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Comparative Pricing of Branded Tenofovir Alafenamide-Emtricitabine Relative to Generic Tenofovir Disoproxil Fumarate-Emtricitabine for HIV Preexposure Prophylaxis: A Cost-Effectiveness Analysis. Tenofovir alafenamide-emtricitabine (F/TAF) was recently approved as a noninferior and potentially safer option than tenofovir disoproxil fumarate-emtricitabine (F/TDF) for HIV preexposure prophylaxis (PrEP) in the United States.To estimate the greatest possible clinical benefits and economic savings (...) attributable to the improved safety profile of F/TAF and the maximum price payers should be willing to pay for F/TAF over generic F/TDF.Cost-effectiveness analysis.Published literature on F/TDF safety (in persons with and those without HIV) and the cost and quality-of-life effects of fractures and end-stage renal disease (ESRD).Age-stratified U.S. men who have sex with men (MSM) using PrEP.Five years.Health care sector.Preexposure prophylaxis with F/TAF versus F/TDF.Fractures averted, cases of ESRD averted
of screening strategies for early identification of HIV and HCV infection in injection drug users. PloS One. 2012;7(9). Sanders GD, Anaya HD, Asch S, Hoang T, Golden JF, Bayoumi AM, et al. Cost-effectiveness of strategies to improve HIV testing and receipt of results: Economic analysis of a randomized controlled trial. Journal of General Internal Medicine. 2010;25(6):556–63. Dowdy DW, Rodriguez RM, Bradley Hare C, Kaplan B. Cost‐effectiveness of targeted humanimmunodeficiencyvirus screening in an urban (...) Cost-effectiveness of rapid point-of-care testing (POCT) programs for HIV Cost-effectiveness of rapid point-of-care testing (POCT) programs for HIV | The Ontario HIV Treatment Network The Ontario HIV Treatment Network Cost-effectiveness of rapid point-of-care testing (POCT) programs for HIV Cost-effectiveness of rapid point-of-care testing (POCT) programs for HIV , , , , Questions What evidence exists regarding the cost-effectiveness of rapid point-of-care testing (POCT) programs for HIV? How
Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3. Sustainable Development Goal (SDG) 3 aims to "ensure healthy lives and promote well-being for all at all ages". While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas (...) of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available.We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria
with HIV and 9-valent HPV vaccine introduction Guidance on HPV vaccination in EU countries: focus on boys, people living with HIV and 9-valent HPV vaccine introduction Technical guidance 30 Mar 2020 Cite: European Centre for Disease Prevention and Control. Guidance on HPV vaccination in EU countries: focus on boys, people living with HIV and 9-valent HPV vaccine introduction, 2020. Stockholm: ECDC; 2020. This guidance on human papilloma virus (HPV) vaccination in EU countries covers the following areas (...) Guidance on HPV vaccination in EU countries: focus on boys, people living with HIV and 9-valent HPV vaccine introduction Guidance on HPV vaccination in EU countries: focus on boys, people living with HIV and 9-valent HPV vaccine introduction Global Navigation Other sites: European Centre for Disease Prevention and Control An agency of the European Union Main Navigation Secondary Navigation Search Search Search Search Guidance on HPV vaccination in EU countries: focus on boys, people living
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
care providers caring for persons who have experienced significant exposure to blood and/or body fluids in the work place or community setting. The risk of HumanImmunodeficiencyVirus (HIV) acquisition from a given exposure depends on the likelihood the source has transmissible HIV infection, and the biological risk of HIV transmission based on the exposure that has occurred. This guideline is designed to deal specifically with exposures to HIV and is not applicable to other exposures (...) -arv-guidelines/0 Toronto General Hospital, University Health Network Immunodeficiency Clinic. HIV/HCV Drug Therapy Guide. http://app.hivclinic.ca/ 19 XI REFERENCES 1. Kuhar DT, Henderson DK, Struble KA, et al. for the US Public Health Service Working Group. Updated US Public Health Service Guidelines for the Management of Occupational Exposures to HumanImmunodeficiencyVirus and Recommendations for Postexposure Prophylaxis. Infect Control Hosp Epidemiol 2013; 34: 875-92 2. Centers for Disease
Fostemsavir in Adults with Multidrug-Resistant HIV-1 Infection. Among some patients with humanimmunodeficiencyvirus type 1 (HIV-1) infection who have undergone multiple antiretroviral therapies and have limited options for treatment, new classes of antiretroviral drugs with novel mechanisms of action are needed. Fostemsavir is the prodrug of temsavir, a first-in-class investigational HIV-1 attachment inhibitor.In this ongoing phase 3 trial in 23 countries, we enrolled patients with multidrug (...) -resistant HIV-1 infection in two cohorts, according to their remaining treatment options. In the first cohort, we assigned (in a 3:1 ratio) patients who had the option of using at least one fully active, approved antiretroviral drug in at least one but no more than two antiretroviral classes to add either fostemsavir (at a dose of 600 mg twice daily) or placebo to their failing regimen for 8 days, followed by open-label fostemsavir plus optimized background therapy (randomized cohort). In the second
Long-Acting Cabotegravir and Rilpivirine after Oral Induction for HIV-1 Infection. Long-acting injectable regimens may simplify therapy for patients with humanimmunodeficiencyvirus type 1 (HIV-1) infection.We conducted a phase 3, randomized, open-label trial in which adults with HIV-1 infection who had not previously received antiretroviral therapy were given 20 weeks of daily oral induction therapy with dolutegravir-abacavir-lamivudine. Participants who had an HIV-1 RNA level of less than 50 (...) copies per milliliter after 16 weeks were randomly assigned (1:1) to continue the current oral therapy or switch to oral cabotegravir plus rilpivirine for 1 month followed by monthly injections of long-acting cabotegravir plus rilpivirine. The primary end point was the percentage of participants who had an HIV-1 RNA level of 50 copies per milliliter or higher at week 48 (Food and Drug Administration snapshot algorithm).At week 48, an HIV-1 RNA level of 50 copies per milliliter or higher was found
Long-Acting Cabotegravir and Rilpivirine for Maintenance of HIV-1 Suppression. Simplified regimens for the treatment of humanimmunodeficiencyvirus type 1 (HIV-1) infection may increase patient satisfaction and facilitate adherence.In this phase 3, open-label, multicenter, noninferiority trial involving patients who had had plasma HIV-1 RNA levels of less than 50 copies per milliliter for at least 6 months while taking standard oral antiretroviral therapy, we randomly assigned participants (1 (...) :1) to either continue their oral therapy or switch to monthly intramuscular injections of long-acting cabotegravir, an HIV-1 integrase strand-transfer inhibitor, and long-acting rilpivirine, a nonnucleoside reverse-transcriptase inhibitor. The primary end point was the percentage of participants with an HIV-1 RNA level of 50 copies per milliliter or higher at week 48, determined with the use of the Food and Drug Administration snapshot algorithm.Treatment was initiated in 308 participants per
Antiretroviral therapy alone versus antiretroviral therapy with a kick and kill approach, on measures of the HIV reservoir in participants with recent HIV infection (the RIVER trial): a phase 2, randomised trial. Antiretroviral therapy (ART) cannot cure HIV infection because of a persistent reservoir of latently infected cells. Approaches that force HIV transcription from these cells, making them susceptible to killing-termed kick and kill regimens-have been explored as a strategy towards (...) an HIV cure. RIVER is the first randomised trial to determine the effect of ART-only versus ART plus kick and kill on markers of the HIV reservoir.This phase 2, open-label, multicentre, randomised, controlled trial was undertaken at six clinical sites in the UK. Patients aged 18-60 years who were confirmed as HIV-positive within a maximum of the past 6 months and started ART within 1 month from confirmed diagnosis were randomly assigned by a computer generated randomisation list to receive ART-only
Addition of Maraviroc Versus Placebo to Standard Antiretroviral Therapy for Initial Treatment of Advanced HIV Infection: A Randomized Trial. Patients diagnosed with advanced HIV infection have a poor prognosis despite initiation of combined antiretroviral therapy (c-ART).To assess the benefit of adding maraviroc, an antiretroviral drug with immunologic effects, to standard c-ART for patients with advanced disease at HIV diagnosis.Randomized controlled trial. (ClinicalTrials.gov: NCT01348308 (...) ).Clinical sites in France (n = 25), Italy (n = 5), and Spain (n = 20).416 HIV-positive, antiretroviral-naive adults with CD4 counts less than 0.200 × 109 cells/L and/or a previous AIDS-defining event (ADE).C-ART plus placebo or maraviroc (300 mg twice daily with dose modification) for 72 weeks.The primary end point was first occurrence of severe morbidity (new ADE, selected serious infections, serious non-ADE, immune reconstitution inflammatory syndrome, or death). Prespecified secondary outcomes
What methods have been effective in promoting uptake of Pre-exposure prophylaxis (PrEP) among individuals at high risk of HIV, excluding men who have sex with men Knowledge & Library Services (KLS) Evidence Briefing What methods have been effective in promoting uptake of Pre- exposure prophylaxis (PrEP) among individuals at high risk of HIV, excluding men who have sex with men (MSM), in developed cities comparable to London Nicola Pearce-Smith March 15 th 2019 What methods have been effective (...) in promoting uptake of PrEP among individuals at high risk of HIV KLS Evidence Briefing March 19th 2019 Research question This briefing summarises the evidence on the uptake of PrEP amongst high risk groups such as women, transgender, black Africans, sex workers, drug addicts and young people, from January 1 st 2017 to February 28 th 2019. Key messages • Barriers to PrEP uptake identified across all risk groups were safety, side effects, lack of knowledge, medication regimen, socioeconomic factors, stigma
HIV infection and AIDS: When should I screen for HIV infection? Asymptomatic HIV infection | Diagnosis | HIV infection and AIDS | CKS | NICE Search CKS… Menu Asymptomatic HIV infection HIV infection and AIDS: When should I screen for HIV infection? Last revised in October 2018 When should I screen for HIV infection? When should I screen for HIV? Offer an HIV test in primary care to asymptomatic people: If a person requests it — they may not be prepared to discuss their risks so avoid (...) discouraging those with no apparent risk. If a person is at . If the person presents with another sexually transmitted infection. If the person is a new patient registering at a GP practice in an area of the UK with a high local diagnosed HIV prevalence (greater than 2 in 1000) — see the website for annually updated HIV prevalence data by locality produced by Public Health England. All pregnant women should be offered screening for HIV as part of routine antenatal care. HIV screening for the following
be encouraged to bleed freely, but should not be sucked. Local guidelines should be followed and primary healthcare providers should ensure that they have arrangements in place for rapid 24-hour access to urgent advice and post-exposure prophylaxis (PEP) — usually via the local Accident and Emergency department. Occupational exposures to HIV must be reported to the Health and Safety Executive (HSE) as a dangerous occurrence ('accidental release of a biological agent likely to cause severe human illness (...) : If the needle has been used and if so for what purpose. The HIV status of the source. The interval between needle use and exposure. If factors are present that may influence the probability of HIV transmission, seek expert advice from an HIV specialist or Accident and Emergency department. Human bites In general, PEP is not recommended following a human bite as although the risk of transmission following a bite is not known, it is likely to be extremely small. If factors are present that may influence
HIV infection and AIDS: Scenario: How should I manage a new diagnosis of HIV? Scenario: New HIV diagnosis | Management | HIV infection and AIDS | CKS | NICE Search CKS… Menu Scenario: New HIV diagnosis HIV infection and AIDS: Scenario: How should I manage a new diagnosis of HIV? Last revised in October 2018 Scenario: How should I manage a new diagnosis of HIV? From birth onwards. How should I manage a person with a new diagnosis of HIV? If the person is well and there is no indication (...) for : Discuss where the person prefers to be treated and refer urgently to genito-urinary medicine (GUM) or an HIV specialist — they should be seen as soon as possible, ideally within 48 hours and no later than within 2 weeks. Give the person written details of any appointment arranged. Advise the person about sources of . Advise about risk reduction strategies to protect contacts such as: Promoting if risk is through sexual contact — ensure that the person has a supply of . Directing those with risk
HIV infection and AIDS: Scenario: How should I manage acute HIV-related problems? Scenario: Acute HIV-related problems | Management | HIV infection and AIDS | CKS | NICE Search CKS… Menu Scenario: Acute HIV-related problems HIV infection and AIDS: Scenario: How should I manage acute HIV-related problems? Last revised in October 2018 Scenario: How should I manage acute HIV-related problems? From birth onwards. When should I admit a person with HIV? Most serious HIV-related conditions affect (...) people with CD4 counts less than 200 cells/uL, although tuberculosis can occur at higher counts. Arrange admission if: The person is acutely unwell. suggest pneumonia, tuberculosis, or a serious bacterial lower respiratory tract infection. suggest a serious underlying condition such as Cytomegalovirus (CMV) retinitis. Progressive or acute indicate an HIV-related condition such as cryptococcal meningitis, cerebral toxoplasmosis, or cerebral lymphoma. of the lung or gut is suspected. Serious or life
. Longstanding HIV infection Constitutional symptoms Constitutional symptoms can be caused by the HIVvirus itself, or by a related opportunistic infection, such as tuberculosis, or malignancy such as lymphoma, and include: Fever — including glandular fever-like illness and pyrexia of unknown origin. Weight loss. Sweats. Lymphadenopathy, especially if this persists for more than 3 months, occurs in two or more extra-inguinal sites and no other cause has been identified. Respiratory conditions Symptoms (...) HIV infection and AIDS: HIV diagnosis in people with symptoms Symptomatic HIV infection | Diagnosis | HIV infection and AIDS | CKS | NICE Search CKS… Menu Symptomatic HIV infection HIV infection and AIDS: HIV diagnosis in people with symptoms Last revised in October 2018 HIV diagnosis in people with symptoms When should I suspect HIV infection? Consider the possibility of HIV infection when a person presents with one or more alerting features: Common symptoms or infections that are unusually
HIV infection and AIDS HIV infection and AIDS | Topics A to Z | CKS | NICE Search CKS… Menu HIV infection and AIDS HIV infection and AIDS Last revised in October 2018 The HumanImmunodeficiencyVirus (HIV) is a retrovirus that infects and destroys cells of the immune system, in particular CD4 cells Diagnosis Management Background information HIV infection and AIDS: Summary The HumanImmunodeficiencyVirus (HIV) is a retrovirus that preferentially infects and destroys cells of the immune system (...) ). Vertically from mother to child — during pregnancy, childbirth, or with breastfeeding. By inoculation — via a contaminated needle, instrument, blood, or blood product; through direct exposure of mucous membranes or an open wound to infected bodily fluids; or by a human bite that breaks the skin. HIV cannot be transmitted by social interactions, such as shaking hands and kissing, or by the routine sharing of household items. Primary HIV infection (PHI) or HIV seroconversion illness often presents