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Clinical and Public Health Implications of HIV- Genetic Diversity and Drug Resistance Mutations in Angola: A Systematic Review. 艾滋病毒的临床和公共卫生意义-遗传多样性和耐药性突变在安哥拉:系统回顾。
IF 2.2 4区 医学 Q4 IMMUNOLOGY Pub Date : 2020-10-26 DOI: 10.24875/AIDSRev.20000057
Cruz S Sebastião, Joana Morais, Miguel Brito

HIV-1 genetic diversity and drug resistance mutations (DRMs) remain a public health concern mainly in low- and middle-income countries. In this review, we estimated the HIV-1 molecular evolution over the past 40 years (1980-2019) in Angola to help guide affordable strategies for HIV-1 epidemic surveillance. We searched for studies written in English or Portuguese on HIV-1 diversity and DRMs carried out in Angola and published between 1980 and 2019. This review yielded eight studies describing a total of 493 samples. No HIV-1 Group N, O, and P were identified, whereas a ll non-B subtypes f rom Group M were identified. About 66% of HIV-1 subtypes were pure subtype and 34% recombinant strains. The frequency of recombinant strains increases from 1980 to 2019 (23.6%-41.4%, p<0.001). The subtypes C, F1, CRF02_AG, and the recombinant U/H were the most frequent. One DRM in the PIs was found (I54 M), 22 in the nucleoside reverse transcriptase inhibitors (NRTIs), and 18 in the non-nucleoside reverse transcriptase inhibitors (NNRTIs). The major DRM in the NRTIs was the M184V, whereas the G190A, K103N, and Y181C were the major DRMs in the NNRTIs. Over the past 40 years, the frequency of the DRM M184V (50-64.3%, p=0.363), G190A (17.2-46.2%, p=0.021), and K103N (34.5-42.3%, p=0.551) increased, while the frequency of Y181C (17.2-7.7%, p=0.289) decreased. The current review shows an increase in HIV-1 genetic complexity and DRMs in Angola. Our findings suggest the need to include PIs or integrase strand transfer inhibitors in the first-line antiretroviral therapy regimens in Angola.

艾滋病毒-1遗传多样性和耐药突变(DRMs)仍然是一个公共卫生问题,主要是在低收入和中等收入国家。在这篇综述中,我们估计了安哥拉过去40年(1980-2019)的HIV-1分子进化,以帮助指导可负担得起的HIV-1流行病监测策略。我们检索了1980年至2019年间在安哥拉发表的以英语或葡萄牙语撰写的关于HIV-1多样性和drm的研究。这篇综述产生了8项研究,共描述了493个样本。未发现N、O和P组的HIV-1亚型,而M组的所有非b亚型均被发现。约66%的HIV-1亚型为纯亚型,34%为重组株。重组菌株的频率从1980年到2019年增加了23.6% ~ 41.4%,p
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引用次数: 4
Initiation of Antiretroviral Therapy during Primary HIV Infection: Effects on the Latent HIV Reservoir, Including on Analytic Treatment Interruptions. 在原发性 HIV 感染期间开始抗逆转录病毒治疗:对潜伏 HIV 储库的影响,包括对分析治疗中断的影响。
IF 2.2 4区 医学 Q4 IMMUNOLOGY Pub Date : 2020-10-26 DOI: 10.24875/AIDSRev.20000001
Eva M Shelton, Daniel B Reeves, Rachel A Bender Ignacio

Antiretroviral therapy (ART) inhibits HIV replication but does not eradicate the latent reservoir. The previous research suggests that earlier ART initiation provides benefit on limiting reservoir size, but timing and extent of this effect remain unclear. Analytic treatment interruption (ATI) may be used to demonstrate HIV remission, but whether early ART also improves likelihood or duration of even temporary virologic remission is unclear. This review seeks to answer both questions. We performed a systematic review and analysis following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and included 21 interventional or observational studies with sufficient HIV reservoir outcomes. We also aggregated reservoir outcomes and transformed data into approximate measurements of total HIV DNA per million peripheral blood mononuclear cells and analyzed the correlation between timing of ART initiation and reservoir size. People living with HIV who initiate ART in primary infection maintain smaller reservoirs on suppressive ART than those who initiate treatment during chronic infection. The reduction of reservoir is most pronounced when ART is started within 2 weeks of HIV acquisition. Across studies, we found a moderately strong association between longer time to ART initiation and reservoir size, which was strongest when measured after 1 year on ART (Pearson's r = 0.69, p = 0.0003). After ATI, larger pre-ATI reservoir size predicts shorter time to viral rebound. Early ART may also facilitate long-term control of viremia. Although achieving sustained HIV remission will require further interventions, initiating ART very early in infection could limit the extent of the reservoir and also lead to post-ATI control in rare cases.

抗逆转录病毒疗法(ART)可抑制艾滋病毒的复制,但不能根除潜伏库。以往的研究表明,尽早开始抗逆转录病毒疗法有利于限制潜伏库的规模,但这种影响的时间和程度仍不清楚。分析性治疗中断(ATI)可用于证明艾滋病病毒缓解,但早期抗逆转录病毒疗法是否也能提高即使是暂时性病毒学缓解的可能性或持续时间尚不清楚。本综述试图回答这两个问题。我们按照《系统综述和荟萃分析首选报告项目》指南进行了系统综述和分析,纳入了 21 项具有充分 HIV 储库结果的干预性或观察性研究。我们还汇总了储库结果,并将数据转化为每百万外周血单核细胞中 HIV DNA 总量的近似测量值,并分析了开始抗逆转录病毒疗法的时间与储库规模之间的相关性。与在慢性感染期间开始治疗的艾滋病病毒感染者相比,在初次感染时开始抗逆转录病毒疗法的艾滋病病毒感染者在接受抑制性抗逆转录病毒疗法后,其病毒储库的规模较小。在感染艾滋病病毒两周内开始抗逆转录病毒疗法时,储库的减少最为明显。在所有的研究中,我们发现开始抗逆转录病毒疗法的时间越长,储库规模越大,两者之间的关联性就越强(Pearson's r = 0.69,p = 0.0003)。ATI 后,ATI 前储库规模越大,预测病毒反弹的时间越短。早期抗逆转录病毒疗法还有助于长期控制病毒血症。虽然实现持续的艾滋病毒缓解还需要进一步的干预措施,但在感染初期就开始抗逆转录病毒疗法可以限制病毒库的规模,在极少数情况下还能在 ATI 后实现病毒控制。
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引用次数: 0
Hepatitis Delta Virus Epidemiology in the Industrialized World. 工业化国家的丁型肝炎病毒流行病学。
IF 2.2 4区 医学 Q4 IMMUNOLOGY Pub Date : 2020-10-26 DOI: 10.24875/AIDSRev.20000056
Mehlika Toy, Emel Ahishali, Cihan Yurdaydın

Within the hepatitis virus landscape, one incomplete virus, the hepatitis delta virus (HDV), appears to differ from hepatitis B and C viruses in the context as it still may not infrequently lead to complications of chronic liver disease and continues to be associated with significant liver-related mortality even when patients have received available treatment for it. Breakthrough therapies are so far lacking for HDV-infected patients and treatment has not changed since the discovery of HDV in 1977 and consists mainly of interferons. While there was little interest on the global epidemiology of HDV until recently, this has changed in the past 2 years and we are currently observing a stream of papers on the global epidemiology of HDV and commentaries about why prevalence estimates appear to differ so dramatically. This may be related to the fact that reliable data are not available for most of the countries. However, in the industrialized world, data on the epidemiology of HDV are expected to be of better overall quality. Hence, this review was undertaken to provide a detailed overview on the epidemiology of HDV infection in industrialized countries using data from representative larger countries. In industrialized countries, with maybe the exception of China, HDV infection is a disease of high-risk groups. Migrant groups and people who inject drugs are the most encountered high-risk groups. This review summarizes the dynamics of their contribution to the HDV epidemiology in industrialized countries of the west and the east.

在肝炎病毒领域,一种不完全病毒,丁型肝炎病毒(HDV),似乎与乙型和丙型肝炎病毒有所不同,因为它仍然可能导致慢性肝病的并发症,并且即使在患者接受了可用的治疗后,仍然与肝脏相关的重大死亡率相关。迄今为止,对艾滋病毒感染者缺乏突破性的治疗方法,自1977年发现艾滋病毒以来,治疗方法没有改变,主要由干扰素组成。虽然直到最近,人们对HDV的全球流行病学几乎没有兴趣,但在过去两年中,这种情况发生了变化,我们目前正在观察一系列关于HDV全球流行病学的论文和关于为什么流行率估计似乎差异如此之大的评论。这可能与大多数国家没有可靠的数据有关。然而,在工业化国家,关于HDV流行病学的数据预计总体质量会更好。因此,本综述的目的是利用具有代表性的较大国家的数据,对工业化国家HDV感染的流行病学进行详细概述。在工业化国家,也许除了中国,HDV感染是一种高危人群的疾病。流动人群和注射吸毒者是最容易遇到的高危人群。本文综述了它们对东西方工业化国家HDV流行病学的贡献动态。
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引用次数: 8
Fertility Desire in HIV/AIDS Research During 1992-2019: A Systematic Text Mining of Global Literature. 1992-2019年HIV/AIDS研究中的生育欲望:全球文献的系统文本挖掘
IF 2.2 4区 医学 Q4 IMMUNOLOGY Pub Date : 2020-10-26 DOI: 10.24875/AIDSRev.20000026
Giang Hai Ha, Hai T Phan, Giang T Vu, Bach X Tran, Carl A Latkin, Roger C M Ho, Cyrus S H Ho

There has been an increase of fertility desire among people living with HIV/AIDS (PLWH) thanks to the advancement of HIV treatment and prevention of mother-to-children transmission programs. However, the development of research focusing on this topic over the past three decades is not well documented. We aimed to explore the trend of global publications regarding fertility desires among PLWH and identify their contents through the natural language processing technique. Dataset from 1992 to 2019 was downloaded using the Web of Science Core Collection. Bibliometric indicators such as change in total publications, citations, and countries' collaboration were examined. Main topics of selected publications were determined using the latent Dirichlet allocation. There were 303 articles published during the period 1992-2019, with a rapid increase in the number of publications in the past 5 years. Common themes included determinants of fertility desire, HIV prevention for adolescents, and safer conception for couples affected with HIV. However, publications on HIV care and antenatal care for women with HIV had been still limited. Findings suggested a call for the future support and collaborations for fertility intention, as well as the promotion of HIV care and service for adolescents and pregnant women with HIV, especially in countries with poor resources and a high burden of HIV/AIDS.

由于艾滋病毒治疗和预防母婴传播项目的进步,艾滋病毒/艾滋病感染者(PLWH)的生育愿望有所增加。然而,在过去的三十年中,关于这一主题的研究进展并没有得到很好的记录。我们的目的是通过自然语言处理技术来探索PLWH中关于生育愿望的全球出版物的趋势,并确定其内容。1992年至2019年的数据集使用Web of Science Core Collection下载。研究了文献计量指标,如总出版物、引用和国家合作的变化。所选出版物的主要主题采用潜在狄利克雷分配确定。1992-2019年共发表论文303篇,近5年发表论文数量快速增长。共同的主题包括生育愿望的决定因素、青少年预防艾滋病毒以及感染艾滋病毒的夫妇更安全的受孕。但是,关于艾滋病毒护理和感染艾滋病毒妇女产前护理的出版物仍然有限。研究结果表明,今后应加强对生育意愿的支持和合作,并促进对感染艾滋病毒的青少年和孕妇的艾滋病毒护理和服务,特别是在资源贫乏和艾滋病毒/艾滋病负担高的国家。
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引用次数: 0
Drug-drug Interactions in Patients with HIV and Cancer in Sub-Saharan Africa. 撒哈拉以南非洲艾滋病毒和癌症患者的药物相互作用。
IF 2.2 4区 医学 Q4 IMMUNOLOGY Pub Date : 2020-10-26 DOI: 10.24875/AIDSRev.20000005
Jonathan D Strope, Sarah E Lochrin, Tristan M Sissung, Ravie Kem, Prabha Chandrasekaran, Elad Sharon, Douglas K Price, Thomas S Uldrick, Robert Yarchoan, William D Figg

In Sub-Saharan Africa, the cancer burden is predicted to increase by > 85% by 2030, the largest increase worldwide. This region has a large HIV-positive population. Drug-drug interactions (DDIs) from concomitant use of multiple drugs increase the risk of drug toxicities, sub-optimal therapy, and drug resistance. With the increase in polypharmacy, involving antiretroviral (ARV), and anticancer drugs, there is a greater need for an appreciation of clinically relevant DDIs. Anticancer and ARV drugs studied in this review were from The World Health Organization's Model List of Essential Medicines 2017. We reviewed; drug package inserts, www.drugbank.ca and www.UpToDate.com, to evaluate pharmacokinetic interactions with cytochrome P450 (CYP450) and ABCB1. The DDIs between drugs were assessed using the University Of Liverpool, UK HIV Drug Interactions Checker, and the LexiComp Drug Interaction tool of www.UpToDate.com. About 70% of ARVs studied interact with CYP450, all involve CYP3A4, and 55% interact with ABCB1. About 65% of anticancer drugs interact with CYP450, 44% of which do so through CYP3A4. About 75% of anticancer drugs interact with ARV drugs, with nine absolute contraindications to concomitant therapy. There exist a substantial number of DDIs between ARV and anticancer drugs, primarily mediated through CYP450 enzymes. Dolutegravir based regimens offer the safest DDI profile for concurrent use with anticancer drugs. However, there are substantial gaps in our knowledge, and this study serves to highlight the need for additional research to better define these interactions and their effect on drug exposure, as attention to these DDIs is a relatively simple intervention that could lead to optimizing disease treatment.

在撒哈拉以南非洲,预计到2030年癌症负担将增加85%以上,是全世界增幅最大的地区。这个地区有大量艾滋病毒呈阳性的人口。同时使用多种药物引起的药物-药物相互作用(ddi)增加了药物毒性、次优治疗和耐药性的风险。随着包括抗逆转录病毒(ARV)和抗癌药物在内的多种药物的增加,更需要了解临床相关的ddi。本综述研究的抗癌和抗逆转录病毒药物来自世界卫生组织2017年基本药物标准清单。我们回顾了;药物说明书,www.drugbank.ca和www.UpToDate.com,以评估与细胞色素P450 (CYP450)和ABCB1的药代动力学相互作用。使用利物浦大学,英国HIV药物相互作用检查器和LexiComp药物相互作用工具www.UpToDate.com评估药物之间的ddi。约70%的arv与CYP450相互作用,均涉及CYP3A4, 55%与ABCB1相互作用。约65%的抗癌药物与CYP450相互作用,其中44%通过CYP3A4起作用。大约75%的抗癌药物与抗逆转录病毒药物相互作用,同时治疗有9个绝对禁忌症。ARV和抗癌药物之间存在大量ddi,主要通过CYP450酶介导。多替格拉韦为基础的方案提供了最安全的DDI配置文件与抗癌药物同时使用。然而,我们的知识有很大的差距,这项研究强调了需要进一步的研究来更好地定义这些相互作用及其对药物暴露的影响,因为关注这些ddi是一种相对简单的干预措施,可以优化疾病治疗。
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引用次数: 1
Global Mapping of Interventions to Improve the Quality of Life of People Living with HIV/AIDS: Implications for Priority Settings. 改善艾滋病毒/艾滋病感染者生活质量的干预措施全球制图:对优先设置的影响。
IF 2.2 4区 医学 Q4 IMMUNOLOGY Pub Date : 2020-10-26 DOI: 10.24875/AIDSRev.20000135
Bach X Tran, Giang T Vu, Giang H Ha, Hai T Phan, Carl A Latkin, Cyrus S H-Ho, Roger C M- Ho

Enhancing the quality of life (QOL) of people living with HIV and AIDS (PLWHA) has become a significant global health goal, as combination antiretroviral therapy has helped to transform HIV/AIDS from a fatal illness to chronic disease. In this study, we aim to comprehensively describe the growth of research publications and the development of research landscapes regarding interventions to improve QOL among PLWH, as well as to characterize interdisciplinary topics and emerging interests of the research community. English articles and reviews published from 1991 to 2018 concerning interventions to improve QOL among PLWHA were retrieved from the Web of Science. Collaboration among organizations sharing coauthorships and co-occurrence network of authors' keywords was illustrated through network graphs. Latent Dirichlet Allocation was used for classifying papers into corresponding topics. A total of 2304 publications were included in the study. The USA continues to lead in research productivity, followed by South Africa, China, and India. Emerging research themes were found to be the application of multilevel interventions and long-term care, rehabilitation, along with topics relating to mental health issues, behavioral therapy and social supports for patients receiving treatments, and application of e-health approaches in designing and implementing interventions. There has been, however, a modest appearance of topics covering local, cultural, and environmental contexts of interventions. The findings of the study suggest expanding the coverage of psychosocial, behavioral, and contextualized interventions, increasing the involvement of family and community, improving the effectiveness of technology-based and e-health interventions, and developing strategies for lifelong treatment of HIV/AIDS.

提高艾滋病毒/艾滋病感染者的生活质量已成为一项重要的全球卫生目标,因为抗逆转录病毒联合疗法已帮助将艾滋病毒/艾滋病从一种致命疾病转变为慢性病。在这项研究中,我们的目标是全面描述研究出版物的增长和研究景观的发展,有关改善PLWH生活质量的干预措施,以及表征跨学科主题和研究界的新兴兴趣。从Web of Science检索1991年至2018年发表的有关改善艾滋病患者生活质量干预措施的英文文章和综述。通过网络图说明了合作作者组织之间的协作以及作者关键词的共现网络。使用潜狄利克雷分配将论文分类到相应的主题。本研究共纳入2304份出版物。美国在研究生产力方面继续领先,其次是南非、中国和印度。发现新出现的研究主题是多层干预措施和长期护理、康复的应用,以及与心理健康问题、接受治疗的患者的行为治疗和社会支持有关的主题,以及在设计和实施干预措施时应用电子保健方法。然而,关于干预措施的地方、文化和环境背景的主题也有适度的出现。研究结果建议扩大社会心理、行为和情境化干预的覆盖面,增加家庭和社区的参与,提高基于技术和电子卫生干预的有效性,并制定艾滋病毒/艾滋病终身治疗战略。
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引用次数: 11
HIV Gene Therapy Strategies and Safety: What do we know from the Recent Publications? HIV基因治疗策略和安全性:我们从最近的出版物中了解到什么?
IF 2.2 4区 医学 Q4 IMMUNOLOGY Pub Date : 2020-10-26 DOI: 10.24875/AIDSRev.20000008
Silvere D Zaongo, Huan Xia, Ping Ma

Almost 40 years ago, the world was noticing the emergence of one of the major public health threats it has ever known: HIV. Facing the cost-effectiveness and the health-related issues encountered with antiretroviral treatments, scientists have imagined and conceived gene therapies to tackle HIV infection. The success of such an approach was proved with the "Berlin" patient then recently reiterated in the "London" patient. In fact, the recent progress made in HIV gene therapy could provide a rapid emergence of powerful strategies to treat and totally cure the infection. Based on their principles, these approaches can be separated in three strategies that are (1) engineering HIV target cells to render them resistant to HIV replication, (2) generating genemodified cells able to secrete antiviral proteins that interfere with HIV entry, and (3) modifying cytotoxic T cells to selectively target and eliminate infected cells. Herein, we proposed to review these approaches, their safety and their benefits as reported in recent publications.

大约40年前,世界注意到其所知的主要公共卫生威胁之一:艾滋病毒的出现。面对抗逆转录病毒治疗的成本效益和与健康有关的问题,科学家们设想并构思了基因疗法来解决艾滋病毒感染。这种方法的成功在“柏林”病人身上得到了证明,最近又在“伦敦”病人身上得到了重申。事实上,最近在艾滋病毒基因治疗方面取得的进展可能会使治疗和彻底治愈这种感染的有效策略迅速出现。基于它们的原理,这些方法可以分为三种策略:(1)设计HIV靶细胞以使其抵抗HIV复制,(2)产生能够分泌干扰HIV进入的抗病毒蛋白的基因修饰细胞,以及(3)修饰细胞毒性T细胞以选择性地靶向和消除感染细胞。在此,我们建议回顾这些方法,它们的安全性和它们的益处,在最近的出版物报道。
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引用次数: 5
The Resurgence of Medical Ethics During the Coronavirus Disease (COVID)-19 Outbreak. 冠状病毒病(COVID -19)爆发期间医学伦理的复苏。
IF 2.2 4区 医学 Q4 IMMUNOLOGY Pub Date : 2020-07-08 DOI: 10.24875/AIDSRev.M20000034
Rafael Del Río, Joaquín de Ojeda, Vicente Soriano

The unprecedented COVID-19 pandemic has risen a number of clinical situations where the principles of the medical act, the singularity of the patient-physician relationship and the need for revitalizing the medical vocation have all become at front line. Original articles, viewpoints, and perspectives addressing these aspects have appeared in major medical journals. Never before but perhaps with AIDS in the eighties, a disease awakened such feelings of commitment in medicine. Herein, we discuss some of these very sensitive issues for physicians that emerged during the past months of global COVID-19 crisis.

新型冠状病毒感染症(COVID-19)的新冠疫情,使医疗行为的原则、医患关系的单一性、医疗事业的振兴必要性成为了最前沿。针对这些方面的原创文章、观点和观点已经出现在主要的医学期刊上。也许是80年代的艾滋病,以前从未有一种疾病唤醒了医学界的这种责任感。在此,我们讨论了过去几个月全球COVID-19危机期间出现的一些对医生来说非常敏感的问题。
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引用次数: 6
Pre-exposure Prophylaxis in HIV Research: A Latent Dirichlet Allocation Analysis (GAPRESEARCH). HIV暴露前预防研究:一个潜在的狄利克雷分配分析(GAPRESEARCH)。
IF 2.2 4区 医学 Q4 IMMUNOLOGY Pub Date : 2020-07-08 DOI: 10.24875/AIDSRev.20000131
Bach X Tran, Hai T Phan, Quang N Nguyen, Olagoke A Ewedairo, Giang T Vu, Giang H Ha, Thao P Nguyen, Carl A Latkin, Cyrus S H Ho, Roger C M Ho

Pre-exposure prophylaxis (PrEP) has been shown to be an effective approach to prevent human immunodeficiency virus (HIV) infections; however, implementation of the service remains challenging. This global bibliometric analysis aims to describe the current trends in HIV research prevention through PrEP to reveal the potential gaps of knowledge and to put forward recommendations for future research. A bibliometric analysis was conducted through Web of Science from 1990 to 2017. Exploratory factor analysis was also employed to find research domains emerging from the abstracts' contents. Latent Dirichlet allocation, which is a topic modeling algorithm, was utilized to perform text mining and determine relationships among text documents. A total of 4852 papers regarding HIV PrEP research were retrieved. The number of papers and their impact has significantly increased. Preventing sexual transmissions, improving access, and quality of health-care services for current users, as well as men who have sex with men, pregnant women and children, were the research domains most related to PrEP. We found a data gap in research regarding sex workers, potential side effects of PrEP, and misjudgment toward PrEP users. Despite the growth in research about HIV PrEP, there exist barriers to scaling up the implementation of PrEP worldwide and for such intervention to reach its fWull potential. International research collaboration efforts to investigate the potential safety concerns of PrEP and develop strategies to eliminate social misjudgment against PrEP users are warranted. Addressing these knowledge gaps might facilitate the development of effective global implementation strategies for PrEP in the future.

暴露前预防(PrEP)已被证明是预防人类免疫缺陷病毒(HIV)感染的有效方法;然而,服务的实现仍然具有挑战性。这项全球文献计量分析旨在描述通过PrEP预防HIV研究的当前趋势,揭示潜在的知识差距,并为未来的研究提出建议。通过Web of Science从1990年到2017年进行了文献计量分析。探索性因子分析也用于从摘要内容中寻找研究领域。利用主题建模算法潜狄利克雷分配进行文本挖掘,确定文本文档之间的关系。共检索到4852篇有关HIV PrEP研究的论文。论文数量及其影响显著增加。预防性传播、改善现有使用者以及男男性行为者、孕妇和儿童的卫生保健服务的可及性和质量,是与PrEP最相关的研究领域。我们发现,关于性工作者、PrEP的潜在副作用和对PrEP使用者的误判的研究存在数据缺口。尽管关于艾滋病毒预防措施的研究有所增长,但在世界范围内扩大实施预防措施和充分发挥这种干预措施的潜力方面存在障碍。有必要开展国际研究合作,调查PrEP的潜在安全问题,并制定战略,消除对PrEP使用者的社会误判。解决这些知识差距可能有助于未来制定有效的全球预防准备实施战略。
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引用次数: 4
COVID-19 Comes 40 Years After AIDS - Any Lesson? COVID-19比艾滋病晚了40年——有什么教训吗?
IF 2.2 4区 医学 Q4 IMMUNOLOGY Pub Date : 2020-07-08 DOI: 10.24875/AIDSRev.M20000030
Vicente Soriano, Pablo Barreiro, José Manuel Ramos, José M Eirós, Carmen de Mendoza

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has hit health-care systems and societies in an unprecedented manner. In 1981, the first cases of AIDS were reported and wide diagnostic testing helped to characterize high-risk groups and the global burden of the epidemic. With Coronavirus Disease (COVID)-19, everything has happened too fast and both cases and fatalities are huge but still uncertain in most places. Diagnostic testing of active and past SARS-CoV-2 infections needs to expand rapidly, ideally using rapid tests. COVID-19 deaths are highly concentrated in the elderly population, with a large proportion of fatalities being "with" rather than "by" SARS-CoV-2 infection. They are often the result of inadequate health care due to overwhelming demands. To date, there is no specific therapy for SARS-CoV-2 infection. Several antivirals are being tested clinically, including remdesivir, at this time the most promising. For others such as lopinavir/ritonavir, neither significant virological nor clinical benefit has been shown. Given the characteristic pulmonary cytokine storm underlying the pathogenic mechanism of severe COVID-19 pneumonia and acute respiratory distress, antiinflammatory agents are being investigated. The benefit of orticosteroids, hydroxychloroquine, etc., is limited. Monoclonal antibodies targeting different pro-inflammatory cytokines, such as tocilizumab, an anti-interleukin 6 agent, are being tried with encouraging results. Ultimately a protective vaccine will be the best response for controlling the COVID-19 pandemic.

由严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)引起的大流行以前所未有的方式打击了卫生保健系统和社会。1981年,报告了第一批艾滋病病例,广泛的诊断测试有助于确定高危群体的特征和这一流行病的全球负担。随着冠状病毒病(COVID -19)的发生,一切都发生得太快了,病例和死亡人数都很大,但在大多数地方仍然不确定。需要迅速扩大对活跃和过去的SARS-CoV-2感染的诊断检测,理想情况下使用快速检测。COVID-19的死亡高度集中在老年人群中,很大一部分死亡是由于“感染”而不是“感染”SARS-CoV-2。它们往往是由于需求过大而导致的卫生保健不足造成的。迄今为止,还没有针对SARS-CoV-2感染的特异性治疗方法。几种抗病毒药物正在进行临床试验,包括目前最有希望的瑞德西韦。对于其他药物,如洛匹那韦/利托那韦,没有显示出显著的病毒学和临床益处。鉴于特征性的肺细胞因子风暴是COVID-19重症肺炎和急性呼吸窘迫的致病机制,抗炎药物正在研究中。皮质类固醇、羟氯喹等药物的疗效有限。针对不同促炎细胞因子的单克隆抗体,如抗白细胞介素6药物tocilizumab,正在进行试验,并取得了令人鼓舞的结果。最终,保护性疫苗将是控制COVID-19大流行的最佳对策。
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引用次数: 3
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AIDS reviews
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