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Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2018 Recommendations of the International Antiviral Society-USA Panel. Antiretroviral therapy (ART) is the cornerstone of prevention and management of HIV infection.To evaluate new data and treatments and incorporate this information into updated recommendations for initiating therapy, monitoring individuals starting therapy, changing regimens, and preventing HIV infection for individuals at risk.New evidence (...) collected since the International Antiviral Society-USA 2016 recommendations via monthly PubMed and EMBASE literature searches up to April 2018; data presented at peer-reviewed scientific conferences. A volunteer panel of experts in HIV research and patient care considered these data and updated previous recommendations.ART is recommended for virtually all HIV-infected individuals, as soon as possible after HIV diagnosis. Immediate initiation (eg, rapid start), if clinically appropriate, requires
HIV. The benefits of combination antiretroviral therapy (cART) for HIV replication and transmission control have led to its universal recommendation. Many people living with HIV are, however, still undiagnosed or diagnosed late, especially in sub-Saharan Africa, where the HIV disease burden is highest. Further expansion in HIV treatment options, incorporating women-centred approaches, is essential to make individualised care a reality. With a longer life expectancy than before, people living (...) with HIV are at an increased risk of developing non-AIDS comorbidities, such as cardiovascular diseases and cancers. Antiretroviral strategies are evolving towards a decrease in drug burden, and some two-drug combinations have proven efficacy for maintenance therapy. Investigational immune checkpoint inhibitors and broadly neutralising antibodies with effector functions have energised the HIV cure research field as the search for an effective vaccine continues. In this Seminar, we review advances
a parallel study in rhesus monkeys (NHP 13-19) to assess the immunogenicity and protective efficacy of these vaccine regimens against a series of six repetitive, heterologous, intrarectal challenges with a rhesus peripheral blood mononuclear cell-derived challenge stock of simian-humanimmunodeficiencyvirus (SHIV-SF162P3). The APPROACH trial is registered with ClinicalTrials.gov, number NCT02315703.Between Feb 24, 2015, and Oct 16, 2015, we randomly assigned 393 participants to receive at least one dose (...) vaccine candidates in parallel studies in humans and rhesus monkeys to define the optimal vaccine regimen to advance into clinical efficacy trials.We conducted a multicentre, randomised, double-blind, placebo-controlled phase 1/2a trial (APPROACH). Participants were recruited from 12 clinics in east Africa, South Africa, Thailand, and the USA. We included healthy, HIV-1-uninfected participants (aged 18-50 years) who were considered at low risk for HIV-1 infection. We randomly assigned participants
2018LancetControlled trial quality: predicted high
Violence, abuse and discrimination: key factors militating against control of HIV/AIDS among the LGBTI sector The Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) South Africans continue to face considerable challenges, including societal stigma, homophobic violence (particularly corrective rape), and high rates of sexually transmitted diseases and infections (particularly HumanImmunodeficiencyVirus (HIV)/AIDS) even when discrimination based on sexual orientation was outlawed by South (...) African's post-apartheid constitution. This study was conducted to ascertain violence, abuse and discrimination against the LGBTI sector as key factors that hinder the smooth implementation of HIV/AIDS programme among sexually minority (LGBTI) group in Walter Sisulu University, South Africa. The self-structured questionnaire was used to collect data. The study involved 3048 purposively selected participants (1285 male and 1763 female) aged 17-38 years. About 70.5% of the participants witnessed physical
Rapid urine-based screening for tuberculosis in HIV-positive patients admitted to hospital in Africa (STAMP): a pragmatic, multicentre, parallel-group, double-blind, randomised controlled trial. Current diagnostics for HIV-associated tuberculosis are suboptimal, with missed diagnoses contributing to high hospital mortality and approximately 374 000 annual HIV-positive deaths globally. Urine-based assays have a good diagnostic yield; therefore, we aimed to assess whether urine-based screening (...) in HIV-positive inpatients for tuberculosis improved outcomes.We did a pragmatic, multicentre, double-blind, randomised controlled trial in two hospitals in Malawi and South Africa. We included HIV-positive medical inpatients aged 18 years or more who were not taking tuberculosis treatment. We randomly assigned patients (1:1), using a computer-generated list of random block size stratified by site, to either the standard-of-care or the intervention screening group, irrespective of symptoms
2018LancetControlled trial quality: predicted high
Performance of verbal autopsy methods in estimating HIV-associated mortality among adults in South Africa Verbal autopsy (VA) can be integrated into civil registration and vital statistics systems, but its accuracy in determining HIV-associated causes of death (CoD) is uncertain. We assessed the sensitivity and specificity of VA questions in determining HIV status and antiretroviral therapy (ART) initiation and compared HIV-associated mortality fractions assigned by different VA interpretation (...) methods.Using the WHO 2012 instrument with added ART questions, VA was conducted for deaths among adults with known HIV status (356 HIV positive and 103 HIV negative) in South Africa. CoD were assigned using physician-certified VA (PCVA) and computer-coded VA (CCVA) methods and compared with documented HIV status.The sensitivity of VA questions in detecting HIV status and ART initiation was 84.3% (95% CI 80 to 88) and 91.0% (95% CI 86 to 95); 283/356 (79.5%) HIV-positive individuals were assigned HIV
Dolutegravir (HIV infection) - Addendum to commission A17-11 1 Translation of addendum A17-37 Dolutegravir (HIV-Infektion) – Addendum zum Auftrag A17-11 (Version 1.0; Status: 30 August 2017). Please note: This translation is provided as a service by IQWiG to English-language readers. However, solely the German original text is absolutely authoritative and legally binding. Addendum 30 August 2017 1.0 Commission: A17-37 Version: Status: IQWiG Reports – Commission No. A17-37 Dolutegravir (HIV (...) infection) – Addendum to Commission A17-11 1 Addendum A17-37 Version 1.0 Dolutegravir – Addendum to Commission A17-11 30 August 2017 Institute for Quality and Efficiency in Health Care (IQWiG) - i - Publishing details Publisher: Institute for Quality and Efficiency in Health Care Topic: Dolutegravir (HIV infection) – Addendum to Commission A17-11 Commissioning agency: Federal Joint Committee Commission awarded on: 10 August 2017 Internal Commission No.: A17-37 Address of publisher: Institut für Qualität
contributions to the process.vi HIV AND INFANT FEEDING IN EMERGENCIES: OPERATIONAL GUIDANCE Abbreviations and acronyms AIDS acquired immunodeficiency syndrome ANC antenatal care ART antiretroviral therapy ARV antiretroviral drug AZT zidovudine BMS breast-milk substitute(s) ENN Emergency Nutrition Network HIVhumanimmunodeficiencyvirus IFE infant and young child feeding in emergencies IYCF infant and young child feeding MTCT mother-to-child transmission of HIV NGO nongovernmental organization NVP (...) : the infant receives only breast milk without any other liquids or solids, not even water, except for oral rehydration solution or drops or syrups of vitamins, minerals or medicines. Generalized HIV epidemic: HIV is firmly established in the general population. Numerical proxy: HIV prevalence is consistently over 1% among pregnant women. Most generalized HIV epidemics are mixed in nature, where certain (key) subpopulations are disproportionately affected. HIV: the humanimmunodeficiencyvirus
Raltegravir (Isentress) - humanimmunodeficiencyvirus in neonates Published 9 July 2018 Statement of Advice: raltegravir 100mg granules for oral suspension (Isentress ® ) SMC2101 Merck Sharp & Dohme Limited 8 June 2018 ADVICE: in the absence of a submission from the holder of the marketing authorisation raltegravir (Isentress ® ) is not recommended for use within NHSScotland. Indication under review: in combination with other anti-retroviral medicinal products in the treatment of human (...) immunodeficiencyvirus in neonates. The holder of the marketing authorisation has not made a submission to SMC regarding this product in this setting. As a result we cannot recommend its use within NHSScotland. Advice context: No part of this advice may be used without the whole of the advice being quoted in full. This advice represents the view of the Scottish Medicines Consortium. It is provided to inform the considerations of Area Drug & Therapeutics Committees and NHS Boards in Scotland in determining
in the EU will be sent a dear healthcare professional letter concerning these recommendations. More about the medicine Dolutegravir is an integrase inhibitor. This means that it blocks an enzyme called integrase that is needed by the HIVvirus to make new copies of itself in the body. When it is given with other medicines, it helps to prevent the spread of HIV and keep the amount of the virus in the blood at a low level. Dolutegravir does not cure HIV infection or AIDS, but it may hold off damage (...) New study suggests risk of birth defects in babies born to women on HIV medicine dolutegravir New study suggests risk of birth defects in babies born to women on HIV medicine dolutegravir | European Medicines Agency Search Search Menu New study suggests risk of birth defects in babies born to women on HIV medicine dolutegravir Press release 18/05/2018 While EMA review is ongoing, dolutegravir should not be used in women seeking to become pregnant The European Medicines Agency (EMA
Depression and Suicidal Ideation Among HIV-Infected Adults Receiving Efavirenz Versus Nevirapine in Uganda: A Prospective Cohort Study. Evidence regarding potential adverse neuropsychiatric effects of efavirenz is conflicting, and data from sub-Saharan Africa, where 70% of persons living with HIV (PLHIV) reside and efavirenz is used as first-line therapy, are limited.To estimate associations between efavirenz use and depression and suicidal ideation among PLHIV in Uganda.Prospective
The rise and fall of mortality inequality in South Africa in the HIV era Post-apartheid South Africa has seen an unprecedented rise and fall of mortality in less than two decades as a result of the HIV/AIDS epidemic and the subsequent rollout of free antiretroviral therapy (ART). Since the incidence of both was not equal for rich and poor, it is likely to also have affected disparities in health and survival chances by income. We use large nationwide surveys for 2001, 2007 and 2011 to obtain (...) the 2001-2011 period. The analysis of age-sex-specific mortality rates shows that it was in particular for adults aged 18-59 years that mortality and absolute inequality increased substantially between 2001 and 2006, followed by a rapid drop thereafter. These trends were far more pronounced for males than females. This means that the HIV/AIDS epidemic has taken a serious death toll, which was concentrated disproportionately among the poorest segments of the population and especially affected (older
NK-cell activation is associated with increased HIV transcriptional activity following allogeneic hematopoietic cell transplantation 29921650 2019 03 15 2473-9537 2 12 2018 06 26 Blood advances Blood Adv NK-cell activation is associated with increased HIV transcriptional activity following allogeneic hematopoietic cell transplantation. 1412-1416 10.1182/bloodadvances.2018016329 Hogan Louise E LE Division of Experimental Medicine, University of California, San Francisco, San Francisco, CA
Association of Viral Suppression With Lower AIDS-Defining and Non-AIDS-Defining Cancer Incidence in HIV-Infected Veterans: A Prospective Cohort Study. Viral suppression is a primary marker of HIV treatment success. Persons with HIV are at increased risk for AIDS-defining cancer (ADC) and several types of non-AIDS-defining cancer (NADC), some of which are caused by oncogenic viruses.To determine whether viral suppression is associated with decreased cancer risk.Prospective cohort.Department (...) of Veterans Affairs.HIV-positive veterans (n = 42 441) and demographically matched uninfected veterans (n = 104 712) from 1999 to 2015.Standardized cancer incidence rates and Poisson regression rate ratios (RRs; HIV-positive vs. uninfected persons) by viral suppression status (unsuppressed: person-time with HIV RNA levels ≥500 copies/mL; early suppression: initial 2 years with HIV RNA levels <500 copies/mL; long-term suppression: person-time after early suppression with HIV RNA levels <500 copies/mL
Autoimmune blistering disorders in the setting of humanimmunodeficiencyvirus infection The interplay between immune dysfunction and humanimmunodeficiencyvirus (HIV) is complex. Reports of autoimmune disorders including autoimmune bullous disorders (AIBDs) have been increasing in prevalence in the HIV population since the introduction of highly active antiretroviral therapy in 1995. We offer a literature review of clinical experiences in various AIBDs with particular emphasis on therapeutic (...) management as well as a brief overview of the mechanisms that explain the relationship between AIBD and HIV. Because immunosuppressants are first-line therapies for AIBD treatment, careful consideration is warranted when considering management in the HIV population.
Frequent HIV and Young Age Among Individuals With Diverse Cancers at a National Teaching Hospital in Malawi Purpose Cancer surveillance provides a critical evidence base to guide cancer control efforts, yet population-based coverage in Africa is sparse. Hospital-based registries may help fill this need by providing local epidemiologic data to guide policy and forecast local health care needs. We report the epidemiology of patients with cancer recorded by a de novo hospital-based cancer registry (...) at Kamuzu Central Hospital, Malawi, the sole provider of comprehensive oncology services for half the country and location of a high-volume pathology laboratory. Methods We conducted active case finding across all hospital departments and the pathology laboratory from June 2014 to March 2016. Patient demographics, tumor characteristics, treatment, and HIV status were collected. We describe epidemiology of the cancer caseload, registry design, and costs associated with registry operations. Results Among
Food & the Nutrition Care Process. 14 ed. St. Louis, Missouri: Elsevier; 2017. p. 757–74. van Graan AE. Nutritional management in HIV/AIDS infection. World Review of Nutrition & Dietetics. 2015;111:130–5. Willig A, Wright L, Galvin TA. Practice paper of the Academy of Nutrition and Dietetics: Nutrition intervention and humanimmunodeficiencyvirus infection. Journal of the Academy of Nutrition and Dietetics. 2018;118(3):486–98. Pribham V. Introduction to Nutrition and HIV. In: Pribham V, editor (...) . Nutrition and HIV. Chichester: Wiley-Blackwell; 2011. p. 18–29. Somarriba G, Neri D, Schaefer N, Miller TL. The effect of aging, nutrition, and exercise during HIV infection. HIV/AIDS — Research and Palliative Care. 2010;2:191–201. Clark WA, Cress EM. Nutritional issues and positive living in humanimmunodeficiencyvirus/AIDS. Nursing Clinics of North America. 2018;53(1):13–24. Batterham MJ. Investigating heterogeneity in studies of resting energy expenditure in persons with HIV/AIDS: A meta-analysis
Cardiovascular Risk Prediction Functions Underestimate Risk in HIV Infection Cardiovascular disease (CVD) risk is elevated in HIV-infected individuals, with contributions from both traditional and nontraditional risk factors. The accuracy of established CVD risk prediction functions in HIV is uncertain. We sought to assess the performance of 3 established CVD risk prediction functions in a longitudinal cohort of HIV-infected men.The FHS (Framingham Heart Study) functions for hard coronary heart (...) disease (FHS CHD) and atherosclerotic CVD (FHS ASCVD) and the American College of Cardiology/American Heart Association ASCVD function were applied to the Partners HIV cohort. Risk scores were calculated between January 1, 2006, and December 31, 2008. Outcomes included CHD (myocardial infarction or coronary death) for the FHS CHD function and ASCVD (myocardial infarction, stroke, or coronary death) for the FHS ASCVD and American College of Cardiology/American Heart Association ASCVD functions. We