 Title |
Authors |
Publication |
Page(s) |
Link / File |
| HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention |
Rebecca F Baggaley, Richard G White and Marie-Claude Boily |
International Journal of Epidemiology |
(2010) doi: 10.1093/ije/dyq057 |
 :
|
| Background The human immunodeficiency virus (HIV) infectiousness of anal intercourse (AI) has not been systematically reviewed, despite its role driving HIV epidemics among men who have sex with men (MSM) and its potential contribution to heterosexual spread. We assessed the per-act and per-partner HIV transmission risk from AI exposure for heterosexuals and MSM and its implications for HIV prevention.
Methods Systematic review and meta-analysis of the literature on HIV-1 infectiousness through AI was conducted. PubMed was searched to September 2008. A binomial model explored the individual risk of HIV infection with and without highly active antiretroviral therapy (HAART).
Results A total of 62 643 titles were searched; four publications reporting per-act and 12 reporting per-partner transmission estimates were included. Overall, random effects model summary estimates were 1.4% [95% confidence interval (CI) 0.2–2.5)] and 40.4% (95% CI 6.0–74.9) for per-act and per-partner unprotected receptive AI (URAI), respectively. There was no significant difference between per-act risks of URAI for heterosexuals and MSM. Per-partner unprotected insertive AI (UIAI) and combined URAI–UIAI risk were 21.7% (95% CI 0.2–43.3) and 39.9% (95% CI 22.5–57.4), respectively, with no available per-act estimates. Per-partner combined URAI–UIAI summary estimates, which adjusted for additional exposures other than AI with a ‘main’ partner [7.9% (95% CI 1.2–14.5)], were lower than crude (unadjusted) estimates [48.1% (95% CI 35.3–60.8)]. Our modelling demonstrated that it would require unreasonably low numbers of AI HIV exposures per partnership to reconcile the summary per-act and per-partner estimates, suggesting considerable variability in AI infectiousness between and within partnerships over time. AI may substantially increase HIV transmission risk even if the infected partner is receiving HAART; however, predictions are highly sensitive to infectiousness assumptions based on viral load.
Conclusions Unprotected AI is a high-risk practice for HIV transmission, probably with substantial variation in infectiousness. The significant heterogeneity between infectiousness estimates means that pooled AI HIV transmission probabilities should be used with caution. Recent reported rises in AI among heterosexuals suggest a greater understanding of the role AI plays in heterosexual sex lives may be increasingly important for HIV prevention. |
| Guide to starting and managing needle and syringe programmes. World health organization, department of HIV/AIDS. |
AIDS Projects Management Group (APMG) - Dave Burrows at al |
|
57 |
:
:
|
| This guide is designed to assist in expanding the response to HIV among injecting drug users globally. To do this, many more NSPs will need to be established. Sections I and II of this guide aim to foster this process. Many existing NSPs also need to expand the services that they offer and greatly increase their coverage. How to do this is the topic of sections III and IV. The scaling up of programmes must also include the establishment of many more NSPs in prisons and detention centres. The particular needs of NSPs in such “closed settings”are the subject of section V. The end of this guide provides a list of useful web sites, publications and networks, followed by annexes and notes. |
| Эффективность применения презерватива в целях снижения передачи ВИЧ инфекции при гетеросексуальных контактах |
Wilkinson D |
|
http://apps.who.int/rhl/hiv_aids/dwcom/ru/index.html |
:
|
| Эффективность применения презерватива в целях снижения передачи ВИЧ инфекции при гетеросексуальных контактах |
| Nonoccupational Postexposure Prophylaxis |
AETC |
|
1 |
:
|
| Although avoiding exposure to HIV is the only reliable way of preventing HIV infection, postexposure prophylaxis (PEP) can decrease the risk of infection after exposure to HIV. Antiretroviral (ARV) therapy is an important prophylactic intervention in appropriate persons with nonoccupational exposures (eg, sexual contact; sharing of injection drug needles or other equipment), as well as those with occupational exposures (eg, needlesticks). The U.S. Department of Health and Human Services has established guidelines for nonoccupational PEP (nPEP) based on data from animal models, perinatal clinical trials, and observational studies.
Overall, the data suggest that nPEP is more likely to be effective when the exposure is a single episode and nPEP is initiated in a timely manner. It is not appropriate for cases of multiple sexual exposures or injection drug use (IDU) exposures over time or for exposures that occurred more than 72 hours before starting nPEP treatment ( Figure 1 ).
The model for nPEP is derived in part from protocols for occupational PEP (eg, in terms of risk stratification, pretreatment testing, timing of treatment, treatment regimens, and duration of treatment). However, the recommendations for PEP and nPEP are distinct from each other and should not be confused. The nPEP guidelines exclude exposures to workers in health care, public safety, sanitation, and laboratory settings. Guidelines for the management of these occupational exposures to HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) are available at: http://www.aidsinfo.nih.gov. |
| Post-exposure prophylaxis to prevent HIV infection |
World Health Organization |
|
[website] |
:
|
| Since the early 1990s, in many countries antiretroviral medicines have been prescribed for post-exposure prophylaxis (PEP) following occupational exposure to the human immunodeficiency virus (HIV). This practice has since been extended to non-occupational situations, primarily for cases of sexual assault.
Increasingly, however, both policy-makers and health care providers have been raising questions about certain aspects of the use of HIV PEP: in particular, about the indications for post-exposure prophylaxis, the most suitable antiretroviral medicines to use and various issues relating to prescribing protocols and clinical management. Awareness of these areas of uncertainty has been further heightened by the expanding availability of antiretroviral therapy in more resource constrained settings and has led to calls for clear operational guidance on providing PEP.
In September 2005, a Joint WHO/ILO expert consultation for the development of policy and guidelines on occupational and non-occupational HIV post-exposure prophylaxis was held in Geneva. The objectives of this consultation were:
o to review scientific evidence and programmatic experience in relation to providing PEP in occupational and non-occupational settings; and
o to recommend a consensus approach to formulating policy and operational guidelines for HIV PEP.
Although the needs of workers and people who have been sexually assaulted provided the focus of the consultation, consideration was given to other types of non-occupational exposure for which PEP might be indicated: specifically, those arising from isolated or episodic injecting drug use and consensual sexual exposure. The consultation recommendations, which are based on current understanding of the efficacy of PEP and available data for comparing different PEP strategies, represent the collective opinion of experts working in this field and form the basis of the present policy guidelines and service delivery recommendations. |
| Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis |
Centers for Disease Control and Prevention |
MMWR |
50(RR11);1-42 |
:
|
| This report updates and consolidates all previous U.S. Public Health Service recommendations for the management of health-care personnel (HCP) who have occupational exposure to blood and other body fluids that might contain hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV).
Recommendations for HBV postexposure management include initiation of the hepatitis B vaccine series to any susceptible, unvaccinated person who sustains an occupational blood or body fluid exposure. Postexposure prophylaxis (PEP) with hepatitis B immune globulin (HBIG) and/or hepatitis B vaccine series should be considered for occupational exposures after evaluation of the hepatitis B surface antigen status of the source and the vaccination and vaccine-response status of the exposed person. Guidance is provided to clinicians and exposed HCP for selecting the appropriate HBV PEP.
Immune globulin and antiviral agents (e.g., interferon with or without ribavirin) are not recommended for PEP of hepatitis C. For HCV postexposure management, the HCV status of the source and the exposed person should be determined, and for HCP exposed to an HCV positive source, follow-up HCV testing should be performed to determine if infection develops.
Recommendations for HIV PEP include a basic 4-week regimen of two drugs (zidovudine [ZDV] and lamivudine [3TC]; 3TC and stavudine [d4T]; or didanosine [ddI] and d4T) for most HIV exposures and an expanded regimen that includes the addition of a third drug for HIV exposures that pose an increased risk for transmission. When the source person's virus is known or suspected to be resistant to one or more of the drugs considered for the PEP regimen, the selection of drugs to which the source person's virus is unlikely to be resistant is recommended.
In addition, this report outlines several special circumstances (e.g., delayed exposure report, unknown source person, pregnancy in the exposed person, resistance of the source virus to antiretroviral agents, or toxicity of the PEP regimen) when consultation with local experts and/or the National Clinicians' Post-Exposure Prophylaxis Hotline ([PEPline] 1-888-448-4911) is advised.
Occupational exposures should be considered urgent medical concerns to ensure timely postexposure management and administration of HBIG, hepatitis B vaccine, and/or HIV PEP. |
| Essential prevention and care interventions for adults and adolescents living with HIV in resource-limited settings |
|
|
|
:
|
|
| Nutrition: Feeding in exceptionally difficult circumstances |
|
www.who.int/nutrition/topics/feeding_difficulty/en |
|
:
|
| WHO recommends exclusive breastfeeding for six months, and sustained breastfeeding with appropriate complementary foods up to two years or beyond. Families in difficult circumstances require specially attention and practical support to be able to feed their children adequately. In such cases, the likelihood of not breastfeeding increases, due to the dangers of artificial feeding and inappropriate complementary feeding. Where-ever possible, mothers and babies should remain together and be provided the support they need to exercise the most appropriate feeding option under the circumstances. |
| HIV - Related Stigma, Discrimination and Human Rights Violations |
Peter Aggleton, Kate Wood and Anne Malcolm |
UNAIDS Best Practice |
75 |
:
|
| From the start of the AIDS epidemic, stigma and discrimination have fuelled the transmission of HIV and have greatly increased the negative impact associated with the epidemic. HIV-related stigma and discrimination continue to be manifest in every country and region of the world, creating major barriers to preventing further infection, alleviating impact and providing adequate care, support and treatment. |
| Lowering the Risk of HIV After Sex or Other Exposure |
Tony Hosey, Pharm.D. |
Test Positive Aware Network |
|
:
|
|
