Posts filed under ‘GUIDELINES’

Management of Adult Syphilis

Clinical Infectious Diseases Dec.2011 V.53 N.12 Suppl.3  S110-S128

Khalil G. Ghanem1 and Kimberly A. Workowski2,3

1Johns Hopkins University School of Medicine, Baltimore, Maryland

2National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention

3Emory University, Atlanta, Georgia

There are several important unanswered key questions in the management of adult syphilis. A systematic literature review was conducted and tables of evidence were constructed to answer these important questions. A single dose of 2.4 million units of benzathine penicillin G remains the drug of choice for managing early syphilis. Enhanced antibiotic therapy has not been shown to improve treatment outcomes, regardless of human immunodeficiency virus (HIV) status. Although additional data on the efficacy of azithromycin in treating early syphilis have emerged, reported increases in the prevalence of a mutation associated with azithromycin resistance precludes a recommendation for its routine use. Cerebrospinal fluid (CSF) examination should be performed in all persons with serologic evidence of syphilis infection and neurologic symptoms. In those persons with early syphilis who do not achieve a ≥4-fold serologic decline in their rapid plasma reagin (RPR) titers 6–12 months after adequate therapy and those with late latent infection who do not achieve a similar decline within 12–24 months, CSF examination should be considered. Among HIV-infected persons, CSF examination among all those with asymptomatic late latent syphilis is not recommended owing to lack of evidence that demonstrates clinical benefit. HIV-infected persons with syphilis of any stages whose RPR titers are ≥1:32 and/or whose CD4 cell counts are <350 cells/mm3 may be at increased risk for asymptomatic neurosyphilis. If CSF pleocytosis is evident at initial CSF examination, these examinations should be repeated every 6 months until the cell count is normal. Several important questions regarding the management of syphilis remain unanswered and should be a priority for future research.

PDF

http://cid.oxfordjournals.org/content/53/suppl_3/S110.full.pdf+html

June 29, 2016 at 9:05 am

Sexually Transmitted Diseases in Men Who Have Sex With Men

Clinical Infectious Diseases Dec.2011 V.53 N.12 Suppl.3  S79-S83

Kenneth H. Mayer1,2

1Harvard Medical School, Beth Israel Deaconess Medical Center

2Fenway Institute, Fenway Health, Boston, Massachusetts

Men who have sex with men (MSM) have increased rates of human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs) compared with demographically matched controls. The reasons for the disproportionate infection burden are complex, including biological, behavioral, and sociocultural factors. HIV and syphilis may often be coprevalent among MSM. The use of nucleic acid amplification testing has enhanced the ability to detect frequently asymptomatic gonococcal and chlamydial infections of the rectum and other sites. Lymphogranuloma proctitis outbreaks among MSM were noted in the developed world several years ago but have not been common recently. MSM are at increased risk for viral hepatitis and anal human papillomavirus disease. Preventive interventions include vaccination for the former and anal cytologic screening for the latter. Because of the diverse ways in which MSM may be exposed to STDs, it is essential for clinicians to obtain a thorough sexual history in a culturally competent manner.

PDF

http://cid.oxfordjournals.org/content/53/suppl_3/S79.full.pdf+html

June 29, 2016 at 9:03 am

Sexually Transmitted Infections Among Women Who Have Sex With Women

Clinical Infectious Diseases Dec.2011 V.53 N.12 Suppl.3  S84-S91

Linda M. Gorgos1 and Jeanne M. Marrazzo2

1Infectious Disease Bureau, Public Health Division, New Mexico Department of Health, Santa Fe

2Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle

Women who have sex with women (WSW) are a diverse group with variations in sexual identity, sexual behaviors, sexual practices, and risk behaviors. WSW are at risk of acquiring bacterial, viral, and protozoal sexually transmitted infections (STIs) from current and prior partners, both male and female. Bacterial vaginosis is common among women in general and even more so among women with female partners. WSW should not be presumed to be at low or no risk for STIs based on sexual orientation, and reporting of same-sex behavior by women should not deter providers from considering and performing screening for STIs, including chlamydia, in their clients according to current guidelines. Effective delivery of sexual health services to WSW requires a comprehensive and open discussion of sexual and behavioral risks, beyond sexual identity, between care providers and their female clients.

PDF

http://cid.oxfordjournals.org/content/53/suppl_3/S84.full.pdf+html

June 29, 2016 at 9:01 am

Análisis de costes y de coste/eficacia de las pautas recomendadas por GESIDA/Plan Nacional sobre el Sida en 2015 para el tratamiento antirretroviral inicial en adultos infectados por el VIH

Enf Inf & Microb Clin Junio 2016 V.34 N.6 P.361-71

Juan Berenguer, Antonio Rivero, Antonio Javier Blasco, José Ramón Arribas, Vicente Boix, Bonaventura Clotet, Pere Domingo, Juan González-García, Hernando Knobel, Pablo Lázaro, Juan Carlos López, Josep M. Llibre, Fernando Lozano, José M. Miró, Daniel Podzamczer, Montserrat Tuset, Josep M. Gatell

a Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Madrid, Spain

b Sección de Enfermedades Infecciosas, Hospital Universitario Reina Sofía/IMIBIC, Cordoba, Spain

c Independent Researcher, Madrid, Spain

d Servicio de Medicina Interna, Unidad de VIH, IdiPAZ, Hospital Universitario La Paz, Madrid, Spain

e Unidad de Enfermedades Infecciosas, Hospital General de Alicante, Alicante, Spain

f Fundació Lluita contra la Sida, Unitat VIH, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

g Universitat Autònoma de Barcelona, Barcelona, Spain

h Irsicaixa, UVic, Barcelona, Spain

i Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain

j Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, Spain

k Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain

l Servicio de Enfermedades Infecciosas, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain

m Unidad VIH, Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

n Servicio de Farmacia, Hospital Clínic, Barcelona, Spain

Introducción

El panel de expertos de GESIDA/Plan Nacional del Sida ha recomendado pautas preferentes (PP), pautas alternativas (PA) y otras pautas (OP) para el tratamiento antirretroviral como terapia de inicio en pacientes infectados por VIH para 2015. El objetivo de este estudio es evaluar los costes y la eficiencia de iniciar tratamiento con estas pautas.

Métodos

Evaluación económica de costes y eficiencia (coste/eficacia) mediante construcción de árboles de decisión. Se definió eficacia como la probabilidad de tener carga viral <50 copias/mL en la semana 48 en análisis por intención de tratar. Se definió coste de iniciar tratamiento con una pauta como los costes del tratamiento antirretroviral y de todas sus consecuencias (efectos adversos, cambios de pauta y estudio de resistencias) que se producen en las siguientes 48 semanas. Se utilizó la perspectiva del Sistema Nacional de Salud, considerando solo costes directos diferenciales: tratamiento antirretroviral (a precio oficial), manejo de efectos adversos, estudios de resistencias y determinación de HLA B*5701. El ámbito es España, con costes de 2015. Se realizó análisis de sensibilidad determinista construyendo 3 escenarios para cada pauta: basal, más favorable y más desfavorable.

Resultados

En el escenario basal, los costes de iniciar tratamiento oscilaron entre 4.663 euros para 3TC + LPV/r (OP) y 10.902 euros para TDF/FTC + RAL (PP). La eficacia osciló entre 0,66 para ABC/3TC + ATV/r (PA) y ABC/3TC + LPV/r (OP), y 0,89 para TDF/FTC + DTG (PP) y TDF/FTC/EVG/COBI (PA). La eficiencia, en términos de coste/eficacia, osciló entre 5.280 y 12.836 euros por respondedor a las 48 semanas, para 3TC + LPV/r (OP) y RAL + DRV/r (OP), respectivamente.

Conclusión

La pauta más eficiente fue 3TC + LPV/r (OP). Entre las PP o PA, la pauta más eficiente fue TDF/FTC/RPV (PA). De las PP, la más eficiente fue ABC/3TC + DTG.

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90455073&pident_usuario=0&pcontactid=&pident_revista=28&ty=6&accion=L&origen=zonadelectura&web=www.elsevier.es&lan=en&fichero=28v34n06a90455073pdf001.pdf

June 28, 2016 at 8:25 am

The 2015 Clinical Guidelines for the Treatment and Prevention of Opportunistic Infections in HIV-Infected Koreans: Guidelines for Opportunistic Infections.

Infect Chemother. 2016 Mar;48(1):54-60.

Korean Society for AIDS.

Abstract

The Committee for Clinical Guidelines for the Treatment and Prevention of Opportunistic Infections of the Korean Society for AIDS was founded in 2011. The first edition of the Korean guidelines was published in 2012. The guideline recommendations contain important information for physicians working with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in the clinical field. It has become necessary to revise the guidelines due to new data in this field. These guidelines aim to provide up-to-date, comprehensive information regarding the treatment and prevention of opportunistic infections in HIV-infected Koreans. These guidelines deal with several common opportunistic infections, including pneumocystis pneumonia, tuberculosis, cryptococcal meningitis, etc. A brief summary of the revised guidelines is provided below. Recommendations are rated using the same system used in the previous guidelines.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835437/pdf/ic-48-54.pdf

June 28, 2016 at 8:22 am

Time to HAART Initiation after Diagnosis and Treatment of Opportunistic Infections in Patients with AIDS in Latin America.

PLoS One. 2016 Jun 7;11(6):e0153921.

Crabtree-Ramírez B1, Caro-Vega Y1, Shepherd BE2, Grinsztejn B3, Wolff M4, Cortes CP4, Padgett D5, Carriquiry G6, Fink V7, Jayathilake K8, Person AK8, McGowan C8, Sierra-Madero J1; Caribbean, Central and South America Network for HIV Epidemiology (CCASAnet), of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Program.

Author information

1Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Infectious Diseases Department. Mexico City, Mexico.

2Vanderbilt University, Department of Biostatistics, Nashville, TN, United States of America.

3Instituto Nacional de Infectologia Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil.

4Universidad de Chile- Fundación Arriarán, Santiago, Chile.

5Instituto Hondureño de Seguro Social and Hospital Escuela Universitario, Tegucigalpa, Honduras.

6Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru.

7Fundación Huésped, Investigaciones Clínicas, Buenos Aires, Argentina.

8Vanderbilt University, Department of Medicine, Nashville, TN, United States of America.

Abstract

BACKGROUND:

Since 2009, earlier initiation of highly active antiretroviral therapy (HAART) after an opportunistic infection (OI) has been recommended based on lower risks of death and AIDS-related progression found in clinical trials. Delay in HAART initiation after OIs may be an important barrier for successful outcomes in patients with advanced disease. Timing of HAART initiation after an OI in “real life” settings in Latin America has not been evaluated.

METHODS:

Patients in the Caribbean, Central and South America network for HIV Epidemiology (CCASAnet) ≥18 years of age at enrolment, from 2001-2012 who had an OI before HAART initiation were included. Patients were divided in an early HAART (EH) group (those initiating within 4 weeks of an OI) and a delayed HAART (DH) group (those initiating more than 4 weeks after an OI). All patients with an AIDS-defining OI were included. In patients with more than one OI the first event reported was considered. Calendar trends in the proportion of patients in the EH group (before and after 2009) were estimated by site and for the whole cohort. Factors associated with EH were estimated using multivariable logistic regression models.

RESULTS:

A total of 1457 patients had an OI before HAART initiation and were included in the analysis: 213 from Argentina, 686 from Brazil, 283 from Chile, 119 from Honduras and 156 from Mexico. Most prevalent OI were Tuberculosis (31%), followed by Pneumocystis pneumonia (24%), Invasive Candidiasis (16%) and Toxoplasmosis (9%). Median time from OI to HAART initiation decreased significantly from 5.7 (interquartile range [IQR] 2.8-12.1) weeks before 2009 to 4.3 (IQR 2.0-7.1) after 2009 (p<0.01). Factors associated with starting HAART within 4 weeks of OI diagnosis were lower CD4 count at enrolment (p-<0.001), having a non-tuberculosis OI (p<0.001), study site (p<0.001), and more recent years of OI diagnosis (p<0.001).

DISCUSSION:

The time from diagnosis of an OI to HAART initiation has decreased in Latin America coinciding with the publication of evidence of its benefit. We found important heterogeneity between sites which may reflect differences in clinical practices, local guidelines, and access to HAART. The impact of the timing of HAART initiation after OI on patient survival in this “real life” context needs further evaluation.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896474/pdf/pone.0153921.pdf

June 28, 2016 at 8:19 am

2016-01 Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents

What’s New in the Guidelines?

https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-treatment-guidelines/0

June 28, 2016 at 8:17 am

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