Current Issue : April - June Volume : 2015 Issue Number : 2 Articles : 5 Articles
Background: The goal of chronic hepatitis C treatment is to remove the virus to avoid progression of HCV-related\ndisease. Sustained virologic response (SVR) is the most widely used efficacy endpoint in clinical studies of hepatitis C,\nand represents the eradication of HCV from the body. The aim of the current review was to examine the long-term\nclinical, economic and quality of life benefits associated with achieving SVR.\nMethods: A systematic literature review was performed using the PubMed, EMBASE and Cochrane library databases to\nidentify articles examining the clinical, economic and quality of life benefits associated with SVR, published in English\nlanguage from 2002ââ?¬â??2013. For inclusion studies were required to enroll ?100 patients and to report clinical endpoints\nincluding hepatocellular carcinoma, overall- or liver-related mortality, or progression of disease/complications (e.g.\nportal hypertension, esophageal varices). Review of economic studies on cost/cost-effectiveness of achieving SVR were\nfocused on studies assessing boceprevir/telaprevir plus pegIFN and ribavirin as this represents the current standard of\ncare in several jurisdictions worldwide. Quality of life evidence was required to use validated quality of life instruments\nand provide a quantitative analysis of the impact of SVR versus no treatment or treatment failure.\nResults: SVR is durable with late relapse rates over 4ââ?¬â??5 year periods being in the range of 1ââ?¬â??2%. Patients who\nachieve SVR frequently demonstrate some regression of fibrosis/cirrhosis and have a substantially reduced risk for\nhepatocellular carcinoma (relative risk [RR] 0.1ââ?¬â??0.25), liver-related mortality (RR 0.03ââ?¬â??0.2) and overall mortality\n(RR 0.1ââ?¬â??0.3) in comparison with no treatment or treatment failure. In the 5 years post-treatment, medical costs for\npatients achieving SVR are 13-fold lower than patients not achieving SVR. Patients who achieve SVR also have health\nstate utility values that are 0.05 to 0.31 higher than non-responders to treatment.\nConclusions: SVR represents the fundamental goal of antiviral treatment for patients infected with chronic HCV, so as to\nreduce risk of liver disease progression. Achievement of SVR has implications beyond those of clearing viral infection; it is\nassociated with improved long-term clinical outcomes, economic benefits and improved health-related quality of life....
Background: Gonorrhoea and widely spread antimicrobial resistance (AMR) in its etiological agent Neisseria\ngonorrhoeae are major public health concerns worldwide. Gonococcal AMR surveillance nationally and\ninternationally, to identify emerging resistance and inform treatment guidelines, is imperative for public health\npurposes. In 2009, AMR surveillance was initiated in Belarus, Eastern Europe because no gonococcal AMR data had\nbeen available for at least two decades. Herein, the prevalence and trends of gonococcal AMR and molecular\nepidemiological characteristics of N. gonorrhoeae strains from 2010 to 2013 in Belarus, are described.\nMethods: N. gonorrhoeae isolates (n=193) obtained in the Mogilev (n=142), Minsk (n=36) and Vitebsk (n=15)\nregions of Belarus in 2010 (n=72), 2011 (n=6), 2012 (n=75) and 2013 (n=40) were analyzed in regards to AMR using\nthe Etest method and for molecular epidemiology with N. gonorrhoeae multi-antigen sequence typing (NG-MAST).\nResults: During 2010ââ?¬â??2013, the proportions of resistant N. gonorrhoeae isolates were as follows: tetracycline 36%,\nciprofloxacin 28%, penicillin G 9%, azithromycin 5%, and cefixime 0.5%. Only one (0.5%) ?-lactamase producing\nisolate was detected. No isolates resistant to ceftriaxone and spectinomycin were identified. Overall, the resistance\nlevels to tetracycline, ciprofloxacin and penicillin G were relatively stable. Interestingly, the level of resistance to\nazithromycin declined from 12% in 2010 to 0% in 2013 (P < 0.05). In total, 70 NG-MAST STs were identified. The\npredominant STs were ST1993 (n=53), ST807 (n=13), ST285 (n=8) and ST9735 (n=8). Many novel STs (n=43, 61%),\nrepresenting 41% of all isolates, were found.\nConclusions: During 2010ââ?¬â??2013, the N. gonorrhoeae population in Belarus displayed high and relatively stable\nresistance levels to tetracycline, ciprofloxacin, and penicillin G, while the resistance to azithromycin declined. One\nisolate was resistant to cefixime, but no resistance to ceftriaxone or spectinomycin was found. The results of the\npresent surveillance initiated in 2009 were also used to replace penicillin G with ceftriaxone (1 g single dose\nintramuscularly) as the first-line drug for empiric treatment of gonorrhoea in the national treatment guidelines in\nBelarus in late 2009. It is essential to further strengthen the surveillance of gonococcal AMR and ideally survey also\ntreatment failures and molecular epidemiological genotypes in Belarus....
Background: Around 3.3 million children worldwide are infected with HIV and 90% of them live in sub-Saharan\nAfrica. Our study aimed to estimate adherence levels and find the determinants, facilitators and barriers of ART\nadherence among children and teenagers in rural Tanzania.\nMethods: We applied a sequential explanatory mixed method design targeting children and teenagers aged 2ââ?¬â??19\nyears residing in Ifakara. We conducted a quantitative cross sectional study followed by a qualitative study combining\nfocus group discussions (FGDs) and in-depth interviews (IDIs). We used pill count to measure adherence and defined\noptimal adherence as > =80% of pills being taken. We analysed determinants of poor adherence using logistic\nregression. We held eight FGDs with adolescent boys and girls on ART and with caretakers. We further explored\nissues emerging in the FGDs in four in-depth interviews with patients and health workers. Qualitative data was\nanalysed using thematic content analysis.\nResults: Out of 116 participants available for quantitative analysis, 70% had optimal adherence levels and the\naverage adherence level was 84%. Living with a non-parent caretaker predicted poor adherence status. From the\nqualitative component, unfavorable school environment, timing of the morning ART dose, treatment longevity,\nbeing unaware of HIV status, non-parental (biological) care, preference for traditional medicine (herbs) and\nforgetfulness were seen to be barriers for optimal adherence.\nConclusion: The study has highlighted specific challenges in ART adherence faced by children and teenagers.\nHaving a biological parent as a caretaker remains a key determinant of adherence among children and teenagers.\nTo achieve optimal adherence, strategies targeting the caretakers, the school environment, and the health system\nneed to be designed....
Summary Objectives: Hemagglutination inhibiting (HI) antibodies correlate with influenza\nvaccine protection but their association with protection induced by natural infection has\nreceived less attention and was studied here.\nMethods: 940 people from 270 unvaccinated households participated in active ILI surveillance\nspanning 3 influenza seasons. At least 494 provided paired blood samples spanning each season.\nInfluenza infection was confirmed by RT-PCR on nose/throat swabs or serum HI assay conversion.\nResults: Pre-season homologous HI titer was associated with a significantly reduced risk of\ninfection for H3N2 (OR 0.61, 95%CI 0.44e0.84) and B (0.65, 95%CI 0.54e0.80) strains, but not H1N1 strains, whether re-circulated (OR 0.90, 95%CI 0.71e1.15), new seasonal (OR 0.86,\n95%CI 0.54e1.36) or pandemic H1N1-2009 (OR 0.77, 95%CI 0.40e1.49). The risk of seasonal\nand pandemic H1N1 decreased with increasing age (both p < 0.0001), and the risk of pandemic\nH1N1 decreased with prior seasonal H1N1 (OR 0.23, 95%CI 0.08e0.62) without inducing measurable\nA/California/04/2009-like titers.\nConclusions: While H1N1 immunity was apparent with increasing age and prior infection, the\neffect of pre-season HI titer was at best small, and weak for H1N1 compared to H3N2 and B.\nAntibodies targeting non-HI epitopes may have been more important mediators of infectionneutralizing\nimmunity for H1N1 compared to other subtypes in this setting....
Background: Data on the association between influenza and tuberculosis are limited. We describe the characteristics of\npatients with laboratory-confirmed tuberculosis, laboratory-confirmed influenza and tuberculosis-influenza co-infection.\nMethods: Patients hospitalized with severe respiratory illness (acute and chronic) were enrolled prospectively in four\nprovinces in South Africa. Naso/oropharyngeal specimens were tested for influenza virus by real time reverse\ntranscriptase polymerase chain reaction. Tuberculosis testing was conducted as part of clinical management.\nResults: From June 2010 through December 2011, 8032 patients were enrolled and influenza testing was conducted\non 7863 (98%). Influenza virus was detected in 765 (10%) patients. Among 2959 patients with tuberculosis and\ninfluenza results, 2227 (75%) were negative for both pathogens, 423 (14%) were positive for tuberculosis alone,\n275 (9%) were positive for influenza alone and 34 (1%) had influenza and tuberculosis co-infection. On multivariable\nanalysis amongst individuals with symptoms for ?7 days, tuberculosis influenza co-infection was associated with\nincreased risk of death, (adjusted relative risk ratio (aRRR) (6.1, 95% confidence interval (CI) 1.6-23.4), as compared\nto tuberculosis only infection. This association was not observed in individuals with symptoms for <7 days\n(aRRR.0.8, 95% CI 0.1-7.0).\nConclusion: Tuberculosis and influenza co-infection compared to tuberculosis single infection was associated with\nincreased risk of death in individuals with symptoms ?7 days. The potential public health impact of influenza\nvaccination among persons with laboratory-confirmed tuberculosis should be explored....
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