HIV pre-exposure prophylaxis: It is time to consider harm reduction care for adolescents in Canada

Youth (aged 15 to 29 years) account for one quarter of new HIV cases in Canada. Of those, men-who-have-sex-with-men make up one third to one half of new cases in that age range. Moreover, Indigenous youth are over-represented in the proportion of new cases. The use of emtricitabine/tenofovir disoproxil fumarate as pre-exposure prophylaxis (PrEP) significantly reduces the risk of HIV acquisition in adults. Its use was expanded to include youth over 35 kg by the U.S. Food and Drug Administration in 2018. However, PrEP uptake remains low among adolescents. Prescriber-identified barriers include lack of experience, concerns about safety, unfamiliarity with follow-up guidelines, and costs. This article provides an overview of PrEP for youth in Canada, and its associated safety and side effect profiles. Hypothetical case vignettes highlight some of the many demographics of youth who could benefit from PrEP. We present a novel flow diagram that explains the baseline workup, prescribing guidelines, and follow-up recommendations in the Canadian context. Additional counselling points highlight some of the key discussions that should be elicited when prescribing PrEP.

The Use of Retinoids for the Prevention and Treatment of Skin Cancers: An Updated Review

Retinoids are natural and synthetic vitamin A derivatives that are effective for the prevention and the treatment of non-melanoma skin cancers (NMSC). NMSCs constitute a heterogenous group of non-melanocyte-derived skin cancers that impose substantial burdens on patients and healthcare systems. They include entities such as basal cell carcinoma and cutaneous squamous cell carcinoma (collectively called keratinocyte carcinomas), cutaneous lymphomas and Kaposi’s sarcoma among others. The retinoid signaling pathway plays influential roles in skin physiology and pathology. These compounds regulate diverse biological processes within the skin, including proliferation, differentiation, angiogenesis and immune regulation. Collectively, retinoids can suppress skin carcinogenesis. Both topical and systemic retinoids have been investigated in clinical trials as NMSC prophylactics and treatments. Desirable efficacy and tolerability in clinical trials have prompted health regulatory bodies to approve the use of retinoids for NMSC management. Acceptable off-label uses of these compounds as drugs for skin cancers are also described. This review is a comprehensive outline on the biochemistry of retinoids, their activities in the skin, their effects on cancer cells and their adoption in clinical practice.

HPV vaccination practices and attitudes among primary care physicians since FDA approval to age 45

PURPOSE

The aim of this study was to examine HPV vaccine administration practices since FDA approval to age 45 and assess knowledge regarding HPV and its association with oropharyngeal cancer.

METHODS

A survey was distributed to 86 primary care physicians at Loyola University Medical Center. The survey contained 11 questions designed to capture HPV vaccination practices, knowledge of FDA approval, and barriers to vaccination.

RESULTS

46 (53%) physicians completed the survey and 45 responses were included. Among respondents who treat males ages 9-21 and females ages 9-26, the vaccination is widely recommended with >95% always or almost always recommending the vaccination. Among those treating males >21, and females >26, 52% and 35% of physicians recommend vaccination to these cohorts, respectively. Only 17% and 26% of respondents would recommend the vaccine to men and women respectively up to age 45. 100% of respondents recognize an association between HPV and cervical cancer, and 90% of respondents recognize HPV's association with oropharyngeal cancer. However, respondents also associate HPV with oral cavity and laryngeal cancer. 28% of respondents said parents are barriers to vaccination, while 7% said that insurance is a barrier.

CONCLUSIONS

HPV vaccination is widely recommended by physicians at our institution; however, for men older than 21 and women older than 26, vaccination recommendation rates decrease, and relatively few physicians would offer the vaccination up to age 45. Primary care physicians at our institution recognize HPV's close association to oropharyngeal cancer. Barriers to vaccination are primarily negative perception of the vaccine by patients and parents.