Posts filed under ‘HIV/SIDA Mujeres’

Disminución del nivel de conciencia, fiebre y disnea en una paciente infectada con HIV.

Revista Argentina de Microbiologia 2014 V.46 N.3 P.271-272

Carta al Editor

Shock séptico con meningitis debido a la bacteriemia por Klebsiella pneumoniae y falla multiorgánica en el contexto de un síndrome de hiperinfección por Strongyloides stercoralis,

PDF

https://www.redalyc.org/pdf/2130/213032482015.pdf

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March 24, 2019 at 5:31 pm

2017-10 European AIDS Clinical Society (EACS). European guidelines for clinical management and treatment of HIV-1-infected adults in Europe 102 pag

Welcome to the EACS Guidelines!

These Guidelines were developed by the European AIDS Clinical Society (EACS), a not-for-profit organisation, whose mission is to promote excellence in standards of care, research and education in HIV infection and related co-infections, and to actively engage in the formulation of public health policy, with the aim of reducing HIV disease burden across Europe.

The EACS Guidelines were first published in 2005, and are currently available in print, online, and as a free App for both iOS and Android devices. The Guidelines are translated to a number of different languages, and are formally revised at least annually for the electronic version and biennially for the printed version. The electronic version can, however, be updated at any given moment if the panels consider it necessary.

The aim of the EACS Guidelines is to provide easily accessible and comprehensive recommendations to clinicians centrally involved in the care of HIV-positive persons.

The EACS Guidelines are covering a relatively large and diverse area geographically, with different national levels of access to care. As a natural consequence, the Guidelines aim to cover a relatively wide range of recommendations as opposed to the often more uniform national guidelines.

The Guidelines consist of five main sections, including a general overview table of all major issues in HIV infection, as well as detailed recommendations on antiretroviral treatment, diagnosis, monitoring and treatment of co-morbidities, co-infections and opportunistic diseases.

Each respective section of the Guidelines is managed by a panel of experienced European HIV experts, and additional experts, where needed. All recommendations are evidence-based whenever possible, and based on expert opinions in the rare instances where adequate evidence is unavailable. It was decided not to provide formal grades of evidence in the Guidelines. The panels make decisions by consensus or by vote when necessary. Yet, it was decided not to publish results of the votes or discrepancies if any.

A list of the main references used to produce the Guidelines is provided as a separate section. Please reference the EACS Guidelines as follows: EACS Guidelines version 9.0, October 2017. Video links to the EACS online course on Clinical Management of HIV are provided throughout the Guidelines, see Video links.

The diagnosis and management of HIV infection and related co-infections, opportunistic diseases and co-morbidities continue to require a multidisciplinary effort for which we hope the 2017 version of the EACS Guidelines will provide you with an easily accessible and updated overview.

All comments to the Guidelines are welcome and can be directed to guidelines@eacsociety.org

We wish to warmly thank all panellists, external experts, linguists, translators, the EACS Secretariat, the Sanford team and everyone else who helped to build up and to publish the EACS Guidelines for their dedicated work.

 

Enjoy!

Manuel Battegay and Lene Ryom – October 2017

PDF

http://www.eacsociety.org/files/guidelines_9.0-english.pdf

March 19, 2019 at 4:00 pm

Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV 332 pag – Department of Health and Human Services – OCTOBER 2018

What’s New in the Guidelines?

(Last updated October 25, 2018; last reviewed October 25, 2018)

Resistance Testing

New information has been added regarding the use of HIV-1 proviral DNA genotypic resistance tests to identify drug resistance mutations, especially in the setting of low-level viremia or when plasma HIV RNA is below the limit of detection. The section now includes a discussion on the benefits and limitations of these tests.

Co-Receptor Tropism Testing

For patients who have undetectable HIV RNA, the Panel now recommends using a proviral DNA tropism assay to assess co-receptor usage before maraviroc is initiated as part of a new regimen.

Dolutegravir and Association with Neural Tube Defects

Preliminary data from Botswana suggest that there is an increased risk of neural tube defects in infants born to women who were receiving dolutegravir (DTG) at the time of conception. In response to these preliminary data, several sections in the Adult and Adolescent Guidelines have been updated to provide guidance for clinicians who are considering the use of DTG or other integrase strand transfer inhibitors (INSTIs) in individuals who are pregnant, or in those of childbearing potential who plan to get pregnant or who are sexually active and not using effective contraception.

The sections that have been updated with this new information include:

  • What to Start
  • Virologic Failure
  • Optimizing Antiretroviral Therapy in the Setting of Viral Suppression (formerly Regimen Switching in the

Setting of   Virologic Suppression)

  • Acute and Recent (Early) HIV-1 Infection
  • Adolescents and Young Adults with HIV
  • Women with HIV

 

What to Start

The following changes have been made to the recommendations for initial antiretroviral (ARV) regimens:

  • Bictegravir/Tenofovir Alafenamide/Emtricitabine (BIC/TAF/FTC): BIC is a new INSTI that is approved by the Food and Drug Administration (FDA) as part of a single-tablet regimen (STR) that also includes TAF and FTC. This regimen is now classified as a Recommended Initial Regimen for Most People with HIV.
  • Elvitegravir/Cobicistat/Emtricitabine with Tenofovir Alafenamide or Tenofovir Disoproxil Fumarate (EVG/c/FTC/TAF or EVG/c/FTC/TDF): These regimens have been moved to the category of Recommended Initial Regimens in Certain Clinical Situations. This change was made because these combinations include cobicistat, a pharmaco-enhancer that inhibits cytochrome P450 3A4 and increases the likelihood of drug-drug interactions. EVG also has a lower barrier to resistance than DTG and BIC.
  • Doravirine (DOR): DOR, a new non-nucleoside reverse transcriptase inhibitor, was recently approved by the FDA and is available as a single-drug tablet and as part of an STR that also includes TDF and lamivudine (3TC). DOR/TDF/3TC and DOR plus TAF/FTC have been added to the category of Recommended Initial Regimens in Certain Clinical Situations.
  • Dolutegravir plus Lamivudine (DTG plus 3TC): This two-drug regimen is now one of the regimens to consider when abacavir, TAF, or TDF cannot be used or are not optimal.
  • A new table, Table 6b, has been added to provide guidance to clinicians who are considering the use of DTG or other INSTIs in those who are pregnant and in those of childbearing potential.
  • Several new tables (Tables 8a–8d) have been added to the sections for the individual drug classes. These tables compare the characteristics of the different drugs within the classes.
  • Updates have been made throughout the section with new safety and clinical trial data.

 

Virologic Failure

  • This section was updated to include newly reported data and new language on recently published clinical trial data for first- line ARV treatment failure.
  • The Panel notes that, in some persons with multidrug-resistant HIV, DTG may be the only treatment option, or one of few treatment options. Accordingly, the language on the use of DTG in those of childbearing potential has been updated. The section now emphasizes that clinicians and patients should discuss the risk of neural tube defects if pregnancy occurs while the patient is taking DTG, as well as the risk of persistent viremia in the patient and the risk of HIV transmission to the fetus if pregnancy occurs while the patient is not on effective ARV therapy. The decision of whether to initiate or continue DTG should be made after carefully considering these risks.
  • Ibalizumab (IBA), a CD4 post-attachment inhibitor, was recently approved for use in persons with multidrug-resistant HIV. A review of the results of a clinical trial on IBA use in this setting has been added to the section.

 

Optimizing Antiretroviral Therapy in the Setting of Viral Suppression

  • The title of this section has been changed from Regimen Switching in the Setting of Virologic Suppression to Optimizing Antiretroviral Therapy in the Setting of Viral Suppression to better reflect the rationale for regimen changes in this setting.

 

  • The Panel emphasizes the importance of reviewing all available resistance test results when constructing a new regimen.
  • The role of HIV-1 proviral DNA genotypic resistance testing in detecting archived drug resistance mutations in the setting of viral suppression is discussed.
  • The Panel recommends performing pregnancy testing for those of childbearing potential before a regimen switch and provides recommendations for INSTI use in these patients.
  • Clinical trial data on the use of several ARV combinations in switch studies are updated and discussed in this section.

 

Exposure-Response Relationship and Therapeutic Drug Monitoring Section

  • This section has been removed from the guidelines.
  • The subsection regarding the role of therapeutic drug monitoring in managing drug-drug interactions has been moved to the Drug-Drug Interactions section of the guidelines.

 

Additional Updates

Various tables in the guidelines have been updated with new data, as well as information related to BIC and DOR.

 

  • Hepatitis C Virus/HIV Coinfection
  • Adverse Effects of Antiretroviral Agents
  • Monthly Average Prices of Commonly Used Antiretroviral Drugs
  • Drug-Drug Interactions
  • Appendix B Tables: Characteristics of Antiretroviral Drugs and Antiretroviral Dosing Recommendations in

Patients with   Renal and Hepatic Insufficiency

 

PDF

https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf

 

March 19, 2019 at 3:47 pm

Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States.   January 4, 2019. 366 pag

Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States.   January 4, 2019.  366 pag

Developed by the HHS Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission – A Working Group of the Office of AIDS Research Advisory Council (OARAC)

What’s New in the Guidelines

Text, references, and appendices were updated to include new data and publications where relevant.

The sections that address infant feeding now include links to a new section that was added on March 27, 2018, titled Guidance for Counseling and Managing Women Living with HIV in the United States Who Desire to Breastfeed.

Major content changes are summarized below; all changes are highlighted throughout the guidelines.

PDF

http://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf

January 8, 2019 at 8:08 am

Increased Risk of HIV Acquisition Among Women Throughout Pregnancy and During the Postpartum Period: A Prospective Per-Coital-Act Analysis Among Women With HIV-Infected Partners

The Journal of Infectious Diseases July 1, 2018 V.218 N.1 P.16-25

EDITOR’S CHOICE

Kerry A Thomson; James Hughes; Jared M Baeten; Grace John-Stewart; Connie Celum

The risk of human immunodeficiency virus type 1 (HIV-1) acquisition by women per condomless sex act was 3-fold and 4-fold higher during late pregnancy and the postpartum period, respectively, relative to the nonpregnant period. Enhanced HIV-1 prevention and testing strategies are needed during pregnancy and the postpartum period.

FULL TEXT

https://academic.oup.com/jid/article/218/1/16/4915924

PDF (CLIC en PDF)

August 13, 2018 at 6:16 pm

Risk of HIV Acquisition During Pregnancy and Postpartum: A Call for Action

The Journal of Infectious Diseases July 1, 2018 V.218 N.1 P.1-4

EDITOR’S CHOICE

Lynne M Mofenson

Prospective studies exploring the relationship between pregnancy and HIV acquisition in women have had inconsistent results, with some studies documenting an increased risk [1–3], while others finding no increase in risk — or even lower risk — after controlling for sexual behavior and other confounding factors such as sexually transmitted infections [4–7]. A meta-analysis of 19 cohort studies estimated a pooled HIV incidence during pregnancy and postpartum of 3.9 per 100 person-years (4.7 per 100 person-years during pregnancy and 2.9 per 100 person-years postpartum) [8], similar to that defined as “substantial risk” in nonpregnant individuals, such as female sex workers, by the World Health Organization (WHO) [9]. The pooled meta-analysis reported that HIV incidence was not significantly higher among pregnant or postpartum women than among nonpregnant/nonpostpartum women, but only 5 studies had appropriate data and were not able to control for a variety of confounding factors, limiting the power to detect associations…

FULL TEXT

https://academic.oup.com/jid/article/218/1/1/4913312

PDF (CLIC en PDF)

August 13, 2018 at 6:15 pm

Protecting Mothers and Babies — A Delicate Balancing Act

N Engl J of Medicine July 24, 2018

PERSEPCTIVE

Protecting Mothers and Babies — A Delicate Balancing Act

S.A. Rasmussen, W. Barfield, and M.A. Honein

More than 50 years ago, an epidemic of serious birth defects caused by prenatal exposure to thalidomide shattered the prevailing notion that the placenta served as a barrier against damaging influences and led to recognition that exposures during pregnancy can result in harm to a developing fetus. Since that time, ensuring that a pregnant woman has access to potentially lifesaving treatments while safeguarding her fetus has become a delicate balancing act, one that requires a careful evaluation of risks and benefits to both the mother and her fetus…

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp1809688?query=RP

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp1809688

 

 

 

N Engl J of Medicine July 24, 2018

CORRESPONDENCE

Neural-Tube Defects with Dolutegravir Treatment from the Time of Conception

  1. Zash, J. Makhema, and R.L. Shapiro

Since August 2014, the Botswana Harvard AIDS Institute Partnership has conducted birth outcome surveillance at eight government hospitals throughout Botswana. A primary ongoing aim of the surveillance is to evaluate the prevalence of neural-tube defects associated with exposure to antiretroviral drugs from the time of conception (the risk period for neural-tube defects ends approximately 28 days after conception). At each site, trained government midwives perform surface examinations of consecutive live-born and stillborn infants who are born in the hospital to women infected with human immunodeficiency virus (HIV) and to women without HIV infection. As part of …

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMc1807653?query=RP

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMc1807653

July 24, 2018 at 11:44 am

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