Lamivudine-based two-drug regimens with dolutegravir or protease inhibitor: Virological suppression in spite of previous therapy failure or renal dysfunction

Abstract Background Two-Drug Regimens (2DR) have proven effective in clinical trials but real-world data, especially in resource-limited settings, is limited. Objectives To evaluate viral suppression of lamivudine-based 2DR, with dolutegravir or ritonavir-boosted protease inhibitor (lopinavir/r, atazanavir/r or darunavir/r), among all cases regardless of selection criteria. Patients and methods A retrospective study, conducted in an HIV clinic in the metropolitan area of São Paulo, Brazil. Per-protocol failure was defined as viremia above 200 copies/mL at outcome. Intention-To-Treat-Exposed (ITT-E) failure was considered for those who initiated 2DR but subsequently had either (i) Delay over 30 days in Antiretroviral Treatment (ART) dispensation, (ii) ART changed or (iii) Viremia > 200 copies/mL in the last observation using 2DR. Results Out of 278 patients initiating 2DR, 99.6% had viremia below 200 copies/mL at last observation, 97.8% below 50 copies/mL. Lamivudine resistance, either documented (M184V) or presumed (viremia > 200 copies/mL over a month using 3TC) was present in 11% of cases that showed lower suppression rates (97%), but with no significant hazard ratio to fail per ITT-E (1.24, p= 0.78). Decreased kidney function, present in 18 cases, showed of 4.69 hazard ratio (p= 0.02) per ITT-E for failure (3/18). As per protocol analysis, three failures occurred, none with renal dysfunction. Conclusions The 2DR is feasible, with robust suppression rates, even when 3TC resistance or renal dysfunction is present, and close monitoring of these cases may guarantee long-term suppression.

Efficacy and tolerability of dolutegravir plus lamivudine as a switch simplified strategy in treatment-experienced human immunodeficiency virus/acquired immunodeficiency syndrome patients / 中华传染病杂志

Objective:To evaluate the efficacy and tolerability of the dual therapy of dolutegravir (DTG) plus lamivudine (3TC) as a switch simplified strategy in treatment-experienced human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients.Methods:Treatment-experienced HIV/AIDS patients who switched to a dual therapy containing DTG (50 mg, once daily) plus 3TC (300 mg, once daily) were included in Beijing You′an Hospital, Capital Medical University from September 2016 to May 2019. HIV RNA, CD4 + T lymphocyte count, blood lipid indexes, renal function indexes were collected when patients changed the treatment regimen (baseline) and after 48 weeks of treatment. Efficacy (HIV RNA<50 copies/mL) and safety of the dual therapy were analyzed. Statistical comparisons were performed using the Wilcoxon matched-pairs signed rank test. Results:The reasons for 33 patients switching the treatment regimen were virologic failure (four cases, 12.1%), simplification of regimen (11 cases, 33.3%), and drug toxicity (18 cases, 54.5%). The patients were treated with anti-retroviral therapy (ART) for 2.13 (1.05, 4.23) years before regimens switching. Twenty-nine (87.9%) patients were virologically suppressed at baseline, and four (12.1%) patients were virological failure. After switching to DTG plus 3TC, all 33 patients showed HIV RNA<50 copies/mL after 48 weeks of treatment. The baseline CD4 + T lymphocyte count was 543 (363, 595)/μL. After switching the treatment regimens for 48 weeks, CD4 + T lymphocyte count was significantly increased to 625 (455, 651)/μL, and the difference was statistically significant ( Z=3.14, P=0.002). Compared with baseline, low-density lipoprotein-cholesterol was increased after 48 weeks of treatment (2.35(1.80, 3.08) mmol/L vs 3.12(2.74, 3.87) mmol/L), while triglyceride (2.21(1.27, 4.37) mmol/L vs 1.61(1.20, 2.22) mmol/L), the ratio of total cholesterol to high-density lipoprotein-cholesterol (5.02 (4.13, 6.40) vs 4.70 (3.55, 5.35)) and estimated glomerular filtration rate (106.4(78.2, 118.2) mL/(min·1.73 m 2) vs 88.6 (75.7, 107.9) mL/(min·1.73 m 2)) were decreased. The differences were all statistically significant ( Z=4.89, 2.37, 2.09 and 2.83, respectively, all P<0.050). No patient discontinued due to adverse events. Conclusions:The use of dual therapy containing DTG and 3TC is effective and well-tolerated in treatment-experienced HIV/AIDS patients under any prior ART without significant adverse events.

The efficacy of dual therapy for eradicating H. pylori in a Colombian population

Abstract Background: Helicobacter pylori (H. pylori) affects 50% of the human population. The efficacy of the usual treatments has decreased due to increased antibiotic resistance, except for that of amoxicillin, tetracycline, furazolidone and bismuth. Recently, there has been a new interest in dual therapy with high-dose proton pump inhibitors (PPI) and amoxicillin as initial and rescue treatment. There are no studies on this topic in our setting. Objective: to determine the efficacy of dual therapy with high-dose IPP and amoxicillin for eradicating H. pylori. Materials and methods: this was a quasi-experimental study carried out from December 2019 to July 2020 in people over the age of 18 with histologically confirmed H. pylori. All received 40 mg of esomeprazole half an hour before breakfast, lunch and dinner, plus 1 gram of oral amoxicillin every eight hours for 14 days. Eradication was determined by fecal antigens (OnSiteTM H. pylori Biotech Inc.) after four weeks of treatment. Results: 108 patients with an average age of 67 years were included, 70% of whom were women. Eradication per protocol (PP) and intention to treat (ITT) was 86% (95%CI 79.4-92.5%) for both. In previously treated patients (26%) the efficacy was 85.7% (95%CI 71.8-99.5%). Adverse events were mild in 31%, especially nausea (16%) and abdominal distension (14%). Treatment was not suspended in any patient. Conclusion: Dual therapy is effective, easy to administer, and has few adverse effects. It would be a good option in our setting as initial or rescue therapy. Larger studies are needed to confirm our results. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2091).

Research Progress on Dual Therapy in Primary Treatment of Helicobacter pylori Infection / 胃肠病学

At present, the global prevalence of Helicobacter pylori (Hp) infection is still high. Although bismuth-containing quadruple regimens are recommended by international consensus and guidelines as a first-line treatment for Hp infection, the compliance is decreasing due to more drugs needed and higher adverse events. In recent years, many studies on eradication regimen containing high-dose proton pump inhibitor (PPI) and amoxicillin, a low-resistance and acid-labile antibiotic, demonstrated that the dual therapy could achieve high eradication rate equivalent to the mainstream fist-line therapies and had the advantages of less adverse events, simpler drug composition and higher compliance. However, there are discrepancies in dosage and frequencies of drugs in dual therapies, and cannot reach a unified regimen. This article reviewed all kinds of the dual therapy regimens, which might be helpful for determining the optimal dosage, frequencies, and treatment course, so as to standardize the dual therapy.

Research Progress of High-dose Dual Therapy in Eradication of Helicobacter pylori Infection / 胃肠病学

In the era of increasing of antibiotic resistance, Helicobacter pylori (Hp) eradication rates of traditional triple and quadruple therapy are gradually declining. High-dose dual therapy (HDDT) containing proton pump inhibitors and amoxicillin may be a new breakthrough in eradicating Hp infection. Current research shows that HDDT, whether used as a first-line regimen or a rescue regimen, has a high eradication rate and a low incidence of adverse reactions. It has the potential to become a new first-line eradication therapy or rescue therapy for Hp infection in clinical practice. This article reviewed the research progress of HDDT in eradication of Hp infection.

High-dose Dual Therapy for Treatment of Helicobacter pylori Infection: A Meta-analysis of Randomized Controlled Trials / 胃肠病学

Background: High-dose dual therapy (HDDT) is a novel regimen for the eradication of Helicobacter pylori (Hp) infection, however, its efficacy and safety remain unclear. Aims: To evaluate the efficacy, safety and compliance of HDDT for Hp eradication. Methods: Randomized controlled trials (RCTs) on HDDT for eradication of Hp infection were retrieved from PubMed, Embase, The Cochrane Library, Web of Science from the date of database establishment to October 2020. Literatures were enrolled according to the inclusion and exclusion criteria, and the data were extracted. RevMan 5.2 software was used for performing meta-analysis. Results: Nine RCTs including 2 627 patients were included. Meta-analysis results showed that no significant differences in ITT eradication (85.4% vs. 79.8%, RR=1.03, 95% CI: 0.96-1.10, P=0.40), PP eradication (88.7% vs. 83.4%, RR=1.01, 95% CI: 0.95-1.08, P=0.68), and compliance (96.5% vs. 95.9%, RR=1.01, 95% CI: 0.99-1.02, P=0.37) were found between HDDT and the guideline-recommended regimens, however, the incidence of adverse events was significantly decreased in HDDT (15.3% vs. 27.0%, RR=0.57, 95% CI: 0.42-0.76, P=0.000 2). Conclusions: There are no significant differences in eradication rates and compliance between HDDT and the guideline-recommended regimens, however, HDDT is much safer.

Strive to Improve the Eradication Rate of Helicobacter pylori / 胃肠病学

As the awareness of the harmfulness of Helicobacter pylori (Hp) infection increases, the indications for Hp eradication continue to expand. "Kyoto Global Consensus Report on Helicobacter pylori Gastritis" puts forward "Hp infected individuals should be offered eradication therapy, unless there are competing considerations" and the statement has been accepted by more and more scholars. In our country, "the confirmed Hp infection" has been listed as an indication for eradication. However, as the antibiotic resistance rate of Hp increases, the eradication rate of Hp is gradually decreasing, and the proportion of people who has failed multiple treatments is increasing. This article was specially written for helping the clinicians to improve the eradication rate of Hp infection.

Evidencias para el uso combinado de ácido acetilsalicílico (aspirina) y clopidogrel en síndromes coronarios agudos / Evidences about combination use of acetylsalicylic acid (aspirin) and clopidogrel in acute coronary syndrome

Las enfermedades tromboembólicas siguen siendo una de las causas más importantes de morbilidad y mortalidad en todo el mundo. El mecanismo fisiopatológico subyacente en los síndromes coronarios agudos es la trombosis coronaria. Por eso, la base de su tratamiento se ha centrado en los fármacos antiplaquetarios, fibrinolíticos y anticoagulantes. En un número importante de individuos deben emplearse medidas adicionales como, por ejemplo, el intervencionismo percutáneo coronario (angioplastia y la colocación de los llamados stentsintracoronarios). La aspirina se ha considerado como el fármaco de primera elección en la prevención de las afecciones tromboembólicas. La combinación aspirina-clopidogrel ha representado una terapéutica sumamente eficiente en el tratamiento de los eventos tromboembólicos. La introducción de tabletas de combinación fija representa un avance para facilitar el cumplimiento de la terapia.

Thromboembolic diseases remain one of the most important causes of morbidity and mortality worldwide. The pathophysiologic mechanism underlying the acute coronary syndromes is coronary thrombosis. That is why the basis of its treatment has focused on antiplatelet, fibrinolytic and anticoagulant drugs. In a significant number of individuals, additional measures must be used, such as, for example, the coronary percutaneous intervention (angioplasty and placement of the so-called intracoronary stents). Aspirin has been regarded as the drug of first choice in the prevention of thromboembolic diseases. The combination aspirin-clopidogrel has represented a highly efficient therapeutic measure for thromboembolic events. The introduction of fixed combination tablets represents a step forward in order to facilitate therapeutic compliance.

Tratamiento acortado a 16 semanas en paciente con infección por genotipo 2 del virus de hepatitis C: Reporte de un caso y revisión de la literatura / Case Report and Literature Review: Shortened 16 Week Treatment of Patient with Genotype 2 Hepatitis C Infection

Presentamos el caso de una paciente de 46 años con hepatitis C infectada por el genotipo 2 quien recibió tratamiento acortado con dosis bajas de interferón pegilado alfa 2b (1 mcg/k semana SC) y ribavirina (800 mg día oral) durante 16 semanas alcanzando respuesta viral sostenida a las 12 (RVS12) y a las 24 semanas (RVS24). La tolerancia al tratamiento fue muy buena sin presentarse anemia clínicamente significativa o efectos adversos. Se plantea la posibilidad de este tipo de terapia en pacientes con factores relacionados con un buen pronóstico como carga viral baja, poca fibrosis (< F2), respuesta viral rápida (RVR) e IL28B genotipo CC. Esta estrategia puede reducir significativamente los costes relacionados con los nuevos antivirales de acción directa (AAD) tipo sofosbuvir asociado a ribavirina que deben ser administrados durante 12 semanas.

We report the case of a 46-year patient infected with genotype 2 of hepatitis C. The patient received short-course treatment with low doses of pegylated interferon alfa 2b (1 mcg/week SC k) and ribavirin (800 mg/day orally) for 16 weeks. The patient had sustained virologic response at 12 weeks (SVR12) viral and at 24 weeks (SVR24). Tolerance to treatment was very good, and there were no clinically significant signs of anemia or adverse effects. We propose that this type of therapy be considered for patients with factors associated with good prognoses such as low viral loads, low levels of fibrosis (

Dual Therapy and Triple Therapy of Prophylactic Antibiotics After Elective Colorectal Surgery: A Comparative Study

PURPOSE: The use of prophylactic antibiotics is the current standard of care after elective colorectal surgery. The aim of this study was to compare the efficacy of antibiotic prophylaxis with dual antibiotic therapy and triple antibiotic therapy after elective colorectal surgery. METHODS: We studied consecutive patients underwent elective colorectal surgery from January to June, 2007. Patients of triple-therapy group were administered second cephalosporin, metronidazole, and aminoglycoside for early 3 mo and dual-therapy group were administered second cephalosporin and metronidazole for next 3 mo. The prophylactic antibiotics were administered 2-3 doses for 24 hr after surgery. The surgery for diverticulitis, inflammatory bowel disease, and colon obstruction were excluded. Wound conditions were checked on alternate days during the hospital stay and follow up at least for 30 days after discharge. RESULTS: Over 6 mo, 110 patients were enrolled (59 dual-therapy group, 51 triple-therapy group). In two group, sex, age, American Society of Anesthesiology score, body mass index, combined diseases, and location of disease were similar. Wound infection rate were 1.7% in dual-therapy group and 2.0% in triple-therapy group (P=1.0). Anastomotic leakage rate were 5.1% in dual-therapy group and 2.0% in triple-therapy group (P=0.622). CONCLUSION: The addition of aminoglycoside to dual antibiotic therapy, second cephalosporin-metronidazole showed on advantage in prevention of postoperative wound complications. Further studies are required to establish appropriate guideline of antibiotic prophylaxis after elective colorectal surgery.