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BMC Medicine Dec 2022Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa...
BACKGROUND
Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15-59 years across SSA.
METHODS
We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units.
RESULTS
We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group.
CONCLUSIONS
As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.
Topics: Male; Female; Adult; Humans; Pregnancy; Adolescent; Young Adult; Middle Aged; HIV; Acquired Immunodeficiency Syndrome; Prevalence; Seroepidemiologic Studies; HIV Infections; Africa South of the Sahara
PubMed: 36529768
DOI: 10.1186/s12916-022-02639-z -
HIV Medicine Sep 2022The European AIDS Clinical Society (EACS) Guidelines were revised in 2021 for the 17th time with updates on all aspects of HIV care.
BACKGROUND
The European AIDS Clinical Society (EACS) Guidelines were revised in 2021 for the 17th time with updates on all aspects of HIV care.
KEY POINTS OF THE GUIDELINES UPDATE
Version 11.0 of the Guidelines recommend six first-line treatment options for antiretroviral treatment (ART)-naïve adults: tenofovir-based backbone plus an unboosted integrase inhibitor or plus doravirine; abacavir/lamivudine plus dolutegravir; or dual therapy with lamivudine or emtricitabine plus dolutegravir. Recommendations on preferred and alternative first-line combinations from birth to adolescence were included in the new paediatric section made with Penta. Long-acting cabotegravir plus rilpivirine was included as a switch option and, along with fostemsavir, was added to all drug-drug interaction (DDI) tables. Four new DDI tables for anti-tuberculosis drugs, anxiolytics, hormone replacement therapy and COVID-19 therapies were introduced, as well as guidance on screening and management of anxiety disorders, transgender health, sexual health for women and menopause. The sections on frailty, obesity and cancer were expanded, and recommendations for the management of people with diabetes and cardiovascular disease risk were revised extensively. Treatment of recently acquired hepatitis C is recommended with ongoing risk behaviour to reduce transmission. Bulevirtide was included as a treatment option for the hepatitis Delta virus. Drug-resistant tuberculosis guidance was adjusted in accordance with the 2020 World Health Organization recommendations. Finally, there is new guidance on COVID-19 management with a focus on continuance of HIV care.
CONCLUSIONS
In 2021, the EACS Guidelines were updated extensively and broadened to include new sections. The recommendations are available as a free app, in interactive web format and as an online pdf.
Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Anti-HIV Agents; Anti-Retroviral Agents; Child; Female; HIV Infections; Humans; Lamivudine; Lipopeptides; COVID-19 Drug Treatment
PubMed: 35338549
DOI: 10.1111/hiv.13268 -
Acta Obstetricia Et Gynecologica... May 2019International guidelines recommend that health-care providers initiate discussions about the impact of treatment on fertility with cancer patients of reproductive age,... (Review)
Review
International guidelines recommend that health-care providers initiate discussions about the impact of treatment on fertility with cancer patients of reproductive age, or with parents/legal guardians of children, as early as possible in the treatment process. Still, both physicians and patients confirm that this is not always the case. This literature review summarizes findings regarding oncologists' and pediatric oncologists' perspectives and challenges of providing fertility preservation care, and points out directions for development. The results concerning the challenges facing clinicians are consistent and encompass both internal and external factors. The internal factors relate to clinicians' characteristics and values and include their knowledge of fertility preservation, clinical experience, perceptions of patients' plans for children, and how comfortable they are to discuss sensitive issues. The external factors relate to the availability of health-care services and the organization of care, including the clinicians' working conditions. Several strategies to overcome identified challenges for clinicians to provide high-quality fertility preservation care are proposed. These include educational interventions to increase clinicians' knowledge about treatment-induced fertility impairment and available fertility preservation measures, as well as interventions aimed to increase clinicians' readiness and competence to communicate with patients and their parents. In addition, different types of educational resources for patients have been suggested to improve patient-provider communication about fertility preservation, such as age-appropriate brochures and decision aids. Organizational approaches suggested to address the identified external factors include development and implementation of policies and guidelines as well as closer collaboration between oncological and fertility clinics. Also, modifications of electronic medical record systems may support clinicians by prompting the documentation of discussions about potential treatment impact on future fertility and about available fertility preservation options. The development and implementation of multifaceted oncofertility programs appears to be a promising way forward towards high-quality fertility preservation care meeting patients' needs.
Topics: Attitude of Health Personnel; Child; Female; Fertility Preservation; Health Services Accessibility; Humans; Medical Oncology; Neoplasms; Pediatrics; Practice Patterns, Physicians'
PubMed: 30714120
DOI: 10.1111/aogs.13551 -
Annual Review of Pharmacology and... Jan 2023Modern antiretroviral therapy safely, potently, and durably suppresses human immunodeficiency virus (HIV) that, if left untreated, predictably causes acquired... (Review)
Review
Modern antiretroviral therapy safely, potently, and durably suppresses human immunodeficiency virus (HIV) that, if left untreated, predictably causes acquired immunodeficiency syndrome (AIDS), which has been responsible for tens of millions of deaths globally since it was described in 1981. In one of the most extraordinary medical success stories in modern times, a combination of pioneering basic science, innovative drug development, and ambitious public health programming resulted in access to lifesaving, safe drugs, taken as an oral tablet daily, for most of the world. However, substantial challenges remain in the fields of prevention, timely access to diagnosis, and treatment, especially in pediatric and adolescent patients. As HIV-positive adults age, treating their comorbidities will require understanding the course of different chronic diseases complicated by HIV-related and antiretroviral toxicities and finding potential treatments. Finally, new long-acting antiretrovirals on the horizon promise exciting new options in both the prevention and treatment fields.
Topics: Adult; Adolescent; Humans; Child; Anti-HIV Agents; HIV Infections; Acquired Immunodeficiency Syndrome
PubMed: 36662580
DOI: 10.1146/annurev-pharmtox-052020-094321 -
Antiviral Therapy Apr 2022The advent of antiretroviral combination therapy has significantly impacted the HIV/AIDS epidemic. No longer a death sentence, HIV infection can be controlled and... (Review)
Review
The advent of antiretroviral combination therapy has significantly impacted the HIV/AIDS epidemic. No longer a death sentence, HIV infection can be controlled and suppressed using cocktail therapies that contain two or more small molecule drugs. This review aims to highlight the discovery, development, and impact of one such molecule, namely, emtricitabine (FTC, emtriva), which is one of the most successful drugs in the fight against HIV/AIDS and has been taken by over 94% of individuals infected with HIV in the USA. We also pay tribute to Dr. John C. Martin, former CEO and Chairman of Gilead Sciences, who unexpectedly passed away in 2021. A true visionary, he was instrumental in delivering FTC, as part of combination therapy with TDF (tenofovir, viread) to the global stage. As the fight to eradicate HIV marches on, we honor Dr. Martin's legacy of collaboration, achievement, and hope.
Topics: Acquired Immunodeficiency Syndrome; Anti-HIV Agents; Emtricitabine; HIV Infections; HIV-1; Humans; Male; Tenofovir
PubMed: 35491570
DOI: 10.1177/13596535211067599 -
Cold Spring Harbor Perspectives in... Mar 2020Both genome sequencing (GS) and exome sequencing (ES) have proven to be revolutionary in the diagnosis of pediatric rare disease. The diagnostic potential and increasing... (Review)
Review
Both genome sequencing (GS) and exome sequencing (ES) have proven to be revolutionary in the diagnosis of pediatric rare disease. The diagnostic potential and increasing affordability make GS and ES more accessible as a routine clinical test in some centers. Herein, I review aspects of rare disease in pediatrics associated with the use of genomic technologies with an emphasis on the benefits and limitations of both ES and GS, complexities of variant classification, and the importance of genetic counseling. Indications for testing, the role of genetic counselors in genomic test selection, and the diagnostic potential of ES and GS in various pediatric multisystem disorders are discussed. The neonatal population represents an important cohort in pediatric rare disease. Rapid ES and GS in critically ill neonates can have an immediate impact on medical management and present unique genetic counseling challenges. This work includes reviews of recommendations for genetic counseling for families considering genome-wide sequencing, and issues of access to genetic counseling that affect clinical use and will necessitate implementation of innovative methods such as online decision aids. Finally, this work will also review the challenges of having a child with a rare disease, the impact of results from ES and GS on these families, and the role of various support agencies.
Topics: Adolescent; Child; Child, Preschool; Databases, Genetic; Genetic Counseling; Genetic Diseases, Inborn; Genetic Testing; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Pediatrics; Practice Guidelines as Topic; Rare Diseases; Exome Sequencing
PubMed: 31501267
DOI: 10.1101/cshperspect.a036632 -
Journal of Infection in Developing... Jul 2021HIV/AIDS and hepatitis B are diseases with major epidemiological and social impacts, with important effects in the dentistry context. This study aimed to compare the...
INTRODUCTION
HIV/AIDS and hepatitis B are diseases with major epidemiological and social impacts, with important effects in the dentistry context. This study aimed to compare the knowledge, presence, and manifestation of discriminatory and stigmatizing acts of dental surgeons, dental assistants, and dental students concerning social representations of HIV/AIDS and hepatitis B.
METHODOLOGY
This cross-sectional, quantitative study was carried out in Brazil with primary health care dental surgeons (n = 219) and dental assistants (n = 152) in 40 municipalities and dental students of a public university (n = 179). The z-test for proportions (p ≤ 0.05) was used for data analysis to compare the three groups.
RESULTS
We found statistically significant differences regarding knowledge about HIV/AIDS and hepatitis B, with a higher percentage of correct answers by dental surgeons (97.7%). Regarding infection, the fear of contracting HIV/AIDS was more representative, whereas hepatitis B was more mentioned concerning the risk of infection. In general, only 30.7% and 42.2% of individuals would accept care from professionals with HIV/AIDS and hepatitis B, respectively; assistants and students had the higher proportion of refusal of care. Also, a higher proportion of assistants (47.4%) believed there are different conducts in the care of patients with HIV and hepatitis B.
CONCLUSIONS
The knowledge of individuals about infectious diseases is still inconsistent, especially among dental assistants and students. Moreover, these groups showed a silent and hidden presence and manifestation of discriminatory and stigmatizing attitudes, with greater representativeness for HIV/AIDS.
Topics: Acquired Immunodeficiency Syndrome; Adult; Aged; Brazil; Cross-Sectional Studies; Dental Assistants; Dentistry; Dentists; Educational Status; Female; HIV Infections; Health Knowledge, Attitudes, Practice; Hepatitis B; Humans; Male; Middle Aged; Students, Dental; Young Adult
PubMed: 34343123
DOI: 10.3855/jidc.12283 -
The Yale Journal of Biology and Medicine Sep 2020S.L. was one of our first HIV-positive babies. He was born at Yale-New Haven Hospital (YNHH) in 1982. His mother was a sex worker who also injected drugs. He died at 3½... (Review)
Review
S.L. was one of our first HIV-positive babies. He was born at Yale-New Haven Hospital (YNHH) in 1982. His mother was a sex worker who also injected drugs. He died at 3½ years following multiple episodes of opportunistic infection and metastatic lymphoma. In the years between 1986 and 1990, 163 HIV-positive mothers gave birth at YNHH. The mother-to-child transmission (MTCT) rate was 20 percent. Women represented 8 percent of all HIV cases in the US compared with 29 percent in New Haven. We had a six times greater proportion of children living with HIV. The mean number of HIV-exposed babies rose annually from 26 (1985-87) to 37 (1988-90). Our first team of caregivers comprised a nurse practitioner, a social worker, and me. We were, in time, joined by a growing number of colleagues. Enlightened and generous hospital administrators provided us with outpatient space and the promise of continued funding to support additional staff and in 1987, an independent Pediatric AIDS Care Program. We implemented the proven MTCT prevention guidelines articulated in the Pediatric AIDS Clinical Trials Group (PACTG) protocol 076 and by 1995, the MTCT rate at YNHH fell to 9 percent. Since 1996, the MTCT rate at YNHH has been zero percent. Combination antiretroviral therapy, cART, made its debut in the mid-1990s; five classes of drugs with multiple agents in each were licensed between 2003 and 2013. We designed individual treatment plans for each child and gradually entered an era when our clinic was populated with healthier long-term survivors. Our Program flourished, based on a multidisciplinary approach which honored interprofessional collaboration.
Topics: Acquired Immunodeficiency Syndrome; Anti-HIV Agents; Child; Epidemics; Female; HIV Infections; Humans; Infant; Infectious Disease Transmission, Vertical; Male; Pregnancy; Pregnancy Complications, Infectious
PubMed: 33005128
DOI: No ID Found -
PLoS Pathogens Nov 2018In this brief review and perspective, we address the question of whether the immune responses that bring about immune control of acute HIV infection are the same as, or... (Review)
Review
In this brief review and perspective, we address the question of whether the immune responses that bring about immune control of acute HIV infection are the same as, or distinct from, those that maintain long-term viral suppression once control of viremia has been achieved. To this end, we describe the natural history of elite and post-treatment control, noting the lack of data regarding what happens acutely. We review the evidence suggesting that the two clinical phenotypes may differ in terms of the mechanisms required to achieve and maintain control, as well as the level of inflammation that persists once a steady state is achieved. We then describe the evidence from longitudinal studies of controllers who fail and studies of biologic sex (male versus female), age (children versus adults), and simian immunodeficiency virus (SIV) (pathogenic/experimental versus nonpathogenic/natural infection). Collectively, these studies demonstrate that the battle between the inflammatory and anti-inflammatory pathways during acute infection has long-term consequences, both for the degree to which control is maintained and the health of the individual. Potent and stringent control of HIV may be required acutely, but once control is established, the chronic inflammatory response can be detrimental. Interventional approaches designed to bring about HIV cure and/or remission should be nuanced accordingly.
Topics: Acquired Immunodeficiency Syndrome; Animals; Antibodies, Neutralizing; Antibodies, Viral; CD8-Positive T-Lymphocytes; Female; HIV Infections; HIV-1; Humans; Macaca mulatta; Male; Simian Acquired Immunodeficiency Syndrome; Simian Immunodeficiency Virus; Viral Load; Viremia
PubMed: 30383857
DOI: 10.1371/journal.ppat.1007222 -
Microbes and Infection Aug 2015
Topics: Acquired Immunodeficiency Syndrome; Developing Countries; Global Health; HIV; Humans; Malaria; Neglected Diseases; Tuberculosis; World Health Organization
PubMed: 26003523
DOI: 10.1016/j.micinf.2015.05.004