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Pretreatment HIV-1 drug resistance in Argentina: results from a surveillance study performed according to WHO-proposed new methodology in 2014-15.
Journal of Antimicrobial Chemotherapy. 2017 Feb; 72(2):504-510.BACKGROUND: In Argentina, current national guidelines recommend starting with NNRTI-based regimens. Recently, there have been some local reports regarding concerning levels of NNRTI-transmitted resistance, but surveillance has never been carried out at a national level. OBJECTIVES: To determine the prevalence of HIV drug resistance in people starting ART in Argentina using a WHO-proposed methodology. METHODS: This was a cross-sectional, nationally representative study. Twenty-five antiretroviral-dispensing sites throughout the country were randomly chosen to enrol at least 330 persons starting ART, to generate a point prevalence estimate of resistance-associated mutations (RAMs) with a 5% CI (for the total population and for those without antiretroviral exposure). All consecutive patients older than 18 years starting or restarting ART in the chosen clinics were eligible. Samples were processed with Trugene and analysed using the Stanford algorithm. RESULTS: Between August 2014 and March 2015, we obtained 330 samples from people starting ART. The mean +/- SD age was 35 +/- 11 years, 63.4% were male, 16.6% had prior antiretroviral exposure and the median (IQR) CD4 count was 275 cells/mm3 (106-461). The prevalence of RAMs found was 14% (+/-4%) for the whole population (3% NRTI-RAMs; 11% NNRTI-RAMs and 2% PI-RAMs) and 13% (+/-4%) for those without prior antiretroviral exposure (3%, 10% and 2%, respectively). The most common mutation was K103N. CONCLUSIONS: This surveillance study showed concerning levels of HIV drug resistance in Argentina, especially to NNRTIs. Due to this finding, Argentina's Ministry of Health guidelines will change, recommending performing a resistance test for everyone before starting ART. If this is taken up properly, it also might function as a continuing surveillance tool. (c) The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: email@example.com.
Clinics In Perinatology. 2010 Dec; 37(4):765-76, viii.The World Health Organization's Strategic Approaches to the Prevention of HIV Infection in Infants includes 4 components: primary prevention of HIV-1 infection; prevention of unintended pregnancies among HIV-1-infected women; prevention of transmission of HIV-1 infection from mothers to children; and provision of ongoing support, care, and treatment to HIV-1-infected women and their families. This review focuses on antiretrovirals for secondary prevention of HIV-1 infection-prevention of HIV-1 transmission from an HIV-1-infected woman to her child. Antiretroviral strategies to prevent the mother-to-child transmission of HIV-1 in nonbreastfeeding populations comprise antiretroviral treatment of HIV-1-infected pregnant women needing antiretrovirals for their own health, antiretroviral prophylaxis for HIV-1-infected pregnant women not yet meeting criteria for treatment, and antiretroviral prophylaxis for infants of HIV-1-infected mothers. The review primarily addresses antiretroviral strategies for nonbreastfeeding, HIV-1-infected women and their infants in resource-rich settings, such as the United States. Antiretroviral strategies to prevent antepartum, intrapartum, and early postnatal transmission in resource-poor settings are also addressed, albeit more briefly. Copyright (c) 2010 Elsevier Inc. All rights reserved.
Turning gender and HIV commitments into action for results: an update on United Nations interagency activities on women, girls, gender equality and HIV.
[Geneva, Switzerland], UNAIDS, 2009 Dec. 4 p.In September 2000, 189 UN Member States committed to achieving the Millennium Development Goals (MDGs) by 2015. Among these goals is a commitment to promoting gender equality and empowering women and combating HIV, malaria, and other diseases. Today, almost 10 years on, addressing gender inequality and AIDS remains the most significant challenge to achieving the MDGs, as well as broader health, human rights, and development goals. This update highlights key 2009 interagency initiatives, all of which operate at the intersection of gender equality, women's empowerment, and HIV.
Journal of Health Care Finance. 2010; 36(4):75-79.When the United Nations declared "health care for all" (at the conferences at Alma-Ata in 1978 and the Ottawa Charter in 1986),(1) the declarations were largely premature to impact the upcoming HIV/AIDS epidemic. These UN declarations still apply today, as multitudes of humanity continue to die from what amounts now to be a treatable chronic disease. Can the wealthier, industrialized countries stand by and watch the decimation of the populations of the developing world by HIV / AIDS? The global "health 9/10 gap," relates that only 10 percent of global heath resources go to developing countries - i.e., those having 90 percent of the poorest world populations. (2) The World Bank/World Health Organization has been at the forefront of providing resources for the global HIV/AIDS epidemic, (3) but for many countries of the developing world (especially Sub-Saharan Africa) it may be too little, too late. This work explores the application of an ecological model to global policy against HIV/AIDS, highlighting access to antiretroviral drugs (ARV). ARV distribution is constrained by patents and laws protecting the intellectual property rights of the international pharmaceutical corporations. In response to this situation, more questions arise. Will governments in the developing world invoke compulsory licensing (patent-breaking) in their negotiations with the international pharmaceutical corporations to provide medications against HIV/AIDS in their countries? Can international political and financial negotiations with these pharmaceutical corporations speed the growing push for a solution to this solvable crisis? The answers may lie in the "Brazilian model," that is a developing world government using all means available to provide ARV drugs for all its citizens with HIV/AIDS. The basis of this model includes negotiating with the pharmaceutical corporations over patent rights and importation of copied drugs from the Far East.
The sexual and reproductive health of young people in Latin America: Evidence from WHO case studies.
Salud Publica de Mexico. 2008 Jan-Feb; 50(1):10-16.This original article addresses the sexual and reproductive health needs of young people aged 15 to 24 in Latin America. It introduces five articles from original research projects in three countries: Argentina, Brazil, and Peru. These projects were funded by the World Health Organization. This article explains the importance of studies that address the sexual and reproductive health of young people in developing countries. It provides an overview of sexual and reproductive health issues in Latin America and a discussion these issues in the three study countries. The five articles deal with difficult and challenging issues, including: knowledge of STIs and HIV/ AIDS; pregnancy related practices; quality of care; the role of young men in couple formation, pregnancy and adoption of contraceptive practice; and, the role of obstetricians and gynecologists in public policy debate about family planning and abortion. The four articles in this special section help to improve our understanding of the factors that contribute to risky sexual behavior and negative reproductive health outcomes among youth in Latin America. The findings are useful to help inform and improve health care interventions in various contexts. (author's)
In: The HIV challenge to education: a collection of essays, edited by Carol Coombe. Paris, France, UNESCO, International Institute for Educational Planning, 2004. 253-263. (Education in the Context of HIV / AIDS)Twenty years after the identification of AIDS, some 60 million people have been infected by HIV, a number corresponding to the entire population of France, the United Kingdom or Thailand. Those who have died equal the population of Norway, Sweden, Finland and Denmark combined. Those currently infected - more than 40 million - number more than the entire population of Canada. The number of children thought to be orphaned by HIV/AIDS - some 14 million - is already more than the total population of Ecuador. Over the coming decade their numbers may rise to a staggering 50 million worldwide. In other words, the extent of this pandemic is unprecedented in human history. And the worst is yet to come, for many millions more will be infected, many millions more will die, many millions more will be orphaned. On September 11 2001, more than 3,000 people died in the New York bombings. Every day, around the world, HIV infects at least five times that number. But it is not only individuals who are at risk. The social fabric of whole communities, societies and cultures is threatened. The disease is certain to be a scourge throughout our lifetime. (excerpt)
Zhonghua Liu Xing Bing Xue Za Zhi / Chinese Journal of Epidemiology. 1997 Oct; 18(5):309-311.Global HIV infection and AIDS: according to WHO estimates, by mid 1996 there were 7 million cumulative AIDS cases. Today the number of people infected with HIV is even more alarming: roughly 21.8 million, of those 42% are women. By the year 2000 there will be between 40 and 50 million cases. Each day about 8,500 additional people are infected with AIDS; one can say the situation is grim. Currently, the AIDS and HIV epidemic regions are shifting, they have gradually moved from the original sites of North America and West Europe toward the mass populations of developing countries in Asia, Africa, and Latin America. In the Asian region which contains about 60% of the world's population, beginning in 1988, with Thailand and India at the center, an exploding epidemic has taken shape. Recent materials indicate, those infected with HIV in Thailand exceed 700,000, over 2 million in India, and the HIV epidemic has already spread to the near neighbors Burma, southern China, Cambodia, Malaysia and Vietnam. With the accumulation of molecular epidemiology research materials, the complete picture of the causes and characteristics of this massive epidemic happening in the Asian region is gradually becoming clear. (excerpt)
In: State of the art: AIDS and economics, edited by Steven Forsythe. Washington, D.C., Futures Group International, POLICY Project, 2002 Jul. 2-8.Policymakers need a reasonably complete picture of resource flows from sources to uses that finance HIV/AIDS prevention, care, support, and treatment. Without that picture, they risk misallocation, waste, and faulty strategic planning. For now, in most parts of the developing world, the picture remains largely unpainted. Filling in the details on financing is among the key challenges to HIV/AIDS policymakers today. Limited data for Latin American and Caribbean (LAC) region countries offer virtually the only cases of adequate resource flow data outside the United States. Those countries spent a thousand dollars per person living with HIV/AIDS (PLWHA) in 2000. The U.S. federal government’s Medicaid program for indigents spent 35 times as much for each AIDS patient under its care in that same year. Low-income countries, largely dependent on donor assistance, spent far less per person and per PLWHA—as little as 31 cents per person, and eight dollars per PLWHA in sub-Saharan Africa. These enormous disparities underline a dual challenge: First, use what little money is available in poor countries very effectively; and second, demonstrate to all concerned that more resources must be forthcoming to confront the HIV/AIDS pandemic in poor countries, lest the negative effects swamp any effort to develop. (author's)
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 2-4. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)The 2003 Expert Working Group made several changes to the MEC to indicate that women often can safely use IUDs in conditions related to HIV and other sexually transmitted infections (STIs). Taken together, these changes should help reduce some providers’ concerns about offering IUDs in areas where HIV infection and other STIs are common. At the meeting the WHO Expert Working Group concluded that a woman generally can start using an IUD, if she wishes, even if she has AIDS—provided she is receiving ARV therapy and is clinically well—or if she has HIV infection or she is at high risk of HIV infection. The Expert Working Group changed these conditions from category 3 to category 2 for starting IUD use. According to the bulk of research considered at the WHO meeting, IUD use does not increase a woman’s chances of acquiring HIV infection. Women generally can keep their IUDs if they become infected with HIV or develop AIDS while using IUDs (category 2), although IUD users with AIDS should be carefully monitored for pelvic infection. Limited evidence shows that complications of IUD use are no more common among IUD users infected with HIV than among IUD users who are not infected with HIV. Also, IUD use does not increase HIV transmission to sexual partners. (excerpt)
Boston Globe. 2003 Jun 22;  p..A draft report for the UN's AIDS agency has found that even when people use condoms consistently, the failure rate for protection against HIV is an estimated 10 percent, making them a larger risk than portrayed by many advocate groups. The report, which looked at two decades of scientific literature on condoms, is likely to add fuel to a heated political battle on US policy in fighting AIDS in the developing world. (excerpt)
MEMORIAS DO INSTITUTO OSWALDO CRUZ. 1996 May-Jun; 91(3):335-8.The World Health Organization (WHO) Global Program on AIDS (GPA) organized the WHO Network for HIV-1 Isolation and Characterization to monitor HIV-1 variability. Brazil is one of the HIV vaccine trial sites selected by WHO-GPA. HIV-1 subtypes B, F, and C have thus far been found in the country. A study involving 235 Brazilian isolates found subtype B to prevail in 88.5% of cases, subtype F in 8.9%, and subtype C in 1.7%. 2 samples (0.9%) were variants resulting from a recombination between subtypes B and F. Further studies have found that Brazilian HIV-1 strains have genetic and antigenic differences compared to North American/European prototype strains, potentially affecting the success of immunoprophylactic programs based upon HIV-1 vaccine candidates currently proposed for testing in Brazil. A Brazilian Network for HIV-1 Isolation and Characterization (BNHIC) was thus established in March 1993, as part of the National Program of HIV/AIDS Vaccine Development and Evaluation. The BNHIC was organized upon a 3-tier basis including primary site, central reference laboratory, and secondary laboratories. The authors discuss efforts made to achieve network goals in Brazil.
Issues related to scientific, technical, population, and behavioral preparation in WHO-selected sites.
In: International Symposium on Biomedical Research Issues of HIV Infection in Thailand. Bangkok, Thailand, January 31 - February 2, 1994. Sponsors: Thailand Health Research Institute, Harvard AIDS Institute, Ministry of Public Health of Thailand, Center for Vaccine Development, Mahidol University. Cambridge, Massachusetts, Harvard AIDS Institute, 1994. 23-4.For the past three years, the World Health Organization (WHO) has been working with national authorities and scientists from the four countries which have been identified as appropriate for the establishment of WHO-sponsored sites for HIV vaccine evaluation: Brazil, Rwanda, Thailand, and Uganda. National plans for HIV vaccine development and evaluation have been prepared by the countries and endorsed by the WHO. The plans detail the national policy and nationally acceptable guidelines for the approval and initiation of HIV vaccine-related activities. They provide specific recommendations for the selection of participating institutions, for interactions with other national and international AIDS research programs, for infrastructure strengthening, and for training and specific research activities. In preparation for phase III vaccine efficacy trials, the following priority research areas have been identified: virologic, clinical, epidemiologic, and sociobehavioral research. Research in these areas is discussed. It is also important to develop a comprehensive public information strategy to help maintain community support and political commitment. Finally, trials must be conducted with only the highest ethical standards.