updated: April 2018 Summary The risk of OIs in HIV-infected people increases as the CD4+ count declines. Risk also increases in patients who are not receiving, or are not responding to, antiretroviral treatment (ART). For most (...) HIV-infected patients with an acute OI, ART should be considered within the first 2 weeks of initiation of treatment for the acute OI. However, in TB it might be appropriate to wait for a therapeutic response before ART is started. The use of ART among patients treated for OIs is complicated by drug interactions, drug toxicity profiles, and immune reconstitution inflammatory syndrome (IRIS). IRIS has been observed most commonly with mycobacterial infections (TB and disseminated MAC), but may also
Overview of HIV Overview of HIV - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Overview of HIV Last reviewed: August 2018 Last updated: June 2018 Introduction Human immunodeficiency virus (HIV) is a retrovirus that destroys CD4 T cells and is the aetiological agent of acquired immunodeficiency syndrome (AIDS). HIV is divided into 2 types, both of which cause AIDS: HIV 1, responsible for the global epidemic; and HIV 2 (...) , less pathogenic and restricted mostly to West Africa. AIDS, which usually occurs after approximately 6 to 9 years of HIV infection, is a constellation of opportunistic and other infections, conditions, or malignancies. These occur as a result of increasing immune depletion over time. Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. May 2018 [internet
Assessment of dermatological disorders in HIV Assessment of dermatological disorders in HIV - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Assessment of dermatological disorders in HIV Last reviewed: August 2018 Last updated: June 2018 Summary In the early phases of the HIV epidemic, skin disease was frequently a presenting manifestation of the infection. Leslie KS, Levell NJ. Dermatologists, beacons of epidemics (...) ; past, present and future! Int J Dermatol. 2004;43:468-470. http://www.ncbi.nlm.nih.gov/pubmed/15186235?tool=bestpractice.com Cutaneous manifestations often reflect immune status and may offer insight into long-term prognosis. Although morbidity from skin diseases, particularly from opportunistic infection, has decreased with the advent of antiretroviral treatment, there are still significant dermatological problems in the post-antiretroviral therapy era. Dermatological disorders in HIV may be
Post-exposure HIV prophylaxis Post-exposure HIV prophylaxis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Post-exposure HIV prophylaxis Last reviewed: August 2018 Last updated: May 2018 Important updates US CDC no longer recommends dolutegravir as part of PEP regimen in early pregnancy or women of childbearing age The US Centers for Disease Control and Prevention (CDC) have updated their HIV post-exposure (...) a low risk of HIV transmission even in the absence of PEP. PEP given to HIV-negative people reduces likelihood of HIV seroconversion by approximately 80%. Duration of treatment is 28 days. New antiretroviral treatment regimens for PEP offer low risk of toxicity. There is an absence of randomised controlled studies evaluating PEP. Definition Post-exposure prophylaxis (PEP) is the administration of antiretroviral therapy (ART) to HIV-negative people who may have been occupationally or sexually exposed
HIV infection in pregnancy HIV infection in pregnancy - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search HIV infection in pregnancy Last reviewed: August 2018 Last updated: June 2018 Important updates US guidance now recommends consideration of intrapartum zidovudine in women with detectable viral loads <1000 copies/mL Updated guidelines on the use of antiretroviral drugs in pregnant women with HIV infection have been (...) published by the US Department of Health and Human Services. The panel now recommends considering intrapartum intravenous zidovudine for women with HIV RNA levels between 50 and 999 copies/mL. Previously, intrapartum zidovudine was only recommended in women with HIV RNA levels >1000 copies/mL or unknown viral load near delivery. There are inadequate data to determine whether reducing this threshold provides additional protection against perinatal transmission; however, some experts administer zidovudine
HIV infection HIV infection - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search HIV infection Last reviewed: August 2018 Last updated: September 2018 Important updates US and EU drug regulators warn of possible increased risk of neural tube defects in babies born to women taking dolutegravir The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have both issued alerts after preliminary results (...) from an ongoing study reported an increased risk of serious neural tube defects in women who became pregnant while taking dolutegravir-based regimens. The risk appears to be highest in women taking the drug at the time of becoming pregnant or early in the first trimester. It is recommended that women of childbearing age with HIV currently taking dolutegravir are counselled about this new potential risk. Pregnant women currently taking dolutegravir should not stop their treatment but should discuss
Symptom screening for active tuberculosis in pregnant women living with HIV. This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To assess the accuracy of the four-symptom screen (cough, fever, night sweats, or weight loss) for identifying active TB in pregnant PLHIV who are screened in an outpatient or community setting. To investigate potential sources of heterogeneity of the accuracy of the four-symptom screen between studies including: ART
Guidelines on the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children: policy brief WHO IRIS: Guidelines on the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children: policy brief Browse Related links Files in This Item: File Description Size Format 645.65 kB Adobe PDF Title: Guidelines on the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults (...) , adolescents and children: policy brief Authors: Issue Date: 2018 Publisher: World Health Organization Place of publication: Geneva Language: English Description: 4 p. Subject: Gov't Doc #: WHO/CDS/HIV/18.2 URI: License: CC BY-NC-SA 3.0 IGO License URL: Appears in Collections: Items in WHO IRIS are protected by copyright, with all rights reserved, unless otherwise indicated. |
Low Prevalence of Hepatitis B Vaccination Among Patients Receiving Medical Care for HIV Infection in the United States, 2009 to 2012. Background: Persons with HIV infection are at increased risk for hepatitis B virus infection. In 2016, the World Health Organization resolved to eliminate hepatitis B as a public health threat by 2030. Objective: To estimate the prevalence of hepatitis B vaccination among U.S. patients receiving medical care for HIV infection ("HIV patients"). Design: Nationally (...) representative cross-sectional survey. Setting: United States. Participants: 18 089 adults receiving HIV medical care who participated in the Medical Monitoring Project during 2009 to 2012. Measurements: Primary outcomes were prevalence of 1) no documentation of hepatitis B vaccination or laboratory evidence of immunity or infection (candidates to initiate vaccination), and 2) initiation of vaccination among candidates, defined as documentation of at least 1 vaccine dose in a 1-year surveillance period