RESUMO
Although entirely preventable, rheumatic heart disease (RHD), a disease of poverty and social disadvantage resulting in high morbidity and mortality, remains an ever-present burden in low-income and middle-income countries (LMICs) and rural, remote, marginalised and disenfranchised populations within high-income countries. In late 2021, the National Heart, Lung, and Blood Institute convened a workshop to explore the current state of science, to identify basic science and clinical research priorities to support RHD eradication efforts worldwide. This was done through the inclusion of multidisciplinary global experts, including cardiovascular and non-cardiovascular specialists as well as health policy and health economics experts, many of whom also represented or closely worked with patient-family organisations and local governments. This report summarises findings from one of the four working groups, the Tertiary Prevention Working Group, that was charged with assessing the management of late complications of RHD, including surgical interventions for patients with RHD. Due to the high prevalence of RHD in LMICs, particular emphasis was made on gaining a better understanding of needs in the field from the perspectives of the patient, community, provider, health system and policy-maker. We outline priorities to support the development, and implementation of accessible, affordable and sustainable interventions in low-resource settings to manage RHD and related complications. These priorities and other interventions need to be adapted to and driven by local contexts and integrated into health systems to best meet the needs of local communities.
Assuntos
Cardiopatia Reumática , Estados Unidos , Humanos , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/prevenção & controle , Prevenção Terciária , National Heart, Lung, and Blood Institute (U.S.)RESUMO
The search for an effective HIV vaccine continues to be a challenge. Several candidates have been tested in preclinical protocols, and a few have been tested in clinical trials without resounding success. It is unclear why vaccine approaches to control HIV infection have been unsuccessful, but opportunities to dissect the causes for the failure have surfaced from recent work on the virology, immunology and pathogenesis of HIV and from analysis of vaccine studies. The significance of the innate immune system in HIV infection may provide new paths to discover effective approaches. This report summarizes a workshop held to discuss the role of selected aspects of innate immunity to viral infections and successful vaccines that may have important implications for designing effective HIV vaccines.
Assuntos
Vacinas contra a AIDS/imunologia , Infecções por HIV/prevenção & controle , Infecções por HIV/terapia , HIV/imunologia , Imunidade Inata , HIV/patogenicidade , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , National Institute of Allergy and Infectious Diseases (U.S.) , Estados UnidosRESUMO
HIV vaccine research is at a crossroads carefully contemplating on the next path. The unexpected results of the Merck vaccine trial, while providing a stunning blow to a field in dire need of a protective vaccine, has also raised several fundamental questions regarding the candidate immunogen itself, preexisting immunity to vaccine vectors, surrogate assays and animal models used for assessing preclinical protective responses, as well as relevant endpoints to be measured in a clinical trial. As a result, the research community is faced with the daunting task of identifying novel vaccine concepts and products to continue the search. This review highlights and addresses some of the scientific and practical concerns.
Assuntos
Vacinas contra a AIDS/imunologia , Infecções por HIV/prevenção & controle , HIV-1/imunologia , Imunidade nas Mucosas , Vacinas de DNA/imunologia , Vacinas contra a AIDS/efeitos adversos , Adenoviridae , Animais , Ensaios Clínicos como Assunto , Feminino , Vetores Genéticos/efeitos adversos , Infecções por HIV/imunologia , Humanos , Memória Imunológica , Primatas , Falha de Tratamento , Vacinas de DNA/efeitos adversosRESUMO
In October 2007, a joint ANRS-NIH workshop was held on "Mucosal immunity and HIV/AIDS vaccines" in Veyrier-du-Lac, France. Goal of the meeting was to discuss recent developments in the understanding of viral entry and dissemination at mucosal surfaces, rationale for designing vaccines to elicit mucosal immune responses by various routes of immunization, and the types of immune responses elicited. Lessons were drawn from existing vaccines against viral mucosal infections, from the recent failure of the Merck Ad5/HIV vaccine and from attempts at mucosal immunization against SIV. This report summarizes the main concepts and conclusions that came out of the meeting.