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Lancet (London, England) Mar 2021New diagnoses of HIV infection have decreased among women in the USA overall, but marked racial and geographical disparities persist. The federal government has... (Review)
Review
New diagnoses of HIV infection have decreased among women in the USA overall, but marked racial and geographical disparities persist. The federal government has announced an initiative that aims to decrease the number of new infections in the nation by 90% within the next 10 years. With this in mind, we highlight important recent developments concerning HIV epidemiology, comorbidities, treatment, and prevention among women in the USA. We conclude that, to end the US HIV epidemic, substantially greater inclusion of US women in clinical research will be required, as will better prevention and treatment efforts, with universal access to health care and other supportive services that enable women to exercise agency in their own HIV prevention and care. Ending the epidemic will also require eliminating the race, class, and gender inequities, as well as the discrimination and structural violence, that have promoted and maintained the distribution of HIV in the USA, and that will, if unchecked, continue to fuel the epidemic in the future.
Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Clinical Protocols; Comorbidity; Epidemics; Female; HIV Infections; Health Services Accessibility; Health Status Disparities; Healthcare Disparities; Humans; Prevalence; Sexism; Transgender Persons; United States; Young Adult
PubMed: 33617768
DOI: 10.1016/S0140-6736(21)00396-2 -
The American Journal of Tropical... Oct 2021
Topics: Acquired Immunodeficiency Syndrome; Africa South of the Sahara; COVID-19; Disability-Adjusted Life Years; Global Health; Health Resources; Humans; Malaria; Mass Drug Administration; Neglected Diseases; Organizations; Public Health; SARS-CoV-2; Tuberculosis
PubMed: 34695793
DOI: 10.4269/ajtmh.21-1026 -
Cancers Nov 2020Traditional cancer treatments may lose efficacy following the emergence of novel mutations or the development of chemoradiotherapy resistance. Late diagnosis, high-cost... (Review)
Review
Traditional cancer treatments may lose efficacy following the emergence of novel mutations or the development of chemoradiotherapy resistance. Late diagnosis, high-cost of treatment, and the requirement of highly efficient infrastructure to dispense cancer therapies hinder the availability of adequate treatment in low-income and resource-limited settings. Repositioning approved drugs as cancer therapeutics may reduce the cost and timeline for novel drug development and expedite the availability of newer, efficacious options for patients in need. Nelfinavir is a human immunodeficiency virus (HIV) protease inhibitor that has been approved and is extensively used as an anti-infective agent to treat acquired immunodeficiency syndrome (AIDS). Yet nelfinavir has also shown anti-cancer effects in in vitro and in vivo studies. The anti-cancer mechanism of nelfinavir includes modulation of different cellular conditions, such as unfolded protein response, cell cycle, apoptosis, autophagy, the proteasome pathway, oxidative stress, the tumor microenvironment, and multidrug efflux pumps. Multiple clinical trials indicated tolerable and reversible toxicities during nelfinavir treatment in cancer patients, either as a monotherapy or in combination with chemo- or radiotherapy. Since orally available nelfinavir has been a safe drug of choice for both adult and pediatric HIV-infected patients for over two decades, exploiting its anti-cancer off-target effects will enable fast-tracking this newer option into the existing repertoire of cancer chemotherapeutics.
PubMed: 33228205
DOI: 10.3390/cancers12113437 -
Journal of the International AIDS... Aug 2023Common mental disorders (CMDs) are highly prevalent among people with HIV. Integrating mental healthcare into HIV care may improve mental health and HIV treatment...
Availability of screening and treatment for common mental disorders in HIV clinic settings: data from the global International epidemiology Databases to Evaluate AIDS (IeDEA) Consortium, 2016-2017 and 2020.
INTRODUCTION
Common mental disorders (CMDs) are highly prevalent among people with HIV. Integrating mental healthcare into HIV care may improve mental health and HIV treatment outcomes. We describe the reported availability of screening and treatment for depression, anxiety and post-traumatic stress disorder (PTSD) at global HIV treatment centres participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) Consortium in 2020 and changes in availability at sites in low- or middle-income countries (LMICs) between 2016/2017 and 2020.
METHODS
In 2020, 238 sites contributing individual-level data to the IeDEA Consortium and in 2016/2017 a stratified random sample of IeDEA sites in LMICs were eligible to participate in site surveys on the availability of screening and treatment for CMDs. We assessed trends over time for 68 sites across 27 LMICs that participated in both surveys.
RESULTS
Among the 238 sites eligible to participate in the 2020 site survey, 227 (95%) participated, and mental health screening and treatment data were available for 223 (98%) sites across 41 countries. A total of 95 sites across 29 LMICs completed the 2016/2017 survey. In 2020, 68% of sites were in urban settings, and 77% were in LMICs. Overall, 50%, 14% and 12% of sites reported screening with a validated instrument for depression, anxiety and PTSD, respectively. Screening plus treatment in the form of counselling was available for depression, anxiety and PTSD at 46%, 13% and 11% of sites, respectively. Screening plus treatment in the form of medication was available for depression, anxiety and PTSD at 36%, 11% and 8% of sites, respectively. Among sites that participated in both surveys, screening for depression was more commonly available in 2020 than 2016/2017 (75% vs. 59%, respectively, p = 0.048).
CONCLUSIONS
Reported availability of screening for depression increased among this group of IeDEA sites in LMICs between 2016/2017 and 2020. However, substantial gaps persist in the availability of mental healthcare at HIV treatment sites across global settings, particularly in resource-constrained settings. Implementation of sustainable strategies to integrate mental health services into HIV care is needed.
Topics: Humans; Acquired Immunodeficiency Syndrome; HIV Infections; Stress Disorders, Post-Traumatic; Anxiety Disorders; Ambulatory Care Facilities
PubMed: 37535703
DOI: 10.1002/jia2.26147 -
The Journal of Adolescent Health :... Apr 2021An adolescent male with persistent conjunctivitis and an episcleral nodule presented with new-onset focal seizures and headaches. The patient was found to have cotton...
An adolescent male with persistent conjunctivitis and an episcleral nodule presented with new-onset focal seizures and headaches. The patient was found to have cotton wool spots and papilledema on retinal examination. He was ultimately diagnosed with HIV retinopathy and AIDS. Ocular manifestations are rare presenting symptoms of AIDS among adolescents in the United States. Ocular disease in pediatric HIV/AIDS patients is most often caused by opportunistic infections. HIV retinopathy, the most common cause of blindness in patients with HIV, is usually a late disease manifestation. It is important for providers caring for adolescents to be aware of the potential ocular manifestations of HIV/AIDS. Teenagers are less likely to be aware of their HIV status and less likely to be tested for HIV, despite high risk exposures, and therefore, universal and routine HIV screening is recommended for all patients.
Topics: Acquired Immunodeficiency Syndrome; Adolescent; Child; Conjunctivitis; Eye Pain; Humans; Male; United States
PubMed: 33280977
DOI: 10.1016/j.jadohealth.2020.10.031 -
Journal of Child Neurology Aug 2015Noninvasive brain stimulation is now an accepted technique that is used as a diagnostic aid and in the treatment of neuropsychiatric disorders in adults, and is being... (Review)
Review
Noninvasive brain stimulation is now an accepted technique that is used as a diagnostic aid and in the treatment of neuropsychiatric disorders in adults, and is being increasingly used in children. In this review, we will discuss the basic principles and safety of one noninvasive brain stimulation method, transcranial magnetic stimulation. Improvements in the spatial accuracy of transcranial magnetic stimulation are described in the context of image-guided transcranial magnetic stimulation. The article describes and provides examples of the current clinical applications of transcranial magnetic stimulation in children as an aid in the diagnosis and treatment of neuropsychiatric disorders and discusses future potential applications. Transcranial magnetic stimulation is a noninvasive tool that is safe for use in children and adolescents for functional mapping and treatment, and for many children it aids in the preoperative evaluation and the risk-benefit decision making.
Topics: Brain Mapping; Humans; Nervous System Diseases; Neurology; Pediatrics; Transcranial Magnetic Stimulation
PubMed: 25342309
DOI: 10.1177/0883073814553274 -
The Pediatric Infectious Disease Journal Mar 2022The World Health Organization (WHO) 2019 antiretroviral treatment guidelines recommend use of optimal treatment regimens in all populations. Dolutegravir-based regimens... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The World Health Organization (WHO) 2019 antiretroviral treatment guidelines recommend use of optimal treatment regimens in all populations. Dolutegravir-based regimens are the preferred first-line and second-line treatment in infants and children with HIV 4 weeks of age and above. There is an urgent need for optimal pediatric formulations of dolutegravir as single-entity (SE) and fixed-dose combination (FDC) to ensure correct dosing and adherence for swallowing and palatability. This article outlines the chronology of dolutegravir pediatric formulation development as granules and conventional and dispersible tablets in a total of 5 pharmacokinetic studies evaluating the relative bioavailability of dolutegravir SE and FDC formulations in healthy adults.
METHODS
The relative bioavailability studies were 2-part, Phase I, open-label, randomized studies in healthy adults. Dolutegravir SE study compared conventional dolutegravir 50 and 25 mg with equivalent conventional 10-mg and dispersible 5-mg tablets, respectively. Subsequently, dolutegravir FDC study compared adult FDC of abacavir/dolutegravir/lamivudine and adult FDC of dolutegravir/lamivudine with their respective pediatric FDC formulations, taken as dispersion immediately or swallowed whole.
RESULTS
As observed in previous studies, dolutegravir administered as dispersion (granules/dispersible tablets) showed relatively higher bioavailability compared with conventional tablets. The bioavailability of dolutegravir dispersible tablets (both SE and FDC) was approximately 1.6-fold higher when compared with conventional tablets. In addition, the bioavailability of abacavir/lamivudine was not impacted by dispersible formulation.
CONCLUSIONS
These studies demonstrate the successful development of pediatric dolutegravir-containing formulations as SE and FDC that permit pediatric dosing in line with WHO recommendations.
Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Adolescent; Adult; Aged; Anti-HIV Agents; Biological Availability; Dideoxynucleosides; Drug Combinations; Heterocyclic Compounds, 3-Ring; Humans; Lamivudine; Middle Aged; Oxazines; Piperazines; Pyridones; Tablets; Young Adult
PubMed: 34817414
DOI: 10.1097/INF.0000000000003366 -
Current Opinion in HIV and AIDS Jul 2016The introduction of effective antiretroviral therapy (ART) has transformed HIV infection from a deadly to a chronic infection. Despite its successes in reducing... (Review)
Review
PURPOSE OF REVIEW
The introduction of effective antiretroviral therapy (ART) has transformed HIV infection from a deadly to a chronic infection. Despite its successes in reducing mortality, ART fails to cure HIV allowing HIV to persist in vivo. HIV persistence under ART is thought to be mediated by a combination of latent infection of long-lived cells, homeostatic proliferation of latently infected cells, anatomic sanctuaries, and low-level virus replication. To understand the contribution of specific cell types and anatomic sites to virus persistence in vivo animal models are necessary.
RECENT FINDINGS
The advancements in ART and our understanding of animal models have facilitated the development of models of HIV persistence in nonhuman primates and mice. Simian immunodeficiency virus (SIV) or simian/HIV infection (SHIV) of rhesus and pigtail macaques followed by effective ART represents the most faithful animal model of HIV persistence. HIV infection of humanized mice also provides a useful model for answering specific questions regarding virus persistence in a uniquely mutable system.
SUMMARY
In this review, we describe the most recent findings using animal models of HIV persistence. We will first describe the important aspects of HIV infection that SIV/SHIV infection of nonhuman primates are able to recapitulate, then we will discuss some recent studies that have used these models to understand viral persistence.
Topics: Animals; Anti-Retroviral Agents; Disease Models, Animal; HIV Infections; Mice, SCID; Primates; Simian Acquired Immunodeficiency Syndrome; Virus Latency
PubMed: 27152962
DOI: 10.1097/COH.0000000000000290 -
Der Anaesthesist May 2017Preclinical pediatric emergencies are rare events and are therefore often associated with stress and uncertainty for emergency medical service personnel. To ensure... (Review)
Review
Preclinical pediatric emergencies are rare events and are therefore often associated with stress and uncertainty for emergency medical service personnel. To ensure adequate treatment of pediatric patients a variety of different cognitive aids exist (e.g. books, apps, rulers, weight-adapted bag systems). Especially the size specifications of the medical equipment and the dosage of emergency medication are individually very different in children and are dependent on parameters, such as body height and weight. Therefore, cognitive aids often enable length measurement whereby it is possible to draw conclusions on body weight for calculating the child's medication dosage. These aids may help to avoid the wrong medication dose or the wrong therapy of children but uncritical and untrained usage of these aids carries a potential risk of mistakes. This recommendation gives an overview of the general requirements and different problems of cognitive aids and should help improve the general framework and the rational basis for the use and further development of cognitive aids in emergency medicine.
Topics: Adolescent; Audiovisual Aids; Body Height; Body Weight; Child; Child, Preschool; Consensus; Emergency Medical Services; Humans; Infant; Infant, Newborn; Medication Errors; Pediatrics; Pharmaceutical Preparations
PubMed: 28455650
DOI: 10.1007/s00101-017-0310-8 -
Journal of Acquired Immune Deficiency... Dec 2022An increasing number of women living with perinatally acquired HIV are reaching adulthood and becoming pregnant. Achieving viral suppression is challenging in this...
BACKGROUND
An increasing number of women living with perinatally acquired HIV are reaching adulthood and becoming pregnant. Achieving viral suppression is challenging in this population frequently exposed to numerous antiretroviral regimens. This study describes the long-term outcomes of pregnant women living with perinatally acquired HIV in Spain.
METHODS
Descriptive, retrospective, multicenter study of the women living with perinatally acquired HIV who gave birth between January 2000 and December 2019 in Madrid. Epidemiological, clinical, and HIV-related data were collected from the first delivery to the end of the study period, including antiretroviral therapy, prevention strategies, and outcomes.
RESULTS
Sixty-three live births in 33 women were included. The mean number of pregnancies per women was 1.9 (range: 1-6). At first delivery, women's median age was 20 years (interquartile range: 18-23), 11 (33.3%) had been previously diagnosed with AIDS and 6 (18%) with mental health disorders. Forty percent became pregnant unsuppressed, whereas 81% achieved viral suppression at delivery. Treatment interruptions were common after delivery, as were losses to follow-up, with no positive effect of pregnancy on retention to care or the immune virological situation. Five women (15%) experienced a new AIDS event, and there were 2 deaths (6%) during follow-up. There was 1 case of mother-to-child transmission in a nonadherent woman in whom preventive measures could not be implemented.
CONCLUSIONS
Pregnancy in this unique population of women living with perinatally acquired HIV poses particular challenges. Specific strategies, including a multidisciplinary approach, are needed to minimize perinatal transmission risks and improve outcomes during the postpartum period.
Topics: Female; Pregnancy; Humans; Adult; Young Adult; Infectious Disease Transmission, Vertical; Pregnancy Outcome; Anti-HIV Agents; Pregnancy Complications, Infectious; HIV Infections; Retrospective Studies; Spain; Acquired Immunodeficiency Syndrome
PubMed: 36215978
DOI: 10.1097/QAI.0000000000003070