Updated assessment of risks and benefits of dolutegravir versus efavirenz in new antiretroviral treatment initiators in sub-Saharan Africa: modelling to inform treatment guidelines

Publication date: Available online 5 February 2020Source: The Lancet HIVAuthor(s): Andrew N Phillips, Loveleen Bansi-Matharu, Francois Venter, Diane Havlir, Anton Pozniak, Daniel R Kuritzkes, Annemarie Wensing, Jens D Lundgren, Deenan Pillay, John Mellors, Valentina Cambiano, Andreas Jahn, Tsitsi Apollo, Owen Mugurungi, David Ripin, Juliana Da Silva, Elliot Raizes, Nathan Ford, George K Siberry, Ravindra K GuptaSummaryBackgroundThe integrase inhibitor dolutegravir is being considered in several countries in sub-Saharan Africa instead of efavirenz for people initiating antiretroviral therapy (ART) because of superior tolerability and a lower risk of resistance emergence. WHO requested updated modelling results for its 2019 Antiretroviral Guidelines update, which was restricted to the choice of dolutegravir or efavirenz in new ART initiators. In response to this request, we modelled the risks and benefits of alternative policies for initial first-line ART regimens.MethodsWe updated an existing individual-based model of HIV transmission and progression in adults to consider information on the risk of neural tube defects in women taking dolutegravir at time of conception, as well as the effects of dolutegravir on weight gain. The model accounted for drug resistance in determining viral suppression, with consequences for clinical outcomes and mother-to-child transmission. We sampled distributions of parameters to create various epidemic setting scenarios, which reflected the diver...
Source: The Lancet HIV - Category: Infectious Diseases Source Type: research

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This article analyzes current issues related to maternal vaccination with a focus on emerging and epidemic viral infections and human rights.Recent FindingsHistorically, pregnant women have not been considered in the development of vaccines and have been excluded from participating in clinical trials and vaccination campaigns. Because of risk for injury and death of mothers and fetuses/infants during infectious disease outbreaks, it is important to consider their rights to receive any potential form of prevention or therapy available to non-pregnant individuals in order to enhance their well-being.SummaryIt is unacceptable...
Source: Current Tropical Medicine Reports - Category: Tropical Medicine Source Type: research
Abstract Children whose mothers used or misused opioids during their pregnancies are at an increased risk of exhibiting cognitive or behavioral impairments in the future, which may result in identifiable disabilities that require special education services in school. The costs associated with these additional educational services, however, have remained unknown. Using data from available empirical work, we calculated a preliminary set of cost estimates of special education and related services for children diagnosed with neonatal abstinence syndrome (NAS). We estimated these costs for a single cohort of children f...
Source: The American Journal of Managed Care - Category: Health Management Authors: Tags: Am J Manag Care Source Type: research
Readers in some of the 22 states where measles have been diagnosed this year discuss how the fear of catching the disease is affecting their daily lives.
Source: NYT Health - Category: Consumer Health News Authors: Tags: Measles Epidemics Vaccination and Immunization Disabilities Source Type: news
Mildren Porchas-Quijada1, Zyanya Reyes-Castillo1*, José Francisco Muñoz-Valle2, Sergio Durán-Barragán3,4, Virginia Aguilera-Cervantes1, Antonio López-Espinoza1, Mónica Vázquez-Del Mercado4, Mónica Navarro-Meza1 and Patricia López-Uriarte1 1Instituto de Investigaciones en Comportamiento Alimentario y Nutrición, Centro Universitario del Sur, Universidad de Guadalajara, Ciudad Guzmán, Mexico 2Instituto de Investigaciones en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexic...
Source: Frontiers in Endocrinology - Category: Endocrinology Source Type: research
Conclusions Apart West Nile virus (78), thousands of congenital microcephaly cases, fetal brain tissue damage and neurological syndromes have been associated with ZIKV infection. Unfortunately, the epidemics of this mosquito born, and a relative stable virus is on a rise. Although congenital microcephaly is a rare disorder however, due to lack of standardized diagnostic test facilities, the incidence in the geographically widespread ZIKV epidemic regions is higher. Animals studies showed that ZIKV is a neurotropic virus. It directly targets the developing embryonic brain cells by inducing apoptosis, cell-cycle arrest, and...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Ellen Waters is the Director of Development at Doctors of the World UK. She is passionate about access to healthcare around the world and spent four years in India working for human rights organisations.   On Thursday 14th March, Cyclone Idai swept Mozambique, leaving behind it a trail of destruction and death. Organisations from all around the world mobilised in just a few hours to get help to the population hit. Rapid intervention is key to save lives, but there is an often hidden need to provide healthcare for a long time after the disaster, while reconstruction takes place. On World Health Day, I want to bri...
Source: Doctors of the World News - Category: International Medicine & Public Health Authors: Tags: Uncategorised Source Type: news
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Source: blog.bioethics.net - Category: Medical Ethics Authors: Tags: Health Care syndicated Source Type: blogs
Authors: Esquilín-Rivera IO, Reyes-Báez G, Pérez-Torres R Abstract The Zika virus epidemic and the possible devastating teratogenic effects of the virus represent a challenge. Health authorities have the responsibility to create programs that provide adequate preventive, medical and psychological services to the affected population. The estimated risk of microcephaly in infants of mothers infected with Zika virus is 1 to 13% when the infection occurs in the first trimester of pregnancy. There is insufficient data to estimate the risk of microcephaly when infection occurs in the second or third ...
Source: Puerto Rico Health Sciences Journal - Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research
July 25, 2018Close to 800,000 Zambians received HIV services —including testing, counseling, antiretroviral therapy (ART), tuberculosis screening, and more—through IntraHealth International’sHTC Project, which for five years focused on serving clients who are often the most difficult (and crucial) to reach.Throughout 2012 –2018, the project provided HIV care and services to female sex workers, men who have sex with men, transgendered individuals, prison inmates, couples, pregnant and breastfeeding mothers, adolescent girls and young women, adolescent boys and young men, cross-border traders, seasona...
Source: IntraHealth International - Category: International Medicine & Public Health Authors: Source Type: news
July 25, 2018Close to 800,000 Zambians received HIV services —including testing, counseling, antiretroviral therapy (ART), tuberculosis screening, and more—through IntraHealth International’sHTC Project, which for five years focused on serving clients who are often the most difficult (and crucial) to reach.Throughout 2012 –2018, the project provided HIV care and services to female sex workers, men who have sex with men, transgendered individuals, prison inmates, couples, pregnant and breastfeeding mothers, adolescent girls and young women, adolescent boys and young men, cross-border traders, seasona...
Source: IntraHealth International - Category: International Medicine & Public Health Authors: Source Type: news
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