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1.
Ars pharm ; 62(1): 89-95, ene.-mar. 2021.
Artigo em Inglês | IBECS | ID: ibc-196716

RESUMO

INTRODUCTION: The coronavirus disease 2019 (COVID-19) is a viral disease that affects several human organs and sys¬tems. Preventive or prophylactic treatments are specifically useful in emerging infectious diseases such as COVID-19 because they reduce the need for hospitalization and public health spending. Although the SARS-CoV-2 preventive effect of several therapeutic agents (e.g., hydroxychloroquine/chloroquine, remdesivir, lopinavir, and ritonavir) has been extensively evaluated, none of them have demonstrated significant clinical efficacy. METHOD: We aim to address and discuss the recently published studies on the chemoprophylactic potential of quer¬cetin against SARS-CoV-2. A literature search was carried out on different databases, such as PubMed/MEDLINE, Scielo, Scopus, Web of Science, Cochrane Library, and Clinical Trials.gov. Studies that report the effect of quercetin against SARS-CoV-2 or other types of coronaviruses were included and critically evaluated. RESULTS: Studies have shown that quercetin, an FDA-approved flavonoid used as an antioxidant and anti-inflamma¬tory agent, inhibits the entry of coronavirus (SARS-CoV) into the host cell. Moreover, an in silico study showed that quercetin is a potent inhibitor of the SARS-CoV-2 main protease (Mpro), suggesting that this flavonoid is also active against COVID-19. CONCLUSIONS: Because quercetin might prevent and lessen the duration of SARS-CoV-2 infections, it is plausible to assume that the prophylactic use of this flavonoid produces several clinical benefits. However, this preliminary evidence needs to be confirmed by in vitro assays and, posteriorly, in randomized clinical trials


INTRODUCCIÓN: La enfermedad del coronavirus 2019 (COVID-19) es una enfermedad viral que afecta a varios órganosy sistemas. Los tratamientos preventivos o profilácticos son especialmente útiles en enfermedades infecciosas emergentes como COVID-19 porque reducen la necesidad de hospitalización y el gasto en salud pública. Aunque el efecto preventivo del SARS-CoV-2 de varios agentes terapéuticos (e.g., hidroxicloroquina/cloroquina, remdesivir,lopinavir y ritonavir) se ha evaluado ampliamente, ninguno de ellos ha demostrado una gran eficacia clínica. MÉTODO: Por lo tanto, aquí nuestro objetivo es abordar y discutir los estudios publicados recientemente sobre el potencial quimioprofilático de la quercetina contra el SARS-CoV-2. METODOLOGÍA: Se realizó una búsqueda de la literaturaen bases como PubMed/MEDLINE, Scielo, Scorpus, Web of Science, Cochrane Library y Clinical Trials.gov. Se incluyeron y evaluaron críticamente estudios que abordan la quercetina contra el SARS-CoV-2 u otros tipos decoronavirus. RESULTADOS: Algunos estudios han demostrado que la quercetina, un flavonoide aprobado por la FDA que se utiliza como agente antioxidante y antiinflamatorio, inhibe la entrada del coronavirus (SARS-CoV) en la célula huésped.Además, un estudio in silico mostró que la quercetina es un potente inhibidor de la proteasa principal del SARSCoV-2 (Mpro), lo que sugiere que este flavonoide también es activo contra COVID-19. CONCLUSIONES: Debido a que la quercetina podría prevenir y disminuir la duración de las infecciones por SARSCoV-2, es plausible suponer que el uso profiláctico de este flavonoide produce varios beneficios clínicos. Pero, estas pruebas preliminares deben ser confirmadas mediante ensayos in vitro y, posteriormente, en un ensayo clínico aleatorizado


Assuntos
Humanos , Quercetina/uso terapêutico , Profilaxia Pré-Exposição/métodos , Infecções por Coronavirus/prevenção & controle , Antivirais/uso terapêutico , Suplementos Nutricionais , Inibidores de Proteases/uso terapêutico , Reprodutibilidade dos Testes
2.
PLoS One ; 16(1): e0244778, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33406138

RESUMO

BACKGROUND: Populations such as healthcare workers (HCW) that are unable to practice physical distancing are at high risk of acquiring Coronavirus disease-2019 (COVID-19). In these cases pharmacological prophylaxis would be a solution to reduce severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) transmission. Hydroxychloroquine has in vitro antiviral properties against SARS CoV-2. We therefore sought to determine the efficacy and safety of hydroxychloroquine as prophylaxis for COVID-19. METHODS AND FINDINGS: We electronically searched EMBASE, MEDLINE, the Cochrane COVID-19 Register of Controlled Trials, Epistemonikos COVID-19, clinicaltrials.gov, and the World Health Organization International Clinical Trials Registry Platform up to September 28th, 2020 for randomized controlled trials (RCTs). We calculated pooled relative risks (RRs) for dichotomous outcomes with the corresponding 95% confidence intervals (CIs) using a random-effect model. We identified four RCTs (n = 4921) that met our eligibility criteria. The use of hydroxychloroquine, compared to placebo, did not reduce the risks of developing COVID-19 (RR 0.82, 95% CI 0.65 to 1.04, moderate certainty), hospitalization (RR 0.72, 95% CI 0.34 to 1.50, moderate certainty), or mortality (RR 3.26, 95% CI 0.13 to 79.74, low certainty), however, hydroxychloroquine use increased the risk of adverse events (RR 2.76, 95% CI 1.38 to 5.55, moderate certainty). CONCLUSION: Although pharmacologic prophylaxis is an attractive preventive strategy against COVID-19, the current body of evidence failed to show clinical benefit for prophylactic hydroxychloroquine and showed a higher risk of adverse events when compared to placebo or no prophylaxis.


Assuntos
/tratamento farmacológico , Hidroxicloroquina/efeitos adversos , Hidroxicloroquina/uso terapêutico , Antibioticoprofilaxia/métodos , Antivirais/uso terapêutico , Humanos , Hidroxicloroquina/metabolismo , Profilaxia Pré-Exposição/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , /patogenicidade
4.
JAMA Netw Open ; 3(12): e2030806, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33355675

RESUMO

Importance: There have been concerns that HIV preexposure prophylaxis (PrEP) may be associated with increases in sexually transmitted infections (STIs) because of subsequent reductions in condom use and/or increases in sexual partners. Objective: To determine trends in STI test positivity among high-risk men who have sex with men (MSM) before and after the start of HIV PrEP. Design, Setting, and Participants: A before-after analysis was conducted using a subcohort of a single-group PrEP implementation study cohort in New South Wales, Australia (Expanded PreEP Implementation in Communities in New South Wales [EPIC-NSW]), from up to 1 year before enrollment if after January 1, 2015, and up to 2 years after enrollment and before December 31, 2018. STI testing data were extracted from a network of 54 sexual health clinics and 6 primary health care clinics Australia-wide, using software to deidentify, encrypt, and anonymously link participants between clinics. A cohort of MSM dispensed PrEP for the first time during the study, with 2 or more STI tests in the prior year and who tested during follow-up, were included from the EPIC-NSW cohort of HIV-negative participants with high-risk sexual behavior. Data analysis was performed from June to December 2019. Exposures: Participants were dispensed coformulated tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg) as HIV PrEP. Main Outcomes and Measures: The main outcome was STI, measured using test positivity, defined as the proportion of participants testing positive for an STI at least once per quarter of follow-up. Outcomes were calculated for Chlamydia trachomatis and Neisseria gonorrhoea by site of infection (anorectal, pharyngeal, urethral, or any) and for syphilis. Results: Of the EPIC-NSW cohort of 9709 MSM, 2404 were included in the before-after analysis. The mean (SD) age of the participants was 36 (10.4) years, and 1192 (50%) were Australia-born. STI positivity was 52% in the year after PrEP (23.3% per quarter; 95% CI, 22.5%-24.2% per quarter) with no significant trend (mean rate ratio [RR] increase of 1.01 per quarter [95% CI, 0.99-1.02]; P = .29), compared with 50% positivity in the year prior to PrEP (20.0% per quarter [95% CI, 19.04%-20.95% per quarter]; RR for overall STI positivity, 1.17 [95% CI, 1.10-1.24]; P < .001), with an increase in quarterly STI positivity (mean RR of 1.08 per quarter, or an 8% increase per quarter [95% CI, 1.05-1.11]; P < .001; RR, 0.93 [95% CI, 0.90-0.96]; P < .001). Findings were similar when stratified by specific STIs and anatomical site. Conclusions and Relevance: STI rates were high but stable among high-risk MSM while taking PrEP, compared with a high but increasing trend in STI positivity before commencing PrEP. These findings suggest the importance of considering trends in STIs when describing how PrEP use may be associated with STI incidence.


Assuntos
Emtricitabina/uso terapêutico , Infecções por HIV , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero , Doenças Sexualmente Transmissíveis , Tenofovir/uso terapêutico , Adulto , Fármacos Anti-HIV/uso terapêutico , Austrália/epidemiologia , Estudos de Coortes , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Comportamentos de Risco à Saúde , Humanos , Incidência , Masculino , Profilaxia Pré-Exposição/métodos , Profilaxia Pré-Exposição/estatística & dados numéricos , Comportamento Sexual , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia
5.
Angiol. (Barcelona) ; 72(6): 286-297, nov.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-195584

RESUMO

El SARS-CoV-2, responsable de la pandemia, ha demostrado un alto potencial trombogénico y, a pesar de ser un virus de reciente aparición, evidencia una relación estrecha con mecanismos fisiopatológicos previamente descritos. La enfermedad tromboembólica venosa es una de sus complicaciones más frecuentes, cuya presencia es directamente proporcional al incremento en la mortalidad de estos pacientes. En el contexto del SARS-CoV-2, si bien las heparinas han mostrado superioridad frente a otros fármacos por su efecto antiinflamatorio añadido, no se logra un consenso sobre su dosificación en los diferentes escenarios y, en condiciones de alta hospitalaria, la elección de la droga más idónea y la duración de la profilaxis farmacológica también han generado controversias y discrepancias. Tras una revisión exhaustiva y basada en la literatura publicada tanto en la era COVID-19 como en años pasados, presentamos para su discusión la escala de coagulopatía inducida por sepsis (SIC) y el valor del dímero D como parámetros objetivos frente a las incertidumbres planteadas. Además, se sugiere el uso de escalas previamente validadas y manejadas para evaluar el riesgo tromboembólico venoso, el sangrado y las probabilidades de sospecha diagnóstica de trombosis venosa profunda y embolia pulmonar, las mismas que podrían ayudar a reducir sesgos subjetivos


SARS-CoV-2, responsible for the pandemic; has shown a high thrombogenic potential, but; despite being a newly emerging virus, it shows a close relationship with previously described pathophysiological mechanisms. Venous thromboembolic disease is the most frequent complication and it is directly proportional to the increase in mortality in these patients. In SARS-CoV-2 context, heparins have shown superiority over other drugs for their anti-inflammatory effect but there is not an established consensus about their dosage in different stages of the disease; moreover, at hospital discharge, the most suitable drug choice and pharmacological prophylaxis duration is controversial. After an exhaustive review and based in both, current COVID-19 era literature and the past years related scientific information, we propose sepsis-induced coagulopathy (SIC) score and D-dimer quantification as objective parameters; in addition, we suggest the use of previously validated scores to assess venous thromboembolic risk, bleeding and diagnostic suspicion of deep vein thrombosis and pulmonary embolism; these could help to reduce subjective bias and try to clear uncertainties about this topic


Assuntos
Humanos , Infecções por Coronavirus/complicações , Betacoronavirus/patogenicidade , Tromboembolia Venosa/virologia , Fatores de Risco , Medição de Risco , Tromboembolia Venosa/prevenção & controle , Anticoagulantes/uso terapêutico , Profilaxia Pré-Exposição/métodos , Infecções por Coronavirus/prevenção & controle
6.
Medicine (Baltimore) ; 99(46): e23233, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181710

RESUMO

BACKGROUND: Acute mountain sickness (AMS) is the effect when people accessing high altitude in a short period of time. As a cyclooxygenase (COX) inhibitor, ibuprofen could alleviate the symptoms of AMS. However, whether it can prevent AMS or not is still controversial. It is necessary to perform a meta-analysis to evaluate the role of ibuprofen in AMS prophylaxis. METHODS: PubMed, EMBASE, Medline, ISI Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) will be searched for the relevant published studies that explored the value of ibuprofen in AMS prophylaxis from inception to October 2020. The data will be independently extracted by 2 researchers. Risk of bias will be evaluated based on Cochrane risk of bias assessment tool. Heterogeneity among the included studies will be evaluated by χ and I values. The meta-analysis was conducted by RevMan software version 5.3. RESULTS: This study will evaluate the role of ibuprofen in AMS prophylaxis. CONCLUSION: This study will summarize the current evidence of ibuprofen in AMS prophylaxis, which could further guide the recommendation in prevention of AMS.Open Science Framework (OSF) registration number: October 8, 2020. osf.io/n3mjt.


Assuntos
Doença da Altitude/prevenção & controle , Protocolos Clínicos , Ibuprofeno/uso terapêutico , Profilaxia Pré-Exposição/normas , Doença da Altitude/tratamento farmacológico , Humanos , Ibuprofeno/farmacologia , Metanálise como Assunto , Profilaxia Pré-Exposição/métodos , Revisões Sistemáticas como Assunto
7.
JAMA ; 324(16): 1651-1669, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33052386

RESUMO

Importance: Data on the use of antiretroviral drugs, including new drugs and formulations, for the treatment and prevention of HIV infection continue to guide optimal practices. Objective: To evaluate new data and incorporate them into current recommendations for initiating HIV therapy, monitoring individuals starting on therapy, changing regimens, preventing HIV infection for those at risk, and special considerations for older people with HIV. Evidence Review: New evidence was collected since the previous International Antiviral (formerly AIDS) Society-USA recommendations in 2018, including data published or presented at peer-reviewed scientific conferences through August 22, 2020. A volunteer panel of 15 experts in HIV research and patient care considered these data and updated previous recommendations. Findings: From 5316 citations about antiretroviral drugs identified, 549 were included to form the evidence basis for these recommendations. Antiretroviral therapy is recommended as soon as possible for all individuals with HIV who have detectable viremia. Most patients can start with a 3-drug regimen or now a 2-drug regimen, which includes an integrase strand transfer inhibitor. Effective options are available for patients who may be pregnant, those who have specific clinical conditions, such as kidney, liver, or cardiovascular disease, those who have opportunistic diseases, or those who have health care access issues. Recommended for the first time, a long-acting antiretroviral regimen injected once every 4 weeks for treatment or every 8 weeks pending approval by regulatory bodies and availability. For individuals at risk for HIV, preexposure prophylaxis with an oral regimen is recommended or, pending approval by regulatory bodies and availability, with a long-acting injection given every 8 weeks. Monitoring before and during therapy for effectiveness and safety is recommended. Switching therapy for virological failure is relatively rare at this time, and the recommendations for switching therapies for convenience and for other reasons are included. With the survival benefits provided by therapy, recommendations are made for older individuals with HIV. The current coronavirus disease 2019 pandemic poses particular challenges for HIV research, care, and efforts to end the HIV epidemic. Conclusion and Relevance: Advances in HIV prevention and management with antiretroviral drugs continue to improve clinical care and outcomes among individuals at risk for and with HIV.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Fatores Etários , Antirretrovirais/economia , Betacoronavirus , Comorbidade , Infecções por Coronavirus/epidemiologia , Esquema de Medicação , Custos de Medicamentos , Farmacorresistência Viral/genética , Substituição de Medicamentos/normas , Quimioterapia Combinada/métodos , Feminino , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Humanos , Agências Internacionais , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Polimedicação , Profilaxia Pré-Exposição/métodos , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , RNA Viral/sangue , Sociedades Médicas , Estados Unidos , Carga Viral/genética
8.
BMC Infect Dis ; 20(1): 792, 2020 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-33106179

RESUMO

BACKGROUND: The program for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) was launched in 2003 in China, but few studies have been conducted to describe the panorama of PMTCT. We investigated the rate and associated factors of mother-to-child transmission (MTCT) in China from 2004 to 2018. METHODS: HIV-infected pregnant women from two areas in China between 2004 and 2018 were enrolled. Antiretrovirals (ARVs) were provided to the mothers and their babies, and the children were followed and tested for HIV. RESULTS: In total, 857 mothers and their 899 children were enrolled, and the overall MTCT rate was 6.6% (95% CI 5.0-8.2). The MTCT rates of nonintervention, only formula feeding (FF), infant prophylaxis (IP) + FF, single dosage antiretrovirals (sdARVs) + IP + FF, zidovudine (AZT) alone+IP + FF and prenatal combination antiretroviral therapy (cART) + IP + FF were 36.4, 9.4, 10.0, 5.7, 3.8 and 0.3%, respectively. The MTCT rate declined over time. No ARVs, CD4 count < 200/µL, low birth weight, and breastfeeding were associated with MTCT of HIV. For different ARVs, a higher MTCT rate was observed for AZT alone, sdARVs, and no ARVs compared to cART for pregnant women. CONCLUSIONS: Although the overall MTCT rate remains relatively high, the real-world effect of prenatal cART+IP + FF in China has exerted the same protective effects in high-income countries. With the extension of prenatal cART for pregnant women with HIV, the MTCT rate of HIV has gradually declined in China. However, the coverage of prenatal cART for pregnant women should be further improved. The effect of only post-exposure prophylaxis for infants was limited.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Profilaxia Pré-Exposição/métodos , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Zidovudina/uso terapêutico , Adolescente , Adulto , Contagem de Linfócito CD4 , China/epidemiologia , Feminino , Seguimentos , Infecções por HIV/virologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/virologia , Fatores de Risco , Adulto Jovem
10.
BMC Infect Dis ; 20(1): 704, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32977745

RESUMO

INTRODUCTION: In sub-Saharan Africa, considerable HIV-burden exists among women. Anti-retroviral (ARV) based prevention products could decrease this burden, and their uptake could be increased if they also protect against pregnancy and sexually transmitted infections (STI). METHODS: A discrete choice experiment (DCE) was undertaken in South Africa (2015) through a household survey of adult females (n = 158) and adolescent girls (n = 204) who self-reported HIV-negative status. The DCE was used to project the uptake (percentage using product) of oral pre-exposure prophylaxis (PrEP), vaginal rings, and injectable long-lasting ARV agents among these women, and how uptake could depend on whether these products protect against pregnancy or STI acquisition. Uptake estimates were used to model how each product could decrease a women's HIV acquisition risk. RESULTS: In adolescent women, there will be limited uptake (< 6% for any product) and impact (< 4% decrease in HIV acquisition risk) of new products unless they provide pregnancy protection, which could quadruple use and impact. Adult women have weaker preference for pregnancy protection, with moderate use (< 17% for each) and impact (< 14 percentage point decrease) if they only provide HIV protection. All women had highest preference for injectable ARVs, with oral PrEP having high preference if injectable ARVs are not available. Adult women will use the ring, but adolescent women will not. Importantly, even with three additional prevention products, all providing pregnancy and STI protection, > 14% of women will remain unprotected and > 31% of the baseline acquisition risk will remain. CONCLUSIONS: Incorporating multiple prevention components into new ARV-based prevention products may increase their uptake and impact among women.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Dispositivos Anticoncepcionais Femininos , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , HIV , Profilaxia Pré-Exposição/métodos , Adolescente , Adulto , Feminino , Infecções por HIV/virologia , Humanos , Gravidez , Autorrelato , África do Sul/epidemiologia , Adulto Jovem
11.
AIDS Patient Care STDS ; 34(9): 380-391, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32931316

RESUMO

Prior research found low acceptability of HIV treatment as prevention (TasP; or Undetectable = Untransmittable) among HIV-negative men who have sex with men (MSM). This study reports on qualitative data regarding TasP adoption in a sample of 170 self-reported HIV-negative MSM who had engaged in exchange sex (received money, drugs, or other things in exchange for sex). We classified participants along five stages of TasP adoption: 1-unaware of TasP (11.2%); 2-aware, but perceived ineffective (17.1%); 3-perceived effective, but unwilling to use (35.3%); 4-willing to rely on TasP, but had never done so (24.1%); and 5-had relied on TasP (12.4%). Obstacles to TasP adoption included the following: not believing that it could completely prevent HIV transmission; deeply ingrained fears of HIV/AIDS; concerns about viral load fluctuation; and reluctance to trust a partner's claimed undetectable status. TasP promotion efforts, which can decrease barriers to HIV testing and HIV stigma, will be more effective if tailored to the obstacles specific to each stage of TasP adoption.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Soronegatividade para HIV/efeitos dos fármacos , Homossexualidade Masculina/psicologia , Profilaxia Pré-Exposição/métodos , Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/epidemiologia , Humanos , Masculino , Parceiros Sexuais , Minorias Sexuais e de Gênero/psicologia , Carga Viral
12.
AIDS Educ Prev ; 32(3): 212-228, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32749880

RESUMO

Pre-exposure prophylaxis (PrEP) can efficaciously avert HIV acquisition for individuals at risk, including transgender individuals (trans) in the Philippines. We conducted multivariate logistic regression procedures in an online sample of Filipina trans women (n = 139) to examine associations of PrEP awareness. In this sample, 53% of Filipina trans women were unaware of PrEP, but almost all (93%) expressed interest in taking PrEP once learning about it. Greater odds of PrEP awareness was associated with discussion of HIV services with their health care providers, higher HIV knowledge, and discussion of PrEP among trans friends. Lower odds of PrEP awareness was associated with reporting being currently unemployed. The findings underscore a subset of trans women who might be early adopters of PrEP, and highlight PrEP inequities among trans women most marginalized, including those who are unemployed and have engaged in sex work.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Profilaxia Pré-Exposição/métodos , Pessoas Transgênero/psicologia , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Estudos Transversais , Feminino , Disparidades em Assistência à Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Filipinas , Indicadores de Qualidade em Assistência à Saúde
13.
Front Immunol ; 11: 1623, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32733488

RESUMO

Countries worldwide have confirmed a staggering number of COVID-19 cases, and it is now clear that no country is immune to the SARS-CoV-2 infection. Resource-poor countries with weaker health systems are struggling with epidemics of their own and are now in a more uncertain situation with this rapidly spreading infection. Frontline healthcare workers are succumbing to the infection in their efforts to save lives. There is an urgency to develop treatments for COVID-19, yet there is limited clinical data on the efficacy of potential drug treatments. Countries worldwide implemented a stay-at-home order to "flatten the curve" and relieve the pressure on the health system, but it is uncertain how this will unfold after the economy reopens. Trehalose, a natural glucose disaccharide, is known to impair viral function through the autophagy system. Here, we propose trehalose as a potential preventative treatment for SARS-CoV-2 infection and transmission.


Assuntos
Antivirais/uso terapêutico , Betacoronavirus/fisiologia , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Profilaxia Pós-Exposição/métodos , Profilaxia Pré-Exposição/métodos , Trealose/uso terapêutico , Adulto , Idoso , Antivirais/farmacologia , Doenças Assintomáticas , Autofagia/efeitos dos fármacos , Criança , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Trealose/farmacologia , Replicação Viral/efeitos dos fármacos
14.
Public Health Rep ; 135(1_suppl): 158S-171S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735199

RESUMO

OBJECTIVES: In 2014, the governor of New York announced the Ending the Epidemic (ETE) plan to reduce annual new HIV infections from 3000 to 750, achieve a first-ever decrease in HIV prevalence, and reduce AIDS progression by the end of 2020. The state health department undertook participatory simulation modeling to develop a baseline for comparing epidemic trends and feedback on ETE strategies. METHODS: A dynamic compartmental model projected the individual and combined effects of 3 ETE initiatives: enhanced linkage to and retention in HIV treatment, increased preexposure prophylaxis (PrEP) among men who have sex with men, and expanded housing assistance. Data inputs for model calibration and low-, medium-, and high-implementation scenarios (stakeholders' rollout predictions, and lower and upper bounds) came from surveillance and program data through 2014, the literature, and expert judgment. RESULTS: Without ETE (baseline scenario), new HIV infections would decline but remain >750, and HIV prevalence would continue to increase by 2020. Concurrently implementing the 3 programs would lower annual new HIV infections by 16.0%, 28.1%, and 45.7% compared with baseline in the low-, medium-, and high-implementation scenarios, respectively. In all concurrent implementation scenarios, although annual new HIV infections would remain >750, there would be fewer new HIV infections than deaths, yielding the first-ever decrease in HIV prevalence. PrEP and enhanced linkage and retention would confer the largest population-level changes. CONCLUSIONS: New York State will achieve 1 ETE benchmark under the most realistic (medium) implementation scenario. Findings facilitated framing of ETE goals and underscored the need to prioritize men who have sex with men and maintain ETE's multipronged approach, including other programs not modeled here.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Epidemias/prevenção & controle , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Simulação por Computador , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Acesso aos Serviços de Saúde/organização & administração , Humanos , Masculino , Modelos Teóricos , New York , Cooperação do Paciente , Profilaxia Pré-Exposição/métodos , Prevalência , Avaliação de Programas e Projetos de Saúde
15.
Lancet HIV ; 7(10): e721-e730, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32861269

RESUMO

When used appropriately, pre-exposure prophylaxis (PrEP) substantially reduces the risk of HIV acquisition. Early implementation outcomes often suggest poor PrEP adherence and persistence; however, this intervention is time-limited and the need for PrEP fluctuates as risk behaviours change. In this Viewpoint we examine the current guidelines and early programmatic outcomes after starting, stopping, and restarting PrEP, and we review the implications of PrEP in relation to HIV testing algorithms. Guidelines suggest to discontinue PrEP when a person is no longer at risk for HIV, but effectively implementing this strategy requires support tools to make the decision of stopping and restarting PrEP that considers the complex relationship between risk perceptions and risk behaviours. Safely discontinuing PrEP also requires greater understanding of the daily dosing duration that is needed to protect the person after their last HIV exposure. Additionally, clear strategies are needed to re-engage a person as their HIV exposure risk changes over time.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/efeitos adversos , Tomada de Decisão Clínica , Gerenciamento Clínico , Infecções por HIV/diagnóstico , Implementação de Plano de Saúde , Humanos , Guias de Prática Clínica como Assunto , Profilaxia Pré-Exposição/métodos , Retratamento , Medição de Risco , Tempo para o Tratamento
16.
AIDS Patient Care STDS ; 34(8): 336-343, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32757980

RESUMO

Adolescent girls and young women (AGYW) are a priority population for HIV prevention in high-burden settings. We evaluated psychosocial characteristics, behavioral risk factors for HIV, and pre-exposure prophylaxis (PrEP) awareness and uptake among AGYW seeking contraceptive services at four public sector family planning (FP) clinics offering integrated PrEP delivery in Kisumu, Kenya. From October 2018 to June 2019, we approached all AGYW (aged 15-24 years) seeking contraception to participate in a survey following receipt of FP services and PrEP screening. Overall, 470 AGYW were screened for PrEP at their FP visit by facility staff and subsequently enrolled in the survey. Median age was 22 years (interquartile range 20-23), 22% of AGYW were in school, and 55% were married. The most frequent forms of contraception were implants and injectables (41% each). Over a third of AGYW (36%) reported low social support, 13% had symptoms of moderate to severe depression, and 3% reported intimate partner violence. Three-quarters (75%) of AGYW reported recent condomless sex and 42% suspected that their primary partner had other sexual partners. Most AGYW (89%) had previously heard of PrEP; 76% had at least one PrEP eligibility criterion as per national guidelines; however, only 4% initiated PrEP at their current FP visit. PrEP initiators more frequently had high HIV risk perception than noninitiators (85% vs. 10%, p < 0.001). Low perceived HIV risk (76%) and pill burden (51%) were common reasons for declining PrEP among AGYW with HIV behavioral risk factors. PrEP counseling should be tailored to AGYW to guide appropriate PrEP decision-making in this important population.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profilaxia Pré-Exposição/estatística & dados numéricos , Prevenção Primária/métodos , Adolescente , Adulto , Conscientização , Serviços de Planejamento Familiar/organização & administração , Feminino , Humanos , Quênia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Profilaxia Pré-Exposição/métodos , Gravidez , Adulto Jovem
17.
J Glob Antimicrob Resist ; 22: 864-865, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32777441

RESUMO

The potentiality of Hydroxychloroquine (HCQ) for pre-exposure prophylaxis against SARS-CoV-2 has not been explored in randomized controlled trials. However, there is rationale behind this potentiality in terms of demonstrated in-vitro effect of HCQ against SARS-CoV-2, safety profile of HCQ in healthy individuals and a recent observational study demonstrating benefits of HCQ prophylaxis in terms of a significant reduction (>80%) in the odds of SARS-CoV-2 infection in the health-care workers (HCWs) with the intake of six or more doses of HCQ prophylaxis as per the guidelines of the National Task Force for COVID-19 in India. Hence, pre-exposure prophylaxis with HCQ in appears to be a reasonable strategy in the current scenario for prevention of SARS-CoV-2 infection in healthy HCWs.


Assuntos
Antivirais/administração & dosagem , Infecções por Coronavirus/prevenção & controle , Hidroxicloroquina/administração & dosagem , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Profilaxia Pré-Exposição/métodos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/virologia , Pessoal de Saúde , Humanos , Índia , Pneumonia Viral/virologia
18.
Public Health Rep ; 135(5): 547-554, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780671

RESUMO

In 2019, President Trump announced a new initiative, Ending the HIV Epidemic: A Plan for America (EHE). EHE will use 3 key strategies-diagnose, treat, and prevent-to reduce new HIV infections at least 90% by 2030, as well as new laboratory methods and epidemiological techniques to respond quickly to potential outbreaks. Partnerships are an important component in the initiative's success. Pharmacists and pharmacies can play important roles in EHE, including dispensing antiretroviral therapy and providing HIV screening, adherence counseling, medication therapy management, preexposure prophylaxis, and nonprescription syringe sales. The objective of this report is to discuss potential roles that pharmacists and pharmacies can play under the key strategies of EHE.


Assuntos
Epidemias/prevenção & controle , Infecções por HIV/prevenção & controle , Programas de Rastreamento/normas , Farmácias/normas , Farmacêuticos/normas , Profilaxia Pré-Exposição/normas , Papel Profissional , Adolescente , Adulto , Epidemias/legislação & jurisprudência , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Profilaxia Pré-Exposição/métodos , Estados Unidos/epidemiologia , Adulto Jovem
19.
Eur J Med Res ; 25(1): 32, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787926

RESUMO

BACKGROUND: The German government has made it mandatory to wear respiratory masks covering mouth and nose (MNC) as an effective strategy to fight SARS-CoV-2 infections. In many countries, this directive has been extended on shopping malls or public transportation. The aim of this paper is to critically analyze the statutory regulation to wear protective masks during the COVID-19 crisis from a medical standpoint. METHODS: We performed an extensive query of the most recent publications addressing the prevention of viral infections including the use of face masks in the community as a method to prevent the spread of the infection. We addressed the issues of practicability, professional use, and acceptability based on the community and the environment where the user resided. RESULTS: Upon our critical review of the available literature, we found only weak evidence for wearing a face mask as an efficient hygienic tool to prevent the spread of a viral infection. However, the use of MNC seems to be linked to relevant protection during close contact scenarios by limiting pathogen-containing aerosol and liquid droplet dissemination. Importantly, we found evidence for significant respiratory compromise in patients with severe obstructive pulmonary disease, secondary to the development of hypercapnia. This could also happen in patients with lung infections, with or without SARS-CoV-2. CONCLUSION: Epidemiologists currently emphasize that wearing MNC will effectively interrupt airborne infections in the community. The government and the politicians have followed these recommendations and used them to both advise and, in some cases, mandate the general population to wear MNC in public locations. Overall, the results seem to suggest that there are some clinically relevant scenarios where the use of MNC necessitates more defined recommendations. Our critical evaluation of the literature both highlights the protective effects of certain types of face masks in defined risk groups, and emphasizes their potential risks.


Assuntos
Infecções por Coronavirus/prevenção & controle , Máscaras/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Profilaxia Pré-Exposição/métodos , Dispositivos de Proteção Respiratória/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Utilização de Equipamentos e Suprimentos/legislação & jurisprudência , Utilização de Equipamentos e Suprimentos/estatística & dados numéricos , Humanos , Máscaras/efeitos adversos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Profilaxia Pré-Exposição/legislação & jurisprudência , Dispositivos de Proteção Respiratória/efeitos adversos
20.
Front Immunol ; 11: 1451, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32636851

RESUMO

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) represents an emergent global threat which is straining worldwide healthcare capacity. As of May 27th, the disease caused by SARS-CoV-2 (COVID-19) has resulted in more than 340,000 deaths worldwide, with 100,000 deaths in the US alone. It is imperative to study and develop pharmacological treatments suitable for the prevention and treatment of COVID-19. Ascorbic acid is a crucial vitamin necessary for the correct functioning of the immune system. It plays a role in stress response and has shown promising results when administered to the critically ill. Quercetin is a well-known flavonoid whose antiviral properties have been investigated in numerous studies. There is evidence that vitamin C and quercetin co-administration exerts a synergistic antiviral action due to overlapping antiviral and immunomodulatory properties and the capacity of ascorbate to recycle quercetin, increasing its efficacy. Safe, cheap interventions which have a sound biological rationale should be prioritized for experimental use in the current context of a global health pandemic. We present the current evidence for the use of vitamin C and quercetin both for prophylaxis in high-risk populations and for the treatment of COVID-19 patients as an adjunct to promising pharmacological agents such as Remdesivir or convalescent plasma.


Assuntos
Antivirais/uso terapêutico , Ácido Ascórbico/uso terapêutico , Betacoronavirus/fisiologia , Infecções por Coronavirus/prevenção & controle , Fatores Imunológicos/uso terapêutico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Profilaxia Pré-Exposição/métodos , Quercetina/uso terapêutico , Animais , Antivirais/efeitos adversos , Antivirais/química , Antivirais/farmacocinética , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/virologia , Sinergismo Farmacológico , Quimioterapia Combinada , Humanos , Camundongos , Pneumonia Viral/virologia , Quercetina/efeitos adversos , Quercetina/química , Quercetina/farmacocinética , Replicação Viral/efeitos dos fármacos
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