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·7% of 5119) community controls without HIV infection. Wheezing was present in 555 (31·7%) of 1752 cases (range by site 10·6-97·3%). 30-day case-fatality ratio was 6·4% (114 of 1769 cases). Blood cultures were positive in 56 (3·2%) of 1749 cases, and Streptococcus pneumoniae was the most common bacteria isolated (19 [33·9%] of 56). Almost all cases (98·9%) and controls (98·0%) had at least one pathogen detected by PCR in the NP-OP specimen. The detection of respiratory syncytial virus (RSV (...) ), parainfluenza virus, human metapneumovirus, influenza virus, S pneumoniae, Haemophilus influenzae type b (Hib), H influenzae non-type b, and Pneumocystis jirovecii in NP-OP specimens was associated with case status. The aetiology analysis estimated that viruses accounted for 61·4% (95% credible interval [CrI] 57·3-65·6) of causes, whereas bacteria accounted for 27·3% (23·3-31·6) and Mycobacterium tuberculosis for 5·9% (3·9-8·3). Viruses were less common (54·5%, 95% CrI 47·4-61·5 vs 68·0%, 62·7-72·7
HIV incidence among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: a randomised, multicentre, open-label trial. Observational and laboratory studies suggest that some hormonal contraceptive methods, particularly intramuscular depot medroxyprogesterone acetate (DMPA-IM), might increase women's susceptibility to HIV acquisition. We aimed to compare DMPA-IM, a copper intrauterine device (IUD (...) ), and a levonorgestrel (LNG) implant among African women seeking effective contraception and living in areas of high HIV incidence.We did a randomised, multicentre, open-label trial across 12 research sites in eSwatini, Kenya, South Africa, and Zambia. We included HIV-seronegative women aged 16-35 years who were seeking effective contraception, had no medical contraindications to the trial contraceptive methods, agreed to use the assigned method for 18 months, and reported not using injectable, intrauterine
2019LancetControlled trial quality: predicted high
Preexposure Prophylaxis for the Prevention of HIV Infection: US Preventive Services Task Force Recommendation Statement. An estimated 1.1 million individuals in the United States are currently living with HIV, and more than 700 000 persons have died of AIDS since the first cases were reported in 1981. In 2017, there were 38 281 new diagnoses of HIV infection reported in the United States; 81% of these new diagnoses were among males and 19% were among females. Although treatable, HIV infection (...) has no cure and has significant health consequences.To issue a new US Preventive Services Task Force (USPSTF) recommendation on preexposure prophylaxis (PrEP) for the prevention of HIV infection.The USPSTF reviewed the evidence on the benefits of PrEP for the prevention of HIV infection with oral tenofovir disoproxil fumarate monotherapy or combined tenofovir disoproxil fumarate and emtricitabine and whether the benefits vary by risk group, population subgroup, or regimen or dosing strategy
Screening for HIV Infection: US Preventive Services Task Force Recommendation Statement. Approximately 1.1 million persons in the United States are currently living with HIV, and more than 700 000 persons have died of AIDS since the first cases were reported in 1981. There were approximately 38 300 new diagnoses of HIV infection in 2017. The estimated prevalence of HIV infection among persons 13 years and older in the United States is 0.4%, and data from the Centers for Disease Control (...) and Prevention show a significant increase in HIV diagnoses starting at age 15 years. An estimated 8700 women living with HIV give birth each year in the United States. HIV can be transmitted from mother to child during pregnancy, labor, delivery, and breastfeeding. The incidence of perinatal HIV infection in the United States peaked in 1992 and has declined significantly following the implementation of routine prenatal HIV screening and the use of effective therapies and precautions to prevent mother
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
Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. The level of evidence for HIV transmission risk through condomless sex in serodifferent gay couples with the HIV-positive partner taking virally suppressive antiretroviral therapy (ART) is limited compared with the evidence available for transmission risk in heterosexual (...) couples. The aim of the second phase of the PARTNER study (PARTNER2) was to provide precise estimates of transmission risk in gay serodifferent partnerships.The PARTNER study was a prospective observational study done at 75 sites in 14 European countries. The first phase of the study (PARTNER1; Sept 15, 2010, to May 31, 2014) recruited and followed up both heterosexual and gay serodifferent couples (HIV-positive partner taking suppressive ART) who reported condomless sex, whereas the PARTNER2
). Encephalopathy and progress of humanimmunodeficiencyvirus disease in a cohort of children with perinatally acquired humanimmunodeficiencyvirus. Journal of Paediatrics, 135 (5), 808-812. Elliott-DeSorbo, D. K., Martin, S., & Wolters, P. L. (2009). Stressful life events and their relationship to psychological and medical functioning in children and adolescents with HIV infection. JAIDS Journal of Acquired Immune Deficiency Syndromes, 52, 364–370 Franklin, S., Lim, H. J., Rennie, K. M., Eastwood, D., Cuene (...) immunodeficiencyvirus (HIV-1) infection. Journal of child neurology, 26(11), 1355-1364. Innes, S., Lazarus, E., Otwombe, K., Liberty, A., Germanus, R., Janse Van Rensburg, A., Grobbelaar, N., Hurter, T., Eley, B., Violari, A. & Cotton, M. F. (2014). Early severe HIV disease precedes early antiretroviral therapy in infants: Are we too late?. Journal of the International AIDS Society, 17(1). Judd, A., Le Orevost, M, Melvin, D., Arenas-Pinto, A., Parrott, F., Winston, Al., Foster, C., Strurgeon, K., Rowson, K
for HIV testing of adults, adolescents, and pregnant women in health-care settings. Available from: . Morbidity and Mortality Weekly Report: Recommendations and Reports. 2006;55(14):1–17. Accessed April 24, 2019. Austin T, Traversy GP, Ha S, Timmerman K. Canadian and international recommendations on the frequency of HIV screening and testing: A systematic review. Canada Communicable Disease Report. 2016;42(8):161–8. Public Health Agency of Canada (PHAC). Humanimmunodeficiencyvirus – HIV screening (...) and testing guide. 2014. Available from: . Accessed April 24, 2019. Institut national de santé publique du Québec, Sous-comité Optimiser le dépistage du VIH, Comité sur les infections transmissibles sexuellement et par le sang (ITSS). Optimiser le dépistage et le diagnostic de l’infection par le virus de l’immunodéficience humaine. 2011. Available from: . Accessed April 24, 2019. Gustafson R, Ogilvie G, Moore D, Kendall P. New HIV testing guidelines in BC. Available from: . BC Medical Journal. 2014;56(4
Out-of-pocket costs associated with HIV in publicly funded high-income health care settings Out-of-pocket costs associated with HIV in publicly funded high-income health care settings | The Ontario HIV Treatment Network The Ontario HIV Treatment Network Out-of-pocket costs associated with HIV in publicly funded high-income health care settings Out-of-pocket costs associated with HIV in publicly funded high-income health care settings , , Question What out-of-pocket costs are associated (...) with aging among people living with HIV? Key take-home messages The aging of the people living with HIV in care is leading to increased HIV care costs (1). There is considerable inter-jurisdictional heterogeneity in the cost-sharing policies for antiretrovirals across Canada’s public drug programs (2). Out-of-pocket costs such as inadequate drug coverage, pharmacy dispensing fees, and clinic travel costs may affect treatment adherence and related health outcomes among people living with HIV (3, 4
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
Effect of Anti-CD4 Antibody UB-421 on HIV-1 Rebound after Treatment Interruption. Administration of a single broadly neutralizing humanimmunodeficiencyvirus (HIV)-specific antibody to HIV-infected persons leads to the development of antibody-resistant virus in the absence of antiretroviral therapy (ART). It is possible that monotherapy with UB-421, an antibody that blocks the virus-binding site on human CD4+ T cells, could induce sustained virologic suppression without induction of resistance (...) in HIV-infected persons after analytic treatment interruption.We conducted a nonrandomized, open-label, phase 2 clinical study evaluating the safety, pharmacokinetics, and antiviral activity of UB-421 monotherapy in HIV-infected persons undergoing analytic treatment interruption. All the participants had undetectable plasma viremia (<20 copies of HIV RNA per milliliter) at the screening visit. After discontinuation of ART, participants received eight intravenous infusions of UB-421, at a dose
Association of HIV Preexposure Prophylaxis With Incidence of Sexually Transmitted Infections Among Individuals at High Risk of HIV Infection. Emerging evidence suggests that risk of bacterial sexually transmitted infections (STIs) increases among gay and bisexual men following initiation of HIV preexposure prophylaxis (PrEP).To describe STI incidence and behavioral risk factors among a cohort of predominantly gay and bisexual men who use PrEP, and to explore changes in STI incidence following (...) PrEP commencement.The Pre-exposure Prophylaxis Expanded (PrEPX) Study, a multisite, open-label intervention study, was nested within the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) clinic network. A total of 4275 participants were enrolled (July 26, 2016-April 1, 2018) in Victoria, Australia. Of these, 2981 enrolled at 5 ACCESS clinics (3 primary care, 1 sexual health, and 1 community-based HIV rapid testing service), had at least 1 follow-up visit, and were
will lead to many fewer deaths among women, as well as fewer overall HIV transmissions. These results argue against a uniform policy of avoiding dolutegravir in women of child-bearing potential.National Institutes of Health, National Institute of Allergy and Infectious Diseases and Eunice Kennedy Shriver National Institute of Child Health and Human Development; Massachusetts General Hospital; and Harvard University Center for AIDS Research. (...) Risks and Benefits of Dolutegravir- and Efavirenz-Based Strategies for South African Women With HIV of Child-Bearing Potential: A Modeling Study. Dolutegravir is superior to efavirenz for HIV antiretroviral therapy (ART) but may be associated with an increased risk for neural tube defects (NTDs) in newborns if used by women at conception.To project clinical outcomes of ART policies for women of child-bearing potential in South Africa.Model of 3 strategies: efavirenz for all women of child
and extent of added benefit 4 2 Table numbers start with “2” as numbering follows that of the full dossier assessment. Extract of dossier assessment A18-01 Version 1.0 EVG/COBI/FTC/TAF (HIV-infected children) 12 April 2018 Institute for Quality and Efficiency in Health Care (IQWiG) - v - List of abbreviations Abbreviation Meaning ACT appropriate comparator therapy COBI cobicistat EVG elvitegravir FTC emtricitabine G-BA Gemeinsamer Bundesausschuss (Federal Joint Committee) HIVhumanimmunodeficiencyvirus (...) HIV-1 humanimmunodeficiencyvirus type 1 IQWiG Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (Institute for Quality and Efficiency in Health Care) RCT randomized controlled trial SGB Sozialgesetzbuch (Social Code Book) TAF tenofovir alafenamide Extract of dossier assessment A18-01 Version 1.0 EVG/COBI/FTC/TAF (HIV-infected children) 12 April 2018 Institute for Quality and Efficiency in Health Care (IQWiG) - 1 - 2 Benefit assessment 2.1 Executive summary of the benefit
Doravirine (Pifeltro) - for the treatment of adults infected with humanimmunodeficiencyvirus-1 (HIV-1) Search Page - Drug and Health Product Register Language selection Search and menus Search Search website Search Topics menu You are here: Summary Basis of Decision - - Health Canada Expand all Summary Basis of Decision (SBD) for Contact: Summary Basis of Decision (SBD) documents provide information related to the original authorization of a product. The for is located below. Recent Activity
and nonoccupational postexposure prophylaxis: Updated version, June 13, 2018. Canadian Medical Association Journal. 2017;189(47):E1448–e58. 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. Cardo DM, Culver DH, Ciesielski CA, Srivastava PU, Marcus R (...) after. There was no difference in the rate at which PEP was offered to cases or controls after controlling for HIV transmission risk. However, the odds of HIV seroconversion among health care workers who had received PEP after occupational exposure was reduced by approximately 81%, compared to those who did not receive PEP (4). This study is considered the strongest example of the benefit of PEP in humans (1). Evidence from more recent studies suggests that the administration of antiretroviral
The impact of location on implementation of HIV/STI prevention interventions among LGBTQ communities The impact of location on implementation of HIV/STI prevention interventions among LGBTQ communities | The Ontario HIV Treatment Network The Ontario HIV Treatment Network The impact of location on implementation of HIV/STI prevention interventions among LGBTQ communities The impact of location on implementation of HIV/STI prevention interventions among LGBTQ communities , , Questions What (...) is the impact of geographical location on implementation of HIV/STI prevention programs or interventions among LGBTQ communities? Key take-home messages The characteristics of a location, including segregation, community-level stigma, and infrastructural resources, may influence HIV service utilization and the HIV continuum of care among men who have sex with men (1). Implementation of HIV prevention interventions may be affected by whether a location is convenient, allows for anonymity, and makes one
Yield and Efficiency of Novel Intensified Tuberculosis Case-Finding Algorithms for People Living with HIV The recommended tuberculosis (TB) intensified case finding (ICF) algorithm for people living with HIV (symptom-based screening followed by Xpert MTB/RIF [Xpert] testing) is insufficiently sensitive and results in unnecessary Xpert testing.To evaluate whether novel ICF algorithms combining C-reactive protein (CRP)-based screening with urine Determine TB-LAM (TB-LAM), sputum Xpert (...) , and/or sputum culture could improve ICF yield and efficiency.We compared the yield and efficiency of novel ICF algorithms inclusive of point-of-care CRP-based TB screening and confirmatory testing with urine TB-LAM (if CD4 count ≤100 cells/μl), sputum Xpert, and/or a single sputum culture among consecutive people living with HIV with CD4 counts less than or equal to 350 cells/μl initiating antiretroviral therapy in Uganda.Of 1,245 people living with HIV, 203 (16%) had culture-confirmed TB including 101 (49
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