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1.
Antimicrob Resist Infect Control ; 10(1): 170, 2021 12 20.
Article in English | MEDLINE | ID: mdl-34930466

ABSTRACT

A survey of hospitals on three continents was performed to assess their infection control preparedness and measures, and their infection rate in hospital health care workers during the COVID-19 pandemic. All surveyed hospitals used similar PPE but differences in preparedness, PPE shortages, and infection rates were reported.


Subject(s)
COVID-19/epidemiology , Infection Control/methods , Personnel, Hospital/statistics & numerical data , Hospitals , Humans , Internationality , Pandemics , Personal Protective Equipment , Surveys and Questionnaires
2.
Clin Ther ; 33(9): 1308-20, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21872931

ABSTRACT

BACKGROUND: Nevirapine (NVP) is a widely used non-nucleoside reverse transcriptase inhibitor. A once-daily extended-release (XR) formulation would potentially increase adherence and thus efficacy. OBJECTIVE: The aim of this study was to investigate the steady-state bioavailability of 2 once-daily tablet formulations of NVP XR (containing 25% or 20% hypromellose; NVP XR25 and NVP XR20, respectively) in 400- or 300-mg tablets compared with twice-daily immediate-release (IR) NVP 200-mg tablets. METHODS: This Phase Ib multinational, multicenter, open-label trial was conducted in patients aged 18 to 60 years, infected with HIV-1 (viral load, ≤50 copies/mL), and treated for ≥12 weeks with twice-daily NVP IR 200 mg. Patients were switched to NVP XR25 400 or 300 mg or NVP XR20 400 or 300 mg for 19 days. Plasma samples were collected over 24-hour periods at steady state. Primary end points were AUC(0-24,ss), C(max,ss), and C(min,ss), analyzed using an ANOVA statistical model on the logarithmic scale and 2-sided 90% CI. Sample size was determined assuming an intrasubject %CV of 20% for C(max). Adverse events (AEs) and viral loads were monitored. RESULTS: Ninety-two patients were enrolled (NVP XR25 400 mg, 24 patients; NVP XR20 400 mg, 24; NVP XR25 300 mg, 21; NVP XR20 300 mg, 23). Compared with NVP IR, the AUC(0-24,ss) values of the NVP XR formulations were lower (test/reference ratios: 79.5% [90% CI, 73.0-86.7; P = 0.544], 71.0% [90% CI, 63.3-79.7; P = 0.956], 90.3% [90% CI, 80.4-101.4; P = 0.044], and 83.7% [90% CI, 77.9-89.9; P = 0.148] with NVP XR25 400 mg, NVP XR20 400 mg, NVP XR25 300 mg, and NVP XR20 300 mg, respectively). The relative bioavailability of NVP XR25 was greater compared with that of NVP XR20. C(max,ss) values were lower with all NVP XR formulations compared with NVP IR. For C(min,ss), NVP XR25 400 and 300 mg were not significantly different from NVP IR, with 90% CIs within the range of 80% to 125% (P = 0.039 and P = 0.017, respectively). All AEs were mild or moderate, with no significant differences between treatment groups. No virologic failures (viral load, >50 copies/mL over 2 consecutive readings) were observed. CONCLUSIONS: Extent of bioavailability was lower and t(max,ss) was delayed with all NVP XR formulations compared with NVP IR. The bioavailability of the NVP XR25 formulations was greater than that of the NVP XR20 formulations. C(min,ss) with NVP XR25 was similar to that with NVP IR. All of the NVP XR formulations were well tolerated. The 400-mg NVP XR25 formulation was selected for further development.


Subject(s)
Anti-HIV Agents/pharmacokinetics , Food-Drug Interactions , HIV Infections/drug therapy , HIV-1/isolation & purification , Nevirapine/pharmacokinetics , Administration, Oral , Adolescent , Adult , Anti-HIV Agents/administration & dosage , Anti-HIV Agents/blood , Anti-HIV Agents/therapeutic use , Biological Availability , Delayed-Action Preparations , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , HIV Infections/blood , HIV Infections/virology , Humans , Male , Medication Adherence , Middle Aged , Nevirapine/administration & dosage , Nevirapine/blood , Nevirapine/therapeutic use , Young Adult
3.
BMC Infect Dis ; 11: 98, 2011 Apr 19.
Article in English | MEDLINE | ID: mdl-21504595

ABSTRACT

BACKGROUND: Data on combination antiretroviral therapy (cART) in remote rural African regions is increasing. METHODS: We assessed prospectively initial cART in HIV-infected adults treated from 2005 to 2008 at St. Francis Designated District Hospital, Ifakara, Tanzania. Adherence was assisted by personal adherence supporters. We estimated risk factors of death or loss to follow-up by Cox regression during the first 12 months of cART. RESULTS: Overall, 1,463 individuals initiated cART, which was nevirapine-based in 84.6%. The median age was 40 years (IQR 34-47), 35.4% were males, 7.6% had proven tuberculosis. Median CD4 cell count was 131 cells/µl and 24.8% had WHO stage 4. Median CD4 cell count increased by 61 and 130 cells/µl after 6 and 12 months, respectively. 215 (14.7%) patients modified their treatment, mostly due to toxicity (56%), in particular polyneuropathy and anemia. Overall, 129 patients died (8.8%) and 189 (12.9%) were lost to follow-up. In a multivariate analysis, low CD4 cells at starting cART were associated with poorer survival and loss to follow-up (HR 1.77, 95% CI 1.15-2.75, p=0.009; for CD4<50 compared to >100 cells/µl). Higher weight was strongly associated with better survival (HR 0.63, 95% CI 0.51-0.76, p<0.001 per 10 kg increase). CONCLUSIONS: cART initiation at higher CD4 cell counts and better general health condition reduces HIV related mortality in a rural African setting. Efforts must be made to promote earlier HIV diagnosis to start cART timely. More research is needed to evaluate effective strategies to follow cART at a peripheral level with limited technical possibilities.


Subject(s)
Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , HIV Infections/immunology , Adult , CD4 Lymphocyte Count , Female , Follow-Up Studies , HIV Infections/epidemiology , HIV Infections/mortality , Health Status , Humans , Lost to Follow-Up , Male , Middle Aged , Nevirapine/therapeutic use , Prospective Studies , Rural Health/statistics & numerical data , Tanzania/epidemiology
4.
AIDS ; 24(14): 2287-9, 2010 Sep 10.
Article in English | MEDLINE | ID: mdl-20625265

ABSTRACT

In a prospective influenza-vaccination trial we show that HIV-infected individuals with CD4 T-cell counts less than 350 microl were distinct from HIV-infected individuals with more than 350 CD4 T-cell counts/microl, and from HIV-negative individuals, in that an influenza-specific immunoglobulin M-response was absent and expansion of interferon-gamma-secreting CD4 T cells was impaired. By contrast, immunoglobulin G-responses were induced in all study groups. These data suggest that establishing broad influenza-specific (immunoglobulin G) B-cell memory prior to severe immunodeficiency is important.


Subject(s)
Antibodies, Viral/immunology , HIV Infections/immunology , HIV-1/immunology , Influenza Vaccines/immunology , Influenza, Human/prevention & control , CD4 Lymphocyte Count , HIV Infections/complications , Humans , Influenza, Human/immunology
5.
Int J Dermatol ; 49(1): 83-6, 2010 Jan.
Article in English | MEDLINE | ID: mdl-20465620

ABSTRACT

Papular pruritic eruption (PPE) is a frequent HIV-comorbidity in tropical countries. Because of constant itching and social stigma, effective treatment is highly valued. In our HIV cohort in rural Tanzania with 12% prevalence of PPE, we have retrospectively analyzed responses to available treatments. Oral promethazine improved itching (P < 0.0058) and clinical scores (P < 0.032) significantly more than topical steroids. Disease activity did not correlate with CD4+ and CD8+ T cell counts and was independent of anti-retroviral medication. Therefore, oral antihistamines are an effective first-line treatment for PPE.


Subject(s)
Exanthema/drug therapy , HIV Infections/complications , Histamine Antagonists/administration & dosage , Pruritus/drug therapy , Steroids/administration & dosage , Administration, Oral , Administration, Topical , Antiretroviral Therapy, Highly Active , CD4-CD8 Ratio , Exanthema/pathology , Exanthema/virology , HIV Infections/drug therapy , HIV Infections/immunology , Histamine H1 Antagonists/administration & dosage , Humans , Promethazine/administration & dosage , Pruritus/pathology , Pruritus/virology , Retrospective Studies , Surveys and Questionnaires , Tanzania , Treatment Outcome
6.
Trop Med Int Health ; 15(5): 567-73, 2010 May.
Article in English | MEDLINE | ID: mdl-20345555

ABSTRACT

OBJECTIVE: To evaluate the impact of a national HIV voluntary counselling and testing (VCT) campaign on presentation to HIV care in a rural population in Tanzania. METHODS: Retrospective analysis of data of the VCT and of the National AIDS Control Programme registers of the St. Francis Designated District Hospital at Ifakara for the two 6-month periods before (2007) and after (2008) the National VCT Campaign. RESULTS: There were 4354 individuals presenting at St. Francis Hospital tested for HIV; 2065 (47.4%) before the VCT Campaign and 2289 (52.6%) afterwards. The overall HIV test positivity was 24.6% and higher in 2007 than in 2008 (26%vs. 23%, P = 0.034). This rate was much higher than the Tanzanian National HIV prevalence of 5.7%. Of 1069 individuals who tested HIV-positive, the proportion of married, divorced or widowed individuals and those who lived further than 10 km from the hospital increased from 2007 to 2008. In 356 HIV-infected persons with available data, the median CD4 cell count increased from 137 to 163 cells/mm(3) (P = 0.058), while the WHO clinical stage was similar in both periods. Enrolling into the National AIDS Control Programme was significantly more common in 2008 (42%vs. 30%, P < 0.001). In a multivariate analysis, the only positive predictor of testing HIV positive when presenting for care after the National VCT Campaign was being married (OR 1.61, 95%CI 1.21-2.15, P = 0.001) or divorced/widowed compared to single (OR 4.58, 95% CI 3.00-8.12, P < 0.001). CONCLUSIONS: Our results suggest that the National VCT Campaign raised awareness and readiness to test for HIV in a remote rural setting and that the HIV-positive test rate is much higher in conjunction with a specific HIV care programme.


Subject(s)
Counseling/statistics & numerical data , HIV Infections/diagnosis , Patient Acceptance of Health Care/statistics & numerical data , Rural Health Services/statistics & numerical data , Voluntary Programs/statistics & numerical data , Adolescent , Adult , Child , Child, Preschool , Developing Countries/statistics & numerical data , Female , HIV Infections/epidemiology , HIV Infections/psychology , Health Knowledge, Attitudes, Practice , Hospitals, Rural , Humans , Male , Multivariate Analysis , Retrospective Studies , Rural Health , Socioeconomic Factors , Tanzania/epidemiology , Young Adult
7.
Clin Infect Dis ; 48(5): 659-66, 2009 Mar 01.
Article in English | MEDLINE | ID: mdl-19191654

ABSTRACT

BACKGROUND: Yellow fever vaccine (17DV) has been investigated incompletely in human immunodeficiency virus (HIV)-infected patients, and adequate immunogenicity and safety are of concern in this population. METHODS: In the Swiss HIV Cohort Study, we identified 102 patients who received 17DV while they were HIV infected. We analyzed neutralization titers (NTs) after 17DV administration using the plaque reduction neutralization test. NTs of 1:>or=10 were defined as reactive, and those of 1:<10 were defined as nonreactive, which was considered to be nonprotective. The results were compared with data for HIV-uninfected individuals. Serious adverse events were defined as hospitalization or death within 6 weeks after receipt of 17DV. RESULTS: At the time of 17DV administration, the median CD4 cell count was 537 cells/mm(3) (range, 11-1730 cells/mm(3)), and the HIV RNA level was undetectable in 41 of 102 HIV-infected patients. During the first year after vaccination, fewer HIV-infected patients (65 [83%] of 78; P = .01) than HIV-uninfected patients revealed reactive NTs, and their NTs were significantly lower (P < .001) than in HIV-uninfected individuals. Eleven patients with initially reactive NTs lost these reactive NTs

Subject(s)
HIV Infections/immunology , Yellow Fever Vaccine/adverse effects , Yellow Fever Vaccine/immunology , Yellow Fever/prevention & control , Adult , Antibodies, Viral/blood , CD4 Lymphocyte Count , Cohort Studies , Female , Humans , Male , Neutralization Tests , RNA, Viral/blood , Switzerland , Viral Load , Viral Plaque Assay , Yellow Fever/immunology
8.
AIDS ; 22(6): 701-5, 2008 Mar 30.
Article in English | MEDLINE | ID: mdl-18356599

ABSTRACT

OBJECTIVE: To assess the incidence and epidemiological pattern of respiratory viruses in HIV-infected patients and to evaluate their potential clinical impact. DESIGN AND METHODS: A prospective population-based cohort study was conducted at three Swiss university hospitals. Study participants were HIV-infected patients who underwent a bronchoalveolar lavage to rule out an opportunistic event. All bronchoalveolar lavage specimens were screened using a set of real-time reverse transcriptase-polymerase chain reaction assays targeting 17 different respiratory viruses. RESULTS: Between November 2003 and November 2006, 59 bronchoalveolar episodes from 55 HIV-infected patients were analysed. Eleven of 59 episodes (18.6%) were positive for at least one respiratory virus. Coronavirus OC43 was identified in three cases (27.3%) followed by influenza A in two (18.2%). Parainfluenza virus (PIV) 2, PIV 3, PIV 4, bocavirus, human rhinovirus A and human metapneumovirus were each identified in one case (9%). In the majority of these cases (63.6%) no other concomitant microorganism was isolated. CONCLUSIONS: Clinical investigation of respiratory viral infections in HIV-infected patients should not be restricted to prototype viruses and also need to target all the different family of viruses as it seems likely that these viruses contribute to pulmonary complications and morbidity in this population.


Subject(s)
HIV Infections/complications , Opportunistic Infections/virology , RNA, Messenger/analysis , Respiratory Tract Infections/virology , Virus Diseases/virology , Viruses/genetics , Adult , Aged , Bocavirus/genetics , Bronchoalveolar Lavage Fluid/virology , Coronavirus OC43, Human/genetics , Female , Humans , Male , Metapneumovirus/genetics , Middle Aged , Parainfluenza Virus 2, Human/genetics , Parainfluenza Virus 3, Human/genetics , Parainfluenza Virus 4, Human/genetics , Prospective Studies , Rhinovirus/genetics , Switzerland
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