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, Faculty of Medicine, UNSW Australia, Sydney NSW8 HIV, VIRAL HEPATITIS AND STIs – A GUIDE FOR PRIMARY HEALTH CARE Introduction The three major blood-borne viruses, humanimmunodeficiencyvirus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), are members of different virus families but have one thing in common: their major mode of transmission is via blood or bodily fluids. Sexually transmitted infections (STIs) are a diverse group of infections caused by widely differing micro-organisms (...) of them. • Most STIs, in their early stages, are asymptomatic or so mildly symptomatic as to be easily overlooked, yet are infectious, screening at-risk people is essential for population management. kEY POINTS ? Humanimmunodeficiencyvirus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) are distinct viruses with different epidemiological profiles, modes of transmission, natural histories and treatments. ? All three viruses lead to chronic infection in many individuals with the viral
HCV hepatitis C virusHIVhumanimmunodeficiencyvirus HIVST HIV self-testing HPV human papillomavirus HTC HIV testing and counselling IPT isoniazid preventive treatment LPV/r lopinavir/ritonavir M&E monitoring and evaluation MAT medically assisted treatment MMT methadone maintenance treatment NNRTI non-nucleoside reverse transcriptase inhibitor NSP needle and syringe programme OST opioid substitution therapy PEP post-exposure prophylaxis PEPFAR United States President’s Emergency Plan for AIDS (...) populations.vii ACKNOWLEDGEMENTS Guideline development group and steering group Co-chairs: Chris Beyrer (Johns Hopkins Bloomberg School of Public Health, USA) and Adeeba Kamarulzaman (University of Malaya, Malaysia). Elie Aaraj # (Middle East & North Africa Harm Reduction Association (MENAHRA), Lebanon), Eliot Albers * (The International Network of People who Use Drugs (INPUD), United Kingdom), George Ayala * (The Global Forum on MSM and HIV (MSMGF), USA), Carlos F. Cáceres (Sexuality and Human Development
/EEA European Union/European Economic Area GP General practitioner HA-REACT Joint Action on HIV and Co-Infection Prevention and Harm Reduction HBV Hepatitis B virus HBsAg Hepatitis B surface antigen HCV Hepatitis C virusHIVHumanimmunodeficiencyvirus IC Indicator condition IFN Interferon INTEGRATE Joint Action on Integrating Prevention, Testing and Linkage to Care Strategies Across HIV, Viral Hepatitis, TB and STIs in Europe IUSTI International Union Against Sexually Transmitted Infections MSM (...) health guidance on HIV, hepatitis B and C testing in the EU/EEA – An integrated approach 1 Executive summary Reaching and testing those at risk of infection with humanimmunodeficiencyvirus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) is still a public health challenge across Europe. One in two people currently living with HIV is diagnosed late in the course of their infection and an even larger proportion of the estimated 9 million Europeans living with chronic hepatitis B or C
Appendix 1: PICO questions 101 Appendix 2: Summary of the modified GRADE system 104 BHIVA guidelines on the management of HIV in pregnancy and postpartum 6 References 104 Appendix 3: Drug dosing for infants 105 BHIVA guidelines on the management of HIV in pregnancy and postpartum 7 1. Scope and purpose The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of women living with the humanimmunodeficiencyvirus (HIV) in the UK during (...) Section 7. HIV and hepatitis virus co-infections 12 Section 8. Obstetric management 14 Section 9. Neonatal management 16 Section 10. Postpartum management of women 18 2.2 Auditable outcomes 20 3. Introduction 21 3.1 UK prevalence and epidemiology of HIV in pregnancy, antenatal screening and risk of transmission 22 3.2 HIV infection in children 22 3.3 Reporting and long-term follow-up 23 3.4 National Study of HIV in Pregnancy and Childhood (NSHPC) 23 3.5 References 23 4. The psychosocial care of women
antiretroviral medications are taken by HIV-negative people prior to exposure to the virus to prevent infection. Once-daily oral tenofovir/emtricitabine, as a fixed dose combination tablet, has been licensed and available for use as PrEP in Ireland since 2016. Policy provision for PrEP is contained in the National Sexual Health Strategy 2015–2020, with Priority Action 3 calling for ‘the appropriate use of antiretroviral therapy in HIV prevention’. A PrEP programme provides PrEP medication along with holistic (...) Health technology assessment of a PrEP programme for populations at substantial risk of sexual acquisition of HIV Health technology assessment of a PrEP programme for populations at substantial risk of sexual acquisition of HIV 14 June 2019 Health technology assessment of a PrEP programme for populations at substantial risk of sexual acquisition of HIV Health Information and Quality Authority Page 2 of 257 Health technology assessment of a PrEP programme for populations at substantial risk
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
. • A negative serological test in children who have had a positive HIV RNA PCR test does not exclude ongoing HIV infection. • A detailed history of any possible previous ART given to the child and/or mother (or other likely source of infec- tion) should be documented. • The genotypic HIV resistance pro?le should be docu- mented at baseline. • The human leucocyte antigen (HLA) B*5701 genotype shouldbecon?rmednegativebeforeusingabacavir(ABC). • Clinical assessment should be carried out 3-4-monthly in children (...) infants at low risk of HIV transmission (maternal VL 100000 copies/ml); • in asymptomatic children aged 1–3 years irrespective of immune status and VL; • in sexually active adolescents, to minimize the risk of onward transmission; • in the presence of any signi?cant HIV-related clinical symptoms; • in hepatitis B virus (HBV) coinfection irrespective of immune status. 6. Which ART regimen to start as ?rst-line therapy • Children should start effective (at least three drugs) ART, usually a dual
. Knox DC, Anderson PL, Harrigan PR, Tan DH. Multidrug-resistant HIV-1 Infection despite preexposure prophylaxis. New England Journal of Medicine. 2017;376(5):501–2. Montgomery MC, Oldenburg CE, Nunn AS, Mena L, Anderson P, Liegler T, et al. Adherence to pre-exposure prophylaxis for HIV prevention in a clinical setting. PLoS ONE [Electronic Resource]. 2016;11(6):e0157742. Colby DJ, Kroon E, Sacdalan C, Gandhi M, Grant RM, Phanuphak P, et al. Acquisition of multidrug-resistant humanimmunodeficiency (...) drug-resistant mutations; the underlying cause for this infection remains unclear (15). Authors hypothesise infection with a “wild-type” HIVvirus, and that frequent condomless anal sex, potential repeated exposure to HIV, repeated diagnosis of sexually transmitted infections, and the pharmacokinetics of TDF/FTC in rectal mucosa may have contributed to seroconversion (15). Practical considerations While daily oral TDF (with or without FTC) is protective against HIV infection, this is highly
Strategies to link people with undiagnosed HIV infection to HIV testing, care, and prevention services Strategies to link people with undiagnosed HIV infection to HIV testing, care, and prevention services | The Ontario HIV Treatment Network The Ontario HIV Treatment Network Strategies to link people with undiagnosed HIV infection to HIV testing, care, and prevention services Strategies to link people with undiagnosed HIV infection to HIV testing, care, and prevention services , , , , Questions (...) What strategies have been successful at linking people with undiagnosed HIV infection to HIV testing, care, and prevention services? Key take-home messages A variety of strategies have shown promise for identifying individuals with undiagnosed HIV and engaging them with HIV testing using clinical, community-based, network-based, and self-directed approaches. Various service delivery models for implementing rapid initiation of antiretroviral treatment have demonstrated benefits for linking the newly
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
associated with aging) and are expected to grow (1). • With the recent focus on testing as part of routine medical care, the number of people diagnosed with HIV will likely increase (2). The increasing demand for HIV primary care and specialty care is occurring at a time when physicians who began providing care early in the epidemic are expected to retire or transition out of clinical practice (2). To avoid human resource shortages in HIV healthcare settings, there is widespread professional support (...) The role of nurse practitioners in HIV care RAPID RESPONSE SERVICE | #102, MARCH 2016 1 RAPID RESPONSE SERVICE THE ONTARIO HIV TREATMENT NETWORK Questions • What role do nurse practitioners play in HIV care? • What are the benefits of nurse practitioners in HIV care? References 1. Tunnicliff SA, Piercy H, Bowman CA, Hughes C, Goyder EC. The con - tribution of the HIV specialist nurse to HIV care: A scoping review. Journal of Clinical Nursing 2013;22(23-24):3349- 60. 2. Position statement
/ritonavir EFV efavirenz eGFr estimated glomerular filtration rate ELISA enzyme-linked immunosorbent assay ETV etravirine FPV fosamprenavir FPV/r fosamprenavir/ritonavir FTC emtricitabine GNP+ Global Network of People Living with HIV Gr ADE Grading of r ecommendations Assessment, Development and Evaluation HBsAg hepatitis B surface antigen HBV hepatitis B virus HCV hepatitis C virusHIVhumanimmunodeficiencyvirus AbbReVIAt IoNs AND ACRoNyms Abbreviations and acronyms12 Consolidated guidelines (...) UNAIDS Joint United Nations Programme on HIV/AIDS UNICEF United Nations Children’s Fund UNODC United Nations Office on Drugs and Crime WHO World Health Organization13 Definition of key terms GeNeRAL HIV refers to humanimmunodeficiencyvirus. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of HIV infections globally. Within these guidelines, HIV refers to both HIV-1 and HIV-2 unless otherwise specified. AGE GROUPS AND POPULATIONS The following definitions
HIV Medicine (2012), 13 (Suppl. 2), 87–1571.0 Scope and purpose The overall purpose of these guidelines is to provide guid- ance on best clinical practice in the treatment and man- agement of human immunode?ciency virus (HIV)-positive pregnant women in the UK. The scope includes guidance on the use of antiretroviral therapy (ART) both to prevent HIV mother-to-child transmission (MTCT) and for the welfare of the mother herself, guidance on mode of deliv- ery and recommendations in speci?c patient (...) antiretroviral therapy: mother needs antiretroviral therapy for herself 5.3 Naïve to highly active antiretroviral therapy: mother does not need highly active antiretroviral therapy for herself 5.4 Late-presenting woman not on treatment 5.5 Elite controllers 5.6 Stopping antiretroviral therapy postpartum 6.0 HIV and hepatitis virus coinfections 6.1 Hepatitis B virus 6.2 Hepatitis C virus 7.0 Obstetric management 7.1 Antenatal management 7.2 Mode of delivery 7.3 Management of spontaneous rupture of membranes
to start in TB/HIV co infection 99 8.1.3 References 100 8.2 Hepatitis B and C virus co-infection 102 When to start ART? 102 8.2.2 Hepatitis B 102 8.2.3 Hepatitis C 104 8.2.4 References 104 8.3 HIV-related cancers 105 8.3.1 When to start ART? 105 8.3.2 What to start 105 8.3.3 Opportunistic infection prophylaxis in HIV-associated malignancy 106 8.3.4 Other considerations from the BHIVA guidelines for HIV-associated malignancies  106 8.3.5 References 107 8.4 HIV-associated neurocognitive impairment 108 (...) to treat hepatitis B and C 8.2.2 Hepatitis B 18.104.22.168 When to start antiretroviral therapy in HBV co-infection 22.214.171.124.1 Recommendations ? We recommend individuals with HIV and hepatitis B virus (HBV) co-infection are treated with fully suppressive ART inclusive of anti-HBV active antivirals, regardless of CD4 cell count (1A). ? We recommend individuals with HIV and HBV co-infection who have an HBV-DNA =2000 IU/mL and/or evidence of more than minimal fibrosis (Metavir =F2) are treated with fully
), 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
British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis (2019) Guideline Development Group: Cara Saxon (Lead Author), Anne Edwards, Riina Rautemaa- Richardson, Caroline Owen, Bavithra Nathan, Bret Palmer, Clare Wood, Humera Ahmed, Sameena Ahmad, Patient Representatives, Mark FitzGerald (CEG Editor) Clinical Effectiveness Group (...) (CEG), British Association for Sexual Health and HIV (BASHH) NEW IN THE 2019 GUIDELINES Terminology: • The new guidelines refer to ‘acute’ and ‘recurrent’ vulvovaginal candidiasis (VVC) and no longer use the terms ‘uncomplicated’ and ‘complicated’ VVC; the new definitions are felt to be more reflective of how women with VVC typically present to clinical services and are subsequently managed • The elements of complicated VVC where single dose treatments are not always appropriate are still covered
and Gynaecology Canada. 2014;36(8):721–34. Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clinical Infectious Diseases. 2011;52(6):793–800. Skarbinski J, Rosenberg E, Paz-Bailey G, Hall HI, Rose CE, Viall AH, et al. Humanimmunodeficiencyvirus transmission at each step of the care continuum in the United States. JAMA Internal Medicine. 2015;175(4):588–96. CATIE. Your guide to HIV (...) , McGregor DV, Sutton SH, Garcia PM, et al. Is maternal disclosure of HIV serostatus associated with a reduced risk of postpartum depression? American Journal of Obstetrics & Gynecology. 2016;215(4):521.e1–e5. Aaron E, Bonacquisti A, Geller PA, Polansky M. Perinatal depression and anxiety in women with and without humanimmunodeficiencyvirus infection. Women’s Health Issues. 2015;25(5):579–85. Stephens S, Ford E, Paudyal P, Smith H. Effectiveness of psychological interventions for postnatal depression
Effect of Cannabis and Endocannabinoids on HIV Neuropathic Pain Effect of Cannabis and Endocannabinoids on HIV Neuropathic Pain - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Effect of Cannabis (...) and Endocannabinoids on HIV Neuropathic Pain The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03099005 Recruitment Status : Recruiting First Posted : April 4, 2017 Last Update Posted : October 18, 2018 See Sponsor: University