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  1 / 7919 MEDLINE  
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[PMID]:29480831
[Au] Autor:Cheng Y; Sauer B; Zhang Y; Nickman NA; Jamjian C; Stevens V; LaFleur J
[Ad] Endereço:Biomedical Informatics Center, George Washington University, Washington, DC.
[Ti] Título:Adherence and virologic outcomes among treatment-naïve veteran patients with human immunodeficiency virus type 1 infection.
[So] Source:Medicine (Baltimore);97(2):e9430, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Many studies have estimated the association between the adherence to antiretroviral therapies and human immunodeficiency virus (HIV) patients' virologic/immunologic outcomes. However, evidence is lacking on the causal effect of adherence on the outcomes. The goal of this study is to understand whether near perfect adherence is necessary to achieve optimal virologic outcome and also to investigate the effect of initial adherence to antiretroviral therapies on initial viral suppression by different regimens. A cohort study was conducted on HIV veterans initiating antiretroviral therapies in 1999 to 2015. The primary outcome was the first viral suppression occurred within 30 to 60 days since the index date. Multiple imputation was used to impute the missing value of virologic outcomes. The inverse probability of treatment weighting (IPTW) method was applied to estimate the viral suppression rate at each specific adherence category for each regimen category. Marginal structural models with IPTW were used to estimate the risk of viral suppression in lower-adherence categories in comparison to near-perfect adherence level ≥95%. Data showed that lower adherence caused lower viral suppression rate, with the association differentiated by the regimen. Patients on integrase strand transfer had the highest viral suppression rate, with patients on protease inhibitors having the lowest rate. Regardless of regimens, the viral suppression rate among patients at initial adherence of 75 to <95% was not statistically different from patients at adherence of ≥95%; however, the differences might be clinically significant.
[Mh] Termos MeSH primário: Antirretrovirais/uso terapêutico
Infecções por HIV/tratamento farmacológico
Infecções por HIV/virologia
HIV-1
Adesão à Medicação
[Mh] Termos MeSH secundário: Idoso
Estudos de Coortes
Feminino
Infecções por HIV/imunologia
Seres Humanos
Masculino
Meia-Idade
Razão de Chances
Resultado do Tratamento
Veteranos
Carga Viral/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Retroviral Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180227
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009430


  2 / 7919 MEDLINE  
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[PMID]:29229609
[Au] Autor:Desai M; Field N; Grant R; McCormack S
[Ad] Endereço:HIV and STI Department, Public Health England, London NW9 5EQ, UK.
[Ti] Título:Recent advances in pre-exposure prophylaxis for HIV.
[So] Source:BMJ;359:j5011, 2017 12 11.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Although pre-exposure prophylaxis (PrEP)-the use of antiretroviral drugs by non-infected people to prevent the acquisition of HIV-is a promising preventive option, important public health questions remain. Daily oral emtricitabine (FTC)-tenofovir disoproxil fumarate (TDF) is highly efficacious in preventing the acquisition of HIV in people at risk as a result of a range of different types of sexual exposure. There is good evidence of efficacy in women and men, and when men who have sex with men use event based dosing. Studies have been conducted in several countries and epidemics. Because adherence to this treatment varies greatly there are questions about its public health benefit. Oral FTC-TDF is extremely safe, with minimal impact on kidney, bone, or pregnancy outcomes, and there is no evidence that its effectiveness has been reduced by risk compensation during open label and programmatic follow-up. It is too early to assess the impact of this treatment on the incidence of sexually transmitted infections (STIs) at a population level. Many challenges remain. Access to pre-exposure prophylaxis is limited and disparities exist, including those governed by race and sex. Different pricing and access models need to be explored to avoid further widening inequalities. The optimal combination prevention program needs to be defined, and this will depend on local epidemiology, service provision, and cost effectiveness. This review updates the evidence base for pre-exposure prophylaxis regarding its effectiveness, safety, and risk compensation.
[Mh] Termos MeSH primário: Antirretrovirais/uso terapêutico
Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/uso terapêutico
Infecções por HIV/prevenção & controle
HIV/efeitos dos fármacos
Profilaxia Pré-Exposição/métodos
Doenças Sexualmente Transmissíveis/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Antirretrovirais/administração & dosagem
Análise Custo-Benefício
Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/administração & dosagem
Feminino
HIV/isolamento & purificação
Infecções por HIV/epidemiologia
Infecções por HIV/virologia
Disparidades em Assistência à Saúde
Homossexualidade Masculina/psicologia
Seres Humanos
Incidência
Masculino
Meia-Idade
Ensaios Clínicos Controlados Aleatórios como Assunto
Assunção de Riscos
Doenças Sexualmente Transmissíveis/tratamento farmacológico
Doenças Sexualmente Transmissíveis/prevenção & controle
Cooperação e Adesão ao Tratamento
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Anti-Retroviral Agents); 0 (Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5011


  3 / 7919 MEDLINE  
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[PMID]:29419697
[Au] Autor:Petit N; Enel P; Ravaux I; Darque A; Baumstarck K; Bregigeon S; Retornaz F; Visage group
[Ad] Endereço:Department of Internal, Geriatric and Therapeutic Medicine, University Hospital Center AP-HM.
[Ti] Título:Frail and pre-frail phenotype is associated with pain in older HIV-infected patients.
[So] Source:Medicine (Baltimore);97(6):e9852, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:As HIV-infected patients grow older, some accumulate multiple health problems earlier than the noninfected ones in particular frailty phenotypes. Patients with frailty phenotype are at higher risk of adverse outcomes (worsening mobility, disability, hospitalization, and death within three years).Our study aimed to evaluate prevalence of frailty in elderly HIV-infected patients and to assess whether frailty is associated with HIV and geriatric factors, comorbidities, and precariousness in a French cohort of older HIV infected.This 18-month cross-sectional multicenter study carried in 2013 to 2014 had involved 502 HIV-infected patients aged 50 years and older, cared in 18 HIV-dedicated hospital medical units, located in South of France.Prevalence of frailty was 6.3% and of pre-frailty 57.2%. Low physical activity and weakness were the main frailty markers, respectively 49.4% and 19.9%. In univariate models, precariousness, duration of HIV antiretroviral treatment >15 years, 2 comorbidities or more, risk of depression, activities of daily living disability, and presence of pain were significantly associated with frail and pre-frail phenotype. Multivariate logistic regression analyses showed that only pain was significantly different between frail and pre frail phenotype versus non frail phenotype (odds ratio = 1.2; P = .002).Our study is the first showing a significant association between pain and frailty phenotype in older patients infected by HIV. As frailty phenotype could be potentially reversible, a better understanding of the underlying determinant is warranted. Further studies are needed to confirm these first findings.
[Mh] Termos MeSH primário: Idoso Fragilizado/estatística & dados numéricos
Fragilidade
Infecções por HIV
Dor
[Mh] Termos MeSH secundário: Idoso
Antirretrovirais/uso terapêutico
Comorbidade
Avaliação da Deficiência
Feminino
Fragilidade/diagnóstico
Fragilidade/epidemiologia
Fragilidade/etiologia
França/epidemiologia
Avaliação Geriátrica/métodos
Infecções por HIV/tratamento farmacológico
Infecções por HIV/epidemiologia
Infecções por HIV/fisiopatologia
Hospitalização/estatística & dados numéricos
Seres Humanos
Masculino
Meia-Idade
Limitação da Mobilidade
Dor/diagnóstico
Dor/epidemiologia
Fenótipo
Prevalência
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Retroviral Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180209
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009852


  4 / 7919 MEDLINE  
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[PMID]:29253488
[Au] Autor:Williams BG; Gupta S; Wollmers M; Granich R
[Ad] Endereço:South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch, Stellenbosch, South Africa. Electronic address: briangerardwilliams@gmail.com.
[Ti] Título:Progress and prospects for the control of HIV and tuberculosis in South Africa: a dynamical modelling study.
[So] Source:Lancet Public Health;2(5):e223-e230, 2017 May.
[Is] ISSN:2468-2667
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In September, 2016, South Africa adopted a policy of providing antiretroviral treatment to everyone infected with HIV irrespective of their CD4 cell count. Studies of universal treatment and expanded prevention of HIV differ widely in their projections of effects and the associated costs, so we did this analysis to attempt to find a consensus. METHODS: We used data on HIV from the Joint UN Programme on HIV and AIDS (UNAIDS) from 1988 to 2013 and from data from WHO on tuberculosis from 1980 to to 2013 to fit a dynamical model to time trends in HIV prevalence, antiretroviral therapy (ART) coverage, and tuberculosis notification rates in South Africa. We then used the model to estimate current trends and project future patterns in HIV prevalence and incidence, AIDS-related mortality, and tuberculosis notification rates, and we used data from the South African National AIDS Council to assess current and future costs under different combinations of treatment and prevention approaches. We considered two treatment strategies: the Constant Effort strategy, in which people infected with HIV continue to start treatment at the rate in 2016, and the Expanded Treatment and Prevention (ETP) strategy, in which testing rates are increased, treatment is started immediately after HIV is detected, and prevention programmes are expanded. FINDINGS: Our estimates show that HIV incidence among adults aged 15 years or older fell from 2·3% per year in 1996 to 0·65% per year in 2016, AIDS-related mortality decreased from 1·4% per year in 2006 to 0·37% per year in 2016, and both continue to fall at a relative rate of 17% per year. Our model shows that maintenance of Constant Effort will have a substantial effect on HIV but will not end AIDS, whereas ETP could end AIDS by 2030, with incidence of HIV and AIDs-related mortality rates both at less than one event per 1000 adults per year. Under ETP the annual cost of health care and prevention will increase from US$2·3 billion in 2016 to $2·9 billion in 2018, then decrease to $1·7 billion in 2030 and $0·9 billion in 2050. Over the next 35 years, the expansion of treatment will avert an additional 3·8 million new infections, save 1·1 million lives, and save $3·2 billion compared with continuing Constant Effort up to 2050. Expansion of prevention, including provision of pre-exposure prophylaxis, condom distribution, and male circumcision, could avert a further 150 000 new infections, save 5000 lives, and cost an additional $5·7 billion compared with Constant Effort. INTERPRETATION: Our results suggest that South Africa is on track to reduce HIV incidence and AIDS-related mortality substantially by 2030, saving both lives and money. Success will depend on high rates of HIV testing, ART delivery and adherence, good patient monitoring and support, and data to monitor progress. FUNDING: None.
[Mh] Termos MeSH primário: Infecções por HIV/prevenção & controle
Tuberculose/prevenção & controle
[Mh] Termos MeSH secundário: Adulto
Antirretrovirais/uso terapêutico
Infecções por HIV/epidemiologia
Política de Saúde
Seres Humanos
Modelos Teóricos
Avaliação de Programas e Projetos de Saúde
África do Sul/epidemiologia
Resultado do Tratamento
Tuberculose/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Retroviral Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE


  5 / 7919 MEDLINE  
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[PMID]:27776589
[Au] Autor:Daftary A; Padayatchi N
[Ad] Endereço:McGill International TB Centre, McGill University, Montreal, Canada; Centre for the AIDS Programme of Research in South Africa (CAPRISA), SA Medical Research Council Extramural TB Pathogenesis Research Unit, University of KwaZulu-Natal, Durban, South Africa.
[Ti] Título:Provider perspectives on drug-resistant tuberculosis and human immunodeficiency virus care in South Africa: a qualitative case study.
[So] Source:Int J Tuberc Lung Dis;20(11):1483-1488, 2016 Nov.
[Is] ISSN:1815-7920
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To examine influences on health care workers' (HCWs') capacity to deliver health care for multi- and/or extensively drug-resistant tuberculosis (MDR/XDR-TB) and human immunodeficiency virus (HIV) infection in South Africa. DESIGN: Qualitative data were collected via group and individual interviews with a purposive sample of 17 HCWs at a centralised, tertiary TB facility and analysed using grounded theory. RESULTS: Four themes were identified: 1) personal infection control practices among HCWs may be weakened by a workplace culture comprising low motivation, disparate risk perceptions and practices across workforce hierarchies, physical discomfort, and problems managing patients with treatment-induced hearing loss. 2) Patient-provider interactions are likely stronger among nurses, and in HIV vs. MDR/XDR-TB service delivery, due to greater attention to patient empowerment and support. Stigma associated with MDR/XDR-TB, considered worse than HIV, may be perpetuated within non-specialised facilities less familiar with MDR/XDR-TB. 3) HCWs who struggle with the daily tedium of MDR/XDR-TB treatment supervision are becoming increasingly supportive of treatment literacy and self-administration. 4) Effective integration of HIV and MDR/XDR-TB services may be impeded by administrative restrictions, workplace norms and provider mindsets. CONCLUSION: Comprehensive, decentralised management of MDR/XDR-TB and HIV coinfection requires the creation of patient-provider trust and treatment literacy in MDR/XDR-TB programmes, and defying workplace norms that could provoke nosocomial TB exposure and fragmented service provision.
[Mh] Termos MeSH primário: Assistência à Saúde/organização & administração
Tuberculose Extensivamente Resistente a Medicamentos/epidemiologia
Infecções por HIV/epidemiologia
[Mh] Termos MeSH secundário: Antirretrovirais/uso terapêutico
Antituberculosos/uso terapêutico
Gerenciamento Clínico
Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico
Tuberculose Extensivamente Resistente a Medicamentos/prevenção & controle
Infecções por HIV/tratamento farmacológico
Infecções por HIV/prevenção & controle
Alfabetização em Saúde
Pessoal de Saúde
Seres Humanos
Transmissão de Doença Infecciosa do Paciente para o Profissional
Relações Profissional-Paciente
Pesquisa Qualitativa
Fatores de Risco
África do Sul/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Retroviral Agents); 0 (Antitubercular Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:28468637
[Au] Autor:Kigen G; Edwards G
[Ad] Endereço:Department of Pharmacology and Toxicology, Moi University School of Medicine, P.O. Box 4606, 30100, Eldoret, Kenya. kigengfk@gmail.com.
[Ti] Título:Drug-transporter mediated interactions between anthelminthic and antiretroviral drugs across the Caco-2 cell monolayers.
[So] Source:BMC Pharmacol Toxicol;18(1):20, 2017 May 04.
[Is] ISSN:2050-6511
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Drug interactions between antiretroviral drugs (ARVs) and anthelminthic drugs, ivermectin (IVM) and praziquantel (PZQ) were assessed by investigating their permeation through the Caco-2 cell monolayers in a transwell. The impact of anthelminthics on the transport of ARVs was determined by assessing the apical to basolateral (AP → BL) [passive] and basolateral to apical (BL → AP) [efflux] directions alone, and in presence of an anthelminthic. The reverse was conducted for the assessment of the influence of ARVs on anthelminthics. METHODS: Samples from the AP and BL compartments were taken at 60, 120, 180 and 240 min and quantified either by HPLC or radiolabeled assay using a liquid scintillating counter for the respective drugs. Transepithelial resistance (TEER) was used to assess the integrity of the monolayers. The amount of compound transported per second (apparent permeability, Papp) was calculated for both AP to BL (Papp ), and BL to AP (Papp ) movements. Samples collected after 60 min were used to determine the efflux ratio (ER), quotient of secretory permeability and absorptive permeability (PappBL-AP/PappAP-BL). The reverse, (PappAP-BL/PappBL-AP) constituted the uptake ratio. The impact of SQV, EFV and NVP on the transport of both IVM and PZQ were investigated. The effect of LPV on the transport of IVM was also determined. The influence of IVM on the transport of SQV, NVP, LPV and EFV; as well as the effect PZQ on the transport of SQV of was also investigated, and a two-tailed p value of <0.05 was considered significant. RESULTS: IVM significantly inhibited the efflux transport (BL → AP movement) of LPV (ER; 6.7 vs. 0.8, p = 0.0038) and SQV (ER; 3.1 vs. 1.2 p = 0.00328); and increased the efflux transport of EFV (ER; 0.7 vs. 0.9, p = 0.031) suggesting the possibility of drug transporter mediated interactions between the two drugs. NVP increased the efflux transport of IVM (ER; 0.8 vs. 1.8, p = 0.0094). CONCLUSIONS: The study provides in vitro evidence of potential interactions between IVM, an anthelminthic drug with antiretroviral drugs; LPV, SQV, NVP and EFV. Further investigations should be conducted to investigate the possibility of in vivo interactions.
[Mh] Termos MeSH primário: Anti-Helmínticos/metabolismo
Antirretrovirais/metabolismo
Ivermectina/metabolismo
Praziquantel/metabolismo
[Mh] Termos MeSH secundário: Transporte Biológico Ativo
Células CACO-2
Interações Medicamentosas
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anthelmintics); 0 (Anti-Retroviral Agents); 6490C9U457 (Praziquantel); 70288-86-7 (Ivermectin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1186/s40360-017-0129-6


  7 / 7919 MEDLINE  
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[PMID]:27771206
[Au] Autor:Whittle HJ; Palar K; Seligman HK; Napoles T; Frongillo EA; Weiser SD
[Ad] Endereço:Global Health Sciences, University of California, San Francisco (UCSF), Mission Hall/Global Health and Clinical Sciences Building, 550 16th Street, 3rd Floor, San Francisco, CA 94158-2549, United States. Electronic address: henry.whittle.14@ucl.ac.uk.
[Ti] Título:How food insecurity contributes to poor HIV health outcomes: Qualitative evidence from the San Francisco Bay Area.
[So] Source:Soc Sci Med;170:228-236, 2016 12.
[Is] ISSN:1873-5347
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Food-insecure people living with HIV/AIDS (PLHIV) consistently exhibit worse clinical outcomes than their food-secure counterparts. This relationship is mediated in part through non-adherence to antiretroviral therapy (ART), sub-optimal engagement in HIV care, and poor mental health. An in-depth understanding of how these pathways operate in resource-rich settings, however, remains elusive. OBJECTIVE: We aimed to understand the relationship between food insecurity and HIV health among low-income individuals in the San Francisco Bay Area using qualitative methods. METHODS: Semi-structured in-depth interviews were conducted with 34 low-income PLHIV receiving food assistance from a non-profit organization. Interviews explored experiences with food insecurity and its perceived effects on HIV-related health, mental health, and health behaviors including taking ART and attending clinics. Thematic content analysis of transcripts followed an integrative inductive-deductive approach. RESULTS: Food insecurity was reported to contribute to poor ART adherence and missing scheduled clinic visits through various mechanisms, including exacerbated ART side effects in the absence of food, physical feelings of hunger and fatigue, and HIV stigma at public free-meal sites. Food insecurity led to depressive symptoms among participants by producing physical feelings of hunger, aggravating pre-existing struggles with depression, and nurturing a chronic self-perception of social failure. Participants further explained how food insecurity, depression, and ART non-adherence could reinforce each other in complex interactions. CONCLUSION: Our study demonstrates how food insecurity detrimentally shapes HIV health behavior and outcomes through complex and interacting mechanisms, acting via multiple socio-ecological levels of influence in this setting. The findings emphasize the need for broad, multisectoral approaches to tackling food insecurity among urban poor PLHIV in the United States.
[Mh] Termos MeSH primário: Abastecimento de Alimentos/normas
Infecções por HIV/economia
Avaliação de Resultados (Cuidados de Saúde)
[Mh] Termos MeSH secundário: Adulto
Idoso
Antirretrovirais/efeitos adversos
Antirretrovirais/economia
Antirretrovirais/uso terapêutico
Feminino
Assistência Alimentar/utilização
Infecções por HIV/epidemiologia
Infecções por HIV/psicologia
Seres Humanos
Masculino
Adesão à Medicação/psicologia
Adesão à Medicação/estatística & dados numéricos
Meia-Idade
Organizações sem Fins Lucrativos/estatística & dados numéricos
Pesquisa Qualitativa
São Francisco/epidemiologia
Fatores Socioeconômicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Retroviral Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29365306
[Au] Autor:Martin EG; Schackman BR
[Ad] Endereço:From the Rockefeller Institute of Government and the Department of Public Administration and Policy, University at Albany, State University of New York, Albany (E.G.M.); and the Department of Healthcare Policy and Administration, Weill Cornell Medical College, New York (B.R.S.).
[Ti] Título:Treating and Preventing HIV with Generic Drugs - Barriers in the United States.
[So] Source:N Engl J Med;378(4):316-319, 2018 Jan 25.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Antirretrovirais/uso terapêutico
Custos de Medicamentos
Medicamentos Genéricos/uso terapêutico
Infecções por HIV/tratamento farmacológico
[Mh] Termos MeSH secundário: Antirretrovirais/economia
Redução de Custos
Combinação de Medicamentos
Quimioterapia Combinada
Medicamentos Genéricos/economia
Infecções por HIV/prevenção & controle
Seres Humanos
Seguro de Serviços Farmacêuticos/economia
Legislação de Medicamentos
Marketing
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Retroviral Agents); 0 (Drug Combinations); 0 (Drugs, Generic)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMp1710914


  9 / 7919 MEDLINE  
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[PMID]:28465649
[Au] Autor:Teklu AM; Tsegaye E; Fekade D; Hailemelak A; Weiss W; Hassen E; Simmons N; Zewdu S; Berhan Y; Getachew A; Hagos T; Alebachew A; Damena M; Sitotaw Y; Assefa Y; Medhin G; Ruff A
[Ad] Endereço:ACM Project Implementation Office (ACM), Addis Ababa, Ethiopia.
[Ti] Título:Establishing a Multicenter Longitudinal Clinical Cohort Study in Ethiopia: Advanced Clinical Monitoring of Antiretroviral Treatment Project.
[So] Source:Ethiop J Health Sci;27(Suppl 1):3-16, 2017 Feb.
[Is] ISSN:2413-7170
[Cp] País de publicação:Ethiopia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The purpose of this paper is to describe the establishment of the Advanced Clinical Monitoring of ART Project in Ethiopia for monitoring and evaluation of the longitudinal effectiveness of the ART program and to show the opportunities it presents. This cohort was established in response to the 2005 call by WHO for establishing additional mechanisms for stronger monitoring of ART and the need for creating the platform to generate evidence to guide the care given for the ever increasing number of patients on ART in Ethiopia. METHOD: A participatory and multi-stage process which started from a consensus building workshop and steered by a mother protocol as well as guiding documents which dictated the degree of engagement and expectations was followed. The primary and secondary aims of the study were agreed upon. A multi-site longitudinal observational clinical cohort was established by a consortium of stakeholders including seven Ethiopian medical schools and their affiliated referral hospitals, John Hopkins University, Ethiopian Public Health Institute, Ministry of Science and Technology, US Centers for Disease Prevention and Control - CDC-Ethiopia, and the Federal Ministry of Health. Adult and adolescent cohorts covering the age range of 14+ years) and pediatric cohorts covering those below age 14 years were the two main cohorts. During the initial recruitment of these cohorts information was extracted from existing documents for a total of 2,100 adult participants. In parallel, a prospective cohort of 1,400 adult and adolescent patients were enrolled for ART initiation and follow-up. Using similar recruitment procedures, a total of 120 children were enrolled in each of retrospective and prospective cohorts. Replacement of participants were made in subsequent years based on lost follow up and death rates to maintain adequacy of the sample to be followed-up. ACHIEVEMENTS: Between January 2005 and August 2013 a total of 4,339 patients were followed for a median of 41.6 months and data on demographic characteristics, baseline and ongoing clinical features, hospitalization history, medication and laboratory information were collected. 39,762 aliquots and 25,515 specimens of plasma and dryblood-spots respectively were obtained and stored longitudinally from October 2009 to August 2013. The project created a research platform for researchers, policy and decision makers. Moreover, it encouraged local and international investigators to identify and answer clinically and programmatically relevant research questions using the available data and specimens. Calls for concept notes paired with multiple trainings to stimulate investigators to conduct analyses further boosted the potential for doing research. CONCLUSIONS: A comprehensive and resourceful mechanism for scientific inquiry was established to support the national HIV/ART program. With meaningful involvement and defined roles, establishment of a study, which involved multiple institutions and investigators, was possible. Since ACM is the largest multi-site clinical cohort of patients on antiretroviral treatment in Ethiopia-which can be used for research and for improving clinical management-considering options to sustain the project is crucial.
[Mh] Termos MeSH primário: Antirretrovirais/uso terapêutico
Infecções por HIV/tratamento farmacológico
Avaliação de Resultados (Cuidados de Saúde)
Avaliação de Programas e Projetos de Saúde/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fármacos Anti-HIV/uso terapêutico
Criança
Assistência à Saúde/normas
Etiópia
Feminino
Seres Humanos
Estudos Longitudinais
Masculino
Estudos Prospectivos
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Anti-HIV Agents); 0 (Anti-Retroviral Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE


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[PMID]:29320547
[Au] Autor:Augustemak de Lima LR; Petroski EL; Moreno YMF; Silva DAS; Trindade EBMS; Carvalho AP; Back IC
[Ad] Endereço:Research Centre for Kinanthropometry and Human Performance. Department of Physical Education. Federal University of Santa Catarina. Florianópolis, Santa Catarina, Brazil.
[Ti] Título:Dyslipidemia, chronic inflammation, and subclinical atherosclerosis in children and adolescents infected with HIV: The PositHIVe Health Study.
[So] Source:PLoS One;13(1):e0190785, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:HIV-infected children and adolescents may be at risk for cardiovascular disease due to chronic inflammation and exacerbation of risk factors. The aim of this study was as follows: 1) compare cardiovascular risk factors, chronic inflammation, and carotid intima-media thickness (IMTc) between the HIV and control groups; 2) determine the association of HIV and antiretroviral (ART) regimens with cardiovascular risk factors, chronic inflammation, and IMTc; and 3) identify variables associated with elevated IMTc. Cross-sectional analysis of 130 children and adolescents, 8-15 years of age, divided into HIV-infected (n = 65) and healthy control (n = 65) participants. Body fat, blood pressure, glycemia, insulin, and glycated hemoglobin, total cholesterol and fractions (LDL-C and HDL-C), triglycerides, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and the IMTc were measured. The results showed HIV-infected children and adolescents had higher levels of glycemia (87.9 vs. 75.9 mg.dL-1, p< 0.001), LDL-c (94.7 vs. 79.5 mg.dL-1, p = 0.010), triglycerides (101.2 vs. 61.6 mg.dL-1, p< 0.001), CRP (1.6 vs. 1.0 mg.L-1, p = 0.007), IL-6 (1.42 vs. 0.01 pg.mL-1, p< 0.001), TNF-α (0.49 vs. 0.01 pg.mL-1, p< 0.001), mean IMTc (0.526 vs. 0.499 mm, p = 0.009), and lower HDL-c (53.7 vs. 69.4 mg.dL-1, p< 0.001) compared to controls. Systolic blood pressure (ß = 0.006, p = 0.004) and TNF-α (ß = -0.033, p = 0.029) accounted for 16% of IMTc variability in HIV-infected children and adolescents. In patients using protease inhibitors-based ART, male gender (ß = -0.186, p = 0.008), trunk body fat (ß = -0.011, p = 0.006), glucose (ß = 0.005, p = 0.046), and IL-6 (ß = 0.017, p = 0.039) accounted for 28% of IMTc variability. HIV-infected children and adolescents may be at risk for premature atherosclerosis due to chronic inflammation and dyslipidemia. Interventions with the potential to improve lipid profile, mitigate inflammation, and reduce cardiovascular risk are needed.
[Mh] Termos MeSH primário: Aterosclerose/complicações
Dislipidemias/complicações
Infecções por HIV/complicações
Inflamação/complicações
[Mh] Termos MeSH secundário: Adiposidade
Adolescente
Antirretrovirais/uso terapêutico
Aterosclerose/diagnóstico por imagem
Aterosclerose/epidemiologia
Aterosclerose/fisiopatologia
Biomarcadores/sangue
Glicemia
Espessura Intima-Media Carotídea
Criança
Estudos Transversais
Dislipidemias/diagnóstico por imagem
Dislipidemias/epidemiologia
Dislipidemias/fisiopatologia
Feminino
Infecções por HIV/diagnóstico por imagem
Infecções por HIV/tratamento farmacológico
Infecções por HIV/fisiopatologia
Seres Humanos
Inflamação/diagnóstico por imagem
Inflamação/epidemiologia
Inflamação/fisiopatologia
Interleucina-6/sangue
Lipídeos/sangue
Masculino
Inibidores de Proteases/uso terapêutico
Fatores de Risco
Fatores Sexuais
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Retroviral Agents); 0 (Biomarkers); 0 (Blood Glucose); 0 (IL6 protein, human); 0 (Interleukin-6); 0 (Lipids); 0 (Protease Inhibitors)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190785



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