Pan-American Guidelines for the treatment of SARS-CoV-2/COVID-19: a joint evidence-based guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API).

BACKGROUND: Since the beginning of the COVID-19 pandemic, therapeutic options for treating COVID-19 have been investigated at different stages of clinical manifestations. Considering the particular impact of COVID-19 in the Americas, this document aims to present recommendations for the pharmacological treatment of COVID-19 specific to this population. METHODS: Fifteen experts, members of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API) make up the panel responsible for developing this guideline. Questions were formulated regarding prophylaxis and treatment of COVID-19 in outpatient and inpatient settings. The outcomes considered in decision-making were mortality, hospitalisation, need for mechanical ventilation, symptomatic COVID-19 episodes, and adverse events. In addition, a systematic review of randomised controlled trials was conducted. The quality of evidence assessment and guideline development process followed the GRADE system. RESULTS: Nine technologies were evaluated, and ten recommendations were made, including the use of tixagevimab + cilgavimab in the prophylaxis of COVID-19, tixagevimab + cilgavimab, molnupiravir, nirmatrelvir + ritonavir, and remdesivir in the treatment of outpatients, and remdesivir, baricitinib, and tocilizumab in the treatment of hospitalised patients with severe COVID-19. The use of hydroxychloroquine or chloroquine and ivermectin was discouraged. CONCLUSION: This guideline provides recommendations for treating patients in the Americas following the principles of evidence-based medicine. The recommendations present a set of drugs that have proven effective in the prophylaxis and treatment of COVID-19, emphasising the strong recommendation for the use of nirmatrelvir/ritonavir in outpatients as the lack of benefit from the use of hydroxychloroquine and ivermectin.

Antiretroviral therapy use in selected countries in Latin America during 2013-2017: results from the Latin American Workshop in HIV Study Group.

OBJECTIVE: To document antiretroviral use in Latin America during the last decade. METHODS: We collected indicators from 79 HIV health care centres in 14 Latin American Spanish-speaking countries for 2013-2017. Indicators were analysed by age, sex and other characteristics and weighted by the estimated people under care (PUC) population in each country. RESULTS: We gathered information on 116 299 PUC. One-third belonged to centres reporting a shortage of at least one antiretroviral therapy (ART) drug for >30 days during 2017. At end 2017, 95.1% of PUC were receiving ART. During 2013-2017, 45 329 people living with HIV were admitted to 39 centres. ART initiated during the first year after admission increased from 76.7% in 2013 to 83.8% in 2017. In 35 centres across the study period, 71.7% of PUC started ART with tenofovir disoproxil fumarate and lamivudine, and zidovudine use decreased. The third most common ART drug, EFV, reached 64.8%. Raltegravir and other alternatives increased annually to almost 10% of total use in 2017. CONCLUSIONS: Initial ART in Latin America is not based on the most recent scientific evidence and recommendations; use of drugs with higher efficacy and safety profiles and guarantee of ART availability continues to be a public health challenge.

Scientific evidence for the control of antimicrobial resistance

[Extract]. Antimicrobial resistance (AMR) is one of the greatest global threats to human health. It is estimated that by 2050, AMR will lead to approximately 10 million annual deaths worldwide. Considering the impact of AMR on reproductive capacity and food production, in addition to its direct effect on infected people, the world's population could drop by between 11 and 444 million inhabitants by 2050 if AMR control is not achieved. As migrations and shared economies lead to the transmission of resistant bacteria across borders, the impacts of AMR become regionally significant. In the United States, methicillin-resistant Staphylococcus aureus caused 10 600 deaths in 2017. In Latin American and Caribbean countries, information is available from studies conducted in hospitals and other health facilities on the prevalence of antimicrobial-resistant pathogens. In many hospitals in Mexico, Peru, and Colombia, for example, resistance to third-generation cephalosporins and fluoroquinolones in Escherichia coli isolates is reaching almost 60%. Moreover, the dynamics of colonization and infection of multidrug-resistant organisms (such as carbapenemaseproducing Klebsiella pneumoniae) are unique in endemic areas of Latin America, favoring spread and dissemination. [...]

Histoplasmosis asociada al Síndrome de Inmunodeficiencia Adquirida, SIDA : descripción de un caso / Histoplasmosis associated to the Adquired Inmunodeficiency Syndrome, AIDS : description of a case

Reportamos el caso de un paciente masculino de 43 años de edad con el diagnóstico de SIDA ingresado en el Servicio de Infectología del Hospital del Instituto Dominicano de Seguros Sociales Dr. Salvador B. Gautier en Santo Domingo, República Dominicana, quien presentó lesiones de piel generalizadas, polimorfas, de color violáceo, pruriginosas, de 1 a 4 cm. de tamaño. Presentaba también fiebre, tos con secreción amarillenta y estertores crepitantes gruesos en ambos campos pulmonares. El resultado de la biopsia de las lesiones de piel reportó infección por Histoplasma capsulatum. Fue tratado con Ketoconazol sin éxito