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Topics in Antiviral Medicine

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https://www.readbyqxmd.com/read/30384333/policy-and-advocacy-for-the-hiv-practitioner
#1
Carlos Del Rio, Wendy S Armstrong
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...
September 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/30384332/opioid-addiction-opioid-addiction-treatment-and-hiv-infection
#2
R Douglas Bruce
Available data indicate that opioid substitution treatment can successfully reduce rates of HIV transmission and that patients receiving such treatment can adhere to therapies for HIV, hepatitis C, and tuberculosis infection. Integration of opioid substitution treatment into the HIV clinic setting can make such treatment easier and improve retention in treatment. This article summarizes a presentation by R. Douglas Bruce, MD, MA, MS, at the IAS-USA continuing education program held in Chicago, Illinois, in May 2018...
September 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/30384331/human-papillomavirus-related-malignancies-in-hiv-infection-anal-and-oropharyngeal-cancers
#3
Timothy J Wilkin
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...
September 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/30384330/recurring-and-emerging-questions-related-to-management-of-hiv-related-opportunistic-infections
#4
Henry Masur
The incidence of HIV-related opportunistic infections (OIs) has dramatically declined with the ability to achieve viral suppression and immune reconstitution with potent antiretroviral therapy. However, a large number of patients remain at risk for OIs because they are diagnosed at late stages of HIV disease, fail to stay in treatment, or fail to maintain viral suppression. Clinicians should remain vigilant for OIs and for changes in recommended management strategies. Issues that often arise in this regard include how to interpret polymerase chain reaction diagnostic results in individuals with HIV infection; whether primary prophylaxis for Mycobacterium avium complex is still needed; whether clinicians should screen asymptomatic patients for cryptococcal antigen; and need for amphotericin B in treatment regimens for cryptococcal meningitis...
September 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/30384329/the-human-microbiome-implications-for-health-and-disease-including-hiv-infection
#5
Robert T Schooley
Our increased understanding of the human microbiome has brought insight into the role it plays in health and disease, including HIV infection. Studies have shown that the gut microbiome is less diverse in individuals with HIV infection than in noninfected control subjects. Efforts to modify the microbiome to bolster immune reconstitution in people with HIV infection have so far been unsuccessful. The vaginal microbiome affects risk of HIV acquisition, with Lactobacillus dominance being protective compared with vaginosis characterized by larger populations of Gardnerella...
September 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/29906790/strategies-for-linkage-to-and-engagement-with-care-focus-on-intervention
#6
Thomas P Giordano
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...
June 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/29906789/new-and-noteworthy-in-tuberculosis-diagnostics-and-treatment
#7
Susan Swindells
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...
June 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/29727296/croi-2018-advances-in-antiretroviral-therapy
#8
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...
May 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/29727295/croi-2018-highlights-of-viral-hepatitis
#9
REVIEW
Anne F Luetkemeyer, David L Wyles
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...
May 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/29727294/croi-2018-complications-of-hiv-infection-and-antiretroviral-therapy
#10
REVIEW
Judith S Currier, Diane V Havlir
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...
May 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/29727293/croi-2018-advances-in-basic-science-understanding-of-hiv
#11
REVIEW
Mario Stevenson
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...
May 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/29727292/croi-2018-epidemic-trends-and-advances-in-hiv-prevention
#12
Susan P Buchbinder, Albert Y Liu
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...
May 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/29689541/management-of-long-term-complications-of-hiv-disease-focus-on-cardiovascular-disease
#13
Judith S Currier
HIV-infected individuals on effective antiretroviral therapy experience a number of non-AIDS noncommunicable diseases, such as cardiovascular disease, more frequently than uninfected individuals. Common pathways for such diseases are chronic immune activation and inflammation, including the prolonged inflammation associated with lower nadir CD4+ cell count. Prevention and treatment of non-AIDS conditions include treatment of traditional risk factors, lifestyle interventions, earlier initiation of antiretroviral therapy, and potentially therapies specifically targeting inflammation and immune activation (eg, statins)...
April 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/29689540/investigational-antiretroviral-drugs-what-is-coming-down-the-pipeline
#14
Roy M Gulick
Over the past 30 years, antiretroviral drug regimens for treating HIV infection have become more effective, safer, and more convenient. Despite 31 currently approved drugs, the pipeline of investigational HIV drugs remains full. Investigational antiretroviral drugs include the nucleoside analogue reverse transcriptase translocation inhibitor (NRTTI) MK-8591, a long-acting compound that could be dosed once weekly. Investigational nonnucleoside analogue reverse transcriptase inhibitors (NNRTIs) include doravirine, which is active in vitro against NNRTI-resistant HIV and was potent and well-tolerated when used in combination with a dual-nucleoside analogue RTI (nRTI) backbone in treatment-naive individuals...
April 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/29689539/maximizing-the-benefits-of-hiv-preexposure-prophylaxis
#15
Susan P Buchbinder
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...
April 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/29689538/opioids-and-hiv-infection-from-pain-management-to-addiction-treatment
#16
Chinazo O Cunningham
HIV-infected persons are more likely to have chronic pain, receive opioid analgesic treatment, receive higher doses of opioids, and to have substance use disorders and mental illness compared with the general population, putting them at increased risk for opioid use disorder. Management of opioid use in HIV-infected individuals can be complex, and the limited data on opioid treatment in this population are conflicting with regard to its effect on HIV outcomes. Buprenorphine treatment for opioid use disorder improves HIV outcomes and other outcomes...
April 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/29689537/hiv-infection-advances-toward-a-cure
#17
Daniel C Douek
Achieving cure of HIV infection requires eliminating all replication-competent virus from the reservoir of latently infected cells or completely inhibiting infected cells from emerging from latency. Strategies include very early use of antiretroviral therapy; hematopoietic stem cell transplantation; "shock-and-kill" approaches; immune therapy with immune checkpoint inhibitors; gene therapy, including use of CC chemokine receptor 5-modified CD4+ T cells; and broadly neutralizing antibody therapy. Success is likely to require a combination of approaches...
April 2018: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/28208122/a-conversation-among-the-ias-usa-board-of-directors-hot-topics-and-emerging-data-in-hiv-research-and-care
#18
Constance A Benson, Judith S Currier, Carlos Del Rio, Joel E Gallant, Roy M Gulick, Jeanne M Marrazzo, Douglas D Richman, Michael S Saag, Robert T Schooley, Paul A Volberding
The IAS-USA volunteer Board of Directors met in October 2016 for its annual meeting. For the second year, the Board conducted a live, hour-long, interactive, roundtable webinar covering current questions and issues in HIV research, prevention, and care. Important highlights from the Board's discussion, which was moderated by Paul A. Volberding, MD, are included below. Members of the IAS-USA volunteer Board of Directors are Constance A. Benson, MD; Judith S. Currier, MD; Carlos del Rio, MD; Joel E. Gallant, MD, MPH; Roy M...
December 2017: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/28208121/2017-update-of-the-drug-resistance-mutations-in-hiv-1
#19
Annemarie M Wensing, Vincent Calvez, Huldrych F G√ľnthard, Victoria A Johnson, Roger Paredes, Deenan Pillay, Robert W Shafer, Douglas D Richman
The 2017 edition of the IAS-USA drug resistance mutations list updates the figures last published in November 2015. The mutations listed are those that have been identified by specific criteria for evidence and drugs described. The figures are designed to assist practitioners in identifying key mutations associated with resistance to antiretroviral drugs and, therefore, in making clinical decisions regarding antiretroviral therapy.
December 2017: Topics in Antiviral Medicine
https://www.readbyqxmd.com/read/28208120/cardiovascular-complications-of-hiv-infection
#20
REVIEW
Marshall J Glesby
HIV-infected individuals are at increased risk for cardiovascular events. Widely used cardiovascular disease (CVD) risk calculators to determine indications for statin treatment are not well validated for use in the HIV-infecte population. Some experts advocate including HIV infection as an independent risk factor for CVD. The effects of antiretroviral therapy on lipid profiles and the potentially increased risk for cardiovascular events must be taken into account when selecting treatment for HIV-infected individuals...
December 2017: Topics in Antiviral Medicine
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