Posts filed under ‘Antivirales no HIV’

Editor’s Choice: Hepatitis C Virus Postexposure Prophylaxis in the Healthcare Worker: Why Direct-Acting Antivirals Don’t Change a Thing

Clinical Infectious Diseases January 1, 2017 V.64 N.1 P.92-99

Susanna Naggie, David P. Holland, Mark S. Sulkowski, and David L. Thomas

1Duke Clinical Research Institute

2Duke University School of Medicine, Durham, North Carolina

3Emory University School of Medicine, Atlanta, Georgia

4Johns Hopkins School of Medicine, Baltimore, Maryland

Currently, 380 000–400 000 occupational exposures to blood-borne pathogens occur annually in the United States. The management for occupational HIV or hepatitis B virus exposures includes postexposure prophylaxis (PEP) when necessary; however, PEP is not recommended for hepatitis C virus (HCV) exposures.

Recent approval of HCV direct-acting antivirals (DAAs) has renewed discussions as to whether these therapies could be used to prevent infection after exposure. There are no published studies addressing this question, but the prescribing of DAAs for PEP has been reported.

We will discuss the differences in transmission of the 3 most common blood-borne pathogens, the natural history of early HCV infection, and the scientific rationale for PEP.

In particular, we will discuss how the low feasibility of conducting an adequately powered clinical trial of DAA use for PEP and the low cost-effectiveness of such an intervention is not supportive of targeting limited resources for such use.

PDF

https://cid.oxfordjournals.org/content/64/1/92.full.pdf+html

 

 

Clinical Infectious Diseases January 1, 2017 V.64 N.1 P.100-101

Editor’s Choice: Editorial Commentary: Decision Science at Work: The Case of Hepatitis C Virus Postexposure Prophylaxis

Joshua A. Barocas and Benjamin P. Linas

1Division of Infectious Diseases, Massachusetts General Hospital

2Boston University Schools of Medicine and Public Health

3Boston Medical Center, Massachusetts

In this issue of Clinical Infectious Diseases, Naggie et al discuss clinical decision making and present the results of a decision analysis examining the cost of hepatitis C virus (HCV) postexposure prophylaxis (PEP) among healthcare workers who experience a needlestick exposure to HCV-positive body fluids.

The authors discuss that, in an era when we can cure essentially all HCV infections, there are only 3 motivations for PEP. First, it may make sense to use PEP to prevent infections if doing so would decrease HCV transmission during the period of active HCV viremia. The paper succinctly reviews the evidence and quickly makes clear that among healthcare workers in the United States with a known HCV exposure, basic universal precautions reduce the risk of forward transmission to essentially zero.

A second motivation might be cost. Given that HCV medications are expensive, a shorter course PEP may be cost saving compared with full treatment for HCV infection. To address the possible economic rationale for PEP, the authors developed a decision tree to estimate the costs of PEP for HCV in a hypothetical cohort of 100 healthcare workers who had suffered a needlestick injury. They used the model to compare the outcomes with PEP to those with a strategy of “no PEP and treat only patients who develop chronic HCV infection.”

A few notable assumptions were made—namely, that PEP was 100% effective at preventing infection, while treatment for chronic HCV was only 98% effective with the first line of therapy. In addition, individuals who failed first-line treatment for chronic HCV infection were retreated with 100% . . .

PDF

https://cid.oxfordjournals.org/content/64/1/100.full.pdf+html

August 19, 2017 at 10:30 am

Oseltamivir Use Among Children and Adults Hospitalized With Community-Acquired Pneumonia.

Open Forum Infect Dis. Dec. 27, 2016 V.4 N.1

Oboho IK1,2, Bramley A1, Finelli L1, Fry A1, Ampofo K3, Arnold SR4,5, Self WH6, Williams DJ6, Courtney DM7, Zhu Y6, Anderson EJ8, Grijalva CG6, McCullers JA4,5, Wunderink RG7, Pavia AT3, Edwards KM6, Jain S1.

Author information

1 Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

2 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.

3 University of Utah Health Sciences Center, Salt Lake City.

4 Le Bonheur Children’s Hospital, Memphis, Tennessee.

5 University of Tennessee Health Science Center, Memphis.

6 Vanderbilt University School of Medicine, Nashville, Tennessee.

7 Northwestern University Feinberg School of Medicine, Chicago, Illinois.

8 Emory University School of Medicine, Atlanta, Georgia.

Abstract

BACKGROUND:

Data on oseltamivir treatment among hospitalized community-acquired pneumonia (CAP) patients are limited.

METHODS:

Patients hospitalized with CAP at 6 hospitals during the 2010-2012 influenza seasons were included. We assessed factors associated with oseltamivir treatment using logistic regression.

RESULTS:

Oseltamivir treatment was provided to 89 of 1627 (5%) children (<18 years) and 143 of 1051 (14%) adults. Among those with positive clinician-ordered influenza tests, 39 of 61 (64%) children and 37 of 48 (77%) adults received oseltamivir. Among children, oseltamivir treatment was associated with hospital A (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 1.36-4.88), clinician-ordered testing performed (aOR, 2.44; 95% CI, 1.47-5.19), intensive care unit (ICU) admission (aOR, 2.09; 95% CI, 1.27-3.45), and age ≥2 years (aOR, 1.43; 95% CI, 1.16-1.76). Among adults, oseltamivir treatment was associated with clinician-ordered testing performed (aOR, 8.38; 95% CI, 4.64-15.12), hospitals D and E (aOR, 3.46-5.11; 95% CI, 1.75-11.01), Hispanic ethnicity (aOR, 2.06; 95% CI, 1.18-3.59), and ICU admission (aOR, 2.05; 95% CI, 1.34-3.13).

CONCLUSIONS:

Among patients hospitalized with CAP during influenza season, oseltamivir treatment was moderate overall and associated with clinician-ordered testing, severe illness, and specific hospitals. Increased clinician education is needed to include influenza in the differential diagnosis for hospitalized CAP patients and to test and treat patients empirically if influenza is suspected.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413989/pdf/ofw254.pdf

July 16, 2017 at 11:44 am

New hepatitis C antiviral treatments eliminate the virus

Lancet July 8, 2017 V.390 N.10090

Correspondence

Joseph S Doyle, Alexander J Thompson, Peter Higgs, Mark Stoove, Paul M Dietze, Margaret E Hellard

The Cochrane Collaboration has published a topical systematic review1 and meta-analysis on direct-acting antivirals (DAA) for chronic hepatitis C virus (HCV) infection.

Jakobsen and colleagues1 compared the results of randomised trials of any HCV DAA regimen versus no intervention or placebo.

Their review reported data from 138 trials, which included 25 232 participants and encompassed all drugs on the market or under development.

The authors confirm treatment has a significant benefit (relative risk 0·44, 95% CI 0·37–0·52, p<0·001), compared with no treatment, in the elimination of the virus from the bloodstream, measured 12–24 weeks after treatment (sustained virological response, SVR); however, they conclude there was “insufficient evidence to judge if DAAs have beneficial or harmful effects on other clinical outcomes for chronic HCV” and that although DAAs might increase SVR, “the clinical implication of the results on this non-validated surrogate outcome is unclear”…..

FULL TEXT

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31817-2/fulltext?elsca1=etoc

PDF

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)31817-2.pdf

July 7, 2017 at 8:04 am

Cytomegalovirus (CMV) DNA Quantitation in Bronchoalveolar Lavage Fluid From Hematopoietic Stem Cell Transplant Recipients With CMV Pneumonia

Journal of Infectious Diseases May 15, 2017 V.215 N.10 P.1514-1522

EDITOR’S CHOICE

Michael Boeckh  Terry Stevens-Ayers  Giovanna Travi  Meei-Li Huang  Guang-Shing Cheng Hu Xie  Wendy Leisenring  Veronique Erard  Sachiko Seo  Louise Kimball  …

Background.

Quantitative cytomegalovirus (CMV) DNA–specific polymerase chain reaction (PCR) analysis is widely used as a surveillance method for hematopoietic stem cell transplant (HCT) recipients. However, no CMV DNA threshold exists in bronchoalveolar lavage (BAL) to differentiate pneumonia from pulmonary shedding.

Methods.

We tested archived BAL fluid samples from 132 HCT recipients with CMV pneumonia and 139 controls (100 patients with non-CMV pneumonia, 18 with idiopathic pneumonia syndrome [IPS], and 21 who were asymptomatic) by quantitative CMV and β-globin DNA–specific PCR.

Results.

Patients with CMV pneumonia had higher median viral loads (3.9 log10 IU/mL; interquartile range [IQR], 2.6–6.0 log10 IU/mL) than controls (0 log10 IU/mL [IQR, 0–1.6 log10 IU/mL] for patients with non-CMV pneumonia, 0 log10 IU/mL [IQR, 0–1.6 log10 IU/mL] for patients with IPS, and 1.63 log10 IU/mL [IQR, 0–2.5 log10 IU/mL] for patients who were asymptomatic; P < .001 for all comparisons to patients with CMV pneumonia). Receiver operating characteristic curve analyses and predictive models identified a cutoff CMV DNA level of 500 IU/mL to differentiate between CMV pneumonia and pulmonary shedding, using current CMV pneumonia prevalence figures. However, different levels may be appropriate in settings of very high or low CMV pneumonia prevalence. The presence of pulmonary copathogens, radiographic presentation, or pulmonary hemorrhage did not alter predictive values.

Conclusion.

CMV DNA load in BAL can be used to differentiate CMV pneumonia from pulmonary shedding.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/jid/215/10/10.1093_infdis_jix048/3/jix048.pdf?Expires=1499397143&Signature=ZGqgqbQ9a2uE12bomeqsVGChCW1Y3N54DapASFYI-SwrBn~eaUCXlNiXdKohVR-mw9Lx4NsjrxxqpIuvbiiGy8rpCb0sOLHdUlt8eA-mB7oZe249GgBvS8Oz9pXG-D7qBtEJ3jMI235GXMaYneGNv50wGHU6Nu3jzmffhXrz9GqjXrO5u80MlMtQDeB3DtOQVMl5vF4~dLL4o~OSWN4hI6gwqaR998s1l5iSspqNsU4suq4TmFlwcNLrmBpSA8z8XRVsKsS~7RrBDsGENU5SDxXp1AZmY50mHB3fvKjpnLXPdvQdedi3wHLfereEU5i7PaZ3MBlPz-RvtbGiMXjMUA__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

July 5, 2017 at 10:24 pm

European consensus-based (S2k) Guideline on the Management of Herpes Zoster – guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: TREATMENT.

J Eur Acad Dermatol Venereol. January 2017 V.31 N.1 P.20-29.                        

Werner RN1, Nikkels AF2, Marinović B3, Schäfer M4, Czarnecka-Operacz M5, Agius AM6, Bata-Csörgő Z7, Breuer J8, Girolomoni G9, Gross GE10, Langan S11, Lapid-Gortzak R12, Lesser TH13, Pleyer U14, Sellner J15, Verjans GM16, Wutzler P17, Dressler C1, Erdmann R1, Rosumeck S1, Nast A1.

Author information

1 Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine in Dermatology (dEBM), Charité – Universitätsmedizin Berlin, Berlin, Germany.

2 Department of Dermatology, University Medical Center of Liège, Liège, Belgium.

3 Department of Dermatology and Venereology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.

4 Department of Anesthesiology, Charité – Universitätsmedizin Berlin, Berlin, Germany.

5 Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland.

6 Department of Otorhinolaryngology, The Medical School, University of Malta, Msida, Malta.

7 Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.

8 Division of Infection and Immunity, University College London, London, United Kingdom.

9 Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy.

10 Department of Dermatology and Venerology, Universitätsklinik Rostock, Rostock, Germany.

11 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.

12 Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

13 Department of Otolaryngology, University Hospital Aintree NHS Foundation Trust, Liverpool, UK.

14 Department of Ophthalmology, Charité – Universitätsmedizin Berlin, Berlin, Germany.

15 Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.

16 Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.

17 Department of Virology and Antiviral Therapy, Jena University Hospital, Jena, Germany.

Abstract

Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available.

The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations.

This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction in the incidence of postherpetic neuralgia (PHN) and other complications.

The guideline development followed a structured and pre-defined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument.

The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence-Based Medicine, dEBM).

The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology.

Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects.

The guideline was approved by the commissioning societies after an extensive internal and external review process. In this second part of the guideline, therapeutic interventions have been evaluated.

The expert panel formally consented recommendations for the treatment of patients with HZ (antiviral medication, pain management, local therapy), considering various clinical situations.

Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application.

In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.

PDF

http://onlinelibrary.wiley.com/doi/10.1111/jdv.13957/epdf

 

June 28, 2017 at 8:53 am

2016-11 European consensus – Guideline on the Management of H Zoster – guided by the EDF in cooperation with the EADV, Part 1: DIAGNOSIS

Authors

R.N. Werner, A.F. Nikkels, B. Marinović, M. Schäfer, M. Czarnecka-Operacz, A.M. Agius, Z. Bata-Csörgő, J. Breuer, G. Girolomoni, G.E. Gross, S. Langan, R. Lapid-Gortzak, T.H. Lesser, U. Pleyer, J. Sellner, G.M. Verjans, P. Wutzler, C. Dressler, R. Erdmann, S. Rosumeck, A. Nast

PDF

http://onlinelibrary.wiley.com/doi/10.1111/jdv.13995/full

http://onlinelibrary.wiley.com/doi/10.1111/jdv.13995/epdf

June 28, 2017 at 8:51 am

The Race To Find Antivirals for Zika Virus

Antimicrob. Agents Chemother. June 2017 V.61 N.6

Juan-Carlos Saiz and Miguel A. Martín-Acebes

Department of Biotechnology, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA), Madrid, Spain

Zika virus (ZIKV), a flavivirus transmitted by mosquitoes, was an almost neglected pathogen until its introduction in the Americas in 2015 and its subsequent explosive spread throughout the continent, where it has infected millions of people. The virus has caused social and sanitary alarm, mainly due to its association with severe neurological disorders (Guillain-Barré syndrome and microcephaly in fetuses and newborns). Nowadays, no specific antiviral therapy against ZIKV is available. However, during the past months, a great effort has been made to search for antiviral candidates using different approaches and methodologies, ranging from testing specific compounds with known antiviral activity to the screening of libraries with hundreds of bioactive molecules. The identified antiviral candidates include drugs targeting viral components as well as cellular ones. Here, an updated review of what has been done in this line is presented.

PDF

http://aac.asm.org/content/61/6/e00411-17.full.pdf+html

May 28, 2017 at 4:52 pm

Older Posts


Calendar

August 2017
M T W T F S S
« Jul    
 123456
78910111213
14151617181920
21222324252627
28293031  

Posts by Month

Posts by Category