Bugs and Drugs
Overall goals of antibiotic stewardship and infection prevention programs are to improve patient safety as it pertains to risk of infection or multidrug-resistant organism (MDRO) acquisition. Although the focus of day-to-day activities may differ, the themes of surveillance, education, clinician engagement, and multidisciplinary interactions are prevalent in both programs. Synergistic work between programs has yielded benefits in prevention of MDROs, surgical site infections, Clostridioides difficile infection, and reducing inappropriate testing and treatment for asymptomatic bacteriuria. Collaboration between programs can...
Source: Infectious Diseases Clinics of North America - December 10, 2019 Category: Infectious Diseases Authors: Erin M. Gentry, Shelley Kester, Kristin Fischer, Lisa E. Davidson, Catherine L. Passaretti Source Type: research

Collaborative Antimicrobial Stewardship in the Health Department
This article discusses existing public health stewardship activities, opportunities for collaboration between public health and key partners in antibiotic stewardship programs, the potential for improvement and expansion of current activities, and possible new modes of collaboration that could be pursued. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - December 10, 2019 Category: Infectious Diseases Authors: Christopher D. Evans, James W.S. Lewis Source Type: research

Collaborative Antimicrobial Stewardship
This article provides guidance on strategies for engaging hospital and health system administration to support antimicrobial stewardship, including recommendations for designing a successful antimicrobial stewardship program structure, pitching resource requests, setting meaningful and measurable goals, achieving and communicating results, and fostering ongoing relationships with hospital and health system administration. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - December 10, 2019 Category: Infectious Diseases Authors: Whitney R. Buckel, Keith S. Kaye, Payal K. Patel Source Type: research

Collaborative Antimicrobial Stewardship
Information technology (IT) is vitally important to making antimicrobial stewardship a scalable endeavor in modern health care systems. Without IT, many antimicrobial interventions in patient care would be missed. Clinical decision support systems and smartphone apps, either stand-alone or integrated into electronic health records, can all be effective tools to help augment the work of antimicrobial stewardship programs and support the management of infectious diseases in any health care setting. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - December 10, 2019 Category: Infectious Diseases Authors: Kristi M. Kuper, Keith W. Hamilton Source Type: research

Collaborative Antimicrobial Stewardship
There have been tremendous advances in methodologies available for detection and identification of organisms causing infections. Providers can now obtain identification results and antimicrobial susceptibility results in a shorter period of time. However, declining health care resources highlight the importance of selecting the right test at the right time to maximize diagnostic benefits. Therefore, the role of the antimicrobial stewardship team in the clinical microbiology laboratory has expanded to include diagnostic stewardship and provision of guidance on test selection for diagnosis and management of infection. This r...
Source: Infectious Diseases Clinics of North America - December 10, 2019 Category: Infectious Diseases Authors: Elizabeth L. Palavecino, John C. Williamson, Christopher A. Ohl Source Type: research

Antibiotic-Resistant Enteric Infections
Rising rates of antimicrobial resistance (AMR) in enteric infections are now observed across the globe in low-income and middle-income as well as high-income settings owing to global travel and overlapping social drivers. Pathogen-specific risk factors for spread are now also associated with specific AMR phenotypes and profiles. Several of the drivers of AMR intersect with risk factors for enteric infections and are preventable. Concerted focus on OneHealth prevention strategies for enteric infections and AMR are likely to be of significant benefit in optimizing public health outcomes. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: Sadia Shakoor, James A. Platts-Mills, Rumina Hasan Source Type: research

Opportunistic Infections in Transplant Patients
This article focuses on opportunistic infections in the solid organ transplant recipient. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: Rebecca Kumar, Michael G. Ison Source Type: research

Severe Acute Respiratory Syndrome
Severe acute respiratory syndrome coronavirus (SARS-CoV), emerged from China and rapidly spread worldwide. Over 8098 people fell ill and 774 died before the epidemic ended in July 2003. Bats are likely an important reservoir for SARS-CoV. SARS-like CoVs have been detected in horseshoe bats and civet cats. The main mode of transmission of SARS-CoV is through inhalation of respiratory droplets. Faeco-oral transmission has been recorded. Strict infection control procedures with respiratory and contact precautions are essential. Fever and respiratory symptoms predominate, and diarrhea is common. Treatment involves supportive c...
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: David S.C. Hui, Alimuddin Zumla Source Type: research

Antibiotic-Resistant Community-Acquired Bacterial Pneumonia
Antimicrobial resistance is a global concern, and prudent use of antibiotics is essential to preserve the current armamentarium of effective drugs. Acute respiratory tract infection is the most common reason for antibiotic prescription in adults. In particular, community-acquired pneumonia poses a significant health challenge and economic burden globally, especially in the current landscape of a dense and aging population. By updating the knowledge on the common antimicrobial-resistant pathogens in community-acquired respiratory tract infections, their prevalence, and resistance may pave the way to enhancing appropriate an...
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: Jeffery Ho, Margaret Ip Source Type: research

Novel Avian Influenza A Virus Infections of Humans
A high index of suspicion and early diagnosis of avian influenza A virus infection is essential reduce transmission risk. Clinical suspicion relies on eliciting a history of recent exposure to poultry or to sick persons. Diagnosis requires collection of appropriate respiratory specimens. Patients with suspected infection should be isolated immediately and patients with lower respiratory tract disease should be placed on airborne precautions if possible. Antiviral treatment should be started as soon as possible based upon clinical suspicion while awaiting specific viral diagnosis. Corticosteroids and salicylates should be a...
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: Timothy M. Uyeki, Malik Peiris Source Type: research

The Middle East Respiratory Syndrome (MERS)
The Middle East respiratory syndrome (MERS) is a novel lethal zoonotic disease of humans caused by the MERS coronavirus (MERS-CoV). Although MERS is endemic to the Middle East, travelers have exported MERS-CoV on return to their home countries. Clinical manifestations range from mild to severe acute respiratory disease and death. The elderly, immunocompromised, and those with chronic comorbid liver, lung, and hepatic conditions have a high mortality rate. There is no specific treatment. Person-to-person spread causes hospital and household outbreaks, and thus improved compliance with internationally recommended infection c...
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: Esam I. Azhar, David S.C. Hui, Ziad A. Memish, Christian Drosten, Alimuddin Zumla Source Type: research

Lassa Fever
Lassa fever outbreaks West Africa have caused up to 10,000 deaths annually. Primary infection occurs from contact with Lassa virus-infected rodents and exposure to their excreta, blood, or meat. Incubation takes 2 to 21  days. Symptoms are difficult to distinguish from malaria, typhoid, dengue, yellow fever, and other viral hemorrhagic fevers. Clinical manifestations range from asymptomatic, to mild, to severe fulminant disease. Ribavirin can improve outcomes. Overall mortality is between 1% and 15%. Lassa fever s hould be considered in the differential diagnosis with travel to West Africa. There is an urgent need for...
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: Danny A. Asogun, Stephan G √ľnther, George O. Akpede, Chikwe Ihekweazu, Alimuddin Zumla Source Type: research

Viral Hemorrhagic Fevers Other than Ebola and Lassa
Viral hemorrhagic fevers represent a group of diseases caused by enveloped RNA viruses. The epidemiology is broadly variable, ranging from geographically localized to more diffuse infections. Viral hemorrhagic fevers are classified as category A bioweapon agents by the Centers for Disease Control and Prevention. Viral hemorrhagic fevers are severe febrile illnesses with hemorrhagic phenomena. Laboratory diagnosis takes place in highly specialized reference laboratories. Treatment is essentially supportive. In this article, we focus the attention on yellow fever and viral hemorrhagic fevers other than Ebola and Lassa virus ...
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: Marco Iannetta, Antonino Di Caro, Emanuele Nicastri, Francesco Vairo, Honorati Masanja, Gary Kobinger, Ali Mirazimi, Francine Ntoumi, Alimuddin Zumla, Giuseppe Ippolito Source Type: research

Viral Hepatitis
Viral hepatitis is a major global public health problem affecting hundreds of millions of people and is associated with significant morbidity and mortality. Five major biologically unrelated hepatotropic viruses cause most of the global burden of viral hepatitis. Hepatitis B and hepatitis C are associated with a significant number of chronic infections. Most deaths from viral hepatitis are due to hepatitis B and hepatitis C. An estimated 257  million people were living with HBV and 71 million people were living with HCV. Most people are asymptomatic. New diagnostics and highly effective, pangenotypic direct-a...
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: Simone Lanini, Andrew Ustianowski, Raffaella Pisapia, Alimuddin Zumla, Giuseppe Ippolito Source Type: research

Ebola Virus Disease
This article highlights the epidemiology, clinical features, diagnosis, management, and prevention of EVD. The emerging diagnostic technologies, rapid viral characterization, geospatial mapping of EVD transmission, and new treatments and vaccines are discussed. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: Emanuele Nicastri, Gary Kobinger, Francesco Vairo, Chiara Montaldo, Leonard E.G. Mboera, Rashid Ansunama, Alimuddin Zumla, Giuseppe Ippolito Source Type: research

Chikungunya
, a zoonotic disease caused by the Chikungunya virus (CHIKV), is transmitted by infected Aedes spp mosquitoes. CHIKV has now spread to more than 100 countries and is listed on the WHO Blueprint priority pathogens. After an incubation period of 1 to 12  days, symptoms similar to other febrile infections appear, with a sudden onset of high fever, nausea, polyarthralgia, myalgia, widespread skin rash, and conjunctivitis. Serious complications include myocarditis, uveitis, retinitis, hepatitis, acute renal disease, severe bullous lesions, meningoenc ephalitis, Guillain-Barré syndrome, myelitis, and cranial nerve pa...
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: Francesco Vairo, Najmul Haider, Richard Kock, Francine Ntoumi, Giuseppe Ippolito, Alimuddin Zumla Source Type: research

Invasive Pneumococcal and Meningococcal Disease
This review focuses on current knowledge of the epidemiology, prevention, and treatment of invasive pneumococcal (IPD) and meningococcal disease (IMD). IPD decreased significantly with the introduction of effective conjugate vaccines but is on the rise again. Effective antibiotic therapy of IPD includes the combination of a beta-lactam and a macrolide with additional considerations in meningitis. Steroids are mandatory in pneumococcal meningitis but not indicated in pneumococcal pneumonia except in the setting of refractory shock. There is increasing concern about the cardiovascular complications of IPD. IMD continues to b...
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: Deirdre Fitzgerald, Grant W. Waterer Source Type: research

Emerging and Reemerging Infectious Diseases: Global Overview
New emerging and reemerging infectious disease outbreaks have continued to cause much human suffering and loss of life worldwide. During the past 2 decades, several landmark events in the field of infectious diseases with epidemic potential have occurred. The SARS (severe acute respiratory syndrome) pandemic (2002 –2004), the Ebola virus disease (EVD) outbreak in West Africa (2013–2016), the cholera outbreak in Yemen (2015–2018), the Zika virus in the Americas and southeast Asia (2016–2018), Lassa fever (LF) in Nigeria (2018), diphtheria in Venezuela (2016-2017) and in Yemen (2017-2018), Yellow feve...
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: Alimuddin Zumla, David S.C. Hui Tags: Preface Source Type: research

Multidrug and Extensively Drug-resistant Tuberculosis
This article reviews epidemiology, clinical features, management, and treatment, with new updates and recent changes in guidelines that offer patients better tolerated and shorter regimens for enabling therapeutic outcomes. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: Simon Tiberi, Alimuddin Zumla, Giovanni Battista Migliori Source Type: research

Emerging and Re-Emerging Infectious Diseases
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Authors: Alimuddin Zumla, David S.C. Hui Source Type: research

Copyright
Elsevier (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Source Type: research

Contributors
HELEN W. BOUCHER, MD, FIDSA, FACP (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Source Type: research

Contents
Alimuddin Zumla and David S.C. Hui (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Source Type: research

Forthcoming Issues
Collaborative Antimicrobial Stewardship (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - October 26, 2019 Category: Infectious Diseases Source Type: research

HIV and Aging
Health care for older adults with human immunodeficiency virus can be highly complex, resource intensive, and carry a high administrative burden. Data from aging longitudinal cohorts and feedback from the human immunodeficiency virus community suggest that the current model is not meeting the needs of these older adults. We introduce the 6 Ms approach, which acknowledges the multicomplexity of older adults with human immunodeficiency virus, simplifies geriatric principles for non –geriatrics-trained providers, and minimizes extensive training and specialized screening tests or tools. Implementing novel approaches to ...
Source: Infectious Diseases Clinics of North America - August 6, 2019 Category: Infectious Diseases Authors: Kristine M. Erlandson, Maile Y. Karris Source Type: research

On the Road to a HIV Cure
The Berlin patient, a famous example for human immunodeficiency virus (HIV) cure, had received a bone marrow transplantation with an HIV resistance mutation. The authors describe his case and others that had shown HIV control, like the Mississippi baby who was started on antiretroviral therapy very early after birth, and posttreatment controllers, like the VISCONTI cohort. Moreover, the authors outline various strategies, oftentimes informed by these individuals, that have been tried in  vitro, in animal models, or in human trials, to deplete the latent reservoir, which is considered the basis of HIV persistence and t...
Source: Infectious Diseases Clinics of North America - August 6, 2019 Category: Infectious Diseases Authors: Nikolaus Jilg, Jonathan Z. Li Source Type: research

Key Principles of Antiretroviral Pharmacology
Antiretroviral therapy has advanced significantly since zidovudine was first approved. Although 31 antiretrovirals have been approved by the FDA, only about half of those are commonly used. Newer, more tolerable agents have made human immunodeficiency virus into a chronic condition, which can be managed with medication. The most common antiretroviral regimens consist of 2 nucleoside reverse transcriptase inhibitors plus a third agent, often an integrase inhibitor because of better tolerability and fewer drug interactions than other regimens. Understanding the dosage forms, adverse effects, and drug interactions of antiretr...
Source: Infectious Diseases Clinics of North America - August 6, 2019 Category: Infectious Diseases Authors: Brandon Dionne Source Type: research

How Big Data Science Can Improve Linkage and Retention in Care
Ending the HIV Epidemic: A Plan for America ” (EtHE), launched by the Department of Health and Human Services (DHHS), is predicated on actionable data systems to monitor progress toward ambitious goals and to guide human immunodeficiency virus (HIV) testing, prevention, and treatment services. Situated on a status-neutral continuum of HIV p revention and care, EtHE relies on coordination across DHHS agencies and utilization of data systems established for programmatic purposes. Improving efficiencies and timeliness of existing data systems and harnessing the potential of novel data systems, including those afforded b...
Source: Infectious Diseases Clinics of North America - August 6, 2019 Category: Infectious Diseases Authors: Aadia I. Rana, Michael J. Mugavero Source Type: research

Nearly Two Decades Later, Exciting Progress in HIV, But Challenges Remain
In 2001, I wrote an article for Infectious Disease Clinics of North America on human immunodeficiency virus (HIV)-related opportunistic infections (OIs). Entitled, "Opportunistic Infections in Human Immunodeficiency Virus Disease: Down But not Out," the review focused on specific strategies for prevention, diagnosis, and treatment of these potentially life-threatening infections. While citing the dramatic reduction in OIs since the introduction of effective antiretroviral therapy (ART), I also noted that such treatment had just become widely adopted in the late 1990s, hence experience with OIs in the “ART e...
Source: Infectious Diseases Clinics of North America - August 6, 2019 Category: Infectious Diseases Authors: Paul E. Sax Tags: Preface Source Type: research

Hiv
INFECTIOUS DISEASE CLINICS OF NORTH AMERICA (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - August 6, 2019 Category: Infectious Diseases Authors: Paul E. Sax Source Type: research

Copyright
Elsevier (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - August 6, 2019 Category: Infectious Diseases Source Type: research

Contributors
HELEN W. BOUCHER, MD, FIDSA, FACP (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - August 6, 2019 Category: Infectious Diseases Source Type: research

Contents
Paul E. Sax (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - August 6, 2019 Category: Infectious Diseases Source Type: research

Forthcoming Issues
Emerging and Re-Emerging Infectious Diseases (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - August 6, 2019 Category: Infectious Diseases Source Type: research

HIV and Substance Use Disorder
The ongoing syndemic of substance use disorder and human immunodeficiency virus infection threatens progress made in preventing new infections and improving outcomes among those infected. To address this challenge effectively, human immunodeficiency virus physicians must take an increased role in the screening, diagnosis, and treatment of substance use disorders. Such treatment decreases human immunodeficiency virus risk behaviors and improves human immunodeficiency virus and substance use disorder-related outcomes. An effective response to this syndemic requires increased access to adjuvant interventions and a radical mov...
Source: Infectious Diseases Clinics of North America - June 27, 2019 Category: Infectious Diseases Authors: Christopher M. Bositis, Joshua St. Louis Source Type: research

Management of Virologic Failure and HIV Drug Resistance
This article discusses the causes of virologic failure, the use of resistance testing to guide management after failure, interpretation and relevance of HIV drug resistance patterns, considerations for selection of second-line and salvage therapies, and management of virologic failure in special populations. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - June 27, 2019 Category: Infectious Diseases Authors: Suzanne M. McCluskey, Mark J. Siedner, Vincent C. Marconi Source Type: research

Management of Advanced HIV Disease
Great progress has been made in caring for persons with human immunodeficiency virus. However, a significant proportion of individuals still present to care with advanced disease and a low CD4 count. Careful considerations for selection of antiretroviral therapy as well as close monitoring for opportunistic infections and immune reconstitution inflammatory syndrome are vitally important in providing care for such individuals. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - June 27, 2019 Category: Infectious Diseases Authors: Nathan A. Summers, Wendy S. Armstrong Source Type: research

Switching Antiretroviral Therapy in the Setting of Virologic Suppression
This review provides a synopsis of key clinical considerations for switching antiretroviral therapy (ART) for individuals with human immunodeficiency virus who have maintained a routinely suppressed viral load. There may be benefits but also risks involved in every ART regimen change, so strategies for prioritizing individuals for a switch based on the specific antiretroviral agents in the regimen are discussed, along with approaches to ensure maintenance of viral suppression after treatment modifications. Controversial and evolving questions in the area of ART switches and simplifications are also considered. (Source: Inf...
Source: Infectious Diseases Clinics of North America - June 27, 2019 Category: Infectious Diseases Authors: Brian R. Wood Source Type: research

Human Immunodeficiency Virus and Substance Use Disorder
The ongoing syndemic of substance use disorder and human immunodeficiency virus infection threatens progress made in preventing new infections and improving outcomes among those infected. To address this challenge effectively, human immunodeficiency virus physicians must take an increased role in the screening, diagnosis, and treatment of substance use disorders. Such treatment decreases human immunodeficiency virus risk behaviors and improves human immunodeficiency virus and substance use disorder-related outcomes. An effective response to this syndemic requires increased access to adjuvant interventions and a radical mov...
Source: Infectious Diseases Clinics of North America - June 27, 2019 Category: Infectious Diseases Authors: Christopher M. Bositis, Joshua St. Louis Source Type: research

Management of Virologic Failure and Human Immunodeficiency Virus Drug Resistance
This article discusses the causes of virologic failure, the use of resistance testing to guide management after failure, interpretation and relevance of HIV drug resistance patterns, considerations for selection of second-line and salvage therapies, and management of virologic failure in special populations. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - June 27, 2019 Category: Infectious Diseases Authors: Suzanne M. McCluskey, Mark J. Siedner, Vincent C. Marconi Source Type: research

Management of Advanced Human Immunodeficiency Virus Disease
Great progress has been made in caring for persons with human immunodeficiency virus. However, a significant proportion of individuals still present to care with advanced disease and a low CD4 count. Careful considerations for selection of antiretroviral therapy as well as close monitoring for opportunistic infections and immune reconstitution inflammatory syndrome are vitally important in providing care for such individuals. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - June 27, 2019 Category: Infectious Diseases Authors: Nathan A. Summers, Wendy S. Armstrong Source Type: research

Why Everyone (Almost) with HIV Needs to Be on Treatment
Since 2014, a consensus of landmark studies has justified starting antiretroviral therapy (ART) regardless of CD4 count. The evidence for immediate and universal ART is strong, clearly showing individual and population-level benefits, and is supported by all major guidelines groups. Altogether, improvements in ART and recognition of its clinical and epidemiologic benefits justify near-universal ART, preferably as soon after the diagnosis of human immunodeficiency virus (HIV) as possible. Case-based discussions provide a framework to explore the evidence behind the current recommendation for ART for all HIV-positive persons...
Source: Infectious Diseases Clinics of North America - June 24, 2019 Category: Infectious Diseases Authors: Claire E. Farel, Ann M. Dennis Source Type: research

The Reproductive Years of Women with Perinatally Acquired HIV
This article reviews the gynecologic and obstetric concerns experienced by women with PHIV. Cervical cancer screening is suboptimal, and data suggest higher rates of unintended pregnancy. Pregnant women with PHIV are younger and exposed to more antiretroviral therapy regimens compared with women with NPHIV. Although obstetric outcomes are similar between women with PHIV and NPHIV, there are concerns that infant morbidity may be increased in infants of women with PHIV. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - June 24, 2019 Category: Infectious Diseases Authors: Saba Berhie, Lynn Yee, Jennifer Jao Source Type: research

Why Everyone (Almost) with Human Immunodeficiency Virus Needs to Be on Treatment
Since 2014, a consensus of landmark studies has justified starting antiretroviral therapy (ART) regardless of CD4 count. The evidence for immediate and universal ART is strong, clearly showing individual and population-level benefits, and is supported by all major guidelines groups. Altogether, improvements in ART and recognition of its clinical and epidemiologic benefits justify near-universal ART, preferably as soon after the diagnosis of human immunodeficiency virus (HIV) as possible. Case-based discussions provide a framework to explore the evidence behind the current recommendation for ART for all HIV-positive persons...
Source: Infectious Diseases Clinics of North America - June 24, 2019 Category: Infectious Diseases Authors: Claire E. Farel, Ann M. Dennis Source Type: research

HIV Diagnostics
Profound changes in technology have revolutionized laboratory testing for human immunodeficiency virus (HIV) since the first laboratory enzyme immunoassays that detected only immunoglobulin G (IgG) antibodies. Instrumented fourth-generation random-access chemiluminescent assays are now recommended for initial screening because they become reactive in as little as 2  weeks after infection. Using HIV-1 RNA viral load assays after a reactive initial test could confirm infection and provide useful clinical information. Early initiation of antiretroviral therapy and use of preexposure prophylaxis can alter the evolution of...
Source: Infectious Diseases Clinics of North America - June 22, 2019 Category: Infectious Diseases Authors: Bernard M. Branson Source Type: research

Antiretroviral Medications for the Prevention of HIV Infection
Preventing new human immunodeficiency virus (HIV) infections is essential to halting the global pandemic. HIV prevention strategies include integrating both nonpharmacologic (eg, safe sexual counseling, circumcision) and pharmacologic approaches. Several pharmacologic HIV prevention strategies are increasingly used globally and include postexposure prophylaxis, preexposure prophylaxis, and treatment as prevention. These prevention modalities have enormous clinical and public health appeal, as they effectively reduce HIV acquisition in individuals and also may lower HIV incidence in communities when integrated and implement...
Source: Infectious Diseases Clinics of North America - June 22, 2019 Category: Infectious Diseases Authors: Amila Heendeniya, Isaac I. Bogoch Source Type: research

HIV Initial Assessment and Routine Follow-up
This article reviews appropriate testing for patients with human immunodeficiency virus to accomplish these goals with a focus on how each test is useful in clinical practice. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - June 22, 2019 Category: Infectious Diseases Authors: Daniel A. Solomon Source Type: research

Human Immunodeficiency Virus Diagnostics
Profound changes in technology have revolutionized laboratory testing for human immunodeficiency virus (HIV) since the first laboratory enzyme immunoassays that detected only immunoglobulin G (IgG) antibodies. Instrumented fourth-generation random-access chemiluminescent assays are now recommended for initial screening because they become reactive in as little as 2  weeks after infection. Using HIV-1 RNA viral load assays after a reactive initial test could confirm infection and provide useful clinical information. Early initiation of antiretroviral therapy and use of preexposure prophylaxis can alter the evolution of...
Source: Infectious Diseases Clinics of North America - June 22, 2019 Category: Infectious Diseases Authors: Bernard M. Branson Source Type: research

Antiretroviral Medications for the Prevention of Human Immunodeficiency Virus Infection
Preventing new human immunodeficiency virus (HIV) infections is essential to halting the global pandemic. HIV prevention strategies include integrating both nonpharmacologic (eg, safe sexual counseling, circumcision) and pharmacologic approaches. Several pharmacologic HIV prevention strategies are increasingly used globally and include postexposure prophylaxis, preexposure prophylaxis, and treatment as prevention. These prevention modalities have enormous clinical and public health appeal, as they effectively reduce HIV acquisition in individuals and also may lower HIV incidence in communities when integrated and implement...
Source: Infectious Diseases Clinics of North America - June 22, 2019 Category: Infectious Diseases Authors: Amila Heendeniya, Isaac I. Bogoch Source Type: research

Human Immunodeficiency Virus Initial Assessment and Routine Follow-up
This article reviews appropriate testing for patients with human immunodeficiency virus to accomplish these goals with a focus on how each test is useful in clinical practice. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - June 22, 2019 Category: Infectious Diseases Authors: Daniel A. Solomon Source Type: research