In no field of medicine has advocacy, including physician advocacy, been more crucial in shaping policy for delivery of care than in HIV/AIDS. Although the historic tradition is strong, there is an urgent need to re-energize advocacy efforts nationally and internationally to support programs that fund care, change policies that perpetuate stigma and discrimination, and change the public perception that the HIV/AIDS crisis is over. Established programs that require ongoing advocacy attention include the Ryan White Comprehensive AIDS Resources Emergency Act, a US program that serves as a payer of last resort for care for patients with HIV infection, and international programs like the President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Newer issues have emerged, including the need to ensure fair drug pricing and guarantee sustained access to care and medications. Amidst the opioid epidemic, the preservation and establishment of policies to support syringe services programs take on new urgency, and ongoing efforts are necessary to decrease stigma about HIV infection, maintain protection of LGBTQ rights, and reform HIV criminalization laws. All stakeholders in the HIV community, including practitioners, individuals with HIV infection, and professional organizations, need to make their voices heard as they have done in the past in order to effectively continue to address the epidemic. This commentary was submitted by Carlos del Rio, MD, and Wendy S. Armstrong, MD, in March, 2018, and accepted in July, 2018.
在艾滋病毒/艾滋病方面,倡导,包括医生倡导,在制定提供护理的政策方面,没有哪个医学领域比这更重要。尽管历史传统悠久,但迫切需要在国内和国际上重新加强宣传工作,以支持资助护理的项目,改变使耻辱和歧视持续存在的政策,并改变公众对艾滋病毒/艾滋病危机已经结束的看法。需要持续关注的现有项目包括《瑞安·怀特艾滋病综合资源紧急法案》(Ryan White Comprehensive AIDS Resources Emergency Act),这是一个为艾滋病毒感染者提供最后护理的美国项目,以及《总统艾滋病紧急救援计划》(PEPFAR)和《全球抗击艾滋病、结核病和疟疾基金》等国际项目。新的问题已经出现,包括需要确保公平的药品定价和保证持续获得护理和药物。在阿片类药物泛滥的情况下,维持和建立支持注射器服务项目的政策具有新的紧迫性,需要持续努力减少对艾滋病毒感染的耻辱感,保持对LGBTQ权利的保护,并改革艾滋病毒刑事化法律。艾滋病毒界的所有利益攸关方,包括从业人员、艾滋病毒感染者和专业组织,都需要像过去一样发出自己的声音,以便继续有效地应对这一流行病。该评论由Carlos del Rio医学博士和Wendy S. Armstrong医学博士于2018年3月提交,并于2018年7月被接受。
{"title":"Policy and advocacy for the HIV practitioner.","authors":"Carlos Del Rio, Wendy S Armstrong","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In no field of medicine has advocacy, including physician advocacy, been more crucial in shaping policy for delivery of care than in HIV/AIDS. Although the historic tradition is strong, there is an urgent need to re-energize advocacy efforts nationally and internationally to support programs that fund care, change policies that perpetuate stigma and discrimination, and change the public perception that the HIV/AIDS crisis is over. Established programs that require ongoing advocacy attention include the Ryan White Comprehensive AIDS Resources Emergency Act, a US program that serves as a payer of last resort for care for patients with HIV infection, and international programs like the President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Newer issues have emerged, including the need to ensure fair drug pricing and guarantee sustained access to care and medications. Amidst the opioid epidemic, the preservation and establishment of policies to support syringe services programs take on new urgency, and ongoing efforts are necessary to decrease stigma about HIV infection, maintain protection of LGBTQ rights, and reform HIV criminalization laws. All stakeholders in the HIV community, including practitioners, individuals with HIV infection, and professional organizations, need to make their voices heard as they have done in the past in order to effectively continue to address the epidemic. This commentary was submitted by Carlos del Rio, MD, and Wendy S. Armstrong, MD, in March, 2018, and accepted in July, 2018.</p>","PeriodicalId":38738,"journal":{"name":"Topics in antiviral medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291296/pdf/tam-26-094.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36626750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Human papillomavirus (HPV)-related cancers, including anal cancer and oropharyngeal cancer, occur more frequently in individuals living with HIV infection than in the general population. Strategies for prevention among individuals with HIV infection include HPV vaccination, anal cancer screening programs, and early initiation of antiretroviral therapy (ART). HPV vaccination is not yet optimally used; a stronger and more persistent effort is needed to increase vaccination rates. Although anal cancer screening is not recommended by all authorities, there is a least some evidence that screening and treatment of anal high-grade squamous intraepithelial lesions may prevent progression to cancer. However, more definitive evidence is needed. Early initiation of ART reduces the risk of infection-related cancers, with some evidence of benefit in preventing HPV-associated cancer in individuals with HIV infection. This article summarizes a presentation by Timothy J. Wilkin, MD, MPH, at the IAS-USA continuing education program held in Los Angeles, California in April 2018.
人乳头瘤病毒(HPV)相关的癌症,包括肛门癌和口咽癌,在艾滋病毒感染者中比在一般人群中更常发生。艾滋病毒感染者的预防策略包括HPV疫苗接种,肛门癌筛查计划和早期开始抗逆转录病毒治疗(ART)。HPV疫苗接种尚未得到最佳利用;需要作出更强有力和更持久的努力来提高疫苗接种率。尽管并非所有权威机构都推荐进行肛门癌筛查,但至少有一些证据表明,对肛门高级鳞状上皮内病变进行筛查和治疗可以预防癌症的发展。然而,还需要更明确的证据。早期开始抗逆转录病毒治疗可降低感染相关癌症的风险,有一些证据表明,在艾滋病毒感染者中预防hpv相关癌症有益。本文总结了Timothy J. Wilkin,医学博士,公共卫生硕士在2018年4月于加利福尼亚州洛杉矶举行的IAS-USA继续教育项目上的演讲。
{"title":"Human papillomavirus-related malignancies in HIV infection: anal and oropharyngeal cancers.","authors":"Timothy J Wilkin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Human papillomavirus (HPV)-related cancers, including anal cancer and oropharyngeal cancer, occur more frequently in individuals living with HIV infection than in the general population. Strategies for prevention among individuals with HIV infection include HPV vaccination, anal cancer screening programs, and early initiation of antiretroviral therapy (ART). HPV vaccination is not yet optimally used; a stronger and more persistent effort is needed to increase vaccination rates. Although anal cancer screening is not recommended by all authorities, there is a least some evidence that screening and treatment of anal high-grade squamous intraepithelial lesions may prevent progression to cancer. However, more definitive evidence is needed. Early initiation of ART reduces the risk of infection-related cancers, with some evidence of benefit in preventing HPV-associated cancer in individuals with HIV infection. This article summarizes a presentation by Timothy J. Wilkin, MD, MPH, at the IAS-USA continuing education program held in Los Angeles, California in April 2018.</p>","PeriodicalId":38738,"journal":{"name":"Topics in antiviral medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291297/pdf/tam-26-085.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36626748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Retention of HIV-infected patients in care is crucial to optimizing individual patient outcomes and reducing transmission of HIV. A number of strategies are available to improve linkage to care; among them, the AntiRetroviral Treatment and Access Services intervention should be considered standard of care at the clinic level. With regard to retention in care, the Retention Through Enhanced Personal Contact intervention has been shown to improve retention rates and the Centers for Disease Control and Prevention Data to Care program has been successful in assisting public health authorities to locate and return to treatment patients presumed to be lost to follow-up. Patient satisfaction with initial physician and clinic encounters also improves retention. There are some data to support same-day or rapid start of antiretroviral therapy in the clinic setting as a method to immediately establish care and more data on this approach are needed. This article summarizes a presentation by Thomas P. Giordano, MD, MPH, at the Ryan White HIV/AIDS Program Clinical Conference held in San Antonio, Texas, in August 2017.
将感染艾滋病毒的患者留在护理中,对于优化患者个体预后和减少艾滋病毒传播至关重要。有若干战略可用于改善与保健的联系;其中,抗逆转录病毒治疗和获得服务干预措施应被视为诊所一级的标准护理。在留用治疗方面,通过加强个人接触的留用干预措施已被证明提高了留用率,疾病控制和预防中心的数据到护理方案已成功地协助公共卫生当局找到并使可能失去随访的患者返回治疗。患者对最初的医生和诊所接触的满意度也提高了保留率。有一些数据支持在临床环境中当天或快速开始抗逆转录病毒治疗作为立即建立护理的方法,但需要更多关于这种方法的数据。本文总结了2017年8月在德克萨斯州圣安东尼奥举行的Ryan White HIV/AIDS项目临床会议上,医学博士、公共卫生硕士Thomas P. Giordano的演讲。
{"title":"Strategies for Linkage to and Engagement With Care: Focus on Intervention.","authors":"Thomas P Giordano","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Retention of HIV-infected patients in care is crucial to optimizing individual patient outcomes and reducing transmission of HIV. A number of strategies are available to improve linkage to care; among them, the AntiRetroviral Treatment and Access Services intervention should be considered standard of care at the clinic level. With regard to retention in care, the Retention Through Enhanced Personal Contact intervention has been shown to improve retention rates and the Centers for Disease Control and Prevention Data to Care program has been successful in assisting public health authorities to locate and return to treatment patients presumed to be lost to follow-up. Patient satisfaction with initial physician and clinic encounters also improves retention. There are some data to support same-day or rapid start of antiretroviral therapy in the clinic setting as a method to immediately establish care and more data on this approach are needed. This article summarizes a presentation by Thomas P. Giordano, MD, MPH, at the Ryan White HIV/AIDS Program Clinical Conference held in San Antonio, Texas, in August 2017.</p>","PeriodicalId":38738,"journal":{"name":"Topics in antiviral medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6017130/pdf/tam-26-062.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36227452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
People with HIV infection with latent tuberculosis (TB) infection (LTBI) are at a 10-fold greater risk of developing active disease. Interferon gamma release assays and tuberculin skin testing have approximately 65% to 70% specificity for diagnosing LTBI in HIV-infected patients. LTBI can be successfully treated with isoniazid preventive therapy and early antiretroviral therapy (ART). Rapid molecular diagnostics have approximately 88% sensitivity and 98% specificity for identifying active TB. ART should be started early in patients with TB. A number of ART regimens are recommended in co-treatment that minimize the risk of drug-drug interactions. Although progress has been made, better diagnostics and TB regimens with lower risks of drug-drug interactions and shorter treatment durations are still needed. This article summarizes a presentation by Susan Swindells, MBBS, at the Ryan White HIV/AIDS Program Clinical Care Conference held in San Antonio in August 2017.
{"title":"New and Noteworthy in Tuberculosis Diagnostics and Treatment.","authors":"Susan Swindells","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>People with HIV infection with latent tuberculosis (TB) infection (LTBI) are at a 10-fold greater risk of developing active disease. Interferon gamma release assays and tuberculin skin testing have approximately 65% to 70% specificity for diagnosing LTBI in HIV-infected patients. LTBI can be successfully treated with isoniazid preventive therapy and early antiretroviral therapy (ART). Rapid molecular diagnostics have approximately 88% sensitivity and 98% specificity for identifying active TB. ART should be started early in patients with TB. A number of ART regimens are recommended in co-treatment that minimize the risk of drug-drug interactions. Although progress has been made, better diagnostics and TB regimens with lower risks of drug-drug interactions and shorter treatment durations are still needed. This article summarizes a presentation by Susan Swindells, MBBS, at the Ryan White HIV/AIDS Program Clinical Care Conference held in San Antonio in August 2017.</p>","PeriodicalId":38738,"journal":{"name":"Topics in antiviral medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6017128/pdf/tam-26-058.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36227016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The conference on Retroviruses and Opportunistic Infections represents the most important venue for the dissemination of research advances in HIV and AIDS. The 25th conference, held in Boston, featured presentations that provided insight into the mechanisms of HIV-1 spread in tissues as well as new information on mechanisms of HIV-1 persistence in individuals on effective antiretroviral treatment. The ability of the conference to convey research findings for a general audience is enhanced, to a large part, by preconference workshops. These workshops feature leading researchers who aim to present cutting edge research to a general audience. These sessions rank highly in terms of education and professional value.
{"title":"CROI 2018: Advances in Basic Science Understanding of HIV.","authors":"Mario Stevenson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The conference on Retroviruses and Opportunistic Infections represents the most important venue for the dissemination of research advances in HIV and AIDS. The 25th conference, held in Boston, featured presentations that provided insight into the mechanisms of HIV-1 spread in tissues as well as new information on mechanisms of HIV-1 persistence in individuals on effective antiretroviral treatment. The ability of the conference to convey research findings for a general audience is enhanced, to a large part, by preconference workshops. These workshops feature leading researchers who aim to present cutting edge research to a general audience. These sessions rank highly in terms of education and professional value.</p>","PeriodicalId":38738,"journal":{"name":"Topics in antiviral medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963933/pdf/tam-26-017.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36070447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This year marked the 25th Conference on Retroviruses and Opportunistic Infections (CROI), and although there is much progress to celebrate in terms of treatment of HIV infection and expanding ART globally, many challenges remain. Tuberculosis is still the leading cause of death among people with HIV infection globally. This year, the results of investments in research to improve the prevention and treatment of tuberculosis were a highlight of the meeting. Noninfectious causes remain an important source of morbidity. Progress in identifying risk factors for non-AIDS complications and improvements in screening and monitoring for such conditions continue to be reported, but to date, despite the efforts of many investigators around the globe, interventions to effectively reduce HIV-related inflammation beyond effective and safer antiretroviral therapy (ART) remain elusive. This section will review highlights of the meeting on tuberculosis and cryptococcal infection as well as complications of long-term ART.
{"title":"CROI 2018: Complications of HIV Infection and Antiretroviral Therapy.","authors":"Judith S Currier, Diane V Havlir","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This year marked the 25th Conference on Retroviruses and Opportunistic Infections (CROI), and although there is much progress to celebrate in terms of treatment of HIV infection and expanding ART globally, many challenges remain. Tuberculosis is still the leading cause of death among people with HIV infection globally. This year, the results of investments in research to improve the prevention and treatment of tuberculosis were a highlight of the meeting. Noninfectious causes remain an important source of morbidity. Progress in identifying risk factors for non-AIDS complications and improvements in screening and monitoring for such conditions continue to be reported, but to date, despite the efforts of many investigators around the globe, interventions to effectively reduce HIV-related inflammation beyond effective and safer antiretroviral therapy (ART) remain elusive. This section will review highlights of the meeting on tuberculosis and cryptococcal infection as well as complications of long-term ART.</p>","PeriodicalId":38738,"journal":{"name":"Topics in antiviral medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963934/pdf/tam-26-022.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36070448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hong-Van Tieu, Barbara S Taylor, Joyce Jones, Timothy J Wilkin
The 2018 Conference on Retroviruses and Opportunistic Infections (CROI) showcased exciting data on new investigational agents including MK-8591 and tri-specific antibody targeting 3 highly conserved epitopes on HIV-1 in a single antibody. Clinical trials of initial antiretroviral therapy (ART) and switch studies involving bictegravir/emtricitabine/tenofovir alafenamide were presented. Intensification of initial ART with integrase strand transfer inhibitors did not increase the risk of immune reconstitution inflammatory syndrome. Pharmacokinetic issues were discussed, including the substantial drug-drug interactions between efavirenz-based ART and hormonal contraception delivered via a vaginal ring. Studies on pre-ART drug resistance and emergence of drug resistance after initial and second-line ART in different settings and populations were highlighted. Novel technologies to identify drug resistance included a free, cloud-based web service for HIV genotyping analysis and a promising technology for point-of-care drug resistance mutations testing. New strategies to improve the HIV care continuum included home-based testing with initiation of same-day ART and stratified care with specialized clinics to serve those disengaged in care, but the data on financial incentives were not encouraging. Several studies provided insights into the impact of early ART on decreasing the size of the HIV reservoir in HIV-infected infants. Pertinent conference findings relating to women's health issues included similar clinical outcomes between breastfeeding and formula feeding HIV-infected women, the problem of viral rebound and ART nonadherence in pregnancy and postpartum.
{"title":"CROI 2018: Advances in Antiretroviral Therapy.","authors":"Hong-Van Tieu, Barbara S Taylor, Joyce Jones, Timothy J Wilkin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The 2018 Conference on Retroviruses and Opportunistic Infections (CROI) showcased exciting data on new investigational agents including MK-8591 and tri-specific antibody targeting 3 highly conserved epitopes on HIV-1 in a single antibody. Clinical trials of initial antiretroviral therapy (ART) and switch studies involving bictegravir/emtricitabine/tenofovir alafenamide were presented. Intensification of initial ART with integrase strand transfer inhibitors did not increase the risk of immune reconstitution inflammatory syndrome. Pharmacokinetic issues were discussed, including the substantial drug-drug interactions between efavirenz-based ART and hormonal contraception delivered via a vaginal ring. Studies on pre-ART drug resistance and emergence of drug resistance after initial and second-line ART in different settings and populations were highlighted. Novel technologies to identify drug resistance included a free, cloud-based web service for HIV genotyping analysis and a promising technology for point-of-care drug resistance mutations testing. New strategies to improve the HIV care continuum included home-based testing with initiation of same-day ART and stratified care with specialized clinics to serve those disengaged in care, but the data on financial incentives were not encouraging. Several studies provided insights into the impact of early ART on decreasing the size of the HIV reservoir in HIV-infected infants. Pertinent conference findings relating to women's health issues included similar clinical outcomes between breastfeeding and formula feeding HIV-infected women, the problem of viral rebound and ART nonadherence in pregnancy and postpartum.</p>","PeriodicalId":38738,"journal":{"name":"Topics in antiviral medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963936/pdf/tam-26-040.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36069359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
At the 2018 Conference on Retroviruses and Opportunistic Infections, trends in and risk factors for in HIV infection were highlighted. In the United States, new HIV diagnoses are highest in the South and among African Americans and are increasing in rural areas. Youth remain highly vulnerable to HIV infection globally. The epidemiology of HIV infections among people who inject drugs is changing, with overdose deaths, a major public health concern. Phylogenetics are being used to identify HIV transmission clusters and hotspots, which can inform prevention efforts. Vaginal microbial dysbiosis and proteomic alterations are associated with increased risk of HIV acquisition, as are the pregnancy and postpartum periods. HIV testing is a central first step for the HIV care and treatment continua, and several innovative strategies to expand HIV testing coverage and frequency show promise. Preexposure prophylaxis (PrEP) uptake is rapidly increasing in some cities, with reductions of new infections at the population level, but use is lower among African Americans and Latinos, youth, cis- and transgender women, and people who inject drugs. PrEP continuation remains a challenge. Two open-label extension studies of the dapivirine vaginal ring demonstrated high uptake, adherence, and reduced HIV infections. Several novel systemic and topical prevention agents show promise in non-human primates.
{"title":"CROI 2018: Epidemic Trends and Advances in HIV Prevention.","authors":"Susan P Buchbinder, Albert Y Liu","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>At the 2018 Conference on Retroviruses and Opportunistic Infections, trends in and risk factors for in HIV infection were highlighted. In the United States, new HIV diagnoses are highest in the South and among African Americans and are increasing in rural areas. Youth remain highly vulnerable to HIV infection globally. The epidemiology of HIV infections among people who inject drugs is changing, with overdose deaths, a major public health concern. Phylogenetics are being used to identify HIV transmission clusters and hotspots, which can inform prevention efforts. Vaginal microbial dysbiosis and proteomic alterations are associated with increased risk of HIV acquisition, as are the pregnancy and postpartum periods. HIV testing is a central first step for the HIV care and treatment continua, and several innovative strategies to expand HIV testing coverage and frequency show promise. Preexposure prophylaxis (PrEP) uptake is rapidly increasing in some cities, with reductions of new infections at the population level, but use is lower among African Americans and Latinos, youth, cis- and transgender women, and people who inject drugs. PrEP continuation remains a challenge. Two open-label extension studies of the dapivirine vaginal ring demonstrated high uptake, adherence, and reduced HIV infections. Several novel systemic and topical prevention agents show promise in non-human primates.</p>","PeriodicalId":38738,"journal":{"name":"Topics in antiviral medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963932/pdf/tam-26-001.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36070446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
At the 2018 Conference on Retroviruses and Opportunistic Infections (CROI), there was a major focus on hepatitis C virus (HCV) elimination and improving each component of the hepatitis C care cascade. Several countries and cohorts have demonstrated the remarkable impact that universal HCV testing and unrestricted access to hepatitis C treatment can have on markedly reducing incident HCV infections and HCV infection prevalence, including in people who inject drugs and HIV/HCV-coinfected populations. However, in many settings, substantial barriers to widespread HCV treatment remain, including undiagnosed HCV infection, particularly in populations outside the standard "baby boomer" birth cohort (ie, born 1945-1965); restricted access to hepatitis C treatment in those with known HCV infection; reinfection with HCV; and migration of HCV-infected populations. Many innovative programs have successfully implemented HCV testing and treatment outside of traditional care settings, expanding access for harder-to-reach populations, which will be crucial to successful elimination efforts. Outbreaks of hepatitis A virus (HAV) infection continue to occur in among men who have sex with men and homeless populations in the United States, Europe, and Southeast Asia, highlighting the need for improved HAV vaccination programs for populations at risk.
{"title":"CROI 2018: Highlights of Viral Hepatitis.","authors":"Anne F Luetkemeyer, David L Wyles","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>At the 2018 Conference on Retroviruses and Opportunistic Infections (CROI), there was a major focus on hepatitis C virus (HCV) elimination and improving each component of the hepatitis C care cascade. Several countries and cohorts have demonstrated the remarkable impact that universal HCV testing and unrestricted access to hepatitis C treatment can have on markedly reducing incident HCV infections and HCV infection prevalence, including in people who inject drugs and HIV/HCV-coinfected populations. However, in many settings, substantial barriers to widespread HCV treatment remain, including undiagnosed HCV infection, particularly in populations outside the standard \"baby boomer\" birth cohort (ie, born 1945-1965); restricted access to hepatitis C treatment in those with known HCV infection; reinfection with HCV; and migration of HCV-infected populations. Many innovative programs have successfully implemented HCV testing and treatment outside of traditional care settings, expanding access for harder-to-reach populations, which will be crucial to successful elimination efforts. Outbreaks of hepatitis A virus (HAV) infection continue to occur in among men who have sex with men and homeless populations in the United States, Europe, and Southeast Asia, highlighting the need for improved HAV vaccination programs for populations at risk.</p>","PeriodicalId":38738,"journal":{"name":"Topics in antiviral medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963935/pdf/tam-26-030.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36070449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Preexposure prophylaxis (PrEP) with tenofovir/emtricitabine (slash indicates coformulation) is highly effective in preventing new HIV infections. PrEP efficacy is strongly associated with adherence. In clinical trials, PrEP has been more effective in men who have sex with men and HIV-serodiscordant heterosexual couples than in women, likely reflecting pharmacokinetic differences between levels of tenofovir disoproxil fumarate in vaginal and rectal tissues, and poorer adherence in studies in women. Current guidelines recommend daily PrEP for men and women; however, PrEP taken at least 4 days per week for men may be as effective as daily PrEP, and women must take PrEP 6 to 7 days per week to maximize efficacy. Data are accumulating on the effectiveness of pericoital PrEP for men who have sex with men, but it is not yet recommended in the United States. PrEP is underprescribed for younger individuals, black individuals, and Hispanic and Latino individuals. This article summarizes a presentation by Susan P. Buchbinder, MD, at the IAS-USA continuing education program, Improving the Management of HIV Disease, held in Chicago, Illinois, in May 2017.
替诺福韦/恩曲他滨暴露前预防(PrEP)(斜线表示联合制剂)在预防新的艾滋病毒感染方面非常有效。PrEP的有效性与依从性密切相关。在临床试验中,PrEP在男男性行为者和hiv血清不一致的异性恋夫妇中比在女性中更有效,这可能反映了阴道和直肠组织中富马酸替诺福韦二氧吡酯水平的药代动力学差异,以及女性研究中较差的依从性。目前的指南建议男性和女性每天进行PrEP;然而,对于男性来说,每周至少服用4天的PrEP可能与每天服用PrEP一样有效,而女性必须每周服用6至7天才能发挥最大功效。关于头周PrEP对男男性行为者的有效性的数据越来越多,但在美国尚未推荐使用。年轻人、黑人、西班牙裔和拉丁裔人的PrEP处方不足。本文总结了Susan P. Buchbinder医学博士于2017年5月在伊利诺斯州芝加哥举行的IAS-USA继续教育项目“改善艾滋病毒疾病管理”上的演讲。
{"title":"Maximizing the Benefits of HIV Preexposure Prophylaxis.","authors":"Susan P Buchbinder","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Preexposure prophylaxis (PrEP) with tenofovir/emtricitabine (slash indicates coformulation) is highly effective in preventing new HIV infections. PrEP efficacy is strongly associated with adherence. In clinical trials, PrEP has been more effective in men who have sex with men and HIV-serodiscordant heterosexual couples than in women, likely reflecting pharmacokinetic differences between levels of tenofovir disoproxil fumarate in vaginal and rectal tissues, and poorer adherence in studies in women. Current guidelines recommend daily PrEP for men and women; however, PrEP taken at least 4 days per week for men may be as effective as daily PrEP, and women must take PrEP 6 to 7 days per week to maximize efficacy. Data are accumulating on the effectiveness of pericoital PrEP for men who have sex with men, but it is not yet recommended in the United States. PrEP is underprescribed for younger individuals, black individuals, and Hispanic and Latino individuals. This article summarizes a presentation by Susan P. Buchbinder, MD, at the IAS-USA continuing education program, Improving the Management of HIV Disease, held in Chicago, Illinois, in May 2017.</p>","PeriodicalId":38738,"journal":{"name":"Topics in antiviral medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5935218/pdf/tam-25-138.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36039468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}