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Background: Nirmatrelvir/ritonavir (NMV/r), a preferred antiviral for high-risk outpatients with COVID-19, is associated with major drug-drug interactions (DDIs). Given the lack of DDI data with short course ritonavir (RTV), initial NMV/r product information was extrapolated from chronic, full dose RTV use. In Jan 2022, DDI experts from the University of Liverpool (UoL), NIH COVID-19 Guidelines Panel, and Ontario Science Table (OST) contributors established a global collaboration to address DDI challenges limiting NMV/r use in real-life settings. We report how safe, pragmatic, and consistent resources were developed to support NMV/r prescribing, and the utilization of these resources globally. Method(s): The 3 teams met monthly to discuss DDIs, review NMV/r DDI literature, and achieve consensus on recommendations. Additional experts were invited as needed. Metrics from the UoL DDI checker guided review of most searched DDIs overall and by severity. 2022 usage metrics for each DDI guide were collected. Differences in recommendations between initial DDI guides and product information were compared. Result(s): In 2022, 12 meetings were convened. Each team's DDI guide was revised and expanded (Table 1). To factor in the lower RTV dose and shorter treatment duration, some recommendations differed from product information. Drug categories that required the most discussion and revision included: anticoagulants (ACs), immunosuppressants, calcium channel blockers. NMV/r accounted for 85% of queries on the UoL site. NMV/r DDI guidance was the most viewed page of the NIH guidelines and among the OST ID/clinical care Science Briefs. Top searched drugs on the UoL site with serious DDIs were certain ACs and statins. Utilization of DDI guides was not limited to in-country resources: 51% and 7% of UoL queries came from the USA and Canada, respectively. NIH users followed links to the UoL and OST sites 161,478 and 37,619 times, respectively. Conclusion(s): Significant efforts have been made by the 3 teams to provide upto-date, complementary DDI guidance. Usage metrics confirm the demand for DDI guidance during the pandemic. Cross-utilization of the DDI guides confirms the need for consistency. DDI recommendations were more permissive than initial product information, expanding clinicians' ability to prescribe NMV/r. DDI guidance for ACs and immunosuppressants was particularly challenging. During drug development, complex interactions likely to be encountered in target populations should be addressed.
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This article studies the practices of meditation and generosity among Chinese Buddhists in zozo during the COVID-19 outbreak to provide insight into the interplay of religion, faith, well-being, and the pandemic more broadly, as well as to understand the specific ways in which Chinese Buddhists may draw on their faith to combat the ill effects of the pandemic. In particular, we trace the experience of Chinese Buddhists in mainland China, Taiwan, the United States, and other countries, identifying two popular Buddhist practices: meditation and generosity. We study their motivation for those practices, and the different ways Buddhist sites have sought to remain active in offering services to followers. We explore the role of faith in nurturing resiliency in the Chinese Buddhist community and conclude with specific recommendations for the prosperity of Chinese Buddhism during a pandemic and for leveraging specific tenets of the faith to reduce pandemic risks.
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Background: In sub-Saharan Africa many persons who inject drugs (PWID) are living with undiagnosed or untreated HIV and experience high levels of poverty, housing instability, and co morbid conditions that contribute to worse outcomes from SARS-CoV-2. We sought to determine SARS-CoV-2 antibody prevalence and risk factors for PWID and their sexual and injecting partners in Kenya. Identifying the burden of infection in marginalized populations like PWID may contribute to controlling the pandemic in LMIC Methods: In a nested cross-sectional study, we recruited PWID living with HIV and their injecting and/or sexual partners in Nairobi, Kilifi, and Mombasa counties at needle and syringe programs (NSP). Blood samples were collected from consenting participants at enrollment to determine SARS-CoV-2 antibodies using a Platellia BioRad SARS-CoV-2 total antibody enzyme-linked immunosorbent assay. Baseline data was collected on HIV status, antiretroviral therapy (ART) and methadone adherence. Logistic regression was used to identify factors associated with antibody positivity Results: In total,1000 participants were enrolled in the study between April and July 2021, of whom 323 (32.3%) were women and 677 (67.7%) were men. Median age of participants was 36 years (Interquartile range [IQR]: 30, 42). SARS-CoV-2 positivity was reported in 309 (30.9%) of the participants. Of the participants who tested positive for SARS-CoV-2 antibodies, 39.5% did not report any symptoms at any time during the last 3 months. Men were significantly less likely than women to have SARS-CoV-2 antibodies (Odds ratio [OR] 0.70, 95% confidence interval [CI] 0.52, 0.94;p<0.016). Participants from the Coast region had lower odds of SARS-CoV-2 antibody positivity compared to the Nairobi region (OR 0.72, 95% CI, 0.54, 0.95;p<0.019) and participants who had a sexual or injecting partner diagnosed with COVID-19 were more likely to have SARS-CoV-2 antibodies detected (OR 2.12, 95% CI 1.02, 4.39;p<0.042). Living with HIV was not significantly associated with presence of SARS-CoV-2 antibodies Conclusion: SARS-CoV-2 antibody was detected in 30.9% of participants in this cohort of PWID and their partners, suggesting high transmission rates within this key population. SARS-CoV-2 seroprevalence was similar for people living with and without HIV;no increase in risk was found for those living with HIV. This cohort represents an at-risk population that should be considered for COVID-19 vaccination, surveillance and other targeted public health measures.
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Background: Therapies for managing COVID-19 disease may interact with other drugs, particularly in hospitalized patients with comorbidities. Objectives: Characterize the prevalence of drug-drug interactions (DDIs) between investigational/approved medications for managing COVID-19 (COVID-meds) and co-medications (co-meds) in hospitalized COVID-19 patients. Methods: Multicentre retrospective observational study of hospitalized COVID-19 patients screened for the CATCO trial between 1-Apr-20 and 15-Sep-20. Patients' co-meds were assessed for potential DDIs with the following COVID-meds: hydroxychloroquine (HQ), lopinavir/ritonavir (LPV), remdesivir (REM), dexamethasone (DEX), azithromycin (AZ), interferon beta-1B (IFN) and tocilizumab (TOC). The Liverpool-COVID DDI website and Lexicomp were used to identify and characterize DDI severity (red: do not co-administer, amber: potential interaction) and potential clinical impact. QT prolongation risk was assessed with the Tisdale risk score. The primary outcome was the prevalence of subjects with =1 potential clinically significant (red/amber) DDI between each COVID-med and co-med. Secondary outcomes included DDI severity and potential clinical impact. Descriptive statistics are presented as medians (range) or proportions. Results: Data from 51 patients are available: 61% male, age 74 (44-95) years, 6 (1-15) comorbidities, Tisdale risk score 6 (31.4% moderate risk, 11.8% high risk) and 10 (0-19) co-meds. LPV had the highest rate of potential DDIs (92.2%, 45% red, 3 DDIs per patient) with risk of increased co-med toxicity (most commonly psychotropics, anticoagulants/antiplatelets), while REM and IFN had the least (2% and 9.6%, respectively). Most patients (75%) had =1 DEX DDI (mostly amber, 1per patient) with risk of increased co-med toxicity. The most common DDIs with HQ and AZ involved increased risk of QTc prolongation. Over one-third (35%) of patients were deemed ineligible for CATCO at screening due to DDIs with LPV. Conclusions: Hospitalized COVID-19 patients are at high risk of DDIs with many investigational/approved COVID medications. Routine DDI screening is recommended, ideally using both general and COVID-specific DDI resources.