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| A Guide to HIV Drug Resistance |
David Margolis |
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[website] |
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| HIV is a tough little virus. Although scientists have spent the last 25 years designing medications to fight it, HIV can learn to adapt and avoid these medications. When this happens, we say you've developed "drug resistance."
By the time you've finished reading this booklet, we hope you'll have a much better understanding of how resistance works, how your doctors can test for it and what options you have if you find that your HIV is resistant to one or more HIV medications. |
| A prospective study of bacillus Calmette-Guérin scar formation and tuberculin skin test reactivity in infants in Lima, Peru. |
Satiago E M et al. |
Pediatrics |
e298 |
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| OBJECTIVES: To determine the sensitivity of the bacillus Calmette-Guérin (BCG) scar as an indicator of previous vaccination and to ascertain the tuberculin skin test (TST) response in infancy after vaccination in a community from an area hyperendemic for tuberculosis (TB).
METHODS: In a birth cohort of healthy term infants from Lima, Peru, a single dose of BCG vaccine was administered within the first month of life. Scar formation was assessed biweekly during the first 6 months and again at 3 years after vaccination. TST response was evaluated 6 months after vaccination.
RESULTS: Six months after vaccination, 99% (68) of the newborns exhibited a BCG scar (>2 mm). Scar size did not differ by sex, birth weight, age at vaccination, or nutritional status in the first 2 months. Eighty percent of the participants were found 3 years after vaccination, and all of them had a BCG scar. Mean TST reaction size 6 months after vaccination was 2.9 +/- 0.3 mm. No association was found between sex or age at BCG vaccination and TST size. Only 3 children had a TST >10 mm, and the 3 had a TB contact at home.
CONCLUSIONS: The BCG scar was a sensitive indicator of vaccination status up to 3 years after the administration of the vaccine in the first month of life. Although nearly a quarter of the children had a TST response >5 mm 6 months after vaccination, TST reactions >10 mm did not occur in the absence of exposure to a person with tuberculosis. A cutoff of 10 mm should be used for disease control purposes in people who are born in countries where TB is endemic. |
| A Rapid Review of Rapid HIV Antibody Tests |
Jeffrey L. Greenwald, MD, Gale R. Burstein, MD, MPH, FAAP, Jonathan Pincus, MD, and Bernard Branson, MD |
Currrent Infectious Disease Reports |
8:125-131 |
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| Rapid HIV antibody tests recently approved by the Food and
Drug Administration can help reduce unrecognized infections
by improving access to testing in both clinical and nonclinical
settings and increase the proportion of those tested who learn
their results. Four rapid HIV antibody tests are now available
in the United States; two are approved for use at point-ofcare
sites outside a traditional laboratory. All four tests are
interpreted visually. Sites offering rapid HIV testing must
periodically run external controls (known HIV-positive and
HIV-negative specimens) and provide persons who undergo
rapid testing a subject information sheet. This paper reviews
the operating and performance characteristics, quality
assurance and laboratory requirements, and HIV counseling
implications of the currently available rapid HIV tests. |
| American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Treatment of Tuberculosis |
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| The recommendations in this document are intended to guide the treatment of tuberculosis in settings where mycobacterial cultures, drug susceptibility testing, radiographic facilities, and second-line drugs are routinely available. In areas where these resources are not available, the recommendations provided by the World Health Organization, the International Union against Tuberculosis, or national tuberculosis control programs should be followed. |
| Antiretroviral therapy in pregnant women with advanced HIV disease and pregnancy outcomes in Abidjan, Côte d'Ivoire. |
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| BCG scars in northern Malawi: sensitivity and repeatability of scar reading, and factors affecting scar size. |
Floyd S, Ponnighaus JM, Bliss L, Warndorff DK, Kasunga A, Mogha P, Fine PE. |
Int J Tuberc Lung Dis. 2000 Dec;4(12):1133-42. |
1133-42 |
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| SETTING: Karonga district, northern Malawi.
OBJECTIVE: To assess the sensitivity and repeatability of BCG scar reading, and factors affecting scar size.
DESIGN: Follow-up of individuals aged > 3 months who were recruited into a BCG vaccine trial (1986-1989), and of infants vaccinated in health centres (1989-1991), who were examined for presence and size of BCG scars in subsequent years. All examinations were carried out blind of information on true vaccination status or the results of previous examinations.
RESULTS: For trial individuals who were considered scar negative at recruitment and received BCG, the sensitivity of scar reading was > or = 93%, repeatability was > or = 94% for those < 60 years old at vaccination, and only around 1% were assessed as having > 1 BCG scar post-vaccination. For infants vaccinated when < 1 month old in health centres, the proportion who still had recognisable scars 4 years later was < 80%. Scars were larger in individuals with a prior BCG vaccination, and for those aged 15-59 at vaccination the scars were approximately 1 mm larger for males than for females.
CONCLUSIONS: A BCG scar is a highly sensitive and repeatable indicator of vaccination status when the vaccine is properly handled, delivered appropriately, and given at over 3 months of age, but not for vaccinations given within 1 month of birth. Given that most vaccinations in the world are given soon after birth, this low sensitivity will lead to both vaccine coverage and vaccine efficacy being underestimated in studies in which vaccination status is inferred from the presence/absence of a distinctive BCG scar. Age-sex patterns identified for scar size show important similarities to those found with skin test responses to tuberculin. |
| CDC Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings |
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| For pregnant women:
* HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women.
* HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
* Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.
* Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women. |
| Chemotherapy and management of tuberculosis in the United Kingdom: recommendations 1998 |
Joint Tuberculosis Committee of the British Thoracic Society |
Thorax 1998;53:536–548 |
536–548 |
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| Abstract
Background—The guidelines on chemotherapy
and management of tuberculosis
in the United Kingdom have been reviewed
and updated.
Methods—A subcommittee was appointed
by the Joint Tuberculosis
Committee (JTC) of the British Thoracic
Society to revise the guidelines published
in 1990 by the JTC. In preparing the
revised guidelines the authors took account
of new published evidence and
graded the strength of evidence for their
recommendations. The guidelines have
been approved by the JTC and the Standards
of Care Committee of the British
Thoracic Society.
Recommendations—(1) Patients with tuberculosis
should be notified. (2) In view
of the rising incidence of drug resistance,
bacteriological confirmation and drug
susceptibility testing should be sought
whenever possible. (3) A six month short
course regimen, with four drugs in the
initial phase, should be used for all forms
of tuberculosis, except meningitis, in both
adults and children. (4) The fourth drug
(ethambutol) in the initial phase can be
omitted in certain circumstances. (5)
Treatment of all patients should be supervised
by physicians with full training in
the management of tuberculosis and with
direct working access to tuberculosis
nurse specialists or health visitors. (6)
Advice is given on (a) management in
special situations and patient groups, (b)
drug interactions, and special precautions
and pretreatment screening, (c)
chemoprophylaxis for different groups,
and (d) the management of single and
multiple drug resistance. (7) Advice is
given on follow up after treatment and the
organisational framework for tuberculosis
services. (8) The role of directly
observed therapy is discussed. (9) The
management of multidrug resistant tuberculosis
is explained in outline: such
patients should be managed by physicians
with special experience and in close
liaison with the Mycobacterium Reference
Units, and in hospitals with appropriate
isolation facilities. (10) Infection
control and segregation for such patients
and for patients with dual infection with human immunodeficiency virus (HIV)
and tuberculosis are covered in an
appendix. |
| Chronic Hepatitis B: Update 2009 |
AASLD PRACTICE GUIDELINES |
Hepatology |
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| This guideline has been approved by the American Association
for the Study of Liver Diseases and represents the
position of the Association. It has been endorsed by the
Infectious Diseases Society of America. |
| Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings |
Sarah Larney, Bradley Mathers, Kate Dolan et al |
© World Health Organization |
88 |
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| These guidelines provide information about drugs and drug dependence; the management of drug withdrawal; and approaches to treatment for drug dependence. |
| Clinical HIV/AIDS care guidelines |
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| Complications of HIV disease and antiretroviral therapy |
Currier JS, Havlir DV. |
Top HIV Med |
57-67. |
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| Continued progress in the diagnosis, management, and prevention of complications of HIV disease and antiretroviral therapy were reported at the 16th Conference on Retroviruses and Opportunistic Infections. This year's conference brought new data on the optimal management of antiretroviral therapy in the presence of different opportunistic infections and included a number of important studies on pathogenesis and epidemiology of long-term complications. Major areas in which new information was presented are highlighted in this article. |
| Drug Policy Guide |
International Drug Policy Consortium |
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1-115 |
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| This guide, and the network of expertise that exists across the IDPC, is designed to help in that process. The guide is divided into 15 chapters across four sections:
* Principles for Effective Drug Policies
* Criminal Justice
* Health and Social Programmes.
* Strengthening Communities. |
| Early Antiretroviral Therapy Reduces AIDS Progression/Death in Individuals with Acute Opportunistic Infections: A Multicenter Randomized Strategy Trial |
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| Essential prevention and care interventions for adults and adolescents living with HIV in resource-limited settings |
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| Evaluation of opioid substitution therapy in the Kyrgyz Republic |
Emilis Subata Lars Moller and Saliya Karymbaeva |
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16 |
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| An evaluation of the Opioid Substitution Therapy programme in the Kyrgyz Republic took place from the
13th to the 17th October 2008. A delegation from World Health Organization Regional Office for Europe met
with representatives of the Government, Drug Control Agency, Ministry of Health, Ministry of Justice, UN
agencies; international NGOs, staff of drug treatment services and NGOs. Focus group discussions and one
to one interviews were conducted with injecting drug users (IDU) at several OST programmes.
The Kyrgyz Republic has successfully created a decentralized system of provision of Opioid Substitution
Therapy both in specialized institutions and family medicine centers. Opioid Substitution Therapy is provided
by the team of specialists in a comprehensive way and with links to the external sources of support provided
by NGOs. Provision of Opioid Substitution Therapy through family medicine centers offers a potential of
further integration of drug treatment of IDU with family medicine and further reduction of their stigma. |
| Ganczak M, Barss P. Nosocomial HIV infection: epidemiology and prevention-a global perspective. AIDS Rev. 2008;10(1):47-61. |
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| Because, globally, HIV is transmitted mainly by sexual practices and injection drug use and because of a long asymptomatic period, healthcare-associated HIV transmission receives little attention even though an estimated 5.4% of global HIV infections result from contaminated injections alone. It is an important personal issue for healthcare workers, especially those who work with unsafe equipment or have insufficient training. They may acquire HIV occupationally or find themselves before courts, facing severe penalties for causing HIV infections. Prevention of blood-borne nosocomial infections such as HIV differs from traditional infection control measures such as hand washing and isolation and requires a multidisciplinary approach. Since there has not been a review of healthcare-associated HIV contrasting circumstances in poor and rich regions of the world, the aim of this article is to review and compare the epidemiology of HIV in healthcare facilities in such settings, followed by a consideration of general approaches to prevention, specific countermeasures, and a synthesis of approaches used in infection control, injury prevention, and occupational safety. These actions concentrated on identifying research on specific modes of healthcare-associated HIV transmission and on methods of prevention. Searches included studies in English and Russian cited in PubMed and citations in Google Scholar in any language. Medical Subject Headings (MeSH) keywords such as nosocomial, hospital-acquired, iatrogenic, healthcare associated, occupationally acquired infection and HIV were used together with mode of transmission, such as “HIV and haemodialysis”. References of relevant articles were also reviewed. The evidence indicates that while occasional incidents of healthcare-related HIV infection in high-income countries continue to be reported, the situation in many low-income countries is alarming, with transmission ranging from frequent to endemic. Viral transmission in health facilities occurs by unexpected and unusual as well as more frequent modes. HIV can be transmitted to patients and to donors of blood products by specific vehicles and vectors during blood transfusion, plasma donation, and artificial insemination, by improperly sterilized sharps, by medical equipment during activities such as dialysis and organ transplantation, and by healthcare workers infected by occupational exposure to hazards such as blood-contaminated sharps. Personal, equipment, and environmental factors predispose to acquisition of nosocomial HIV and all are pertinent for prevention. For infection and injury control, poverty is often an underlying determinant. While sophisticated new tests offer improved HIV detection, increasingly higher marginal costs limit their feasibility in many settings. Modest investment in safer equipment and appropriate integrated training in infection control, injury prevention, and occupational safety should provide greater benefit. |
| 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 |
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57 |
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| 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. |
| Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia |
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