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Infectious Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Susanna J. Dunachie, Hanif Esmail, Ruth Corrigan, Maria Dudareva
The introduction of highly active antiretroviral therapy (HAART) has transformed the clinical landscape of HIV care. For patients, this therapy has brought about improvement in the CD4 count and a fall in the HIV viral load. ‘Treatment as prevention’ means that successful suppression of HIV viral load by HAART makes the risk of transmission of HIV from an infected person to their uninfected partner negligible.Some HAART regimens are now available as combined single-tablet, once a day treatment.Anti-HIV drugs are used as post-exposure prophylaxis (PEP), e.g. for a healthcare worker who receives a needlestick injury from someone with known uncontrolled HIV, or after high-risk sexual intercourse (PEPSI).It has recently been established that prescribing antiretrovirals to people at high risk of acquiring HIV through their sexual lifestyle is effective in lowering transmission (pre-exposure prophylaxis, PrEP).
Closing the gap in programming for adolescents living with HIV in Eastern and Southern Africa
Published in Kaymarlin Govender, Nana K. Poku, Preventing HIV Among Young People in Southern and Eastern Africa, 2020
Nompumelelo Zungu, Elona Toska, Lesley Gittings, Rebecca Hodes
The findings of the HPTN052 study (showing that ART can prevent onward transmission among HIV-discordant individuals) have challenged the assumption that HIV treatment and prevention are distinct, with a growing body of research demonstrating how effective HIV treatment and prevention are intrinsically connected (Cohen et al., 2013). This evidence, coupled with the UNAIDS 90–90–90 targets and the recent move to adopt a ‘test and treat’ approach in many countries with high HIV prevalence and incidence, has led to the promotion of ART as means of enabling ‘positive prevention’ among key populations and vulnerable groups such as AGYW aged 15–24. The current, burgeoning evidence base on associations between social protection and improvements in health outcomes among HIV-positive children and adolescents opens up a new field of prospective enquiry and promising prospective interventions.
HIV and AIDS
Published in Rae-Ellen W. Kavey, Allison B. Kavey, Viral Pandemics, 2020
Rae-Ellen W. Kavey, Allison B. Kavey
This series of important studies has resulted in the current approach to use of ART – treatment as prevention (TasP): ART is now recommended as soon as HIV infection is confirmed, regardless of symptoms or timing, and for all AIDS patients, regardless of CD4 cell count or ongoing opportunistic infections.112
Nano-vaccines for gene delivery against HIV-1 infection
Published in Expert Review of Vaccines, 2023
Shuang Li, Meng-Yue Zhang, Jie Yuan, Yi-Xuan Zhang
The human immunodeficiency virus type 1 (HIV-1) pandemic remains a devastating infectious pathogen [1,2], with UNAIDS reporting that a total of 38.4 million cases worldwide were infected with HIV until 2021 (https://www.unaids.org/en). Pre-exposure prophylaxis and antiretroviral therapy have revolutionized HIV-1 prevention and treatment, transforming HIV-1 from what used to be regarded as a loss of life sentence to a chronic disease [3–5]. However, effective HIV-1 treatment and prevention demand strict dosing regimens and lifelong medication [6]. In addition, viral rebound inevitably occurs in some HIV-1-infected individuals that are developing drug resistance [7]. Therefore, many experts agree that obliteration of the HIV-1 pandemic still requires valid preventive vaccines [8,9]. Nevertheless, developing an efficient HIV-1 vaccine has been demonstrated to be inordinately hard [10]. To date, a licensed vaccine against HIV-1 has yet to be created. The RV144 trial has been the only clinical trial to demonstrate a significant protection in humans [11]. The vaccine regimen based on a canarypox vector-based vaccine prime and two HIV-1 gp120 boosts in the RV144 trial elicited protective non-neutralizing antibodies against the V1/V2 region of the HIV-1 envelope (Env), resulting in 31.2% efficacy for the prophylaxis of HIV-1 [11].
Tolerability of pharmacological agents in the treatment of headache following brain injury: a scoping review
Published in Brain Injury, 2023
Heather M. MacKenzie, Michael Robinson, Amanda McIntyre
The approach to managing post-traumatic headaches (PTH) typically includes both non-pharmacologic and pharmacologic strategies. Targeted interventional procedures including nerve blocks and botulinum toxin injections may also be considered. However, the scientific evidence describing the management of headaches post TBI is limited, and consequently there are no evidence-based guidelines to support clinical decision-making. The standard of care in managing headaches after TBI involves an assessment of characteristics and associated symptoms to determine which primary headache subtype the clinical presentation most closely resembles. The most common headache subtypes that are observed following TBI include migraine, probable migraine, and tension-type headaches (4,6). Subsequent treatment recommendations include following the primary headache literature; however, this is problematic because individuals who have sustained a TBI have unique needs that are not accounted for by the guidelines developed for primary headache management. Specifically, clinicians must exercise caution when prescribing pharmacologic agents to individuals who have sustained a TBI due to the associated risk of adverse drug reactions. Adverse drug reactions are any “noxious and unintended response to a drug which occurs at doses normally used or tested for the diagnosis, treatment or prevention of a disease or the modification of an organic function” (7).
Perspectives of injectable long acting antiretroviral therapies for HIV treatment or prevention: understanding potential users’ ambivalences
Published in AIDS Care, 2020
Séverine Carillon, Lucille Gallardo, Françoise Linard, Catherine Chakvetadze, Jean-Paul Viard, Agnès Cros, Jean-Michel Molina, Laurence Slama
Antiretroviral therapies (ART), widely used for HIV treatment and prevention, became a central tool towards HIV epidemic control. To reduce the constraints of daily oral drugs intake, long-acting injectable antiretroviral therapies (LA-ART) have been developed (Boffito et al., 2014; Nyaku et al., 2017). Recently published data suggest that LA-ART administered every 4 or 8 weeks can indeed be considered for HIV treatment or prevention (Margolis et al., 2017; Markowitz et al., 2017; McGowan et al., 2016). However, it is not clearly known how potential users perceive this new mode of administration and what they say about it. To date, few data concerning injectable LA-ART acceptability have been published, mostly within clinical trials. Authors identified series of factors enhancing or hindering patients’ experience, willingness and acceptability. The results supported a “high level of acceptability” and a “high interest”. The potential improvement in the quality of life, avoiding omissions common with oral intake medications, and a higher level of discretion were highlighted, despite local pain at the injection site (Kerrigan et al., 2018a, 2018b; Meyers et al., 2014, 2018; Murray et al., 2018). The purpose of this research was to focus on potential injectable LA-ART users’ perceptions in a real-world setting. Our approach aimed to explore discourses according to individuals’ therapeutic itinerary and their singular history with ART, both in HIV prevention and treatment.