Archive for January, 2008

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents 2008

January 29, 2008

Developed by the DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents – A Working Group of the Offi ce of AIDS Research Advisory Council (OARAC)

What’s New in the Document?

The following changes have been made to several sections of the December 1, 2007 version of the guidelines.

What to Start: Initial Combination Regimens for the Antiretroviral-Naïve Patient?

The Panel revised its recommendations for several “preferred” and “alternative” antiretroviral components for treatment-naïve patients:

– “Abacavir + lamivudine” has been changed from “alternative” to “preferred” 2-NRTI component in patients who have tested negative for HLA-B*5701 (AII).
– “Zidovudine + lamivudine” has been changed from “preferred” to “alternative” 2-NRTI component (BII).
– “Ritonavir-boosted saquinavir” has been changed from a PI-option that was considered as “Acceptable as initial antiretroviral components but inferior to preferred or alternative components” to an “alternative” PI component (BII).
– The following options are no longer recommended as components for initial therapy in treatment-naïve patients:

o Nelfinavir as PI component
o Stavudine + lamivudine as 2-NRTI components
o Abacavir + zidovudine + lamivudine as a triple-NRTI combination regimen

A new topic entitled “Other Treatment Options Under Investigation: Insufficient Data to Recommend” has been added, which includes a review of recent clinical trial data in treatment-naïve patients for ritonavir-boosted darunavirbased regimens, maraviroc-based regimens, and raltegravir-based regimens.

Treatment Interruption

This section has been updated with recent data on short-term and long-term treatment interruption. The Panel reaffirms our recommendation that aside from unplanned or planned short-term interruption due to illnesses precluding oral therapy or toxicities, long-term treatment interruption is not recommended unless in the context of a clinical trial (DI).

Acute HIV Infection

• A new table on “Identifying, diagnosing, and managing acute HIV-1 infection” has replaced the table on “Associated signs and symptoms of acute retroviral syndrome and percentage of expected frequency”.
• The Panel also recommends that since clinically significant resistance to PIs is less common than resistance to NNRTIs in antiretroviral-naïve persons who harbor drug resistant virus, if therapy is initiated before drug resistance test results are available, consideration should be given to using a PI-based regimen (BIII).

Mycobacterium Tuberculosis Disease or Latent Tuberculosis Infection with HIV Coinfection

This section has been updated with the following information:

• Discussions and recommendations on the timing of initiation of antiretroviral therapy in patients with active tuberculosis (TB), with emphasis on the risks and benefits of concomitant therapy related to overlapping toxicities, drug interactions, CD4 cell counts, and potential for immune reconstitution inflammatory syndrome.
• Recommendation for repeat testing to detect latent TB infection in persons who had CD4 count <200 cells/mm3 and have tested negative prior to antiretroviral therapy and have improved CD4 count to >200 cells/mm3 (BII).

Table Updates:

• Various tables have been updated to include information regarding etravirine, updates on various antiretroviral drugs, as well as new atazanavir dosing recommendations when used in combination with proton pump inhibitors or H2 receptor antagonists.
• The following tables have been removed from the document:
o “Antiretroviral components that are acceptable as initial antiretroviral components but are inferior to preferred or alternative components”; and
o “Treatment outcome of selected clinical trials of combination antiretroviral regimens in treatment-naïve patients with 48-week follow-up data”.

FREE Full Text (en PDF)
http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf

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January 30, 2008 at 2:52 pm Leave a comment

Evolution and pathogenesis of Staphylococcus aureus: lessons learned from genotyping and comparative genomics

Microbiology Reviews  Jan 2008  V.32  N.1  p.23-37 

REVIEW ARTICLE

Ye Feng1,21James D. Watson Institute of Genome Sciences, Zhejiang University, Hangzhou, China; 2Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China; and , Chih-Jung Chen33Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, Lin-Hui Su33Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, Songnian Hu1,21James D. Watson Institute of Genome Sciences, Zhejiang University, Hangzhou, China; 2Beijing Institute of enomics, Chinese Academy of Sciences, Beijing, China; and , Jun Yu1,21James D. Watson Institute of Genome Sciences, Zhejiang University, Hangzhou, China; 2Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China; and & Cheng-Hsun Chiu33Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan1James D. Watson Institute of Genome Sciences, Zhejiang University, Hangzhou, China; 2Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China; and 3Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

abstract
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1574-6976.2007.00086.x

January 30, 2008 at 2:49 pm Leave a comment

Preventing Hospital-Acquired Urinary Tract Infection in the United States: A National Study

Clinical Infectious Diseases  15 Jan 2008  V.46  N.2  p.243–250

Sanjay Saint,1,2,3 Christine P. Kowalski,1 Samuel R. Kaufman,2,3 Timothy P. Hofer,1,2,3 Carol A. Kauffman,1,2 Russell N. Olmsted,5 Jane Forman,1 Jane Banaszak-Holl,4 Laura Damschroder,1,2 and Sarah L. Krein1,2

1Veterans Affairs Ann Arbor Healthcare System, 2Department of Internal Medicine, University of Michigan Medical School, 3Veterans Affairs/University of Michigan Patient Safety Enhancement Program, 4University of Michigan School of Public Health, and 5Saint Joseph Mercy Health Care System, Ann Arbor, Michigan

abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/524662

January 30, 2008 at 2:47 pm Leave a comment

Emergence of Coagulase-Negative Staphylococci as a Cause of Native Valve Endocarditis

Clinical Infectious Diseases  15 Jan 2008  V.46  N.2  p.232–242

Vivian H. Chu,1,2 Christopher W. Woods,1,3 Jose M. Miro,5 Bruno Hoen,7 Christopher H. Cabell,1,2  Paul. A. Pappas,2 Jerome Federspiel,1 Eugene Athan,9 Martin E. Stryjewski,2,11 Francisco Nacinovich,12 Francesc Marco,5 Donald P. Levine,4 Tom S. Elliott,13 Claudio Q. Fortes,14 Pilar Tornos,6 David L. Gordon,10 Riccardo Utili,15 Francois Delahaye,8 G. Ralph Corey,1,2 and Vance G. Fowler, Jr.,1,2 for the International Collaboration on Endocarditis–Prospective Cohort Study Groupa

1Duke University Medical Center, 2Duke Clinical Research Institute, and 3Veterans Administration Medical Center, Durham, North Carolina; 4Wayne State University, Detroit, Michigan; 5Hospital Clinic Institut d’Investigacions Biomèdiques, August Pi i Sunyer–University of Barcelona, and 6Hospital Universitari Vall d’Hebron, Barcelona, Spain; 7Hôpital Saint-Jacques, Besançon, and 8Hôpital Louis Pradel, Bron Cedex, France; 9Barwon Health, Geelong, and 10Flinders Medical Center, Adelaide, Australia;11Centro de Educación Médica e Investigaciones Clínicas and 12Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina; 13Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom; 14Hospital Universitario Clementino Fraga Filho, Rio de Janiero, Brazil; and 15Second University of Naples, Naples, Italy

abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/524666

January 30, 2008 at 2:45 pm Leave a comment

Influence of Vancomycin Minimum Inhibitory Concentration on the Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia

Clinical Infectious Diseases  15 Jan 2008  V.46  N.2  p.193–200

Alex Soriano,1 Francesc Marco,2 José A. Martínez,1 Elena Pisos,1 Manel Almela,2 Veselka P. Dimova,2 Dolores Alamo,2 Mar Ortega,1 Josefina Lopez,1 and Josep Mensa1

Departments of 1Infectious Diseases and 2Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain

abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/524667

January 30, 2008 at 2:42 pm Leave a comment

Knowledge and Practices of Obstetricians and Gynecologists Regarding Cytomegalovirus Infection During Pregnancy — United States, 2007

MMWR Weekly  25 Jan 2008  V.57  N.3  p.65-68

FREE Full Text
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5703a2.htm?s_cid=mm5703a2_e

January 25, 2008 at 2:21 pm Leave a comment

Sigma factors in Pseudomonas aeruginosa

Microbiology Reviews  Jan 2008  V.32  N.1  p.38-55 

REVIEW ARTICLE

Eric Potvin11Centre de Recherche sur la Fonction, Structure et Ingénierie des Protéines, Faculté de Médecine, Pavillon Charles-Eugène Marchand, Université Laval, QC, Canada, François Sanschagrin11Centre de Recherche sur la Fonction, Structure et Ingénierie des Protéines, Faculté de Médecine, Pavillon Charles-Eugène Marchand, Université Laval, QC, Canada & Roger C. Levesque11Centre de Recherche sur la Fonction, Structure et Ingénierie des Protéines, Faculté de Médecine, Pavillon Charles-Eugène Marchand, Université Laval, QC, Canada1Centre de Recherche sur la Fonction, Structure et Ingénierie des Protéines, Faculté de Médecine, Pavillon Charles-Eugène Marchand, Université Laval, QC, Canada

abstract
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1574-6976.2007.00092.x

January 25, 2008 at 2:19 pm Leave a comment

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