[We must not remain blind to equity: lessons to be learned from the COVID-19 pandemic in the AmericasDeixar de ignorar a equidade: lições a aprender com a pandemia de COVID-19 nas Américas]. / No seguir ciegos a la equidad: lecciones por aprender de la pandemia de COVID-19 en las Américas.

The Region of the Americas has historically experienced social inequalities rooted in colonialism, which are reflected and reproduced in the area of health. The COVID-19 pandemic affected the entire Region, but the most socially disadvantaged groups were hit hardest, intensifying health inequities. Under the premise that pandemics are not socially neutral phenomena, this special report analyzes the unequal impacts of the pandemic from different perspectives: historical, epidemiological, political, social, economic, environmental, and population-related. Critical reflections are offered here on the negative impacts of inequalities on well-being, not only in the most affected populations, but across society as a whole. Strategic recommendations are made for progress toward health equity in the post-pandemic context. This report highlights the importance of advancing toward mature information systems to monitor health equity, developing more resilient health systems, and implementing explicit policies and practices aimed at eliminating health inequities. All of this should pave the way for prosperity and sustainable development in the Region.

Historicamente, a Região das Américas vivencia desigualdades sociais enraizadas no colonialismo, que estão refletidas e se reproduzem no campo da saúde. A pandemia de COVID-19 afetou toda a Região, mas atingiu com mais força os grupos mais desfavorecidos do ponto de vista social, agravando as iniquidades em saúde. Sob a premissa de que as pandemias não são fenômenos neutros em termos sociais, este relatório especial analisa os impactos desiguais da pandemia a partir de diferentes perspectivas: histórica, epidemiológica, política, social, econômica, ambiental e populacional. São apresentadas reflexões críticas sobre as implicações negativas das desigualdades para o bem-estar, não apenas das populações mais afetadas, mas da sociedade como um todo. Conclui-se com recomendações estratégicas para avançar em direção à equidade em saúde no cenário pós-pandemia. Destaca-se a importância de avançar na maturidade dos sistemas de informação para monitorar a equidade em saúde, a resiliência dos sistemas de saúde e a implementação de políticas e práticas explícitas voltadas para a eliminação das iniquidades em saúde. Espera-se que os pontos mencionados abram caminho para a prosperidade e o desenvolvimento sustentável na Região.

The Health Equity Network of the Americas: inclusion, commitment, and action.

The Health Equity Network of the Americas (HENA) is a multidisciplinary network that promotes knowledge sharing and intersectoral action for equity in health and human rights in the Americas. The objectives of HENA are: 1) to share successful experiences in the development of interventions, considering the social determinants and determination of health, to achieve participatory and community-based health responses; 2) to analyze the health, social, political, environmental and economic impacts of the COVID-19 pandemic; 3) to identify the effects of pandemic care on populations most at risk because of their age and pre-existing health conditions; 4) examine the situation at borders and population movements in the spread of the pandemic and its effects on migrant populations; 5) propose strategies to ensure access to comprehensive care for pregnant women in order to reduce maternal and neonatal suffering, morbidity, and mortality; and 6) analyze violations of human rights and the right to health of historically marginalized populations, including street dwellers and other communities that depend on public spaces and the street for survival. The analytical and intervention models for health equity at HENA are based on various approaches, including social medicine, social epidemiology, medical anthropology, human ecology, and One Health.

La Red de las Américas para la Equidad en Salud (RAES) es una red multidisciplinaria que promueve el intercambio de conocimientos y la acción intersectorial para la equidad en salud y los derechos humanos en las Américas. Los objetivos de la RAES consisten en: 1) compartir experiencias exitosas en el desarrollo de intervenciones, considerando la determinación y los determinantes sociales, para lograr respuestas participativas y comunitarias en salud; 2) analizar los impactos sanitarios, sociales, políticos, ambientales y económicos de la pandemia de COVID-19; 3) identificar los efectos de la atención de la pandemia en las poblaciones de mayor riesgo por su edad y las condiciones de salud preexistentes; 4) examinar la situación de las fronteras y de los movimientos de población en la propagación de la pandemia y de sus efectos en las poblaciones migrantes; 5) proponer estrategias para asegurar el acceso a la atención integral de las mujeres gestantes, con el fin de reducir el sufrimiento, la morbilidad y la mortalidad materna y neonatal; y 6) analizar vulneraciones de derechos humanos y del derecho a la salud de poblaciones históricamente marginalizadas, incluyendo habitantes en situación de calle y otras comunidades que dependen de los espacios públicos y de la calle para sobrevivir. Los modelos analíticos y de intervención para la equidad en salud de la RAES se desarrollan desde varios enfoques, como la medicina social, la epidemiologia social, la antropología médica, la ecología humana y el de Una sola salud.

Pedestrian and Vehicle Detection in Autonomous Vehicle Perception Systems-A Review.

Autonomous Vehicles (AVs) have the potential to solve many traffic problems, such as accidents, congestion and pollution. However, there are still challenges to overcome, for instance, AVs need to accurately perceive their environment to safely navigate in busy urban scenarios. The aim of this paper is to review recent articles on computer vision techniques that can be used to build an AV perception system. AV perception systems need to accurately detect non-static objects and predict their behaviour, as well as to detect static objects and recognise the information they are providing. This paper, in particular, focuses on the computer vision techniques used to detect pedestrians and vehicles. There have been many papers and reviews on pedestrians and vehicles detection so far. However, most of the past papers only reviewed pedestrian or vehicle detection separately. This review aims to present an overview of the AV systems in general, and then review and investigate several detection computer vision techniques for pedestrians and vehicles. The review concludes that both traditional and Deep Learning (DL) techniques have been used for pedestrian and vehicle detection; however, DL techniques have shown the best results. Although good detection results have been achieved for pedestrians and vehicles, the current algorithms still struggle to detect small, occluded, and truncated objects. In addition, there is limited research on how to improve detection performance in difficult light and weather conditions. Most of the algorithms have been tested on well-recognised datasets such as Caltech and KITTI; however, these datasets have their own limitations. Therefore, this paper recommends that future works should be implemented on more new challenging datasets, such as PIE and BDD100K.

[The Health Equity Network of the Americas: inclusion, commitment, and action]. / La Red de las Américas para la Equidad en Salud: inclusión, compromiso y acción.

The Health Equity Network of the Americas (HENA) is a multidisciplinary network that promotes knowledge sharing and intersectoral action for equity in health and human rights in the Americas. The objectives of HENA are: 1) to share successful experiences in the development of interventions, considering the social determinants and determination of health, to achieve participatory and community-based health responses; 2) to analyze the health, social, political, environmental and economic impacts of the COVID-19 pandemic; 3) to identify the effects of pandemic care on populations most at risk because of their age and pre-existing health conditions; 4) examine the situation at borders and population movements in the spread of the pandemic and its effects on migrant populations; 5) propose strategies to ensure access to comprehensive care for pregnant women in order to reduce maternal and neonatal suffering, morbidity, and mortality; and 6) analyze violations of human rights and the right to health of historically marginalized populations, including street dwellers and other communities that depend on public spaces and the street for survival. The analytical and intervention models for health equity at HENA are based on various approaches, including social medicine, social epidemiology, medical anthropology, human ecology, and One health.

International prospective observational cohort study of Zika in infants and pregnancy (ZIP study): study protocol.

BACKGROUND: Until recently, Zika virus (ZIKV) infections were considered mild and self-limiting. Since 2015, they have been associated with an increase in microcephaly and other birth defects in newborns. While this association has been observed in case reports and epidemiological studies, the nature and extent of the relationship between ZIKV and adverse pregnancy and pediatric health outcomes is not well understood. With the unique opportunity to prospectively explore the full spectrum of issues related to ZIKV exposure during pregnancy, we undertook a multi-country, prospective cohort study to evaluate the association between ZIKV and pregnancy, neonatal, and infant outcomes. METHODS: At research sites in ZIKV endemic regions of Brazil (4 sites), Colombia, Guatemala, Nicaragua, Puerto Rico (2 sites), and Peru, up to 10,000 pregnant women will be recruited and consented in the first and early second trimesters of pregnancy and then followed through delivery up to 6 weeks post-partum; their infants will be followed until at least 1 year of age. Pregnant women with symptomatic ZIKV infection confirmed by presence of ZIKV RNA and/or IgM for ZIKV will also be enrolled, regardless of gestational age. Participants will be tested monthly for ZIKV infection; additional demographic, physical, laboratory and environmental data will be collected to assess the potential interaction of these variables with ZIKV infection. Delivery outcomes and detailed infant assessments, including physical and neurological outcomes, will be obtained. DISCUSSION: With the emergence of ZIKV in the Americas and its association with adverse pregnancy outcomes in this region, a much better understanding of the spectrum of clinical outcomes associated with exposure to ZIKV during pregnancy is needed. This cohort study will provide information about maternal, fetal, and infant outcomes related to ZIKV infection, including congenital ZIKV syndrome, and manifestations that are not detectable at birth but may appear during the first year of life. In addition, the flexibility of the study design has provided an opportunity to modify study parameters in real time to provide rigorous research data to answer the most critical questions about the impact of congenital ZIKV exposure. TRIAL REGISTRATION: NCT02856984 . Registered August 5, 2016. Retrospectively registered.

Correction to: International prospective observational cohort study of Zika in infants and pregnancy (ZIP study): study protocol.

Following publication of the original article [1], the author mentioned that two additional NIH staff were involved in the development of the protocol who did not receive recognition in the Acknowledgments section in their published article.

Basic and procedural requirements for energy potential from biogas of sewage treatment plants.

The objective of this study is to evaluate the potential for electricity generation in the State of São Paulo (SP) from the sewage treatment. A sewage treatment plant (STP) with domain in the production of biogas from wastewater treatment plant (WWTP) is the basis for this case study. The basic premise is that the very generation of electricity in STPs is advantageous for companies in the sanitation sector in Brazil, resulting in cost reductions of the treatment process. Gains at the end of the process are found in two levels, namely: (i) economic, by generating 165% of electricity from biogas burning in relation to the expend; (ii) energy, by adding a new sustainable and storable energy source equivalent to 4% of natural gas offered in the State of SP and 0,5% of electricity produced from biogas burning in relation to electricity consumption. In conclusion, the potential of electricity production linked to the biogas at STPs is capable of supply its domestic demand and export the surplus to other segments of the state and national economy.

Health promotion and the agenda for sustainable development, WHO Region of the Americas.

The approaches and tools of health promotion can be useful for civil society groups, local and national governments and multilateral organizations that are working to operationalize the 2030 agenda for sustainable development. Health promotion and sustainable development share several core priorities, such as equity, intersectoral approaches and sustainability, that help maximize their impact across traditional sectoral boundaries. In the Region of the Americas, each of these priorities has strong resonance because of prominent and long-standing health inequities that are proving resistant to interventions driven solely by the health sector. We describe several cases from the World Health Organization's (WHO) Region of the Americas in which the approaches and tools of health promotion, with a focus on cities, healthy settings and multisectoral collaboration, have been used to put the agenda into practice. We highlight areas where such approaches and tools can be applied effectively and provide evidence of the transformative potential of health promotion in efforts to achieve the sustainable development goals.

Les approches et outils de promotion de la santé peuvent être utiles aux groupes de la société civile, aux gouvernements locaux et nationaux et aux organismes multilatéraux qui s'efforcent de mettre en œuvre le Programme de développement durable à l'horizon 2030. La promotion de la santé et le développement durable ont plusieurs priorités centrales en commun, telles que l'équité, la collaboration intersectorielle et la durabilité, qui contribuent à optimiser leur impact au-delà des limites sectorielles habituelles. Chacune de ces priorités a une forte résonance dans la Région des Amériques, où les importantes inégalités en termes de santé durent depuis longtemps et semblent résister aux interventions menées à la seule initiative du secteur de la santé. Dans cet article, nous décrivons divers exemples provenant de la Région des Amériques de l'Organisation mondiale de la Santé (OMS), où plusieurs approches et outils de promotion de la santé (ciblant principalement les populations urbaines, la création d'environnements-santé et une collaboration multisectorielle) sont actuellement employés pour mettre en œuvre le Programme de développement durable. Nous mettons l'accent sur les domaines dans lesquels ces approches et outils peuvent être efficacement appliqués et nous proposons des données probantes sur le potentiel de transformation de la promotion de la santé dans les efforts menés pour atteindre les objectifs de développement durable.

Los enfoques y las herramientas para el fomento de la salud son útiles para los grupos de la sociedad civil, los gobiernos locales y nacionales y las organizaciones multilaterales que trabajan para poner en marcha el programa de desarrollo sostenible de 2030. El fomento de la salud y el desarrollo sostenible comparten varias prioridades básicas, como la equidad, los enfoques intersectoriales y la sostenibilidad, que ayudan a maximizar el impacto dentro de los límites sectoriales tradicionales. En la Región de las Américas, cada una de estas prioridades tiene una fuerte repercusión debido a las inequidades sanitarias prominentes y prolongadas que resisten a las intervenciones impulsadas únicamente por el sector de la salud. Se describen varios casos de la Región de las Américas de la Organización Mundial de la Salud (OMS) en los que los enfoques y las herramientas para el fomento de la salud, centrado en ciudades, entornos saludables y colaboración multisectorial, se han utilizado para poner en práctica el programa. Se destacan las áreas donde tales enfoques y herramientas se pueden aplicar de manera efectiva y ofrecer pruebas del potencial transformador del fomento de la salud en los esfuerzos por alcanzar los objetivos de desarrollo sostenible.

Energy interventions that facilitate sustainable development and impact health: an overview of systematic reviews.

Objective To inform policy by providing an overview of systematic reviews on interventions that facilitate sustainable energy use and have a positive impact on health. Methods Systematic review methods were used to synthesize evidence from multiple systematic reviews and economic evaluations through a comprehensive search of 13 databases and nine websites based on a pre-defined protocol, including clear inclusion criteria. Both grey and peer-reviewed literature published in English, Spanish, and Portuguese during the 17 years from January 1997 - January 2014 was included. To classify as "sustainable," interventions needed to aim to positively impact at least two dimensions of the integrated framework for sustainable development and include measures of health impact. Results Five systematic reviews and one economic evaluation met the inclusion criteria. The most promising interventions that impacted health were electricity for lighting and other uses (developing countries); improved stoves for cooking and health and/or cleaner fuels for cooking (developing countries); and household energy efficiency measures (developed countries). These interventions also had potential environmental and economic impacts. Their cost-effectiveness is not known, nor is their impact on health inequalities. Conclusions What is needed now is careful implementation of interventions where the impacts are likely to be positive but their implementation needs to be rigorously evaluated, including possible adverse impacts. Care needs to be taken not to exacerbate health inequalities and to consider context, human behavior and cultural factors so that the potential health benefits are realized in real-life implementation. Possible impact on health inequalities needs to be considered and measured in future primary studies and systematic reviews.

Interventions that facilitate sustainable jobs and have a positive impact on workers' health: an overview of systematic reviews.

OBJECTIVE: To identify interventions that facilitate sustainable jobs and have a positive impact on the health of workers in health sector workplaces. METHODS: This overview utilized systematic review methods to synthesize evidence from multiple systematic reviews and economic evaluations. A comprehensive search was conducted based on a predefined protocol, including specific inclusion criteria. To be classified as "sustainable," interventions needed to aim (explicitly or implicitly) to 1) have a positive impact on at least two key dimensions of the integrated framework for sustainable development and 2) include measures of health impact. Only interventions conducted in, or applicable to, health sector workplaces were included. RESULTS: Fourteen systematic reviews and no economic evaluations met the inclusion criteria for the overview. The interventions that had a positive impact on health included 1) enforcement of occupational health and safety regulations; 2) use of the "degree of experience rating" feature of workers' compensation; 3) provision of flexible working arrangements that increase worker control and choice; 4) implementation of certain organizational changes to shift work schedules; and 5) use of some employee participation schemes. Interventions with negative impacts on health included 1) downsizing/restructuring; 2) temporary and insecure work arrangements; 3) outsourcing/home-based work arrangements; and 4) some forms of task restructuring. CONCLUSIONS: What is needed now is careful implementation, in health sector workplaces, of interventions likely to have positive impacts, but with careful evaluation of their effects including possible adverse impacts. Well-evaluated implementation of the interventions (including those at the pilot-study stage) will contribute to the evidence base and inform future action. Interventions with negative health impacts should be withdrawn from practice (through regulation, where possible). If use of these interventions is necessary, for other reasons, considerable care should be taken to ensure an appropriate balance between business needs and human health and well-being.

Agriculture, food, and nutrition interventions that facilitate sustainable food production and impact health: an overview of systematic reviews.

Objectives To identify the agriculture, food, and nutrition security interventions that facilitate sustainable food production and have a positive impact on health. Methods Systematic review methods were used to synthesize evidence from multiple systematic reviews and economic evaluations through a comprehensive search of 17 databases and 10 websites. The search employed a pre-defined protocol with clear inclusion criteria. Both grey and peer-reviewed literature published in English, Spanish, and Portuguese between 1 January 1997 and November 2013 were included. To classify as "sustainable," interventions needed to aim to positively impact at least two dimensions of the integrated framework for sustainable development and include measures of health impact. Results Fifteen systematic reviews and seven economic evaluations met the inclusion criteria. All interventions had some impact on health or on risk factors for health outcomes, except those related to genetically modified foods. Impact on health inequalities was rarely measured. All interventions with economic evaluations were very cost-effective, had cost savings, or net benefits. In addition to impacting health (inclusive social development), all interventions had the potential to impact on inclusive economic development, and some, on environmental sustainability, though these effects were rarely assessed. Conclusions What is needed now is careful implementation of interventions with expected positive health impacts but with concurrent, rigorous evaluation. Possible impact on health inequalities needs to be considered and measured by future primary studies and systematic reviews, as does impact of interventions on all dimensions of sustainable development.

Health in all policies in the partnership for sustainable development.

This article analyzes the dynamic interaction between the Health in All Policies (HiAP) agenda and the ongoing implementation of the 2030 Agenda for Sustainable Development. At the World Conference on Social Determinants of Health, held in Rio de Janeiro in October 2011, the Rio Political Declaration pledged to use HiAP as a mechanism to address health inequities. In 2014, the Ministers of Health of the Region of the Americas approved a regional Plan of Action of the Pan American Health Organization (PAHO) that sought to call attention to the health consequences and benefits of policies and actions developed by other sectors. The HiAP approach seeks to integrate activities across the pillars of the sustainable development governance framework (economic, social, and environmental development). Advocates of the process are challenged to consider, using guiding questions outlined at the close of this article, how to pursue action at the country level and in what ways the HiAP approach can contribute to timely and effective implementation of the Sustainable Development Goals (SDGs). The authors propose that coordination between the 2030 Agenda and the regional Plan of Action on HiAP can make an important contribution to the implementation of both processes in the Region.

Interventions that facilitate sustainable development by preventing toxic exposure to chemicals: an overview of systematic reviews.

Objective To identify interventions that 1) facilitate sustainable development by preventing toxic exposure to chemicals, including pesticides, and 2) have a positive impact on health. Methods This overview utilized systematic review methods to synthesize evidence from multiple systematic reviews and economic evaluations. A comprehensive search was conducted based on a predefined protocol, including clear inclusion criteria. To be classified as "sustainable" interventions needed to aim (explicitly or implicitly) to 1) have a positive impact on at least two key dimensions of the United Nations integrated framework for sustainable development and 2) include measures of health impact. Results Thirteen systematic reviews and two economic evaluations met the inclusion criteria. The interventions that were most likely to have a positive impact on health included 1) legislation to ban Endosulfan pesticide to prevent fatal poisonings; 2) testing of drinking water for contamination with arsenic, and dissemination of the results to households; and 3) implementation of organic farming / diet to reduce exposure to pesticides. However, the cost-effectiveness of these three interventions and their impact(s) on health inequalities is not known. Strict enforcement of interventions to reduce lead in houses with children was cost-beneficial. Education and dust control interventions performed by cleaning professionals to reduce blood lead levels in children were ineffective. Conclusions What is needed now is careful implementation of the interventions whose impacts are likely to be positive. Ineffective interventions need to be replaced with more effective and cost-effective interventions. Finally, more and better-quality research on the prevention of toxic exposure to chemicals is needed to better support policy development.

The new United Nations approach to sustainable development post-2015: Findings from four overviews of systematic reviews on interventions for sustainable development and health.

Objective To identify reported interventions that facilitate sustainable development and have had a positive impact on health in four areas: sustainable food production; sustainable energy use; sustainable jobs ("decent work"); and prevention of toxic exposure to chemicals. Methods Systematic review methods were used to synthesize evidence from multiple systematic reviews and economic evaluations. A comprehensive search was conducted of at least 14 databases and 8 websites for each of the four overviews, using pre-defined protocols, including clear inclusion criteria. To qualify as "sustainable," interventions needed to aim (explicitly or implicitly) to positively impact at least two dimensions of the integrated framework for sustainable development and had to include measures of health impact. Results In total, 47 systematic reviews and 10 economic evaluations met the inclusion criteria. The most promising interventions, such as agricultural policies, were identified for each of the four topics. While the evidence for the interventions is not strong because of the limited number of studies, there is no evidence of a definite negative impact on health. The only possible exception is that of taxes and subsidies-though this intervention also has the potential to be pro-equity with higher relative impacts for lower income groups. Conclusions The evidence found for effective interventions is useful for guiding countries toward the best options for non-health sector interventions that can positively impact health. This overviews shows that intersectoral work benefits every sector involved.

Health inequalities by gradients of access to water and sanitation between countries in the Americas, 1990 and 2010.

OBJECTIVE: To explore distributional inequality of key health outcomes as determined by access coverage to water and sanitation (WS) between countries in the Region of the Americas. METHODS: An ecological study was designed to explore the magnitude and change-over-time of standard gap and gradient metrics of environmental inequalities in health at the country level in 1990 and 2010 among the 35 countries of the Americas. Access to drinking water and access to improved sanitation facilities were selected as equity stratifiers. Five dependent variables were: total and healthy life expectancies at birth, and infant, under-5, and maternal mortality. RESULTS: Access to WS correlated with survival and mortality, and strong gradients were seen in both 1990 and 2010. Higher WS access corresponded to higher life expectancy and healthy life expectancy and lower infant, under-5, and maternal mortality risks. Burden of life lost was unequally distributed, steadily concentrated among the most environmentally disadvantaged, who carried up to twice the burden than they would if WS were fairly distributed. Population averages in life expectancy and specific mortality improved, but whereas absolute inequalities decreased, relative inequalities remained mostly invariant. CONCLUSIONS: Even with the Region on track to meet MDG 7 on water and sanitation, large environmental gradients and health inequities among countries remain hidden by Regional averages. As the post-2015 development agenda unfolds, policies and actions focused on health equity-mainly on the most socially and environmentally deprived-will be needed in order to secure the right for universal access to water and sanitation.

Combining Digital and Molecular Approaches Using Health and Alternate Data Sources in a Next-Generation Surveillance System for Anticipating Outbreaks of Pandemic Potential.

Globally, millions of lives are impacted every year by infectious diseases outbreaks. Comprehensive and innovative surveillance strategies aiming at early alert and timely containment of emerging and reemerging pathogens are a pressing priority. Shortcomings and delays in current pathogen surveillance practices further disturbed informing responses, interventions, and mitigation of recent pandemics, including H1N1 influenza and SARS-CoV-2. We present the design principles of the architecture for an early-alert surveillance system that leverages the vast available data landscape, including syndromic data from primary health care, drug sales, and rumors from the lay media and social media to identify areas with an increased number of cases of respiratory disease. In these potentially affected areas, an intensive and fast sample collection and advanced high-throughput genome sequencing analyses would inform on circulating known or novel pathogens by metagenomics-enabled pathogen characterization. Concurrently, the integration of bioclimatic and socioeconomic data, as well as transportation and mobility network data, into a data analytics platform, coupled with advanced mathematical modeling using artificial intelligence or machine learning, will enable more accurate estimation of outbreak spread risk. Such an approach aims to readily identify and characterize regions in the early stages of an outbreak development, as well as model risk and patterns of spread, informing targeted mitigation and control measures. A fully operational system must integrate diverse and robust data streams to translate data into actionable intelligence and actions, ultimately paving the way toward constructing next-generation surveillance systems.

Post nirmatrelvir/ritonavir erythema multiforme in a patient with coronavirus disease infection.

Erythema multiforme (EM), an immune-mediated skin condition, can occur after infection or following the use of medications. In this study, we describe a patient who developed EM after nirmatrelvir/ritonavir administration. An 81-year-old woman presented with fever and dyspnea. Laboratory investigations showed positive coronavirus disease (COVID-19) based on polymerase chain reaction assay, and she received a 5-day regimen of nirmatrelvir/ritonavir. We observed development of EM after this treatment and initiated prednisone (1 mg/kg) therapy, which led to rapid improvement. Our study is the first to report EM in a patient with COVID-19, who received nirmatrelvir/ritonavir and showed a favorable response.