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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
Abdominal ultrasound for diagnosing abdominal tuberculosis or disseminated tuberculosis with abdominal involvement in HIV-positive individuals. Accurate diagnosis of tuberculosis in people living with HIV is difficult. HIV-positive individuals have higher rates of extrapulmonary tuberculosis and the diagnosis of tuberculosis is often limited to imaging results. Ultrasound is such an imaging test that is widely used as a diagnostic tool (including point-of-care) in people suspected of having (...) abdominal tuberculosis or disseminated tuberculosis with abdominal involvement.To determine the diagnostic accuracy of abdominal ultrasound for detecting abdominal tuberculosis or disseminated tuberculosis with abdominal involvement in HIV-positive individuals.To investigate potential sources of heterogeneity in test accuracy, including clinical setting, ultrasound training level, and type of reference standard.We searched for publications in any language up to 4 April 2019 in the following databases
of antiretroviral therapy for HIV-1 infection and tuberculosis. N Engl J Med. 2011; 365:1482-1491. 33. Meintjes G, Wilkinson R, Morroni C, et al. Randomized placebo-controlled trial of prednisone for paradoxical tuberculosis- associated immune reconstitution inflammatory syndrome. AIDS 2010; 24:2381-2390. 34. Torok ME, Nguyen TB, Tran THC, et al Timing of initiation of antiretroviral therapy in humanimmunodeficiencyvirus (HIV)-associated tuberculous meningitis. Clin Infect Dis 2011; 52:1374. 35. Hughes JP (...) OF CONTENTS TABLE 3: Factors to Consider when Selecting an ARV Regimen FACTOR CHARACTERISTICS Regimen Regimen efficacy Genetic barrier to resistance Tolerability and short-term adverse events Potential for drug-drug interactions Toxicity and long-term safety Pill burden and dosing frequency Food requirements Virus Resistance test results Individual HIV infection ? Baseline CD4 cell count and HIV viral load HLA-B*5701 test result Co-existing conditions ? Bone disease (osteoporosis) ? Cardiovascular disease
HumanImmunodeficiencyVirus (HIV) Infection: Screening Recommendation | United States Preventive Services Taskforce Toggle navigation Main navigation Main navigation Recommendation Pregnant persons The USPSTF recommends that clinicians screen for HIV infection in all pregnant persons, including those who present in labor or at delivery whose HIV status is unknown. A Adolescents and adults aged 15 to 65 years The USPSTF recommends that clinicians screen for HIV infection in adolescents (...) . In addition, ART treatment in pregnant persons living with HIV and use of other precautions substantially decrease the risk of transmission to the fetus, newborn, or infant. Abbreviations: ACOG=American College of Obstetricians and Gynecologists; AIDS=acquired immunodeficiency syndrome; ART=antiretroviral therapy; CDC=Centers for Disease Prevention and Control; HIV= humanimmunodeficiencyvirus; STI=sexually transmitted infection. For a summary of the evidence systematically reviewed in making
have activity against hepatitis B virus (HBV). HBV infection is common among women with HIV, especially in women born in areas where HBV is endemic. Vertical transmission of HBV occurs in approximately 38% of children born to mothers with active HBV infection in settings where prophylactic measures are not available. The transmission rate is reduced to about 1% in children who receive prophylaxis with hepatitis B immunoglobulin and early hepatitis B vaccination. When transmission does occur (...) . Systematic review with meta-analysis: the risk of mother-to-child transmission of hepatitis B virus infection in sub-Saharan Africa. . Schillie S, Walker T, Veselsky S, et al. Outcomes of infants born to women infected with hepatitis B. . Wiseman E, Fraser MA, Holden S, et al. Perinatal transmission of hepatitis B virus: an Australian experience. . Guyatt G, Yuan Z, Alexander P, et al. Antiretroviral therapy for pregnant women living with HIV or hepatitis B: a systematic review and meta-analysis
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
Pathophysiology in HIV: Metabolic Contributors HIV infection is associated with metabolic complications, including dyslipidemia, insulin resistance, and body composition changes, which can contribute to CVD. Initially, dyslipidemia in HIV was characterized by increased triglyceride levels, thought to be related to immunodeficiency in the pre-ART era. Later, specific ART medications, including several protease inhibitors (PIs) and efavirenz, a non–nucleoside reverse transcriptase inhibitor (NRTI), were (...) Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association | Circulation Search Hello Guest! Login to your account Email Password Keep me logged in Search December 2019 November 2019 October 2019 September 2019 August 2019 July 2019 June 2019 May
Prevention of HumanImmunodeficiencyVirus (HIV) Infection: Preexposure Prophylaxis Recommendation | United States Preventive Services Taskforce Toggle navigation Main navigation Main navigation Recommendation Persons at high risk of HIV acquisition The USPSTF recommends that clinicians offer preexposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at high risk of HIV acquisition. A View the Clinical Summary in Population Persons at high risk of HIV acquisition (...) Once-daily oral treatment with combined tenofovir disoproxil fumarate and emtricitabine is the only formulation of PrEP currently approved by the US Food and Drug Administration for use in the United States in persons at risk of sexual acquisition of HIV infection. Relevant USPSTF Recommendations The USPSTF has issued recommendations on behavioral counseling to reduce risk of STIs and on screening for HIV infection. Abbreviations: HIV=humanimmunodeficiencyvirus; STI=sexually transmitted infection
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