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Carrillo I, López de Las Heras M, Martínez SC, Prieto-Pérez L, Álvarez Álvarez B, Waleed Al-Hayani A, Suarez-Inclan JI, Fernandez SL, Luengo PQ, Diaz MEA, Bernal Palacios M, Mathews PA, Bonafont BS, Bravo Ruiz R, Hernández-Segurado M, Górgolas M, Cabello A. Characteristics and rates of infection by HIV in people receiving non-occupational post-exposure prophylaxis (nPEP) against HIV. Sex Transm Infect 2024; 100:231-235. [PMID: 38744451 DOI: 10.1136/sextrans-2024-056109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/20/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION/OBJECTIVES The use of non-occupational post-exposure prophylaxis (nPEP) emerges as a strategic intervention to reduce HIV infection risk following sexual encounters in our setting. Notwithstanding, there is a scarcity of contemporary data regarding adherence to this treatment, its effectiveness and tolerance. Our study aims to delve into these factors among individuals who have resorted to nPEP after high-risk sexual encounters. METHODS We conducted a retrospective observational study of cases administered nPEP for HIV from 1 January 2018 to 31 December 2021 at a tertiary hospital in Madrid. The study included all adults over 18 years who sought care at the emergency department of the Fundación Jiménez Díaz Hospital following a risky sexual encounter and were subsequently recommended HIV nPEP treatment. RESULTS 878 individuals received nPEP for HIV and underwent initial serological tests. Of these, 621 had comprehensive follow-ups. The prescribed regimen for all was raltegravir (RAL) 1200 mg combined with tenofovir/emtricitabine (TDF/FTC) 245/200 mg daily for 28 days. The study revealed a 1.1% rate (n=10) of previously undetected infection and a 0.16% (n=1) failure rate of nPEP. Regarding regimen tolerability, 5.6% (n=35) experienced symptoms linked to the treatment, yet none necessitated discontinuation of the regimen. On the contrary, six per cent (n=53) reported symptoms consistent with an STI during one of the medical visits; specifically, 4.4% had urethritis, and 1.6% had proctitis. CONCLUSION nPEP with RAL/TDF/FTC demonstrates high efficacy and safety, contingent on proper adherence. There is an observed increase in STI prevalence in this cohort, with nearly half of the participants not engaging in appropriate follow-up after initiating nPEP.
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Affiliation(s)
- Irene Carrillo
- Medicina interna, Hospital Universitario Fundación Jiménez Díaz, Madrid, Madrid, Spain
| | | | | | - Laura Prieto-Pérez
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Beatriz Álvarez Álvarez
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Raquel Bravo Ruiz
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Madrid, Spain
| | | | - Miguel Górgolas
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alfonso Cabello
- Division of Infectious Diseases, Fundación Jiménez Díaz, Madrid, Madrid, Spain
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Liu S, Yuan D, Zhou Y, Fu G, Wang B. Adherence, adverse drug reactions, and discontinuation associated with adverse drug reactions of HIV post-exposure prophylaxis: a meta-analysis based on cohort studies. Ann Med 2023; 55:2288309. [PMID: 38065681 PMCID: PMC10836249 DOI: 10.1080/07853890.2023.2288309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Objective: Evaluate the profiles of post-exposure prophylaxis (PEP) adherence, adverse drug reactions (ADRs), and discontinuation associated with ADRs to provide information for further PEP program improvement and increase adherence to PEP.Methods: The Web of Science, PubMed, Embase, and the Cochrane Library were searched for cohort studies reporting data related to PEP adherence or ADRs (PROSPERO, CRD42022385073). Pooled estimates of adherence, the incidence of ADRs and discontinuation associated with ADRs, and their 95% confidence intervals (CI) were calculated separately for the included literature using random effects models. For substantial heterogeneity, meta-regression and subgroup analyses were conducted to explore sources of heterogeneity.Results: Overall adherence was 58.4% (95% CI: 50.9%-65.8%), with subgroup analysis showing differences in adherence across samples, with the highest adherence among men who had sex with men (MSM) (72.4%, 95% CI: 63.4%-81.3%) and the lowest adherence among survivors of sexual assault (SAs) (41.7%, 95% CI: 28.0%-55.3%). The incidence of ADRs was 60.3% (95% CI: 50.3%-70.3%), and the prevalence of PEP discontinuation associated with ADRs was 32.7% (95% CI: 23.7%-41.7%), with subgroup analyses revealing disparities in the prevalence of discontinuation associated with ADRs among samples with different drug regimens. Time trend analysis showed a slight downward trend in the incidence of ADRs and PEP discontinuation associated with ADRs.Conclusion: Adherence to PEP was less than 60% across samples, however, there was significant heterogeneity depending on the samples. SAs had the lowest adherence and the highest incidence of PEP discontinuation. Ongoing adherence education for participants, timely monitoring, and management of ADRs may improve adherence.
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Affiliation(s)
- Shanshan Liu
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Defu Yuan
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Ying Zhou
- Department of STD/AIDS Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Gengfeng Fu
- Department of STD/AIDS Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Bei Wang
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China
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3
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Mayer KH, Allan-Blitz LT. Post-exposure prophylaxis to prevent HIV: new drugs, new approaches, and more questions. Lancet HIV 2023; 10:e816-e824. [PMID: 37952551 DOI: 10.1016/s2352-3018(23)00238-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 11/14/2023]
Abstract
Post-exposure prophylaxis (PEP) to prevent HIV acquisition has been recommended for over three decades, but remains underutilised. Over the past decade, clinical trials have established the safety and tolerability of newer PEP regimens, particularly those containing integrase strand transfer inhibitors (INSTIs) combined with a tenofovir and lamivudine or emtricitabine backbone. Several of these regimens were better tolerated than historical controls. Studies in macaques found that shorter courses of PEP with INSTIs were effective, particularly if dosing occurred close to the time of retroviral exposure. Despite the increase in well tolerated options, PEP seems to be underused globally and links to other prevention services are suboptimal. Interventions to increase provider and community awareness of PEP are needed.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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4
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McCormick CD, Sullivan PS, Qato DM, Crawford SY, Schumock GT, Lee TA. Trends of nonoccupational postexposure prophylaxis in the United States. AIDS 2023; 37:2223-2232. [PMID: 37650765 DOI: 10.1097/qad.0000000000003701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To describe national annual rates of nonoccupational postexposure prophylaxis (nPEP) in the United States. DESIGN Retrospective cohort study of commercially insured individuals in the Merative MarketScan Database from January 1, 2010 to December 31, 2019. METHODS Patients at least 13 years old prescribed nPEP per recommended Centers for Disease Control and Prevention guidelines were identified using pharmacy claims. Rates of use were described overall and stratified by sex, age group, and region. These rates were qualitatively compared to the diagnosis rates of human immunodeficiency virus (HIV) observed in the data. Joinpoint analysis identified inflection points of nPEP use. RESULTS Eleven thousand, three hundred and ninety-seven nPEP users were identified, with a mean age of 33.7 years. Most were males (64.6%) and lived in the south (33.2%) and northeast (32.4%). The rate of nPEP use increased 515%, from 1.42 nPEP users per 100 000 enrollees in 2010 to 8.71 nPEP users per 10 000 enrollees in 2019. The comparative nPEP use rates among subgroups largely mirrored their HIV diagnosis rates, that is, subgroups with a higher HIV rate had higher nPEP use. In the Joinpoint analysis significant growth was observed from 2012 to 2015 [estimated annual percentage change (EAPC): 45.8%; 95% confidence interval (CI): 29.4 - 64.3] followed by a more moderate increase from 2015 to 2019 (EAPC 16.0%; 95% CI: 12.6-19.6). CONCLUSIONS nPEP use increased from 2010 to 2019, but not equally across all risk groups. Further policy interventions should be developed to reduce barriers and ensure adequate access to this important HIV prevention tool.
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Affiliation(s)
- Carter D McCormick
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, Illinois
| | - Patrick S Sullivan
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Dima M Qato
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California, School of Pharmacy
- USC Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Stephanie Y Crawford
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, Illinois
| | - Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, Illinois
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, Illinois
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Mayer KH, Gelman M, Holmes J, Kraft J, Melbourne K, Mimiaga MJ. Safety and Tolerability of Once Daily Coformulated Bictegravir, Emtricitabine, and Tenofovir Alafenamide for Postexposure Prophylaxis After Sexual Exposure. J Acquir Immune Defic Syndr 2022; 90:27-32. [PMID: 34991141 DOI: 10.1097/qai.0000000000002912] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antiretroviral post-exposure prophylaxis (PEP) is recommended to prevent HIV infection after a high-risk exposure, but current regimens have presented challenges in tolerability, regimen completion, and potential drug-drug interactions. Because coformulated bictegravir, emtricitabine, and tenofovir alafenamide [BIC/FTC/tenofovir alafenamide (TAF)] is effective for HIV treatment, it was evaluated for use for PEP. SETTING Boston community health center. METHODS Individuals accessing PEP were enrolled in an open-label study of coformulated BIC/FTC/TAF, taken as one pill daily for 28 days. Pearson's χ2 and Fisher's exact tests were used to assess whether BIC/FTC/TAF differed with respect to side effects and regimen completion rates compared with historical PEP regimens. RESULTS Between August, 2018 and March, 2020, 52 individuals enrolled in the study. Most identified as cisgender gay (67.3%) or bisexual (11.5%) men, but 7.7% identified as cisgender heterosexual men and 3.8% cisgender heterosexual women. The most common regimen side effects were nausea or vomiting (15.4%), fatigue (9.6%), and diarrhea/loose stools (7.7%), which were less common than historical controls using other PEP regimens, including those containing other integrase strand transfer inhibitors. Only 1 participant discontinued the regimen because of fatigue, and all other side effects were self-limited. Almost all participants (90.4%) completed the indicated regimen, which was a higher completion rate compared with earlier PEP regimens, and none became HIV-positive. CONCLUSIONS BIC/FTC/TAF coformulated as a single daily pill was found to be safe, well-tolerated, and highly acceptable when used for PEP, and compared more favorably than historical PEP regimens used at an urban health center.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | | | | | | | | | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
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Cresswell F, Asanati K, Bhagani S, Boffito M, Delpech V, Ellis J, Fox J, Furness L, Kingston M, Mansouri M, Samarawickrama A, Smithson K, Sparrowhawk A, Rafferty P, Roper T, Waters L, Rodger A, Gupta N. UK guideline for the use of HIV post-exposure prophylaxis 2021. HIV Med 2022; 23:494-545. [PMID: 35166004 DOI: 10.1111/hiv.13208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
We present the updated British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis (PEP) to HIV following sexual exposures, occupational exposures and other nonoccupational exposures in the community. This serves as an update to the 2015 BASHH guideline on PEP following sexual exposures and the 2008 Expert Advisory Group on AIDS guidelines on HIV PEP. We aim to provide evidence-based guidance on best clinical practice in the provision, monitoring and support of PEP for the prevention of HIV acquisition following sexual, occupational and other nonoccupational exposures in the community. The guideline covers when to prescribe PEP, what antiretroviral agents to use and how to manage PEP. This includes (i) evidence of PEP efficacy; (ii) evidence relating to individual-level efficacy of antiretroviral therapy to prevent the sexual transmission of HIV; (iii) data on the detectable (transmissible) prevalence of HIV in specific populations; (iv) risk of HIV transmission following different types of sexual and occupational exposure; (v) baseline risk assessment; (vi) drug regimens and dosing schedules; (vii) monitoring PEP; (viii) baseline and follow-up blood-borne virus testing; (ix) the role of PEP within broader HIV prevention strategies, for example, HIV pre-exposure prophylaxis (PrEP). The guideline also covers special scenarios such as PEP in pregnancy, breastfeeding and chronic hepatitis B virus infection, and when PEP should be considered in people using HIV PrEP. The guidelines are aimed at clinical professionals directly involved in PEP provision and other stakeholders in the field. A proforma to assist PEP consultations is included. A public consultation process was undertaken prior to finalizing the recommendations.
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Affiliation(s)
- Fiona Cresswell
- Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,Clinical Research Department, London School of Hygiene and Tropical Medicine, UK.,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Kaveh Asanati
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
| | - Sanjay Bhagani
- Royal Free Hospital, London, UK.,Institute for Global Health, University College London, London, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
| | - Valerie Delpech
- Department of Epidemiology, Public Health England, London, UK
| | - Jayne Ellis
- Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,University College London, Hospitals NHS Foundation Trust, London, UK
| | - Julie Fox
- HIV Medicine and Clinical Trials, Guy's and St Thomas' Hospital, London, UK.,Kings College London, London, UK
| | | | - Margaret Kingston
- British Association of Sexual Health and HIV Clinical Effectiveness Group, Macclesfield, UK.,Manchester Royal Infirmary, Manchester, UK.,Manchester University, Manchester, UK
| | - Massoud Mansouri
- Occupational Health, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | - Paul Rafferty
- Belfast Health and Social Care Trust, Belfast, UK.,HIV Pharmacy Association Representative, Newcastle upon Tyne, UK
| | | | | | - Alison Rodger
- Royal Free Hospital, London, UK.,Institute for Global Health, University College London, London, UK
| | - Nadi Gupta
- British HIV Association Guideline Committee, London, UK.,Rotherham NHS Foundation Trust, Rotherham, UK
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7
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Nie J, Sun F, He X, Liu J, Wang M, Li C, Gu S, Chen Z, Li Y, Chen Y. Tolerability and Adherence of Antiretroviral Regimens Containing Long-Acting Fusion Inhibitor Albuvirtide for HIV Post-Exposure Prophylaxis: A Cohort Study in China. Infect Dis Ther 2021; 10:2611-2623. [PMID: 34586592 PMCID: PMC8572943 DOI: 10.1007/s40121-021-00540-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/17/2021] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION There have been no prospective clinical studies investigating adherence and tolerability of HIV post-exposure prophylaxis (PEP) in China. Tolerability, adherence, and transmitted drug resistance are concerns, especially when single-tablet regimen (STR) usage is low. The present study aimed to explore the safety, tolerability, and adherence of regimens containing albuvirtide (ABT) compared with recommended non-STR antiretrovirals for HIV PEP. METHODS This was a prospective, open-label, multicenter cohort study. The subjects were stratified into 3 groups based on their preference: ABT + Dolutegravir (DTG) (Group 1), ABT + Tenofovir disoproxil fumarate (TDF) + Lamivudine (3TC) (Group 2), and DTG + TDF + 3TC (Group 3). All enrolled subjects received PEP within 72 h after exposure and continued for 28 days, and were followed-up for 12 weeks. RESULTS A total of 330 participants were enrolled in the three groups. Most participants were male (87.2%). Sexual contact was the most frequent mode of exposure (91.9%). The average time from exposure to treatment was 26.8 ± 19.5 h. There were no statistically significant differences between the three study groups with respect to completion of oral medication at 28 days. The 28-day completion rate was shown to be significantly higher with ABT versus oral (88.9% vs. 64.0%; p < 0.0001), and adherence with ABT was 94.4% compared to 75.7% with oral PEP (p < 0.0001). Subjects in ABT-containing Group 1 exhibited higher adherence than those in Group 3 (87.3% vs. 72.9%; p < 0.05). None of the participants reported serious adverse drug reactions which led to withdrawal from the study. All the drug regimens were found to be safe and well tolerated. No HIV incident case was observed during the study period. CONCLUSIONS ABT-containing regimens (ABT + DTG or ABT + TDF + 3TC) offer a good option for HIV PEP due to higher completion rates and adherence than the DTG + TDF + 3TC regimen. The overall safety was comparable and acceptable among the three groups. REGISTRATION The study was registered in Chinese Clinical Trial Registry with registration number (ChiCTR1900022881, http://www.chictr.org.cn/showprojen.aspx?proj=37395 ).
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Affiliation(s)
- Jingmin Nie
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, China
| | - Feng Sun
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, China
| | - Xuejiao He
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, China
| | - Jun Liu
- Department of Infectious Diseases, Kunming Third People's Hospital, Kunming, China
| | - Min Wang
- Department of Infectious Diseases, The First Hospital of Changsha, Changsha, China
| | - Chongxi Li
- Department of Infectious Diseases, Kunming Third People's Hospital, Kunming, China
| | - Shanqun Gu
- Department of Infectious Diseases, Kunming Third People's Hospital, Kunming, China
| | - Zhong Chen
- Department of Infectious Diseases, The First Hospital of Changsha, Changsha, China
| | - Ying Li
- Department of Infectious Diseases, The First Hospital of Changsha, Changsha, China
| | - Yaokai Chen
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, China.
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8
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Wand H, Ramjee G, Reddy T. Quantifying geographical diversity in sexually transmitted infections using population attributable risk: results from HIV prevention trials in South Africa. Int J STD AIDS 2021; 32:600-608. [PMID: 33769896 DOI: 10.1177/0956462420968998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In this study, we investigated spatial diversities of sexually transmitted infections (STIs) and quantified their impacts on the STIs using population attributable risk (PAR%). The study population was 7,557 women who participated in several HIV prevention trials from KwaZulu-Natal, South Africa. Our results provide compelling evidence for substantial geographical diversities on STI incidence rates in the region. Their population-level impacts on the STIs exceeded the combined impacts of the individual risk factors considered in this study (PAR%: 41% (<25 years), 52% (25-34 years) and 34% (35+ years). When all these factors are considered together, PAR% was the highest among younger women (PAR%: 67%, 82% and 50% for <25, 25-34 and 35+ years old respectively). Results from our study will bring greater insight into the previous research by increasing our understanding of the impacts of the sub-geographical level variations of STI prevalence and incidence rates in the region.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Westville, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
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9
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Malinverni S, Bédoret F, Bartiaux M, Gilles C, De Wit S, Libois A. Single-tablet regimen of emtricitabine/tenofovir disoproxil fumarate plus cobicistat-boosted elvitegravir increase adherence for HIV postexposure prophylaxis in sexual assault victims. Sex Transm Infect 2020; 97:329-333. [PMID: 33106437 DOI: 10.1136/sextrans-2020-054714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/17/2020] [Accepted: 09/27/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Postexposure prophylaxis (PEP) is a recommended public health intervention after a sexual assault to prevent HIV infection. METHODS We conducted a retrospective case-control study on how use of a single-tablet regimen (STR) of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (Stribild) affected adherence to PEP and attendance of a follow-up visit to the STI clinic compared with those who received a multitablet regimen (MTR). Data from sexual assault victims consulting for PEP were prospectively recorded between January 2011 and December 2017. Data were systematically collected on patient demographics, time of medical contact, source risk factors, type of exposure, attendance to follow-up visit, reported completion of PEP and adherence based on pharmacy records. RESULTS A total of 422 patients received PEP following a sexual assault, of whom 52% had documented completion of a 28-day PEP regimen and 71% attended a follow-up clinic visit. Patients who received an elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (EVG/COBI/FTC/TDF)-based STR had a similar likelihood of attending their first follow-up visit (OR: 0.97; 95% CI: 0.64 to 1.48, p=0.90) but were more likely to complete the PEP regimen (OR: 1.70; 95% CI: 1.16 to 2.50, p=0.007). After adjusting for confounders, those who were prescribed an STR regimen were more likely to complete the PEP regimen (OR: 1.66, 95% CI: 1.09 to 2.53, p=0.019) than those who were prescribed an MTR such as stavudine/lamivudine/lopinavir/ritonavir or zidovudine/lamivudine/indinavir/ritonavir. CONCLUSIONS Sexual assault victims who were prescribed an STR based on EVG/COBI/FTC/TDF were more likely to complete PEP than those who were prescribed an MTR.
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Affiliation(s)
| | | | | | | | | | - Agnes Libois
- Infectious Diseases, CHU Saint-Pierre, Bruxelles, Belgium
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10
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Quah SP, McIntyre M, Wood A, Mc Mullan K, Rafferty P. Once-daily raltegravir with tenofovir disoproxil/emtricitabine as HIV post-exposure prophylaxis following sexual exposure. HIV Med 2020; 22:e5-e6. [PMID: 33063431 DOI: 10.1111/hiv.12938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/29/2020] [Accepted: 07/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- S P Quah
- Genitourinary Medicine Department, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - M McIntyre
- Genitourinary Medicine Department, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - A Wood
- Genitourinary Medicine Department, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - K Mc Mullan
- Genitourinary Medicine Department, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Paul Rafferty
- Genitourinary Medicine Department, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
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11
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The "Side Effects" of HIV PEP Use: Forced Reflections and Introspections on Sexual Decision-Making. Res Theory Nurs Pract 2020; 33:196-208. [PMID: 31123163 DOI: 10.1891/1541-6577.33.2.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Postexposure prophylaxis (PEP) for HIV prevention involves giving antiretroviral medications to HIV-negative people to prevent seroconversion after HIV exposure. Available literature suggests this intervention is >80% effective. Accordingly, we implemented a nurse-led PEP program in two sexually transmitted and HIV testing clinics. As part of evaluating this project, we undertook semistructured interviews with participants who accessed PEP to understand their experiences. Twelve men participated: all were HIV-negative males who sought PEP for condomless anal sex with men. Unique to this article is the presentation of the participants' descriptions of the "side effects" they experienced. Notably, the main side effect they described related to emotional distress. Simply put, having to take a medication for 28 days forced reflection and introspection on their sexual decision-making. We feel HIV prevention workers should consider this emotional reaction when designing interventions, and ensure they provide adequate preparation and support to patients.
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12
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Straub DM, Mullins TLK. Nonoccupational Postexposure Prophylaxis and Preexposure Prophylaxis for Human Immunodeficiency Virus Prevention in Adolescents and Young Adults. Adv Pediatr 2019; 66:245-261. [PMID: 31230697 DOI: 10.1016/j.yapd.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Diane M Straub
- Division of Adolescent Medicine, University of South Florida, 2 Tampa General Circle, Suite 500, Tampa, FL 33606, USA.
| | - Tanya L Kowalczyk Mullins
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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13
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Pierce AB, El-Hayek C, McCarthy D, Armishaw J, Watson K, Wilkinson A, Price B, Wright EJ, Hoy JF, Stoové MA. Comparing non-occupational post-exposure prophylaxis drug regimens for HIV: insights from a linked HIV surveillance system. Sex Health 2019; 14:179-187. [PMID: 27914484 DOI: 10.1071/sh16132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/16/2016] [Indexed: 11/23/2022]
Abstract
Background International non-occupational post-exposure prophylaxis (NPEP) guidelines recommend routine use of three drug NPEP regimens, despite absence of evidence for greater prevention efficacy compared with two drug regimens. This study examines the potential for excess HIV seroconversions among high-risk men who have sex with men (MSM) reporting receptive anal intercourse with a source of unknown HIV serostatus (RAIU) following a two-drug versus a three-drug NPEP regimen. METHODS Data for MSM in the Victorian NPEP service database between 10 August 2005 and 31 December 2012 were linked with all Victorian HIV notifications up to 31 December 2013. The primary outcome was NPEP failure following NPEP presentation among MSM reporting RAIU, stratified by the number of drugs prescribed. RESULTS Among 1482 MSM reporting 2002 episodes of RAIU and prescribed two- or three-drug NPEP, 70 seroconverted to HIV, but only 19 were considered possible NPEP failures. HIV diagnosis incidence among men reporting RAIU was 1.2/100 person years (PY) (95%CI=1.0-1.6); 1.1/100 PY (95%CI=0.8-1.4) among MSM prescribed two drugs and 2.2/100 PY (95%CI=1.4-3.7) among MSM prescribed three drugs (P<0.01). Of the 19 possible NPEP failures, 13 (0.7%) were prescribed two drugs and six (2.7%) three drugs (P<0.001). CONCLUSIONS This study suggests that two-drug NPEP regimens do not result in excess seroconversions compared with three-drug regimens when used following RAIU. Clinical services should carefully consider their use of three drug NPEP and whether resources might be better invested in other prevention strategies, particularly pre-exposure prophylaxis (PrEP).
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Affiliation(s)
- Anna B Pierce
- Victorian NPEP Service, Department of Infectious Diseases, The Alfred Hospital, Level 2 Burnet Building, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Carol El-Hayek
- Centre for Population Health, The Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Damien McCarthy
- Centre for Population Health, The Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Jude Armishaw
- Victorian NPEP Service, Department of Infectious Diseases, The Alfred Hospital, Level 2 Burnet Building, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Kerrie Watson
- Victorian NPEP Service, Department of Infectious Diseases, The Alfred Hospital, Level 2 Burnet Building, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Anna Wilkinson
- Centre for Population Health, The Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Brian Price
- Victorian NPEP Service, Department of Infectious Diseases, The Alfred Hospital, Level 2 Burnet Building, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Edwina J Wright
- Victorian NPEP Service, Department of Infectious Diseases, The Alfred Hospital, Level 2 Burnet Building, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Jennifer F Hoy
- Victorian NPEP Service, Department of Infectious Diseases, The Alfred Hospital, Level 2 Burnet Building, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Mark A Stoové
- Centre for Population Health, The Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
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14
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Heendeniya A, Bogoch II. Antiretroviral Medications for the Prevention of HIV Infection: A Clinical Approach to Preexposure Prophylaxis, Postexposure Prophylaxis, and Treatment as Prevention. Infect Dis Clin North Am 2019; 33:629-646. [PMID: 31239092 DOI: 10.1016/j.idc.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Preventing new human immunodeficiency virus (HIV) infections is essential to halting the global pandemic. HIV prevention strategies include integrating both nonpharmacologic (eg, safe sexual counseling, circumcision) and pharmacologic approaches. Several pharmacologic HIV prevention strategies are increasingly used globally and include postexposure prophylaxis, preexposure prophylaxis, and treatment as prevention. These prevention modalities have enormous clinical and public health appeal, as they effectively reduce HIV acquisition in individuals and also may lower HIV incidence in communities when integrated and implemented broadly. Efforts are now underway to scale HIV prevention programs using these techniques in both high- and low-resource settings.
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Affiliation(s)
- Amila Heendeniya
- Division of Infectious Diseases, Toronto General Hospital, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Isaac I Bogoch
- Division of Infectious Diseases, Toronto General Hospital, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Department of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, Ontario M5G 2C4, Canada; Division of General Internal Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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15
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Guilamo-Ramos V, Thimm-Kaiser M, Benzekri A, Futterman D. Shifting the Paradigm in HIV Prevention and Treatment Service Delivery Toward Differentiated Care for Youth. NAM Perspect 2019. [DOI: 10.31478/201903a] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Despite significant progress in the fight against HIV/AIDS in the United States, HIV prevention and treatment disparities among key populations remain a national public health concern. While new HIV diagnoses are increasing among people under age 30—in particular among racial, ethnic, and sexual minority adolescents and young adults (AYA)—dominant prevention and treatment paradigms too often inadequately consider the unique HIV service needs of AYA. To address this gap, we characterize persistent and largely overlooked AYA disparities across the HIV prevention and treatment continuum, identify AYA-specific limitations in extant resources for improving HIV service delivery in the United States, and propose a novel AYA-centered differentiated care framework adapted to the unique ecological and developmental factors shaping engagement, adherence, and retention in HIV services among AYA. Shifting the paradigm for AYA to differentiated HIV care is a promising approach that warrants implementation and evaluation as part of reinforced national efforts to end the HIV epidemic in the United States by 2030.
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Affiliation(s)
| | | | - Adam Benzekri
- Center for Latino Adolescent and Family Health, New York University
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16
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Muller WJ, Chadwick EG. Pediatric Considerations for Postexposure Human Immunodeficiency Virus Prophylaxis. Infect Dis Clin North Am 2019; 32:91-101. [PMID: 29406979 DOI: 10.1016/j.idc.2017.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Exposures that carry risk of transmission of blood-borne disease are rare in pediatrics, but expose patients and families to great anxiety. Specialists in pediatric infectious diseases are often asked about initial antimicrobial prophylaxis in these cases. Guidelines for nonoccupational postexposure prophylaxis for human immunodeficiency virus have evolved as new formulations and medications become available and greater experience obtained in assessing relative risks of different exposures and relative costs and benefits for different interventions. This article discusses the evidence behind recent updates to Centers for Disease Control and Prevention guidelines for nonoccupational postexposure prophylaxis for human immunodeficiency virus, focusing on application in the pediatric population.
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Affiliation(s)
- William J Muller
- Division of Pediatric Infectious Diseases, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Box 20, Chicago, IL 60611, USA.
| | - Ellen G Chadwick
- Division of Pediatric Infectious Diseases, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Box 20, Chicago, IL 60611, USA
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17
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Ncube S, Madikizela LM, Chimuka L, Nindi MM. Environmental fate and ecotoxicological effects of antiretrovirals: A current global status and future perspectives. WATER RESEARCH 2018; 145:231-247. [PMID: 30142521 DOI: 10.1016/j.watres.2018.08.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 05/27/2023]
Abstract
The therapeutic efficacy of antiretroviral drugs as well as challenges and side effects against the human immunodeficiency virus is well documented and reviewed. Evidence is available in literature indication that antiretrovirals are only partially transformed and become completely excreted from the human body in their original form and/or as metabolites in urine and feces. The possibility of massive release of antiretrovirals through human excreta that enters surface water through surface runoff and wastewater treatment plant effluents is now of environmental concern because the public might be experiencing chronic exposure to antiretrovirals. The primary concern of this review is limited data concerning environmental fate and ecotoxicity of antiretrovirals and their metabolites. The review aims to provide a comprehensive insight into the evaluation of antiretrovirals in environmental samples. The objective is therefore to assess the extent of analysis of antiretrovirals in environmental samples and also look at strategies including instrumentation and predictive models that have been reported in literature on the fate and ecotoxicological effects due to presence of antiretrovirals in different environmental compartments. The review also looks at current challenges and offers possible areas of exploration that could help minimize the presence of antiretrovirals in the environment.
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Affiliation(s)
- Somandla Ncube
- Department of Chemistry, University of South Africa, Private Bag X6, Florida, 1710, South Africa
| | - Lawrence M Madikizela
- Department of Chemistry, Durban University of Technology, P.O. Box 1334, Durban, 4000, South Africa
| | - Luke Chimuka
- Molecular Sciences Institute, School of Chemistry, University of the Witwatersrand, Private Bag X3, Johannesburg, 2050, South Africa
| | - Mathew M Nindi
- Department of Chemistry, University of South Africa, Private Bag X6, Florida, 1710, South Africa.
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18
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Inciarte A, Leal L, González E, León A, Lucero C, Mallolas J, Torres B, Laguno M, Rojas J, Martínez-Rebollar M, González-Cordón A, Cruceta A, Arnaiz JA, Gatell JM, García F. Tenofovir disoproxil fumarate/emtricitabine plus ritonavir-boosted lopinavir or cobicistat-boosted elvitegravir as a single-tablet regimen for HIV post-exposure prophylaxis. J Antimicrob Chemother 2018; 72:2857-2861. [PMID: 29091217 DOI: 10.1093/jac/dkx246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/22/2017] [Indexed: 02/07/2023] Open
Abstract
Objectives To assess HIV-1 post-exposure prophylaxis (PEP) non-completion at day 28, comparing ritonavir-boosted lopinavir versus cobicistat-boosted elvitegravir as a single-tablet regimen (STR), using tenofovir disoproxil fumarate/emtricitabine with both of these therapies. Methods A prospective, open, randomized clinical trial was performed. Individuals attending the emergency room due to potential sexual exposure to HIV and who met criteria for PEP were randomized 1:3 into two groups receiving either 400/100 mg of lopinavir/ritonavir (n = 38) or 150/150 mg of elvitegravir/cobicistat (n = 119), with both groups also receiving 245/200 mg of tenofovir disoproxil fumarate/emtricitabine. Five follow-up visits were scheduled at days 1, 10, 28, 90 and 180. The primary endpoint was PEP non-completion at day 28. Secondary endpoints were adherence, adverse effects and rate of seroconversions. Clinical trials.gov number: NCT08431173. Results Median age was 32 years and 95% were males. PEP non-completion at day 28 was 36% (n = 57), with a trend to be higher in the lopinavir/ritonavir arm [lopinavir/ritonavir 47% (n = 18) versus elvitegravir/cobicistat 33% (n = 39), P = 0.10]. We performed a modified ITT analysis including only those patients who attended on day 1. PEP non-completion in this subgroup was higher in the lopinavir/ritonavir arm than in the elvitegravir/cobicistat arm (33% versus 15%, respectively, P = 0.04). Poor adherence was significantly higher in the lopinavir/ritonavir arm versus the elvitegravir/cobicistat arm (47% versus 9%, respectively, P < 0.0001). Adverse events were reported by 73 patients (59%), and were significantly more common in the lopinavir/ritonavir arm (90% versus 49%, P = 0.0001). A seroconversion was observed in the elvitegravir/cobicistat arm in a patient with multiple exposures before and after PEP. Conclusions A higher PEP non-completion, poor adherence and adverse events were observed in patients allocated to the lopinavir/ritonavir arm, suggesting that STR elvitegravir/cobicistat is a well-tolerated antiretroviral for PEP.
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Affiliation(s)
- A Inciarte
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - L Leal
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - E González
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A León
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C Lucero
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J Mallolas
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - B Torres
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Laguno
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J Rojas
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Martínez-Rebollar
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A González-Cordón
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A Cruceta
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J A Arnaiz
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J M Gatell
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - F García
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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19
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Zautner AE, Herchenröder O, Moussi AE, Schwarz NG, Wiemer DF, Groß U, Frickmann H. Pharmaceutical interactions between antiretroviral and antimalarial drugs used in chemoprophylaxis. Acta Trop 2018; 179:25-35. [PMID: 29273442 DOI: 10.1016/j.actatropica.2017.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/08/2017] [Accepted: 12/17/2017] [Indexed: 10/18/2022]
Abstract
Human immunodeficiency virus (HIV) is the causative agent of the Acquired Immunodeficiency Syndrome (AIDS). The pandemic is believed to have originated within the Northern Congo basin covering large parts of the Democratic Republic of Congo, the Republic of Congo, the Central African Republic, Cameroon and Gabon. Although over decades, HIV-1 has spread throughout the World leaving no country unaffected, sub-Saharan Africa remains the region with more than 80% of all infected individuals. The HIV-2 epidemic has largely remained restricted to West Africa along the Upper Guinean forests. Co-incident with these regions of highest HIV distribution is a part of the malaria belt and therefore, co-infections are common. In this review we carve out the consequences of HIV transmission prevention and synchronous malaria prophylaxis during occupational or leisure travelling activities within this World region. In particular, we elaborate on considering pre-existing drug resistances of both, the malaria parasites and the immunodeficiency viruses, when determining a combination for prophylactic and, if necessary, post-expositional measures with a focus on the compatibility of both medications.
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20
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Tan DHS, Hull MW, Yoong D, Tremblay C, O'Byrne P, Thomas R, Kille J, Baril JG, Cox J, Giguere P, Harris M, Hughes C, MacPherson P, O'Donnell S, Reimer J, Singh A, Barrett L, Bogoch I, Jollimore J, Lambert G, Lebouche B, Metz G, Rogers T, Shafran S. Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis. CMAJ 2017; 189:E1448-E1458. [PMID: 29180384 DOI: 10.1503/cmaj.170494] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Darrell H S Tan
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont.
| | - Mark W Hull
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Deborah Yoong
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Cécile Tremblay
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Patrick O'Byrne
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Réjean Thomas
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Julie Kille
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Jean-Guy Baril
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Joseph Cox
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Pierre Giguere
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Marianne Harris
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Christine Hughes
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Paul MacPherson
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Shannon O'Donnell
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Joss Reimer
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Ameeta Singh
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Lisa Barrett
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Isaac Bogoch
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Jody Jollimore
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Gilles Lambert
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Bertrand Lebouche
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Gila Metz
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Tim Rogers
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
| | - Stephen Shafran
- Division of Infectious Diseases (Tan), St. Michael's Hospital, Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Harris), Vancouver, BC; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont.; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (Tremblay), Montréal, Que.; School of Nursing (O'Byrne), University of Ottawa, Ottawa, Ont.; Clinique L'Actuel (Thomas), Montréal, Que.; Canadian Association of Nurses in HIV/AIDS Care (Kille), Vancouver, BC; Clinique du Quartier Latin (Baril), Montréal, Que.; Direction régionale de santé publique (Cox), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Que.; Department of Pharmacy (Giguere), The Ottawa Hospital, Ottawa, Ont.; Faculty of Pharmacy & Pharmaceutical Sciences (Hughes), University of Alberta, Edmonton, Alta.; Division of Infectious Diseases (MacPherson), The Ottawa Hospital, Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Winnipeg Regional Health Authority (Reimer), Winnipeg, Man.; Division of Infectious Diseases, Department of Medicine (Singh, Shafran), University of Alberta, Edmonton, Alta.; Dalhousie University (Barrett), Halifax, NS; Divisions of Internal Medicine and Infectious Diseases (Bogoch), Toronto General Hospital, Toronto, Ont.; Health Initiative for Men (Jollimore), Vancouver, BC; Institut national de santé publique du Québec (Lambert), Montréal, Que.; Research Institute of the McGill University Health Centre (Lebouche), Montréal, Que.; CATIE (Canadian AIDS Treatment Information Exchange) (Rogers), Toronto, Ont
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Malinverni S, Gennotte AF, Schuster M, De Wit S, Mols P, Libois A. Adherence to HIV post-exposure prophylaxis: A multivariate regression analysis of a 5 years prospective cohort. J Infect 2017; 76:78-85. [PMID: 29074102 DOI: 10.1016/j.jinf.2017.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/26/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Non-occupational post-exposure prophylaxis (nPEP) is a recommended public health intervention after a sexual or percutaneous exposure to human immunodeficiency virus (HIV). METHODS We conducted a prospective observational study recording consultations for nPEP at a reference HIV center in Brussels, Belgium from January 2011 to December 2015. We recorded attendance to follow-up, reported completion of nPEP and pharmacy records to measure adherence. Multivariate logistic regressions were performed to identify independent risk factors for adherence to nPEP and attendance to first follow-up visit at the STI clinic. FINDINGS Among 1881 patients receiving nPEP, 66.4% had a documented completion of a 28-day course of nPEP and 87.3% attended their first follow-up clinic visit. MSM (OR, 1.40; 95%CI, 1.04-1.90), being a native Belgian (OR, 1.50; 95%CI, 1.18-1.90), older age (OR, 1.02; 95%CI, 1.01-1.04), being a sexual assault survivor (OR, 0.59; 95%CI, 0.38-0.91), having had a previous nPEP treatment (OR, 1.44; 95%CI, 1.02-2.02), consultation during daytime (OR, 1.35; 95%CI, 1.07-1.70) and benefitting from a health insurance (OR, 2.11; 95%CI, 1.58-2.89) were significant independent predictors for adherence to nPEP. Patients whose initial treatment was AZT/3TC/IDV/r had similar adherence than patients on d4T/3TC/LPV/r (OR, 0.898; 95%CI, 0.68-1.20). INTERPRETATION Multiple independent risk factors for nPEP retention into care and adherence are present at treatment initiation and might be targeted by tailored interventions. Sexual assault victims are overexposed to deleterious consequences of the lack of health insurance on compliance.
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Affiliation(s)
- Stefano Malinverni
- Emergency Department, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Rue Haute 322, 1000 Brussels, Belgium.
| | - Anne-Françoise Gennotte
- Infectious Diseases Department, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Monica Schuster
- Institute of Development Policy and Management (IOB), University of Antwerp, Antwerp, Belgium
| | - Stéphane De Wit
- Infectious Diseases Department, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Mols
- Department of Emergency Medicine, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Agnès Libois
- Infectious Diseases Department, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
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Optimal HIV Postexposure Prophylaxis Regimen Completion With Single Tablet Daily Elvitegravir/Cobicistat/Tenofovir Disoproxil Fumarate/Emtricitabine Compared With More Frequent Dosing Regimens. J Acquir Immune Defic Syndr 2017; 75:535-539. [PMID: 28696345 DOI: 10.1097/qai.0000000000001440] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
STRUCTURE The study evaluated elvitegravir/cobicistat/tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) ("Quad pill") for postexposure prophylaxis (PEP). BACKGROUND HIV-exposed individuals may benefit from PEP, but completion rates have been suboptimal because of regimen complexity and side effects. Newer antiretroviral combinations coformulated as single daily pills may optimize PEP adherence. SETTING One hundred HIV-uninfected individuals who presented to a Boston community health center after an acute HIV sexual exposure were enrolled and initiated PEP with the daily, single-pill combination Quad pill for a 28-day course. METHODS Side effects and medication completion rates from study participants were compared with historical controls who had used PEP regimens consisting of TDF/FTC daily and raltegravir twice daily, or earlier regimens of twice daily zidovudine (AZT)/lamivudine (3TC) and a protease inhibitor, using χ tests for independence. RESULTS Of the 100 participants who initiated the Quad pill for PEP after a high-risk sexual exposure, 71% completed the 28-day Quad pill regimen, which was significantly greater than historical controls who used TDF/FTC and raltegravir (57%, P < 0.05) or AZT/3TC plus a protease inhibitor (39%, P < 0.001). The most common side effects reported by Quad pill users were as follows: abdominal discomfort or pain, gas or bloating (42%), diarrhea (38%), fatigue (28%), nausea or vomiting (28%), headache (14%), or dizziness or lightheadedness (6%). Most symptoms were mild, limited, and did not result in medication discontinuation. No participants became HIV infected. CONCLUSIONS Fixed-dose combination of elvitegravir/cobicistat/TDF/FTC was safe and well tolerated for PEP, with higher regimen completion rates than more frequently dosed PEP regimens.
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HIV Postexposure Prophylaxis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Evaluation of tolerability with the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate for post-HIV exposure prophylaxis. BMC Infect Dis 2016; 16:718. [PMID: 27894270 PMCID: PMC5127047 DOI: 10.1186/s12879-016-2056-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 11/22/2016] [Indexed: 11/30/2022] Open
Abstract
Background The preferred regimen for HIV post-exposure prophylaxis (PEP) is based mainly on safety and tolerability because it is given to immunocompetent people without HIV infection for a limited time (28 days). The frequency of adverse events (AEs) may be > 60%. Although AEs are generally not severe, they can lead to lack of adherence and failure to complete the regimen. We evaluated the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (Stribild®) prescribed as one pill taken once daily for HIV PEP in terms of tolerability and adherence. Methods This was a prospective cohort study conducted in one hospital in Paris (April to December 2015. Each participant receiving the PEP treatment (FTC-150 mg/TDF-245 mg/elvitegravir-200 mg/cobicistat 150 mg once daily) at the pharmacy of the hospital were recruited consecutively. A clinical visit was planned at 8 weeks after sexual exposure. Reminders were sent to participants who missed the appointment. A standardized questionnaire was administered to evaluate completeness and tolerability at week 8. Results Overall, 284 participants (86% men; 80% MSM; median age 30 years) were prescribed Stribild®; 50 stopped after reassessment of risk. Among 234 participants who effectively received PEP, 215 (92%) completed 28 days of PEP with only three who switched from Stribild® to another PEP because of side effects. More than 60% of participants reported at least one AE, which were mild to moderate. Fatigue, central neurological and abdominal side effects were the most frequently reported. Conclusions Stribild® seems to be a good option for HIV PEP due to the easiness of use, the side effects profile and the high completion rate.
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Kalapila AG, Marrazzo J. Antiretroviral Therapy for Prevention of Human Immunodeficiency Virus Infection. Med Clin North Am 2016; 100:927-50. [PMID: 27235622 DOI: 10.1016/j.mcna.2016.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Human immunodeficiency virus (HIV) infection is considered a chronic medical condition. Several new drugs are available, including fixed-dose combination tablets, that have greatly simplified combination antiretroviral therapy (ART) regimens to treat HIV, while increasing the life-expectancy of infected individuals. In the last decade, multiple well-regarded studies have established the benefits of using ART in high-risk, HIV-negative persons to prevent HIV acquisition. The primary care provider must not only understand commonly encountered issues pertaining to ART, such as toxicities and drug interactions, but also needs to be aware of using ART for HIV prevention.
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Affiliation(s)
- Aley G Kalapila
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Jeanne Marrazzo
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
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Fätkenheuer G, Jessen H, Stoehr A, Jung N, Jessen AB, Kümmerle T, Berger M, Bogner JR, Spinner CD, Stephan C, Degen O, Vogelmann R, Spornraft-Ragaller P, Schnaitmann E, Jensen B, Ulmer A, Kittner JM, Härter G, Malfertheiner P, Rockstroh J, Knecht G, Scholten S, Harrer T, Kern WV, Salzberger B, Schürmann D, Ranneberg B. PEPDar: A randomized prospective noninferiority study of ritonavir-boosted darunavir for HIV post-exposure prophylaxis. HIV Med 2016; 17:453-9. [PMID: 27166295 DOI: 10.1111/hiv.12363] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES PEPDar compared the tolerability and safety of ritonavir-boosted darunavir (DRV/r)-based post-exposure prophylaxis (PEP) with the tolerability and safety of standard of care (SOC). The primary endpoint was the early discontinuation rate among the per-protocol population. METHODS PEPDar was an open-label, randomized, multicentre, prospective, noninferiority safety study. Subjects were stratified by type of event (occupational vs. nonoccupational, i.e. sexual) and were randomized to receive DRV/r plus two nucleoside reverse transcriptase inhibitors (NRTIs) or SOC PEP. Twenty-two private or university HIV clinics in Germany participated. Subjects were ≥ 18 years old and had documented or potential HIV exposure and indication for HIV PEP. They initiated PEP not later than 72 h after the event and were HIV negative. RESULTS A total of 324 subjects were screened, the per-protocol population was 305, and 273 subjects completed the study. One hundred and fifty-five subjects received DRV/r-based PEP and 150 subjects received ritonavir-boosted lopinavir (LPV/r)-based PEP for 28-30 days; 298 subjects also received tenofovir/emtricitabine. The early discontinuation rate in the DRV/r arm was 6.5% compared with 10.0% in the SOC arm (P = 0.243). Adverse drug reactions (ADRs) were reported in 68% of DRV/r subjects and 75% of SOC subjects (P = 0.169). Fewer DRV/r subjects (16.1%) had at least one grade 2 or 3 ADR compared with SOC subjects (29.3%) (P = 0.006). All grades of diarrhoea, nausea, and sleep disorders were significantly less frequent with DRV/r, while headache was significantly more frequent. No HIV seroconversion was reported during follow-up. CONCLUSIONS Noninferiority of DRV/r to SOC was demonstrated. DRV/r should be included as a standard component of recommended regimens in PEP guidelines.
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Affiliation(s)
- G Fätkenheuer
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany
| | - H Jessen
- Praxis Jessen2 + Kollegen, Berlin, Germany
| | - A Stoehr
- ifi - Institute for Interdisciplinary Medicine, Study Centre St. Georg, Hamburg, Germany
| | - N Jung
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - A B Jessen
- Praxis Jessen2 + Kollegen, Berlin, Germany
| | - T Kümmerle
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - M Berger
- Immunology Outpatient Clinic, Vivantes Auguste Viktoria Hospital, Berlin, Germany
| | - J R Bogner
- Section Infectcious Diseases, Med IV, University Hospital of Munich, Munich, Germany
| | - C D Spinner
- Department of Medicine II, University Hospital Klinikum rechts der Isar, Munich, Germany
| | - C Stephan
- Department of Medicine, Center for Internal Medicine, J. W. Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - O Degen
- Outpatient Infectious Diseases Unit, University Center Hamburg Eppendorf, Hamburg, Germany
| | - R Vogelmann
- Department of Internal Medicine, Medical Clinic II, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | | | | | - B Jensen
- Department of Gastroenterology, Hepatology and Infectiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Ulmer
- Group Practice Ulmer/Frietsch/Müller/Roll, Stuttgart, Germany
| | - J M Kittner
- Medical Clinic and Outpatient Clinic I, University Hospital Mainz, Mainz, Germany
| | - G Härter
- Clinic for Internal Medizin III, Ulm University Medical Center, Ulm, Germany
| | - P Malfertheiner
- Clinic for Gastroenterology, Hepatology and Infectiology, University Hospital Magdeburg, Magdeburg, Germany
| | - J Rockstroh
- Internal Medicine I, Gastroenterology, Infectious Diseases, University Hospital Bonn, Bonn, Germany
| | - G Knecht
- Internal Medicine Specialist Center Stresemannallee, Frankfurt am Main, Germany
| | - S Scholten
- Practice Hohenstaufenring, Cologne, Germany
| | - T Harrer
- Department of Medicine 3, University Medicine Erlangen, Erlangen, Germany
| | - W V Kern
- Division of Infectious Diseases, University Hospital, Freiburg, Germany
| | - B Salzberger
- Department Internal Medicine I, University Regensburg, Regensburg, Germany
| | - D Schürmann
- Division of Infectiology and Pneumonology, Medical Department, Charité-University Medicine Berlin, Berlin, Germany
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Tan DHS, Goddey-Erikefe B, Yoong D, Naccarato M, Mclntyre S, Qureshi R, Gough K. Selecting an Antiretroviral Regimen for Human Immunodeficiency Virus Postexposure Prophylaxis in the Occupational Setting. Infect Control Hosp Epidemiol 2016; 35:326-8. [DOI: 10.1086/675297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cresswell F, Waters L, Briggs E, Fox J, Harbottle J, Hawkins D, Murchie M, Radcliffe K, Rafferty P, Rodger A, Fisher M. UK guideline for the use of HIV Post-Exposure Prophylaxis Following Sexual Exposure, 2015. Int J STD AIDS 2016; 27:713-38. [PMID: 27095790 DOI: 10.1177/0956462416641813] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/18/2016] [Indexed: 11/15/2022]
Abstract
We present the updated British Association for Sexual Health and HIV guidelines for HIV post-exposure prophylaxis following sexual exposure (PEPSE). This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of infection after a potential exposure, and provides recommendations on when PEPSE should and should not be considered. We also review which medications to use for PEPSE, provide a checklist for initial assessment, and make recommendations for monitoring individuals receiving PEPSE. Special scenarios, cost-effectiveness of PEPSE, and issues relating to service provision are also discussed. Throughout the document, the place of PEPSE within the broader context of other HIV prevention strategies is considered.
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Leal L, León A, Torres B, Inciarte A, Lucero C, Mallolas J, Laguno M, Martínez-Rebollar M, González-Cordón A, Manzardo C, Rojas J, Pich J, Arnaiz JA, Gatell JM, García F. A randomized clinical trial comparing ritonavir-boosted lopinavir versus raltegravir each with tenofovir plus emtricitabine for post-exposure prophylaxis for HIV infection. J Antimicrob Chemother 2016; 71:1987-93. [PMID: 26994089 DOI: 10.1093/jac/dkw049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/04/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objective of this study was to assess post-exposure prophylaxis (PEP) non-completion at day 28, comparing two regimens. METHODS A prospective, open, randomized clinical trial was conducted at a tertiary hospital in Barcelona, Spain. Individuals attending the emergency room because of potential sexual exposure to HIV were randomized to tenofovir disoproxil/emtricitabine (245/200 mg) plus either ritonavir-boosted lopinavir (400/100 mg) or raltegravir (400 mg). The primary endpoint was PEP non-completion at day 28. Secondary endpoints were adherence, adverse events and rate of seroconversions. This study was registered in ClinicalTrials.gov: NCT01576731. RESULTS One-hundred-and-twenty-one individuals were randomized to receive ritonavir-boosted lopinavir and 122 to raltegravir (n = 243). PEP non-completion at day 28 was 43% with no significant difference between arms. We performed a modified ITT analysis including only those patients who attended on day 1 (n = 191). PEP non-completion in this subgroup was higher in the ritonavir-boosted lopinavir arm than in the raltegravir arm (34.6% versus 20.4%, P = 0.04), as was the number of patients lost to follow-up at day 28 (32.6% versus 21.6%, P = 0.08) and the proportion of patients with low adherence (49.2% versus 30.8%, P = 0.03). Adverse events were significantly more common in the ritonavir-boosted lopinavir arm (73.4% versus 60.2%, P = 0.007). There was an HIV seroconversion at day 90 in the raltegravir arm in a patient who had multiple potential sexual risk exposures before and after receiving PEP. CONCLUSIONS Although we found no differences between arms regarding PEP non-completion, poor adherence and adverse events were significantly higher in patients allocated to tenofovir disoproxil/emtricitabine plus ritonavir-boosted lopinavir. These data support the use of raltegravir as the preferred third drug in current PEP recommendations.
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Affiliation(s)
- Lorna Leal
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Agathe León
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Berta Torres
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Alexy Inciarte
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Constanza Lucero
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Josep Mallolas
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Montserrat Laguno
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - María Martínez-Rebollar
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Ana González-Cordón
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Christian Manzardo
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jhon Rojas
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Judit Pich
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Joan A Arnaiz
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Josep M Gatell
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Felipe García
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Mulka L, Annandale D, Richardson C, Fisher M, Richardson D. Raltegravir-based HIV postexposure prophylaxis (PEP) in a real-life clinical setting: fewer drug–drug interactions (DDIs) with improved adherence and tolerability. Sex Transm Infect 2016; 92:107. [DOI: 10.1136/sextrans-2015-052262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kaplan JE, Dominguez K, Jobarteh K, Spira TJ. Postexposure Prophylaxis Against Human Immunodeficiency Virus (HIV): New Guidelines From the WHO: A Perspective. Clin Infect Dis 2016; 60 Suppl 3:S196-9. [PMID: 25972504 DOI: 10.1093/cid/civ087] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Kenneth Dominguez
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Ford N, Shubber Z, Calmy A, Irvine C, Rapparini C, Ajose O, Beanland RL, Vitoria M, Doherty M, Mayer KH. Choice of antiretroviral drugs for postexposure prophylaxis for adults and adolescents: a systematic review. Clin Infect Dis 2016; 60 Suppl 3:S170-6. [PMID: 25972499 DOI: 10.1093/cid/civ092] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The choice of preferred regimens for human immunodeficiency virus postexposure prophylaxis (PEP) has evolved over the last 2 decades as more data have become available regarding the safety and tolerability of newer antiretroviral drugs. We undertook a systematic review to assess the safety and efficacy of antiretroviral options for PEP to inform the World Health Organization guideline revision process. METHODS Four databases were searched up to 1 June 2014 for studies reporting outcomes associated with specific PEP regimens. Data on PEP completion and discontinuation due to adverse events was extracted and pooled estimates were obtained using random-effects meta-analyses. RESULTS Fifteen studies (1830 PEP initiations) provided evaluable information on 2-drug regimens (zidovudine [ZDV]- or tenofovir [TDF]-based regimens), and 10 studies (1755 initiations) provided evaluable information on the third drug, which was usually a protease inhibitor. The overall quality of the evidence was rated as very low. For the 2-drug regimen, PEP completion rates were 78.4% (95% confidence interval [CI], 66.1%-90.7%) for people receiving a TDF-based regimen and 58.8% (95% CI, 47.2%-70.4%) for a ZDV-based regimen; the rate of PEP discontinuation due to an adverse event was lower among people taking TDF-based PEP (0.3%; 95% CI, 0%-1.1%) vs a ZDV-based regimen (3.2%; 95% CI, 1.5%-4.9%). For the 3-drug comparison, PEP completion rates were highest for the TDF-based regimens (TDF+emtricitabine [FTC]+lopinavir/ritonavir [LPV/r], 71.1%; 95% CI, 43.6%-98.6%; TDF+FTC+raltegravir [RAL], 74.7%; 95% CI, 41.4%-100%; TDF+FTC+ boosted darunavir [DRV/r], 93.9%; 95% CI, 90.2%-97.7%) and lowest for ZDV+ lamivudine [3TC]+LPV/r (59.1%; 95% CI, 36.2%-82.0%). Discontinuations due to adverse drug reactions were lowest for TDF+FTC+RAL (1.9%; 95% CI, 0%-3.8%) and highest for ZDV+3TC+boosted atazanavir (21.2%; 95% CI, 13.5%-30.0%). CONCLUSIONS The findings of this review provide evidence supporting the use of coformulated TDF and 3TC/FTC as preferred backbone drugs for PEP. Choice of third drug will depend on setting; for resource-limited settings, LPV/r is a reasonable choice, pending the improved availability of better-tolerated drugs with less potential for drug-drug interactions.
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Affiliation(s)
- Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Zara Shubber
- Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom
| | - Alexandra Calmy
- HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital, Switzerland
| | - Cadi Irvine
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | | | | | - Rachel L Beanland
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Marco Vitoria
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, Boston, Massachusetts
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Antiretrovirals for primary HIV prevention: the current status of pre- and post-exposure prophylaxis. Curr HIV/AIDS Rep 2016; 12:127-38. [PMID: 25600106 DOI: 10.1007/s11904-014-0253-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In light of the 2 million HIV infections that occur globally each year, there is a need to optimize strategies that integrate biomedical and behavioral approaches to HIV prevention. Post-exposure prophylaxis (PEP) immediately after acute high-risk exposures and pre-exposure prophylaxis (PrEP) for those who engage in recurrent high-risk behaviors are promising bio-behavioral approaches to decreasing HIV transmission. Guidelines have recommended PEP for occupational and non-occupational exposures for over 15 years, but uptake of PEP has been limited, partly as a result of insufficient awareness of this intervention among persons at highest risk for acquiring HIV. However, since the publication of large randomized clinical trials demonstrating the efficacy of PrEP, and the dissemination of guidelines endorsing its use, there is a renewed focus on bio-behavioral prevention. Numerous studies have recently assessed the acceptability of bio-behavioral prevention programs among diverse populations or described experiences implementing these programs in "real-world" settings. As research and clinical data informing optimal utilization of PEP and PrEP are rapidly accumulating, this review provides a timely summary of recent progress in bio-behavioral prevention. By contextualizing the most noteworthy recent findings regarding PEP and PrEP, this review seeks to inform the successful implementation of these promising prevention approaches.
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Wiboonchutikul S, Thientong V, Suttha P, Kowadisaiburana B, Manosuthi W. Significant intolerability of efavirenz in HIV occupational postexposure prophylaxis. J Hosp Infect 2016; 92:372-7. [PMID: 26876748 DOI: 10.1016/j.jhin.2015.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 12/11/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Completion of human immunodeficiency virus (HIV) occupational postexposure prophylaxis (PEP) is important for successful prophylaxis. AIM To determine factors associated with failure to complete the four-week HIV PEP. METHODS A retrospective study was conducted among healthcare workers (HCWs) accidentally exposed to blood or body fluids of patients at the Bamrasnaradura Infectious Diseases Institute, Thailand, between March 1996 and June 2014. Logistic regression analysis was used to determine factors associated with failure to complete the four-week HIV PEP. FINDINGS In total, 225 exposure episodes were reported. The mean age of HCWs was 33.1 (standard deviation 9.9) years, and 189 (84%) were female. Nurses (43%) were exposed most frequently. The HIV status of the source was defined in 149 (66%) episodes, and 101 (68%) of these were positive. Of 225 exposures, PEP was prescribed in 155 (69%) cases, with intentional discontinuation in 26 cases. Ninety-one of 129 (71%) HCWs completed the four-week regimen. Multi-variate analysis showed that a regimen of two nucleotide reverse transcriptase inhibitors (NRTI) + efavirenz (EFV) was the only significant factor associated with non-completion of the four-week course (odds ratio 37.8, 95% confidence interval 4.2-342.3; P < 0.01). Other factors including age, sex, staff position, status of the source and other PEP regimens were not associated with non-completion of the four-week course (P > 0.05). None of the HCWs were documented to have HIV seroconversion. CONCLUSION A regimen of two NRTIs + EFV was significantly associated with premature discontinuation of occupational PEP. This regimen should not be used for HIV prophylaxis following occupational exposure.
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Affiliation(s)
- S Wiboonchutikul
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
| | - V Thientong
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - P Suttha
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | | | - W Manosuthi
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
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Gender Reassignment Surgery in Human Immunodeficiency Virus-Positive Patients: A Report of Two Cases. Arch Plast Surg 2015; 42:776-82. [PMID: 26618127 PMCID: PMC4659993 DOI: 10.5999/aps.2015.42.6.776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/04/2015] [Accepted: 09/07/2015] [Indexed: 11/08/2022] Open
Abstract
It is believed that surgery on human immunodeficiency virus (HIV)-positive patients is dangerous and should be avoided due to the possibility of postoperative infection of the patients or HIV occupational transmission to the medical staff. We discuss here the preparations and measures needed to conduct surgery safely on HIV-positive patients, based on our experience. We performed sex reassignment surgery on two HIV-positive patients from January 2013 to January 2015. Both of them were receiving highly active antiretroviral therapy and were asymptomatic, with a normal CD4 count (>500 cells/µL). The HIV-RNA was undetectable within the bloodstream. All the staff wore protective clothing, glasses, and three pairs of protective gloves in the operating room because of the possibility of transmission. Prophylactic antibiotics were administered to the patients, and antiviral therapy was performed during their perioperative course. Neither of the patients had postoperative complications, and none of the medical staff experienced accidental exposure. Both patients had satisfactory surgery outcomes without complications. HIV-positive patients can undergo surgery safely without increased risk of postoperative complications or HIV transmission to the staff through the proper use of antibiotics, active antiretroviral therapy, and supplemental protective measures with post-exposure prophylaxis for the staff in case of HIV exposure.
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Thomas R, Galanakis C, Vézina S, Longpré D, Boissonnault M, Huchet E, Charest L, Murphy D, Trottier B, Machouf N. Adherence to Post-Exposure Prophylaxis (PEP) and Incidence of HIV Seroconversion in a Major North American Cohort. PLoS One 2015; 10:e0142534. [PMID: 26559816 PMCID: PMC4641668 DOI: 10.1371/journal.pone.0142534] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/22/2015] [Indexed: 11/26/2022] Open
Abstract
Background There is limited evidence on the efficacy of post-exposure prophylaxis (PEP) for sexual exposures. We sought to determine the factors associated with adherence to treatment and describe the incidence of PEP failures in a Montreal clinic. Methods We prospectively assessed all patients consulting for PEP following sexual exposures from October 2000 to July 2014. Patients were followed at 4 and 16 weeks after starting PEP. Treatment adherence was determined by self-report at week 4. Multivariable logistic regression was used to estimate the factors predicting adherence to treatment. Results 3547 PEP consults were included. Patients were mainly male (92%), MSM (83%) and sought PEP for anal intercourse (72%). Seventy-eight percent (n = 2772) of patients received a prescription for PEP, consisting of Tenofovir/Emtracitabine (TVD) + Lopinavir/Ritonavir (LPV) in 74% of cases, followed by Zidovudine/Lamivudine (CBV) + LPV (10%) and TVD + Raltegravir (RAL) (8%). Seventy percent of patients were adherent to treatment. Compared to TVD+LPV, patients taking CBV+LPV were less likely to adhere to treatment (OR 0.58, 95% CI 0.44–0.75), while no difference was observed for patients taking TVD+RAL (OR 1.15, 95% CI 0.83–1.59). First-time PEP consults, older and male patients were also more adherent to treatment. Ten treated patients seroconverted (0.37%) during the study period, yet only 1 case can be attributed to PEP failure (failure rate = 0.04%). Conclusion PEP regimen was associated with treatment adherence. Patients were more likely to be adherent to TVD-based regimens. Ten patients seroconverted after taking PEP; however, only 1 case was a PEP failure as the remaining patients continued to engage in high-risk behavior during follow-up. One month PEP is an effective preventive measure to avoid HIV infection.
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Affiliation(s)
- Réjean Thomas
- Clinique médicale l’Actuel, Montreal, Quebec, Canada
| | | | - Sylvie Vézina
- Clinique médicale l’Actuel, Montreal, Quebec, Canada
| | | | | | | | | | - Daniel Murphy
- Clinique médicale l’Actuel, Montreal, Quebec, Canada
| | | | - Nimâ Machouf
- Clinique médicale l’Actuel, Montreal, Quebec, Canada
- * E-mail:
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37
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Changes to Initial Postexposure Prophylaxis Regimens Between the Emergency Department and Clinic. J Acquir Immune Defic Syndr 2015; 69:e182-4. [DOI: 10.1097/qai.0000000000000680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bader MS, Brooks AA, Srigley JA. Postexposure management of healthcare personnel to infectious diseases. Hosp Pract (1995) 2015; 43:107-27. [PMID: 25728206 PMCID: PMC7103705 DOI: 10.1080/21548331.2015.1018091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 02/09/2015] [Indexed: 11/16/2022]
Abstract
Healthcare personnel (HCP) are at risk of exposure to various pathogens through their daily tasks and may serve as a reservoir for ongoing disease transmission in the healthcare setting. Management of HCP exposed to infectious agents can be disruptive to patient care, time-consuming, and costly. Exposure of HCP to an infectious source should be considered an urgent medical concern to ensure timely management and administration of postexposure prophylaxis, if available and indicated. Infection control and occupational health departments should be notified for management of exposed HCP, identification of all contacts of the index case, and application of immediate infection control measures for the index case and exposed HCP, if indicated. This article reviews the main principles of postexposure management of HCP to infectious diseases, in general, and to certain common infections, in particular, categorized by their route of transmission, in addition to primary prevention of these infections.
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Affiliation(s)
- Mazen S. Bader
- Department of Medicine, Hamilton Health sciences, Juravinski hospital and Cancer Centre, Hamilton, Ontario, Canada
| | - Annie A. Brooks
- Department of Pharmacy, Hamilton Health Sciences, Juravinski hospital and Cancer Centre, Hamilton, Ontario, Canada
| | - Jocelyn A. Srigley
- Department of Medicine, Infection Prevention and Control, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Longitudinal trends in HIV nonoccupational postexposure prophylaxis use at a Boston community health center between 1997 and 2013. J Acquir Immune Defic Syndr 2015; 68:97-101. [PMID: 25321180 DOI: 10.1097/qai.0000000000000403] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Secular trends in nonoccupational postexposure prophylaxis (NPEP) use have not been well characterized. We performed a retrospective longitudinal study of 894 electronic medical records of NPEP users, mostly men who have sex with men, at a Boston community health center who presented between July 1997 and August 2013. NPEP use and condomless sexual exposures increased over time; 19.4% had multiple NPEP courses. Having an HIV-infected partner was associated with increased odds of regimen completion, and 3-drug regimens were associated with decreased odds of completion. Targeted adherence and risk-reduction counseling are warranted for select NPEP users at this center.
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Kuhar DT, Struble KA, Henderson DK. Reply to Tan et al. Infect Control Hosp Epidemiol 2015; 35:328-9. [PMID: 24521605 DOI: 10.1086/675350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- David T Kuhar
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Jain S, Oldenburg CE, Mimiaga MJ, Mayer KH. Subsequent HIV infection among men who have sex with men who used non-occupational post-exposure prophylaxis at a Boston community health center: 1997-2013. AIDS Patient Care STDS 2015; 29:20-5. [PMID: 25369451 DOI: 10.1089/apc.2014.0154] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Non-occupational post-exposure prophylaxis (NPEP) has been recommended to prevent HIV acquisition for nearly 20 years. However, limited behavioral and clinical outcome data exist after men who have sex with men (MSM) present for NPEP. We reviewed the electronic medical records of HIV-uninfected adults who presented for NPEP at a large community health center in Boston between July, 1997 and August, 2013. Data from 894 patients were analyzed, 88.1% of whom were MSM. Consensual unprotected sex was the most common reason for NPEP visits among MSM (64.2%), followed by condom failure (30.6%). The HIV serostatus of the partner was unknown for 64.4% of the MSM, positive with unknown treatment status for 18.1%, positive and not on treatment for 4.1%, and positive and on treatment for 13.4%. Thirty-nine patients subsequently became HIV-infected (4.4%), all of whom were MSM. The MSM-specific HIV incidence after NPEP use was 2.2 cases per 100 person-years. Incident HIV infection was associated with younger age (AHR=0.94; p=0.003), being Latino (AHR=2.44; p=0.044), and/or being African American (AHR=3.43; p=0.046). Repeated NPEP use was not associated with incident HIV infection (AHR=0.67; p=0.26). Younger MSM of color who access NPEP, in particular, may benefit from early HIV risk-reduction and pre-exposure prophylaxis counseling.
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Affiliation(s)
- Sachin Jain
- Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, Massachusetts
- The Fenway Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Catherine E. Oldenburg
- The Fenway Institute, Boston, Massachusetts
- Harvard School of Public Health, Department of Epidemiology, Boston, Massachusetts
| | - Matthew J. Mimiaga
- The Fenway Institute, Boston, Massachusetts
- Harvard School of Public Health, Department of Epidemiology, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Department of Psychiatry, Boston, Massachusetts
| | - Kenneth H. Mayer
- Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, Massachusetts
- The Fenway Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Pantalone DW, Tomassilli JC, Starks TJ, Golub SA, Parsons JT. Unprotected Anal Intercourse With Casual Male Partners in Urban Gay, Bisexual, and Other Men Who Have Sex With Men. Am J Public Health 2015; 105:103-110. [PMID: 25393176 DOI: 10.2105/ajph.2014.302093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. We investigated trends in, and predictors of, unprotected anal intercourse (UAI) with casual male partners of gay, bisexual, and other men who have sex with men (GBMSM). Methods. We analyzed data from cross-sectional intercept surveys conducted annually (2003-2008) at 2 large lesbian, gay, and bisexual community events in New York City. Survey data covered GBMSM's highest-risk behaviors for HIV acquisition (HIV-negative or unknown status GBMSM, any UAI) and transmission (HIV-positive GBMSM, any serodiscordant unprotected UAI). Results. Across years, 32.3% to 51.5% of the HIV-negative or unknown status men endorsed any UAI, and 36.9% to 52.9% of the HIV-positive men endorsed serodiscordant UAI. We observed a few statistically significant fluctuations in engagement in high-risk behavior. However, these do not appear to constitute meaningful trends. Similarly, in some years, one or another demographic predictor of UAI was significant. Across years, however, no reliable pattern emerged. Conclusions. A significant proportion of urban GBMSM engage in high-risk sex, regardless of serostatus. No consistent demographic predictors emerged, implying a need for broad-based interventions that target all GBMSM.
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Affiliation(s)
- David W Pantalone
- David W. Pantalone is with the Department of Psychology, University of Massachusetts, Boston, and the Fenway Institute, Fenway Health, Boston, MA. Julia C. Tomassilli is with the Fenway Institute, Fenway Health. Tyrel J. Starks is with Pace University and the Center for HIV/AIDS Educational Studies and Training, Hunter College, City University of New York, New York, NY. Sarit A. Golub is with Hunter College and the Graduate Center, City University of New York. Jeffrey T. Parsons is with the Center for HIV/AIDS Educational Studies and Training, Hunter College, and the Graduate Center, City University of New York
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Abstract
The incidence of human immunodeficiency virus (HIV) infection continues to rise among core groups and efforts to reduce the numbers of new infections are being redoubled. Post-exposure prophylaxis (PEP) is the use of short-term antiretroviral therapy (ART) to reduce the risk of acquisition of HIV infection following exposure. Current guidelines recommend a 28-day course of ART within 36-72 hours of exposure to HIV. As long as individuals continue to be exposed to HIV there will be a role for PEP in the foreseeable future. Nonoccupational PEP, the vast majority of which is for sexual exposure (PEPSE), has a significant role to play in HIV prevention efforts. Awareness of PEP and its availability for both clinicians and those who are eligible to receive it are crucial to ensure that PEP is used to its full potential in any HIV prevention strategy. In this review, we provide current evidence for the use of PEPSE, assessment of the risk of HIV transmission, indications for PEP, drug regimens, and management of patients started on PEP. We summarize national and international guidelines for the use of PEPSE. We explore the place of PEP within the wider strategy of reducing HIV incidence rates in the era of treatment as prevention and pre-exposure prophylaxis. We also consider the implications of recent data from interventional and observational studies demonstrating significant reductions in the risk of HIV transmission within a serodiscordant relationship if the HIV-positive partner is taking effective ART upon PEP guidelines.
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Affiliation(s)
- Binta Sultan
- Department of Genitourinary Medicine, Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Paul Benn
- Department of Genitourinary Medicine, Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Laura Waters
- Department of Genitourinary Medicine, Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
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44
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Abstract
Few studies of pre-exposure prophylaxis (PrEP) to prevent HIV infection have focused on drug users. Between February to September 2013, we asked 351 opiate injectors entering detoxification treatment about HIV risk, knowledge about PrEP, and willingness to use a once daily PrEP pill under one of two randomly assigned effectiveness scenarios-40 % (low) or 90 % (high) effective in reducing HIV risk. Participants were 70 % male and 87 % non-Hispanic White. Only 7 % had heard of a drug to reduce HIV risk, yet once informed, 47 % would be willing to take such a pill [35 % of those in the low effectiveness scenario and 58 % in the high group (p < 0.001)]. Higher perceived HIV risk was associated with greater willingness to take medication. Increasing knowledge of PrEP and the rate of HIV reduction-effectiveness promised will influence its use among targeted high-risk drug users.
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Affiliation(s)
- Michael Stein
- General Medicine Research Unit, Butler Hospital, Alpert School of Medicine at Brown University, 345 Blackstone Blvd, Providence, RI, 02906, USA,
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45
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Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, Montaner JSG, Wheeler DP, Grant RM, Grinsztejn B, Kumarasamy N, Shoptaw S, Walensky RP, Dabis F, Sugarman J, Benson CA. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA 2014; 312:390-409. [PMID: 25038358 PMCID: PMC6309682 DOI: 10.1001/jama.2014.7999] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Emerging data warrant the integration of biomedical and behavioral recommendations for human immunodeficiency virus (HIV) prevention in clinical care settings. OBJECTIVE To provide current recommendations for the prevention of HIV infection in adults and adolescents for integration in clinical care settings. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS Data published or presented as abstracts at scientific conferences (past 17 years) were systematically searched and reviewed by the International Antiviral (formerly AIDS) Society-USA HIV Prevention Recommendations Panel. Panel members supplied additional relevant publications, reviewed available data, and formed recommendations by full-panel consensus. RESULTS Testing for HIV is recommended at least once for all adults and adolescents, with repeated testing for those at increased risk of acquiring HIV. Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if suspected. At diagnosis of HIV, all individuals should be linked to care for timely initiation of antiretroviral therapy (ART). Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections (STIs) is recommended for HIV-infected individuals as part of care. In HIV-uninfected patients, those persons at high risk of HIV infection should be prioritized for delivery of interventions such as preexposure prophylaxis and individualized counseling on risk reduction. Daily emtricitabine/tenofovir disoproxil fumarate is recommended as preexposure prophylaxis for persons at high risk for HIV based on background incidence or recent diagnosis of incident STIs, use of injection drugs or shared needles, or recent use of nonoccupational postexposure prophylaxis; ongoing use of preexposure prophylaxis should be guided by regular risk assessment. For persons who inject drugs, harm reduction services should be provided (needle and syringe exchange programs, supervised injection, and available medically assisted therapies, including opioid agonists and antagonists); low-threshold detoxification and drug cessation programs should be made available. Postexposure prophylaxis is recommended for all persons who have sustained a mucosal or parenteral exposure to HIV from a known infected source and should be initiated as soon as possible. CONCLUSIONS AND RELEVANCE Data support the integration of biomedical and behavioral approaches for prevention of HIV infection in clinical care settings. A concerted effort to implement combination strategies for HIV prevention is needed to realize the goal of an AIDS-free generation.
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Affiliation(s)
| | | | - David R Holtgrave
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | - Beatriz Grinsztejn
- Evandro Chagas Clinical Research Institute (IPEC)-FIOCRUZ, Rio de Janeiro, Brazil
| | - N Kumarasamy
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
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46
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Practical guidance for nonoccupational postexposure prophylaxis to prevent HIV infection: an editorial review. AIDS 2014; 28:1545-54. [PMID: 24785956 DOI: 10.1097/qad.0000000000000301] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Postexposure prophylaxis (PEP) with antiretroviral medication has been used as an HIV-prevention strategy for nearly 20 years. The fact that approximately 50 000 new HIV infections occur in the United States each year reflects marked underutilization of nonoccupational PEP (NPEP). There have been several advances in NPEP in the past 10 years. Clinical trials from different countries have demonstrated better tolerability, completion rates, and fewer drug-drug interactions with newer antiretroviral agents. Notably, there has been a shift from zidovudine-based to tenofovir-based regimens. Three-drug therapy is now favored for all potential HIV exposures. More recently, the US Public Health Service and the New York State Department of Health recommended tenofovir/emtricitabine and raltegravir as the first-line regimen universally for PEP. Advances in HIV testing technology may also allow shorter duration of follow-up HIV testing after a high-risk exposure. This review will discuss challenges with previously recommended regimens, newer potential candidate agents and the rationale for using them, intervals for laboratory monitoring, and cost considerations for NPEP. NPEP can be viewed as an educable moment and a potential bridge to preexposure prophylaxis, as part of a combination prevention package, for those who are likely to have recurrent higher-risk exposures. Thus, risk-reduction counseling should be an integral aspect of NPEP.
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47
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Morlat P, Hoen B, Blanc A, Bonnet F, Bourdillon F, Brun-Vezinet F, Costagliola D, Dabis F, Delobel P, Goujard C, Hoen B, Lortholary O, Mandelbrot L, Matheron S, Morlat P, Persiaux R, Poizot-Martin I, Rey D, Rouzioux C, Simon A, Taburet AM, Tattevin P. Comment on: Antiretroviral treatment French guidelines 2013: economics influencing science. J Antimicrob Chemother 2014; 69:2881-2. [DOI: 10.1093/jac/dku186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Grossman CI, Purcell DW, Rotheram-Borus MJ, Veniegas R. Opportunities for HIV combination prevention to reduce racial and ethnic health disparities. ACTA ACUST UNITED AC 2014; 68:237-46. [PMID: 23688091 DOI: 10.1037/a0032711] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite advances in HIV prevention and care, African Americans and Latino Americans remain at much higher risk of acquiring HIV, are more likely to be unaware of their HIV-positive status, are less likely to be linked to and retained in care, and are less likely to have suppressed viral load than are Whites. The first National HIV/AIDS Strategy (NHAS) has reducing these disparities as one of its three goals by encouraging the implementation of combination high-impact HIV intervention strategies. Federal agencies have expanded their collaborations in order to decrease HIV-related disparities through better implementation of data-driven decision making; integration and consolidation of the continuum of HIV care; and the reorganization of relationships among public health agencies, researchers, community-based organizations, and HIV advocates. Combination prevention, the integration of evidence-based and impactful behavioral, biomedical, and structural intervention strategies to reduce HIV incidence, provides the tools to address the HIV epidemic. Unfortunately, health disparities exist at every step along the HIV testing-to-care continuum. This provides an opportunity and a challenge to everyone involved in HIV prevention and care to understand and address health disparities as an integral part of ending the HIV epidemic in the United States. To further reduce health disparities, successful implementation of NHAS and combination prevention strategies will require multidisciplinary teams, including psychologists with diverse cultural backgrounds and experiences, to successfully engage groups at highest risk for HIV and those already infected with HIV. In order to utilize the comprehensive care continuum, psychologists and behavioral scientists have a role to play in reconceptualizing the continuum of care, conducting research to address health disparities, and creating community mobilization strategies.
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Affiliation(s)
- Cynthia I Grossman
- Division of AIDS Research, National Institute of Mental Health, Bethesda, MD, USA
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49
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Ripamonti D, Benatti SV, Di Filippo E, Ravasio V, Rizzi M. Drug reaction with eosinophilia and systemic symptoms associated with raltegravir use: case report and review of the literature. AIDS 2014; 28:1077-9. [PMID: 24685746 DOI: 10.1097/qad.0000000000000204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Bogoch II, Scully EP, Zachary KC, Yawetz S, Mayer KH, Bell CM, Andrews JR. Patient Attrition Between the Emergency Department and Clinic Among Individuals Presenting for HIV Nonoccupational Postexposure Prophylaxis. Clin Infect Dis 2014; 58:1618-24. [DOI: 10.1093/cid/ciu118] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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