Archive for July 4, 2014

The potential impact of HPV-16 reactivation on prevalence in older Australians.

BMC Infect Dis. 2014 Jun 6;14(1):312.

Korostil IA1, Regan DG.

1The Kirby Institute, University of New South Wales, 2052 Sydney, Australia. ikorostil@kirby.unsw.edu.au.

Abstract

BACKGROUND:

Some regional cross-sectional human papillomavirus (HPV) DNA prevalence data show an increase in prevalence in older women, the reasons for which are as yet unknown. A recently published study suggests that the increase may be at least partly due to reactivation of latent HPV in menopausal women.

METHODS:

We developed a dynamic mathematical model of HPV-16 transmission to estimate the key consequences of hypothetical HPV-16 reactivation in the Australian heterosexual population. We only consider a worst case scenario with regard to reactivation in the Australian setting when all women who are latently infected reactivate and, wherever feasible, we choose model parameter values which may lead to a more pronounced reactivation. The ongoing National HPV vaccination program covering both women and men is incorporated in the model.

RESULTS:

We estimate that about 1 in 10 women and men who appear to have cleared HPV-16 infection may be latently infected. The prevalence of HPV-16 in older Australian women will increase by a factor of up to 3.1 between now and 2025 which will be accompanied by an increase by a factor of around 1.9 in older men. However, the long-term impact of the HPV vaccination is not significantly altered by reactivation.

CONCLUSIONS:

If the reactivation hypothesis we consider is substantiated, the public health response should be focused on further improvement of cervical screening coverage for older women. Our study also highlights the urgent need for surveillance of HPV prevalence in older Australians.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061121/pdf/1471-2334-14-312.pdf

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July 4, 2014 at 7:58 pm

Life expectancy living with HIV – Recent estimates and future implications

Current Opinion in Infectious Diseases Feb 2013 V.26 N.1 P.17–25

Nakagawa, Fumiyoa; May, Margaretb; Phillips, Andrewa

aResearch Department of Infection and Population Health, UCL, London

bSchool of Social and Community Medicine, University of Bristol, Bristol, UK

Correspondence to Fumiyo Nakagawa, Research Department of Infection and Population Health, UCL, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK. Tel: +44 207 794 0500 ext. 34684; e-mail: f.nakagawa@ucl.ac.uk

Purpose of review

The life expectancy of people living with HIV has dramatically increased since effective antiretroviral therapy has been available, and still continues to improve. Here, we review the latest literature on estimates of life expectancy and consider the implications for future research.

Recent findings

With timely diagnosis, access to a variety of current drugs and good lifelong adherence, people with recently acquired infections can expect to have a life expectancy which is nearly the same as that of HIV-negative individuals. Modelling studies suggest that life expectancy could improve further if there were increased uptake of HIV testing, better antiretroviral regimens and treatment strategies, and the adoption of healthier lifestyles by those living with HIV. In particular, earlier diagnosis is one of the most important factors associated with better life expectancy. A consequence of improved survival is the increasing number of people with HIV who are aged over 50 years old, and further research into the impact of ageing on HIV-positive people will therefore become crucial. The development of age-specific HIV treatment and management guidelines is now called for.

Summary

Analyses on cohort studies and mathematical modelling studies have been used to estimate life expectancy of those with HIV, providing useful insights of importance to individuals and healthcare planning.

FULL TEXT

http://journals.lww.com/co-infectiousdiseases/Fulltext/2013/02000/Life_expectancy_living_with_HIV___recent_estimates.4.aspx

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July 4, 2014 at 7:55 pm

Clinical aspects of visceral leishmaniasis in HIV infection

Current Opinion in Infectious Diseases Feb 2013 V.26 N.1 P.1–9

Jarvis, Joseph N.a,b; Lockwood, Diana N.a,b

aThe Hospital for Tropical Diseases, University College Hospital

bDepartment of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK

Correspondence to Joseph N. Jarvis, Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London WC1E 6AU, UK. Tel: +44 20 7927 2457; fax: +44 20 7637 4314; e-mail: joejarvis@doctors.net.uk

Purpose of review

HIV infection profoundly impairs the immune mechanisms needed to control and clear Leishmania infection, and outcomes in patients with HIV-associated visceral leishmaniasis are poor.

This review summarizes recent work describing the epidemiology, presentation and outcomes of HIV-associated visceral leishmaniasis and discusses advances in diagnosis and management.

Recent findings

Studies have shown that serological tests can effectively diagnose HIV-associated visceral leishmaniasis, with a sensitivity of 98% if direct agglutination test and rK39 assays are used in combination.

Few data exist to guide treatment recommendations. Observational data show high rates of toxicity and treatment failure with pentavalent antimonials, and their use is no longer recommended.

Liposomal amphotericin B (L-AmB) is better tolerated, but outcomes are suboptimal, with mortality rates of 7–12%, and parasitological failure rates of up to 32%. Initial reports suggest that L-AmB and miltefosine in combination may be effective in HIV-associated visceral leishmaniasis; however, clinical trial data are lacking.

Secondary prophylaxis reduces the rate of relapse, but optimal regimens have not been defined, and optimal timing of antiretroviral therapy initiation in patients with visceral leishmaniasis is unknown.

Summary

Recent studies have demonstrated the inadequacy of current treatments for HIV-associated visceral leishmaniasis. Clinical trials are needed to improve early diagnosis, develop combination therapies and define effective secondary prophylaxis regimens.

FULL TEXT

http://journals.lww.com/co-infectiousdiseases/Fulltext/2013/02000/Clinical_aspects_of_visceral_leishmaniasis_in_HIV.2.aspx

PDF (CLIC on PDF)

 

July 4, 2014 at 7:53 pm


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