Transmitted HIV Resistance Ups Risk of Tx Failure

	Estimados colegas, les dejo esto para su información.
	Transmitted resistance to HIV drugs sharply increases the risk that a patient's first anti-retroviral regimen will fail, researchers reported. In an analysis of more than 10,000 treatment-naive patients, transmitted resistance to at least one drug in the first regimen increased the risk of virological failure by a factor of three, compared with patients with no resistance mutations, according to Linda Wittkop, MD, of the University Bordeaux Segalen in Bordeaux, France, and colleagues. On the other hand, patients who had transmitted resistance but were still placed on a fully active combination therapy were not significantly less likely to fail treatment, Wittkop and colleagues reported online in The Lancet. Action Points   Explain that in a multi-cohort study of over 10,000 patients, transmitted resistance to HIV drugs sharply increases the risk that a patient's first anti-retroviral regimen will fail. Note that in contrast, patients who had transmitted resistance but were still placed on a fully active combination therapy were not significantly less likely to fail treatment. Note that the vast majority of the patients, 90.5%, had no transmitted resistance on baseline testing. The finding confirms recommendations that physicians and patients should choose an initial three-drug treatment regimen after resistance testing, Wittkop and colleagues argued. Drug resistance is a continuing problem in HIV treatment, especially in the context of poor adherence, and if the resistant strains are transmitted, they are known to make treatment difficulty, the researchers noted. But the effect of transmitted drug resistance has not been fully quantified in large numbers of patients, they reported. To help fill the gap, they studied outcomes of 10,056 anti-retroviral-naïve patients who started combination therapy after Jan. 1, 1998, and had at least one sample for a genotypic test taken before the start of treatment. The good news from the so-called EuroCoord-CHAIN study was that the vast majority of the patients -- 90.5% -- had no transmitted resistance, the researchers reported. Another 4.7% had at least one resistance mutation but still got fully active therapy. And 4.8% had at least one mutation and were resistant to at least one of the drugs they were initially given, Wittkop and colleagues reported. For the analysis, virological failure was defined as two consecutive viral loads over 500 copies for HIV RNA per milliliter of blood after six months of treatment, with the date of the first high viral load being the date of failure. The researchers found that the cumulative Kaplan-Meier estimates for virological failure at 12 months were: 4.2% for patients without resistance. 4.7% for those with resistance but still fully active therapy. And 15.1% for those with resistance to at least one of the drugs they were prescribed. In a multivariate analysis, the hazard ratio for virologic failure was 1.47 when the patients who had resistance but active therapy were compared with the patients who had no treatment resistance. However the difference did not reach significance. On the other hand, the hazard ratio for virologic failure was 3.13, with a 95% confidence interval from 2.33 to 4.20, when the patients with resistance to at least one drug in their first regimen were compared with those who had no resistance, the researchers reported. The difference was significant at P<0.0001. While all the samples were taken before treatment started, not all were tested before a regimen was prescribed, the researchers noted, something that might have accounted for some of the sub-optimal regimens. Primary source: The Lancet Infectious Diseases Source reference: Wittkop L, et al "Effect of transmitted drug resistance on virological and immunological response to initial combination antiretroviral therapy for HIV (EuroCoord-CHAIN joint project): A European multicohort study" Lancet Infect Dis 2011; DOI: 10.1016/S1473-3099(11)70032-9.

La mitad de la población masculina podría estar infectada por el virus del papiloma humano

 Estimados colegas, les dejo esta información sobre una ITS de importancia en relación al VIH.

Saludos

Dr. Carlos Erazo

 http://www.jano.es/jano/actualidad/ultimas/noticias/janoes/agencias/mitad/poblacion/masculina/podria/estar/infectada/virus/papiloma/humano/_f-11+iditem-13012+idtabla-1?utm_source=MailingList&utm_medium=email&utm_campaign=Jano+Diario+%2801%2F03%2F2011%29

"Un estudio publicado en “The Lancet” estima que cada año se infecta con el VPH16, causante de cáncer, el 6% de los varones.

Virus del papiloma humano.

Aproximadamente el 50% de los hombres de una muestra de la población general están infectados con el virus del papiloma humano (VPH), según un estudio del Instituto de Investigación y el Centro del Cáncer H. Lee Moffitt (Estados Unidos) que se publica en la edición digital de The Lancet.

 

Cada año, el 6% de los hombres adquirirá una nueva infección por el VPH16, el virus más conocido por causar el cáncer cervical en mujeres y también tumores en varones. Además, tener múltiples parejas, mujeres u hombres, se asocia en los varones a mayores probabilidades de adquirir la infección por el VPH.

 

Sólo en Estados Unidos se estima que 32.000 casos de cáncer en hombres y mujeres en 2009 eran atribuibles a la infección por VPH. Estos cánceres fueron de cuello de útero, vagina, vulva, pene, cavidad oral, cabeza y cuello y canal anal.

 

Las verrugas anogenitales son las consecuencias más comunes de la infección por el VPH. Además de las enfermedades que el VPH causa directamente en los hombres, el virus se transmite de forma directa de hombres a mujeres y afecta en gran medida al riesgo de enfermedad en mujeres. Por este motivo, el conocimiento de la naturaleza del VPH en hombres es crucial para la salud pública y puede utilizarse para determinar si la vacunación en hombres sería rentable.

 

El estudio analizó 1.159 hombres de entre 18 y 70 años de Estados Unidos, Brasil y México que no estaban infectados por el VPH y no tenían antecedentes de cáncer. Estas personas fueron evaluadas cada 6 meses durante una media de más de dos años. La incidencia de una nueva infección genital por VPH con cualquier tipo del virus fue de 38,4 por 1.000 personas al mes.

 

Las probabilidades de cáncer causado por la infección por el VPH fue 2,4 veces mayor en los hombres que tuvieron 50 o más parejas en comparación con no tener ninguna o solamente una; y 2,6 veces mayor en aquellos que tuvieron al menos tres compañeros sexuales anales masculinos en comparación con los que no tenían parejas recientes. La media de duración de la infección por el VIH fue de 7,5 meses en cualquiera de los tipos y 12 meses en el caso del VPH16 causante de cáncer.

 

Los autores concluyen que la incidencia de la infección del VPH genital en varones fue superior y relativamente constante en todos los grupos de edad en Brasil, México y Estados Unidos. “Los resultados del estudio proporcionan datos muy necesarios sobre la incidencia y eliminación de la infección en hombres por el VPH. Estos datos son esenciales para el desarrollo de modelos de rentabilidad realistas para la vacunación masculina por VPH a nivel internacional”, concluyen los autores."

National Black HIV/AIDS

Estimados colegas esta informacion en el CDC me parece importante .
Saludos
Dr. Carlos Erazo

 http://www.cdc.gov/mmwr/pdf/wk/mm6004.pdf

February 7 is National Black HIV/AIDS Awareness Day, an observance intended to raise awareness of the disproportionate impact of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) on the black population in the United States and to encourage prevention measures, such as HIV testing. Estimates of HIV incidence for 2006 indicated that blacks had a rate of 83.7 per 100,000 population, compared with 11.5 for whites (1). Two of the three goals of the National HIV/AIDS Strategy are to reduce new HIV infections and HIV disparities (2).

In 2006, male-to-male sexual contact was associated with an estimated 63% of new HIV infections among black males (3). Among black females, high-risk heterosexual contact was associated with an estimated 83% of new infections (3). Data from CDC’s National HIV Behavioral System show that, in 2008, 59% of HIV-infected black men who have sex with men (MSM) did not know they were infected, compared with 26% of white MSM (4).

Additional information regarding National Black HIV/AIDS Awareness Day is available at http://www.cdc.gov/features/blackhivaidsawareness. Additional information regarding blacks and HIV/AIDS is available at http://www.cdc.gov/hiv/topics/aa/index.htm.
References

Occupational HIV Transmission and Prevention among Health Care Workers

Estimado colega , les dejo este FACT SHEET del CDC sobre la prevención de la transmisión del VIH en trabajadores de la salud.
Saludos
Dr. Carlos Erazo
http://www.cdc.gov/hiv/resources/factsheets/PDF/hcw.pdf

Health care workers should assume that the blood and other body fluids from all patients are potentially infectious.
They should therefore follow infection control precautions at all times.
These precautions include:

• routinely using barriers (such as gloves and/ or goggles) when anticipating contact with blood or body fluids,
• immediately washing hands and other skin surfaces after contact with blood or body fluids, and
• carefully handling and disposing of sharp instruments during and after use.

Seek and treat: HIV update 2011

Estimados colegas dejo aqui otro artículo.
Saludos
Dr. carlos Erazo

http://www.ccjm.org/content/78/2/95.full.pdf+html

Although mortality rates from human immunodeficiency virus (HIV) infection have declined dramatically in the United States, the incidence of new infections has not improved for more than a decade. The case is now strong for routine screening and early treatment of HIV infection to reduce transmission of the infection and to give patients an opportunity to live a reasonably healthy life.
Clinicians in all health care settings should routinely and matter-of-factly test their patients for HIV infection, just as they screen for other diseases.

Using Pre-Exposure Prophylaxis (PrEP) as a Prevention Tool for MSM: The Promise Comes with Challenges

Estimados colegas, este es un nuevo cometario sobre la implementación del PREP , en USA.
Saludos
Dr. Carlos Erazo

http://blog.aids.gov/2011/02/using-pre-exposure-prophylaxis-prep-as-a-prevention-tool-for-msm-the-promise-comes-with-challenge-.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+aids%2Fgov+%28Blog.AIDS.gov%29

By Ronald Valdiserri, M.D., M.P.H, Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services

Dr. Ronald Valdiserri

On Saturday, February 26^th, I attended a day-long meeting organized by the Centers for Disease Control and Prevention (CDC) and hosted by the Fenway Community Health Center in Boston. The theme of the meeting was “Moving forward with PrEP Implementation.” Meeting participants included researchers involved in the original iPrEX study and other ongoing HIV prevention studies, health care providers caring for men-who-have-sex-with-men (MSM), state and local health department program directors, MSM community advocates, policy experts, and federal officials.
The meeting began with a detailed review of the iPrEx study, which included nearly 2,500 participants from Peru, Ecuador, Brazil, Thailand, South Africa, and the United States. Participants were MSM engaging in high-risk sex with other men—including a small number of transgender women who reported high-risk sex with men. The study findings, released in November 2010, showed that sexually active MSM who took a once-daily pill containing 2 anti-HIV drugs were 44% less likely to become infected with HIV, compared with participants who took a placebo.
Because iPrEx was a “blinded” study, participants did not know if they were receiving active drugs or placebos (inactive drugs). As such, all study participants received intensive risk-reduction counseling. Along with this counseling, all study participants also received monthly HIV testing, condom provision, and treatment for other acquired sexually transmitted diseases.
When these results were summarized at the Saturday meeting in Boston, the audience was reminded that the level of protection experienced by study participants who received the active drug varied widely, depending upon how consistently they took their daily pills. For those who took the daily drug at least 90% of the time, HIV risk was reduced by 73%. Others, who took the drug less frequently, had only a 21% reduction in HIV risk. Given this finding, a significant theme of our discussion in Boston was the critical role that adherence counseling must play in any future efforts to develop and implement PrEP programs for MSM.
The U.S. Public Health Service is currently at work on guidelines for PrEP use among MSM. In the meantime, CDC has released interim guidance, as well as a fact sheet on Pre-Exposure Prophylaxis for HIV Prevention (PDF). But, as our meeting in Boston highlighted, there are many critical questions that must be answered before we can move this important prevention research finding from the pages of a scientific journal and into the day-to-day lives of MSM who are at high, ongoing risk for HIV infection. Several of the major questions raised by participants were:

• Among the diverse communities of MSM in the U.S., what subset of men would be the most appropriate candidates for this new prevention tool?
• Given the disproportionate burden of HIV infection among MSM of color—many of whom also live at or near the poverty level—how will daily drug treatments be financed?
• In the real world of competing needs and resource constraints, how should PrEP programs for MSM be combined with other prevention approaches for MSM to result in the greatest pay-off in terms of decreasing new HIV infections?
• How do we build the needed capacity among medical providers, health departments, and community-based organizations so that PrEP can be implemented as part of a comprehensive package of HIV prevention services for MSM at risk for HIV?
• Could PrEP serve as a “gateway” into other equally effective—and perhaps less costly—prevention approaches for MSM?

While everyone at the Boston meeting recognized the promise of this new tool, there was a general consensus that PrEP is not a “magic bullet” and that it should not be viewed as the sole approach to reducing new HIV infections among MSM.
Moving forward with discussions about how to implement PrEP as a new prevention strategy for MSM, let’s keep in mind the necessity of supporting combined biomedical, behavioral, and structural approaches—all of which are called for in the National HIV/AIDS Strategy. Given the ongoing burden of new HIV infections among MSM communities in the United States, we are obliged to carefully examine our current approaches and, when called for, make changes in where and how we deliver our HIV prevention services.

Postpartum changes in plasma viral load and CD4 percentage among HIV-infected women from Latin American and Caribbean countries: the NISDI Perinatal Study

Saludos
Dr. Carlos Erazo
http://www.scielo.br/pdf/mioc/v106n1/16.pdf

The goal of this study was to evaluate changes in plasma human immunodeficiency virus (HIV) RNA concentration [viral load (VL)] and CD4+  percentage (CD4%) during 6-12 weeks postpartum (PP) among HIV-infected women and to assess differences according to the reason for receipt of antiretrovirals (ARVs) during pregnancy [prophylaxis (PR) vs. treatment (TR)]. Data from a prospective cohort of HIV-infected pregnant women (National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study) were analyzed. Women experiencing their first pregnancy who received ARVs for PR (started during pregnancy, stopped PP) or for TR (initiated prior to pregnancy and/or continued PP) were included and were followed PP. Increases in plasma VL  (≥ 0.5 log 10 ) and decreases in CD4% (≥ 20% relative decrease in CD4%) between hospital discharge (HD) and PP were assessed. Of the 1,229 women enrolled, 1,119 met the inclusion criteria (PR: 601; TR: 518). At enrollment, 87%  were asymptomatic. The median CD4% values were: HD [34% (PR); 25% (TR)] and PP [29% (PR); 24% (TR)]. The  VL increases were 60% (PR) and 19% (TR) (p < 0.0001). The CD4% decreases were 36% (PR) and 18% (TR) (p < 0.0001). Women receiving PR were more likely to exhibit an increase in VL [adjusted odds ratio (AOR) 7.7 (95%  CI: 5.5-10.9) and a CD4% decrease (AOR 2.3; 95% CI: 1.6-3.2). Women receiving PR are more likely to have VL increases and CD4% decreases compared to those receiving TR. The clinical implications of these VL and CD4% changes remain to be explored. 

Vertical transmission of HIV-1 in the western region of the State of São Paulo

Saludos colegas
Dr. Carlos Erazo

http://www.scielo.br/pdf/rsbmt/v44n1/02.pdf

ABSTRACT

Introduction: This study aimed to determine the prevalence of vertical HIV-1 transmission  in the western region of the State of São Paulo, Brazil. Methods: The study analyzed the medical records of HIV-1-infected mothers and infant pairs living in the municipalities of São Paulo Regional Health Departments DRS II (Araçatuba) and DRS XI (Presidente Prudente). From March 2001 to March 2006, blood samples were collected and referred to the Molecular Biology Unit of the Adolfo Lutz Institute (ALI), Presidente Prudente. HIV-1-RNA viral load was determined by bDNA assay. Results: The number of births (109/217, 50.2%) and vertical HIV-1 transmissions (6/109, 5.5%) that occurred in DRS II was similar to births (108/217, 49.8%) and vertical transmissions (7/108, 6.5%) in DRS XI (p > 0.05). Although 80% (4/5) of the infected children were male in DRS II, while in DRS XI, 75% (6/8) were female, no differences between sex regarding infected and noninfected children in the regions of Araçatuba and Presidente Prudente were verified. The overall vertical HIV-1 transmission rate was 6%. No consistent reduction in the prevalence of vertical HIV-1 transmission occurred over the years. About 20% of mothers did not know the HIV-1 status 

of their newborns eight months after delivery. Conclusions: In the present study, MTCT prevalence rates were about 70% higher than those previously determined in the State of São Paulo, with no reduction throughout the period. Furthermore, a significant number of mothers did not know the HIV-status of their newborns eight months after delivery

Acceptability of donated breast milk in a resource limited South African setting

Estimados colegas, continuo colocando información en este sitio donde podemos continuar informandonos de lo que existe en cuanto a VIH.

Saludos 

Dr. Carlos Erazo

http://www.internationalbreastfeedingjournal.com/content/pdf/1746-4358-6-3.pdf

Background 

The importance of breast milk for infants’ growth, development and overall health is widely recognized. In situations where women are not able to provide their infants with sufficient amounts of their own breast milk, donor breast milk is the next preferred option. Although there is considerable research on the safety and scientific aspects of donor milk, and the motivations and experiences of donors, there is limited research addressing the attitudes and experiences of the women and families whose infants receive this milk. This study therefore examined attitudes towards donated breast milk among mothers, families and healthcare providers of potential recipient infants.  

Methods 

The study was conducted at a public hospital and nearby clinic in Durban, South Africa. The qualitative data was derived from eight focus group discussions which included four groups with mothers; one with male partners; and one with grandmothers, investigating attitudes towards receiving donated breast milk for infants. There was also one group each with nurses and doctors about their attitudes towards donated breast milk and its use in the hospital. The focus groups were conducted in September and October 2009 and each group had between four and eleven participants, leading to a total of 48 participants. 

Results 

Although breast milk was seen as important to child health there were concerns about undermining of breast milk because of concerns about HIV and marketing and promotion of formula milks. In addition there were concerns about the safety of donor breast milk and discomfort about using another mother’s milk. Participants believed 3 that education on the importance of breast milk and transparency on the processes 

involved in sourcing and preparing donor milk would improve the acceptability.  

Conclusions 

This study has shown that there are obstacles to the acceptability of donor milk, mainly stemming from lack of awareness/familiarity with the processes around donor breast milk and that these could be readily addressed through education. Even the more psychological concerns would also likely be reduced over time as these educational efforts progress. With government and health care worker endorsement and commitment, breast milk donation could have a promising role in improving child health.

The STEP Study Provides a Hint That Vaccine Induction of the Right CD8 1 T Cell Responses Can Facilitate Immune Control of HIV

Estimados colegas , este es un estudio interesante vale la pena leerlo.

Saludos 

Dr. Carlos Erazo

The STEP study was a large, randomized, placebo-controlled, test-of-concept vaccine trial using an Ad5 vector expressing human immunodeficiency virus (HIV)–1 Gag, Pol, and Nef designed to induce T cell immunity to HIV-1. This trial was stopped and unblinded in 2007 after an interim analysis showed that the vaccine did not achieve efficacy for the 2 primary study end points, HIV-1 acquisition and plasma HIV-1 RNA levels 3 months after diagnosis of HIV-1 infection, and suggested that vaccinated individuals with high preexisting antibody titers against Ad5 might be at a higher risk of acquiring HIV-1 infection [1–2]. These results initiated reconsideration in the HIV-1 research field of the role of T cells in protection from HIV-1 infection and disease progression.

http://jid.oxfordjournals.org/content/203/6/753.full.pdf+html

“One Teabag Is Better than Four”: Participants Response to the Discontinuation of 2% PRO2000/5 Microbicide Gel in KwaZulu-Natal, South Africa

Estimados colegas, otro artículo.

Saludos 

Dr. Carlos Erazo

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0014577

Introduction

The Microbicides Development Programme evaluated the safety and effectiveness of 0.5% and 2% PRO2000/5 microbicide gels in reducing the risk of vaginally acquired HIV. In February 2008 the Independent Data Monitoring Committee recommended that evaluation of 2% PRO2000/5 gel be discontinued due to futility. The Africa Centre site systematically collected participant responses to this discontinuation.

Methods

Clinic and field staff completed field reports using ethnographic participant observation techniques. In-depth-interviews and focus group discussions were conducted with participants discontinued from 2% gel. A total of 72 field reports, 12 in-depth-interviews and 3 focus groups with 250 women were completed for this analysis. Retention of discontinued participants was also analysed. Qualitative data was analysed using NVivo 2 and quantitative data using STATA 10.0.

Results

Participants responded initially with fear that discontinuation was due to harm, followed by acceptance after effective messaging, and finally with disappointment. Participants reported that their initial fear was exacerbated by being contacted and advised to visit the clinic for information about the closure. Operational changes were subsequently made to the contact procedures. By incorporating feedback from participants, messages were continuously revised to ensure that information was comprehensible and misconceptions were addressed quickly thereby enabling participants to accept the discontinuation. Participants were disappointed that 2% PRO2000/5 was being excluded as a HIV prevention option, but also that they would no longer have access to gel that improved their sexual relationships with their partners and assisted condom negotiations. In total 238 women were discontinued from gel and 185 (78%) went on to complete their scheduled follow-up period.

Discussion

The use of qualitative social science techniques allowed the site team to amend operational procedures and messaging throughout the discontinuation period. This proved instrumental in ensuring that the discontinuation was successfully completed in a manner that was both understandable and acceptable to participants.

Associação entre violência por parceiro íntimo contra a mulher e infecção por HIV

Estimados colegas , otro artículo interesante.

Saludos

Dr.Carlos Erazo

RESUMO

OBJETIVO: Analisar a associação entre a violência por parceiro íntimo contra mulheres e a infecção ou suspeita de infecção pelo vírus da imunodefi ciência humana (HIV).

MÉTODOS: Estudo transversal com base em dados de questionários aplicados face-a-face e de prontuários médicos de 2.780 mulheres de 15 a 49 anos, atendidas em unidades do sistema único de saúde da Grande São Paulo, SP, em 2001-2002. As mulheres foram categorizadas em: usuárias em tratamento 

por serem “soropositivas para o HIV”, com “suspeita de HIV” e aquelas que procuraram os serviços por outros motivos. A violência por parceiro íntimo contra mulheres na vida foi categorizada por gravidade e recorrência dos episódios de violência. A associação com o desfecho foi testada pelo modelo de Poisson com variância robusta e ajustada por variáveis sociodemográfi cas, sexuais e reprodutivas.

RESULTADOS: A prevalência de violência foi de 59,8%. Sofrer violência reiterada e grave apresentou maior associação de infecção confi rmada pelo HIV (RP = 1,91). A violência independente da gravidade e da recorrência dos episódios apresentou maior associação para a suspeita de infecção por HIV (RP = 1,29). 

CONCLUSÕES: A violência por parceiro íntimo contra mulheres tem papel relevante nas situações de suspeita e confi rmação da infecção pelo HIV, sendo essencial incluir sua detecção, controle e prevenção como parte da atenção integral à saúde das mulheres.

HCV co-infection in HIV positive population in British Columbia, Canada

Estimados colegas este es otro artículo interesante.

Saludos

Dr. Carlos Erazo

http://www.biomedcentral.com/content/pdf/1471-2458-10-225.pdf

Abstract

Background: As HIV and hepatitis C (HCV) share some modes of transmission co-infection is not uncommon. This study used a population-based sample of HIV and HCV tested individuals to determine the prevalence of HIV/HCV coinfection, the sequence of virus diagnoses, and demographic and associated risk factors. Methods: Positive cases of HIV were linked to the combined laboratory database (of negative and positive HCV antibody results) and HCV reported cases in British Columbia (BC).

Results: Of 4,598 HIV cases with personal identifiers, 3,219 (70%) were linked to the combined HCV database, 1,700  (53%) of these were anti-HCV positive. HCV was diagnosed first in 52% of co-infected cases (median time to HIV identification 3 1/2 years). HIV and HCV was diagnosed within a two week window in 26% of cases. Among individuals who were diagnosed with HIV infection at baseline, subsequent diagnoses of HCV infection was independently associated with: i) intravenous drug use (IDU) in males and females, Hazard Ratio (HR) = 6.64 (95% CI: 4.86-9.07) and 9.76 (95% CI: 5.76-16.54) respectively; ii) reported Aboriginal ethnicity in females HR = 2.09 (95% CI: 1.34-3.27) and iii) males not identified as men-who-have-sex-with-men (MSM), HR = 2.99 (95% CI: 2.09-4.27). Identification of HCV first compared to HIV first was independently associated with IDU in males and females OR = 2.83 (95% CI: 1.84-4.37) and 2.25 (95% CI: 1.15-4.39) respectively, but not Aboriginal ethnicity or MSM. HIV was identified first in 22%, with median time to HCV identification of 15 months; Conclusion: The ability to link BC public health and laboratory HIV and HCV information provided a unique opportunity to explore demographic and risk factors associated with HIV/HCV co-infection. Over half of persons with HIV infection who were tested for HCV were anti-HCV positive; half of these had HCV diagnosed first with HIV identification a median 3.5 years later. This highlights the importance of public health follow-up and harm reduction measures for people identified with HCV to prevent subsequent HIV infection.

Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomised controlled trial

Estimados colegas, aqui un artículo interesante en cuanto a la Transmisión materno infantil.
Saludos
Dr. Carlos Erazo


http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-3WBNMWW-7&_user=10&_coverDate=03/06/1999&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1656570567&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=cd7a81cfe38a07a91f1e78f5db2d535c&searchtype=a

DEPOSITO DE INFORMACION SOBRE EL ESTUDIO HSH

http://sites.google.com/site/ecuadorencuestahsh2010/home

Introduction to Biostatistics

Otro curso gratis para poder ingresar lea el silabus que esta en el siguiente link>

http://www.ccghe.jhmi.edu/assets/Biostats_Syllabus2.pdf

Saludos
Dr. Carlos Erazo

Introduction to Research Ethics Distance Education Online Course http://ccghe.org

Introduction to Research Ethics
Distance Education Online Course
http://ccghe.org

Estimados Colegas este curso on line es gratuito, les adjunto el link para que se enteren de este curso y participen los que esten interesados.

Saludos

Dr, Carlos Erazo
http://www.ccghe.jhmi.edu/assets/Research_Ethics_Online_Syllabus.pdf

Resolución sobre la actualización de la Clasificación Internacional Uniforme de Ocupaciones

Estimados colegas, este es el documento  donde se coloca la lista internacional de ocupaciones respaldados por la OIT(Organización Internacional del Trabajo) .
Esta clasificación será la que se utilizará en el nuevo formato de notificación de casos SIDA.

Les dejo el Link para que puedan bajar el pdf de este documento.
Saludos
Dr. Carlos Erazo


http://www.ilo.org/public/spanish/bureau/stat/isco/docs/resol08.pdf

A Surprising Prevention Success: Why Did the HIV Epidemic Decline in Zimbabwe?

 Estimados colegas, miren este artículo intersante realizado en Zimbawe.
Saludos
Dr. Carlos Erazo

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000414

* Existe un creciente reconocimiento de que la prevención primaria, incluyendo el cambio de comportamiento, debe ser central en la lucha contra el VIH / SIDA. Los éxitos anteriores en Tailandia y Uganda no puede ser totalmente relevantes para los países afectados del sur de África.
     * Se realizó una síntesis amplia multi-disciplinario de los datos disponibles sobre las causas de la notable disminución de VIH que se ha producido en Zimbabwe (29% de prevalencia de adultos estimada en 1997 a 16% en 2007), en el contexto de graves sociales, políticos, y económico interrupción.
     * Los cambios de comportamiento asociados con la reducción del VIH, principalmente reducciones en las relaciones sexuales extramaritales, comercial e informal, y las reducciones asociadas en los países socios de concurrencia-parecen haber sido estimulada principalmente por una mayor conciencia de las muertes por SIDA y en segundo lugar por el deterioro económico del país. Estos cambios fueron ayudados probablemente por los programas de prevención de la utilización de los medios de comunicación de masas y basados en la iglesia, el lugar de trabajo y otras actividades de comunicación interpersonal.
     * El enfoque en la reducción de socios, además de promover el uso de preservativos para el sexo casual y otros enfoques basados en la evidencia, es crucial para el desarrollo de programas de prevención más eficaz, especialmente en las regiones con epidemias generalizadas de VIH.

FELIZ DIA DEL MÈDICO

ESTIMADOS COLEGAS BUENOS DIAS, RECIBAN TODOS UNA FRATERNA FELICITACIÓN EN ESTE DÍA INTERNACIONAL DEL MÉDICO.

SALUDOS

DR. CARLOS ERAZO

Pulmonary Disease in HIV

Estimados colegas ,les comparto otro artículo interesante.
Saludos
Dr. Carlos Erazo

"Both infectious and noninfectious pulmonary diseases were more common among HIV-positive patients than among HIV-negative controls.
Potent combination antiretroviral therapy has substantially reduced the incidence of infectious pulmonary complications of HIV infection. In a recent analysis of U.S. veterans, investigators compared the incidence of infectious and noninfectious respiratory illnesses between HIV-positive and HIV-negative individuals.
The study population consisted of 33,000 HIV-positive patients and 67,000 HIV-negative controls matched for demographic characteristics. The median age in the cohort was 45, and 98% of participants were men. A subset analysis indicated that although most participants were past or current smokers, the proportion was significantly higher among HIV-positive patients (80% vs. 76%). Pulmonary diagnoses were identified using ICD-9 codes.
Bacterial pneumonia was by far the most common infectious illness and occurred about five times more frequently in HIV-positive patients than in HIV-negative controls. Chronic obstructive pulmonary disease (COPD), lung cancer, pulmonary hypertension, and pulmonary fibrosis were also significantly more common among HIV-positive patients. All these differences held after adjustment for smoking status. The incidence of asthma was similar between groups.
Comment: The notable finding here is the increased rate of noninfectious pulmonary diseases — particularly COPD — among HIV-positive patients, even after adjustment for smoking status. Whether this increased risk would still be present in a population with a lower rate of smoking is unknown. Regardless, the authors argue that HIV can be considered one of the many contributors to chronic lung disease, and certainly the results provide additional impetus for emphasizing smoking cessation in clinical care."
— Paul E. Sax, MD
Published in Journal Watch HIV/AIDS Clinical Care February 14, 2011

Citation(s):

Crothers K et al. HIV infection and risk for incident pulmonary diseases in the combination antiretroviral therapy era. Am J Respir Crit Care Med 2011 Feb 1; 183:388.

• Original article (Subscription may be required)"

Statins Prevent Vascular Events, Independent of Baseline CRP Levels

Estimados colegas , aqui les dejo un estudio sobre las estatinas y la prevención de eventos vasculares, recordando el manejo integral de las personas que viven con el virus de inmunodeficiencia y el artículo anterior en el que disminuye la progresión de la enfermedad.

Saludos
Dr. Carlos Erazo
http://general-medicine.jwatch.org/cgi/content/full/2011/217/5?q=etoc_jwgenmed

"Contrary to some claims, statins benefited high-risk patients with low C-reactive protein levels.
In the 2008 JUPITER trial, healthy adults — with LDL cholesterol levels <130 mg/dL and C-reactive protein (CRP) levels 2 mg/L — who received rosuvastatin (20 mg daily) for 2 years experienced significantly fewer cardiovascular endpoints than those who received placebo (JW Gen Med Nov 18 2008). JUPITER suggested that statins had particular benefits in patients with high baseline CRP levels whose risk was otherwise low, perhaps through an anti-inflammatory effect.
In the industry-supported Heart Protection Study, >20,000 U.K. adults at high risk for vascular events received simvastatin (40 mg) or placebo daily for a mean of 5 years. Overall, patients who received simvastatin had 24% fewer first vascular events (myocardial infarction, stroke, or revascularization) than those who received placebo.
LDL cholesterol and CRP levels were available for 2727 patients. When these patients were stratified into six groups according to baseline CRP levels (from <1.25 to 8.0 mg/L), vascular risk was significantly lower for simvastatin recipients than for placebo recipients in all groups, with no relation to CRP levels. When patients were categorized as having high or low CRP levels and high or low LDL cholesterol levels at baseline, simvastatin recipients with low CRP and LDL cholesterol levels had proportional reductions in vascular risk that were similar to those in participants with high CRP and LDL cholesterol levels.
Comment: Recent evidence suggests that statins produce similar proportional reductions in vascular events regardless of baseline LDL cholesterol levels, and this study suggests that benefits of statins are independent of baseline CRP levels as well, at least in high-risk patients."
— Bruce Soloway, MD
Published in Journal Watch General Medicine February 17, 2011

Citation(s):

Heart Protection Study Collaborative Group. C-reactive protein concentration and the vascular benefits of statin therapy: An analysis of 20 536 patients in the Heart Protection Study. Lancet 2011 Feb 5; 377:469. (http://dx.doi.org/10.1016/S0140-6736(10)62174-5)

Survival after neuroAIDS Association with antiretroviral CNS Penetration-Effectiveness score

Estimados colegas , aquí otro artículo realcionado con VIH.
Saludos
Dr. Carlos Erazo

http://www.neurology.org/content/76/7/644.abstract

Objective: We examined if the CNS Penetration-Effectiveness (CPE) score of antiretroviral drugs was associated with survival after a diagnosis of HIV-related encephalopathy, progressive multifocal leukoencephalopathy (PML), cerebral toxoplasmosis, or cryptococcal meningitis.

Methods: Using data from the FHDH-ANRS CO4, we compared the survival of 9,932 HIV-infected patients diagnosed with a first neurologic AIDS-defining event in the pre–combination antiretroviral therapy (cART) (1992–1995), early cART (1996–1998), or late cART (1999–2004) periods. Follow-up was subdivided (CPE < 1.5 and CPE ≥ 1.5), and relative rates (RR) of death were estimated using multivariable Poisson regression models.

Results: In the pre-cART and early cART periods, regimens with CPE ≥ 1.5 were associated with lower mortality after HIV-related encephalopathy (RR 0.64; 95% confidence interval [CI] 0.47–0.86 and RR 0.45; 95% CI 0.35–0.58) and after PML (RR 0.79; 95% CI 0.55–1.12 and RR 0.45; 95% CI 0.31–0.65), compared to regimens with CPE < 1.5, while in the late cART period there was no association between the CPE score and the mortality. A higher CPE score was also associated with a lower mortality in all periods after cerebral toxoplasmosis (RR 0.68, 95% CI 0.56–0.84) or cryptococcal meningitis (RR 0.50, 95% CI 0.34–0.74). Whatever the neurologic event, these associations were not maintained after adjustment on updated plasma HIV-RNA (missing, <500, ≥500 copies/mL) with RR ranging from 0.82 (95% CI 0.36–1.91) to 1.02 (0.69–1.52).

Conclusion: At the beginning of the cART era, the CPE score was of importance for survival after severe neurologic event, while in the late cART period, the additional effect of CPE score vanished with more powerful antiretroviral regimens associated with plasma viral load control.

Trial suggests statin may affect markers associated with progression of HIV

 Estimados colegas , aquí un resultado muy interesante sobre las estatinas en el progreso de la infección por VIH.


Saludos
Dr. Carlos Erazo

http://jid.oxfordjournals.org/content/early/2011/01/31/infdis.jiq115.full.pdf+html


A recent multicenter clinical trial of atorvastatin, a type of cholesterol-lowering drug, found that although the drug did not inhibit plasma HIV RNA levels, it did inhibit expression of cellular markers of immune activation and inflammation in patients with HIV infection. Since immune activation and inflammation are associated with progression of HIV infection, the implication is that the statin may inhibit disease progression and help in the infection's management. The findings are in a study, available online, published in The Journal of Infectious Diseases.
The investigators, led by Anuradha Ganesan, MD, of the National Naval Medical Center and the Infectious Disease Clinical Research Program in the Department of Preventive Medicine and Biometrics at the Uniformed Services University of the Health Sciences in Bethesda, Md., randomized 22 HIV-1-infected patients not on antiretroviral therapy and with cholesterol levels lower than those requiring statin therapy in a double-blind protocol of high-dose drug or placebo for eight weeks. After a four-to-six-week washout phase, each group was switched to the other treatment for another eight weeks.
The primary objective was to study the effect of atorvastatin on plasma HIV-1 RNA levels, as previous studies had shown conflicting results. The effect on cellular markers of immune activation was a secondary objective. HIV-1 RNA levels were not significantly affected by the drug, but levels of such immune activation markers as CD38 and HLA-DR on CD4 and CD8 T cells were reduced.
The researchers noted that their findings with atorvastatin suggest that understanding the mechanism by which statins affect immune markers may identify new approaches for the management of HIV infection. They point out, however, that their trial was not designed to demonstrate clinical benefits, for which larger studies of longer duration are needed.
In an accompanying editorial, Andrew Carr, MD, of St. Vincent's Hospital in Sydney, Australia, agreed, noting that "a very large study would probably be required to determine whether potentially positive effects of statin therapy on inflammatory biomarkers will translate into less HIV disease progression."

Fast Facts:

1. Statins show potential to alter the chronic immune activation observed in HIV-1 infected patients.
2. In the study, investigators randomized 22 HIV-1-infected patients not on antiretroviral therapy and with cholesterol levels lower than those requiring statin therapy in a double-blind protocol of high-dose atorvastatin or placebo for eight weeks. After a four-to-six-week washout phase, each group was switched to the other treatment for another eight weeks.
3. HIV-1 RNA levels were not significantly affected by the drug, but levels of such immune activation markers as CD38 and HLA-DR on CD4 and CD8 T cells were reduced.

A Randomized, Placebo-Controlled Trial of Abacavir Intensification in HIV-1–Infected Adults With Virologic Suppression on a Protease Inhibitor–Containing Regimen

HIV Clinical Trials, 01/17/2011

Hammer SM et al. – The strategy of intensification with abacavir in patients who are virologically suppressed on a stable antiretroviral regimen does not confer a clinical or virologic benefit. As antiretroviral regimens have become more potent since this trial was completed, it will be even more difficult to prove that late intensification of already virologically suppressed patients will add benefit. However, studies are warranted with drugs with new mechanisms of action to determine whether the level of persistent viremia below 50 copies/ mL can be further reduced and what influence this may have on latent HIV reservoirs.

http://www.mdlinx.com/family-medicine/sdoc-article.cfm/3448375

Cognitive and psychosocial development of HIV pediatric patients receiving highly active anti-retroviral therapy: a case-control study

Abstract
Background: The psychosocial development of pediatric HIV patients has not been extensively evaluated. The
study objectives were to evaluate whether emotional and social functions are differentially associated with HIVrelated
complications.
Methods: A matched case-control study design was conducted. The case group (n = 20) consisted of vertically
infected children with HIV (aged 3-18 years) receiving HAART in Greece. Each case was matched with two randomly
selected healthy controls from a school-based population. CNS imaging and clinical findings were used to identify
patients with HIV-related neuroimaging abnormalities. The Wechsler Intelligence Scale III and Griffiths Mental Abilities
Scales were applied to assess cognitive abilities. The age specific Strengths and Difficulties Questionnaire was used to
evaluate emotional adjustment and social skills. The Fisher’s exact test, student’s t-test, and Wilcoxon rank sum test
were used to compare categorical, continuous, and ordinal scores, respectively, of the above scales between groups.
Results: HIV patients without neuroimaging abnormalities did not differ from patients with neuroimaging
abnormalities with respect to either age at HAART initiation (p = 0.306) or months of HAART treatment (p = 0.964).
While HIV patients without neuroimaging abnormalities had similar cognitive development with their healthy
peers, patients with neuroimaging abnormalities had lower mean General (p = 0.027) and Practical (p = 0.042)
Intelligence Quotient scores. HIV patients without neuroimaging abnormalities had an increased likelihood of both
Abnormal Emotional Symptoms (p = 0.047) and Hyperactivity scores (p = 0.0009). In contrast, HIV patients with
neuroimaging abnormalities had an increased likelihood of presenting with Abnormal Peer Problems (p = 0.033).
Conclusions: HIV patients without neuroimaging abnormalities are more likely to experience maladjustment with
respect to their emotional and activity spheres, while HIV patients with neuroimaging abnormalities are more likely
to present with compromised social skills. Due to the limited sample size and age distribution of the study
population, further studies should investigate the psychosocial development of pediatric HIV patients following the
disclosure of their condition.

http://www.biomedcentral.com/content/pdf/1471-2431-10-99.pdfhttp://www.biomedcentral.com/content/pdf/1471-2431-10-99.pdf

Markers of atherosclerosis and inflammation and mortality in patients with HIV infection☆

Este es un artículo que nos hace ver la realidad de la atención integral en los pacientes que viven con VIH.

Espero que les sea útil

Saludos 

Dr. Carlos Erazo

http://www.atherosclerosis-journal.com/article/PIIS0021915010009135/abstract?rss=yes

Abstract 

Objective

HIV-infected patients are at increased risk for cardiovascular disease, which may be mediated in part by inflammation. Surrogate marker studies suggest an increased prevalence of vascular abnormalities in HIV infection. We examined the association of all-cause mortality in HIV-infected patients with carotid artery intima-media thickness (cIMT) and high-sensitivity C-reactive protein (hsCRP).

Design and methods

Baseline risk factors, cIMT and hsCRP were prospectively measured in 327 HIV-infected participants. Follow-up time with median of 3.1 years was calculated from baseline to death or censored dated 7/31/07. Cox Proportional Hazards models were used to study risk factors associated with mortality.

Results

Thirty-eight (11.6%) of participants have died since study enrollment. cIMT was significantly higher in those who died and decedents were significantly more likely to have cIMT above the 75th percentile. Those who died had higher hsCRP than those alive and more had hsCRP values above 3mg/L. CD4 count was lower and log10 viral load was higher in decedents, but antiretroviral regimens were similar in both groups. cIMT and hsCRP levels were significantly associated with mortality (HR=2.74, 95% CI 1.26–5.97, p=0.01; HR=2.38, 95% CI 1.15–4.9, p=0.02).

Conclusions

Our study demonstrated a strong association of carotid IMT and hsCRP with all-cause death in this HIV-infected population despite being similar with respect to exposure to antiretroviral medications. Together these surrogate markers may be indices of chronic inflammation and unfavorable outcomes in HIV-positive patients.

Oral Tenofovir/FTC for Pre-Exposure Prophylaxis: The iPrEx Study

In the first-ever efficacy trial of antiretroviral-based pre-exposure prophylaxis, once-daily oral tenofovir significantly reduced the risk for HIV acquisition among men who have sex with men.
The use of antiretroviral therapy (ART) for HIV prevention holds great promise, as demonstrated by two major trials this year: First, the CAPRISA 004 study demonstrated a 39% reduction in the risk for HIV acquisition among women who used a 1% tenofovir vaginal gel both shortly before and shortly after sex (JW AIDS Clin Care Jul 26 2010). Second, a phase II study demonstrated the safety of oral tenofovir monotherapy as pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) (Abstract FRLBC102, AIDS 2010). Now, results are available from iPrEx, the first-ever efficacy trial of ART-based PrEP.
Nearly 2500 HIV-negative MSM in South America, the U.S., Thailand, and South Africa were randomized 1:1 in double-blinded fashion to receive once-daily oral tenofovir/FTC or placebo. Both groups received condoms and intensive counseling regarding sexual risk behavior, and every 4 weeks, underwent rapid enzyme-linked immunosorbent assay (ELISA) testing. All participants were screened and treated for urethral sexually transmitted infections (STIs) and syphilis at study entry, every 24 weeks on-study, and for any clinical suspicion of STIs.
During 3324 person-years of follow-up (median, 1.2 years), 36 incident HIV infections were identified in the tenofovir/FTC group versus 64 in the placebo group, for a relative risk reduction of 44% (95% confidence interval, 15%–63%). As was seen in CAPRISA 004, efficacy was strongly related to product use, with risk reductions as follows:

• 32% (95% CI, –41%–67%) at adherence levels <50%
  
• 50% (95% CI, 18%–70%) at adherence levels 50%
  
• 73% (95% CI, 41%–88%) at adherence levels 90%
  

Adverse events and discontinuations were similar between groups, except for an early excess of nausea and weight loss in the tenofovir/FTC group. Serum creatinine elevations occurred in 25 patients in the tenofovir/FTC group versus 14 in the placebo group (P=0.08); all were resolved upon drug discontinuation. Risk compensation (an increase in high-risk sexual behavior in response to perceived protection from the intervention) was not observed in either treatment group.
Viral set points and CD4-cell counts were similar throughout follow-up between patients who seroconverted in the tenofovir/FTC group and those who did so in the placebo group. No drug resistance was observed among those who seroconverted on-study. A nested case-control analysis indicated that most seroconversions within the tenofovir/FTC group likely occurred when the drug was not detectable in plasma or intracellular compartments.
Comment: Although the overall efficacy of PrEP in this study (44%) is disappointing compared to projected estimates, the results demonstrate proof-of-principle and suggest that greater efficacy is possible with higher adherence levels. Interestingly, the case-control analysis hints that taking the drug shortly before exposure might be more relevant to efficacy than overall adherence levels are. Ongoing trials exploring different preparations, components, and intervals of ART within various at-risk populations will help clarify the optimal use of ART as a prevention tool. In the meantime, decisions about policy around ART as prevention — and about the obligations of research teams to offer PrEP and/or tenofovir-based microbicide gel as part of future prevention trials — just got exponentially more complicated.
— Raphael J. Landovitz, MD
Dr. Landovitz is Assistant Professor, Division of Infectious Diseases, Center for Clinical AIDS Research and Education, University of California, Los Angeles. He reports no conflicts of interest.
Published in Journal Watch HIV/AIDS Clinical Care November 23, 2010

Citation(s):

Grant RM et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010 Nov 23; [e-pub ahead of print]. (http://dx.doi.org/10.1056/NEJMoa1011205)

Michael NL. Oral preexposure prophylaxis for HIV — Another arrow in the quiver? N Engl J Med 2010 Nov 23; [e-pub ahead of print]. (http://dx.doi.org/10.1056/NEJMe1012929)

Interim Guidance: Preexposure Prophylaxis for the Prevention of HIV Infection in Men Who Have Sex with Men

The iPrEx study was conducted in Peru, Ecuador, Brazil, Thailand, South Africa, and the United States. Eligible participants were consenting HIV-uninfected men and male-to-female transgender adults (aged ≥18 years) who reported sex with a man and reported engaging in high-risk sexual behaviors during the preceding 6 months, and had no clinical contraindication to taking a combined formulation of 300 mg TDF and 200 mg FTC (TDF/FTC).*

LINK: http://www.cdc.gov/mmwr/pdf/wk/mm6003.pdf

HIV/AIDS Clinical Care / Guía del CDC para profilaxis pre exposición para HSH

HIV/AIDS Clinical Care

Go to Journal Watch Subscribe My Alerts

HIV/AIDS Clinical Care for February 14, 2011 CLINICAL PRACTICE GUIDELINE WATCH Interim CDC Guidance on Pre-Exposure Prophylaxis for HIV Prevention in MSM Free! February 14, 2011 | Raphael J. Landovitz, MD, MSc In the wake of the iPrEx study, the CDC offers some general guiding principles for the implementation of pre-exposure prophylaxis. Reviewing: Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2011 Jan 28; 60:65 SUMMARY AND COMMENT What's the Best Way to Measure ART Adherence? February 14, 2011 | Keith Henry, MD The matter is neither simple nor settled. Reviewing: McMahon JH et al. Clin Infect Dis 2011 Feb 15; 52:493 SUMMARY AND COMMENT More Evidence that Treatment Interruptions Are Not SMART February 14, 2011 | Yasir Ahmed, MD, and Helmut Albrecht, MD Intermittent antiretroviral therapy results in inferior CD4-cell recovery and increased rates of opportunistic infections and death, compared to continuous therapy. Reviewing: Kaufmann GR et al. AIDS 2011 Feb 20; 25:441 SUMMARY AND COMMENT Not So Fast: Hepatitis B Vaccination in HIV-Infected Patients February 14, 2011 | Rajesh T. Gandhi, MD An accelerated vaccination schedule improves compliance but sacrifices efficacy in those with CD4 counts <500 cells/mm3. Reviewing: de Vries-Sluijs TEMS et al. J Infect Dis 2011 Jan 25; SUMMARY AND COMMENT Pulmonary Disease in HIV February 14, 2011 | Paul E. Sax, MD Both infectious and noninfectious pulmonary diseases were more common among HIV-positive patients than among HIV-negative controls. Reviewing: Crothers K et al. Am J Respir Crit Care Med 2011 Feb 1; 183:388 SUMMARY AND COMMENT Starting and Switching Antiretroviral Therapy in Children February 14, 2011 | Holly Rawizza, MD First-line PI- and NNRTI-based therapies offer equivalent virologic efficacy in children without prior exposure to NNRTIs. However, when failure occurs, an immediate switch is necessary for those on NNRTIs. Reviewing: The PENPACT-1. (PENTA 9/PACTG 390) Study Team. Lancet Infect Dis 2011 Feb 1; SUMMARY AND COMMENT HIV and Stroke February 9, 2011 | Rajesh T. Gandhi, MD The proportion of hospitalized stroke patients who are HIV-infected is increasing; multiple reasons are likely. Reviewing: Ovbiagele B and Nath A. Neurology 2011 Feb 1; 76:444 Free Full-Text Article Clinical Practice Guideline Watch Interim CDC Guidance on Pre-Exposure Prophylaxis for HIV Prevention in MSM In the wake of the iPrEx study, the CDC offers some general guiding principles for the implementation of pre-exposure prophylaxis. The iPrEx study recently demonstrated proof-of-principle for the efficacy of oral chemoprophylaxis in preventing HIV infection among men who have sex with men (MSM). Daily tenofovir/FTC (Truvada) was associated with a 44% reduction in the risk for HIV acquisition, relative to placebo; efficacy was strongly associated with medication adherence (JW AIDS Clin Care Nov 23 2010). These results are tremendously exciting, but many questions remain about the appropriate use of pre-exposure prophylaxis (PrEP) in real-world clinical settings. On January 28, 2011, the CDC offered some interim guidance. The key points are as follows: PrEP should be considered for use only in MSM who are at ongoing high risk for HIV acquisition. PrEP candidates should undergo conventional HIV antibody testing to ensure that they are HIV-negative. Those with signs or symptoms of acute HIV infection should undergo viral-load testing or nucleic acid amplification testing (NAAT). All candidates should be screened for other sexually transmitted infections (STIs) and for hepatitis B. Tenofovir/FTC, dosed at 1 tablet daily, is the only currently recommended PrEP regimen. It should not be used in people with creatinine clearance <60 mL/minute. PrEP should be prescribed for only 3 months at a time, to ensure appropriate follow-up. Every 2 to 3 months, PrEP recipients should receive HIV antibody testing, counseling regarding risk reduction and medication adherence, and assessment for possible signs and symptoms of STIs. STI testing should be conducted every 6 months. Serum creatinine levels should be assessed 3 months after PrEP initiation and then yearly. HIV antibody testing should be performed at discontinuation of PrEP. Comment: These guidelines provide basic recommendations for clinicians who are interested in implementing PrEP based on the data that are currently available. The recommendation for follow-up every 2 to 3 months is clearly a concession to the reality that monthly follow-up (as was done in iPrEx) is unlikely to be feasible or practical outside the research setting. Many prevention experts will also take issue with the instruction to provide baseline viral-load testing and NAAT only to candidates who are clinically symptomatic; in the iPrEx study, investigators inadvertently enrolled 10 individuals with acute HIV infection, presumably because they were asymptomatic. Given the resistance consequences of missing such infection, one could argue that if an individual is at sufficient risk to warrant PrEP intervention, he should be screened at baseline with both HIV antibody testing and viral-load testing or NAAT. Alternatively, the fourth-generation HIV test that involves both antigen and antibody detection could be employed as a compromise between sensitivity and cost for detection of acute infection. More formal PrEP guidelines from the U.S. Department of Health and Human Services and the FDA are eagerly anticipated and are likely to include guidance on the type of provider that should be prescribing PrEP, application to other populations, and longer-term safety follow-up. — Raphael J. Landovitz, MD, MSc Dr. Landovitz is Assistant Professor, Division of Infectious Diseases, Center for Clinical AIDS Research and Education, University of California, Los Angeles. He reports no conflicts of interest. Published in Journal Watch HIV/AIDS Clinical Care February 14, 2011 Citation(s): Centers for Disease Control and Prevention (CDC). Interim guidance: Preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR Morb Mortal Wkly Rep 2011 Jan 28; 60:65. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6003a1.htm) Medline abstract (Free)

Go to Journal Watch Subscribe My Alerts

School: a place for children to learn their HIV status?

Estimados colegas, les dejo otro editorial interesante, la escuela puede ser el lugar donde los niños sepan y aprendan de su estatus serologico.
Saludos
Dr. Carlos Erazo

http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611601839.pdf

"The South African Government has announced that it will soon launch a controversial step in its national campaign to test 15 million people for HIV by June this year. Under the plans, children and adolescents will be off ered voluntary HIV testing and counselling in high schools. The details of the initiative are thin at present. The health department has promised that the campaign will be “professional” and “responsible”; that testing will be done in private spaces on school premises during weekends and school holidays; that it will be phased in; and that extensive monitoring and evaluation will be done. An expert task team has been set up to work on implementation, including the provision of ageappropriate counselling, support, and care, and they will make their recommendations public in due course. The team has a lot to address. Under South African law, children aged 12 years and older can give consent to a HIV test. But how should a health worker determine whether consent provided by a 12-year-old or adolescent is suffi ciently informed? Will those who test positive get access to antiretroviral therapy? How will health workers ensure confi dentiality? Will children be pressured by peers or parents to divulge their test results? Will condoms be given to those who come for testing? And how often will testing be off ered? The task team should also be allowed to consider whether schools are the best place for children to learn their HIV status. Problems in the national HIV testing and counselling campaign, launched last April, also heed a cautionary warning. Monitoring and evaluation of the campaign has been poor and there have been reports of HIVpositive people not being referred for treatment, clinics not complying with national testing and counselling protocols, and anecdotal reports of coercive testing. 18% of young people (15–24 years) in South Africa report having fi rst sex by 15 years, and early sexual debut is associated with increased risk of HIV infection.
Improving access to age-appropriate HIV testing, treatment, and counselling for children and adolescents is, therefore, important. But South Africa must take its time and consider how best to do this, to ensure the campaign does not do more harm than good."  The Lancet

Potential utility of empirical tuberculosis treatment for HIV-infected patients with advanced immunodeficiency in high TB-HIV burden settings [Unresolved issues]

Estimados colegas , aquí les dejo otro artículo interesante sobre la co infección VIH-TB
Saludos 
Dr. Carlos Erazo
http://www.ingentaconnect.com/content/iuatld/ijtld/2011/00000015/00000003/art00002

Authors: Lawn, S.D.¹; Ayles, H.²; Egwaga, S.³; Williams, B.⁴; Mukadi, Y.D.⁵; Santos Filho, E.D.⁶; Godfrey-Faussett, P.⁷; Granich, R.M.⁸; Harries, A.D.⁹

Abstract:
"The human immunodeficiency virus (HIV) and HIV-associated tuberculosis (TB-HIV) epidemics remain uncontrolled in many resource-limited regions, especially in sub-Saharan Africa. The scale of these epidemics requires the consideration of innovative bold interventions and `out-of-the-box' thinking. To this end, a symposium entitled `Controversies in HIV' was held at the 40th Union World Conference on Lung Health in Cancun, Mexico, in December 2009. The first topic debated, entitled `Annual HIV testing and immediate start of antiretroviral therapy for all HIV-infected persons', received much attention at international conferences and in the literature in 2009. The second topic forms the subject of this article. The rationale for the use of empirical TB treatment is premised on the hypothesis that in settings worst affected by the TB-HIV epidemic, a subset of HIV-infected patients have such a high risk of undiagnosed TB and of associated mortality that their prognosis may be improved by immediate initiation of empirical TB treatment used in conjunction with antiretroviral therapy. In addition to morbidity and mortality reduction, additional benefits may include prevention of nosocomial TB transmission and TB preventive effect. Potential adverse consequences, however, may include failure to consider other non-TB diagnoses, drug co-toxicity, compromised treatment adherence, and logistical and resource challenges. There may also be general reluctance among national TB programmes to endorse such a strategy. Following fruitful debate, the conclusion that this strategy should be carefully evaluated in randomised controlled trials was strongly supported. This paper provides an in-depth consideration of this proposed intervention"

Keywords: empirical treatment; tuberculosis; HIV; Africa; mortality