scholarly journals Treatment durability and virological response in treatment-experienced HIV-positive patients on an integrase inhibitor-based regimen: an Australian cohort study

Sexual Health ◽  
2016 ◽  
Vol 13 (4) ◽  
pp. 335 ◽  
Author(s):  
Nicole L. De La Mata ◽  
David A. Cooper ◽  
Darren Russell ◽  
Don Smith ◽  
Ian Woolley ◽  
...  
Keyword(s):  
Reverse Transcriptase ◽  
Viral Suppression ◽  
Treatment Time ◽  
Treatment Options ◽  
Additional Treatment ◽  
Baseline Viral Load ◽  
Patient Treatment ◽  
Hiv Positive ◽  
Second Line ◽  
Treatment Experience

Background: Integrase inhibitors (INSTI) are a newer class of antiretroviral (ARV) drugs that offer additional treatment options for experienced patients. Our aim is to describe treatment durability and virological outcomes in treatment-experienced HIV-positive patients using INSTI-based regimens. Methods: All patients in the Australian HIV Observational Database who had received an INSTI-based regimen ≥ 14 days as well as previous therapy were included in the study. We defined two groups of treatment-experienced patients: (1) those starting a second-line regimen with INSTI; and (2) highly experienced patients, defined as having prior exposure to all three main ARV classes, nucleoside reverse transcriptase inhibitor, nonnucleoside reverse transcriptase inhibitors and protease inhibitors, before commencing INSTI. Survival methods were used to determine time to viral suppression and treatment switch, stratified by patient treatment experience. Covariates of interest included age, gender, hepatitis B and C co-infection, previous antiretroviral treatment time, patient treatment experience and baseline viral load. Results: Time to viral suppression and regimen switching from INSTI initiation was similar for second-line and highly experienced patients. The probability of achieving viral suppression at 6 months was 77.7% for second-line patients and 68.4% for highly experienced patients. There were 60 occurrences of regimen switching away from INSTI observed over 1274.0 person-years, a crude rate of 4.71 (95% CI: 3.66–6.07) per 100 person-years. Patient treatment experience was not a significant factor for regimen switch according to multivariate analysis, adjusting for relevant covariates. Conclusions: We found that INSTI-based regimens were potent and durable in experienced HIV-positive patients receiving treatment outside clinical trials. These results confirm that INSTI-based regimens are a robust treatment option.

scholarly journals Virological Non-Suppression Among HIV-Positive Patients on Antiretroviral Therapy in Northwestern Nigeria: An Eleven-Year Experience of A Tertiary Care Centre, January 2009–December 2019

2021 ◽  
Author(s):  
Suleiman Bello Abdullahi ◽  
Olayinka Ibrahim ◽  
Abdulkadir Okeji ◽  
Yandoma Iliyasu ◽  
Ibrahim Bashir ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Treatment Success ◽  
Tertiary Care ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Second Line ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Cd4 Counts ◽  
Human Immuno Deficiency Virus

Abstract Background: Human Immuno-Deficiency Virus (HIV) remains one of the world’s significant public health challenges. Viral suppression is the key indicator for treatment success in People living with HIV (PLHIV). We determined the level of viral non-suppression and its associated factors among PLHIV attending Federal Medical Centre Katsina (FMC Katsina), Nigeria. Methods: This retrospective descriptive study was conducted on 913 HIV positive adults enrolled in care between January 2009 and December 2019. Information on socio-demographics, clinical, immunological, Viral Load (VL) and other relevant parameters were extracted from the patients’ care Centre Katsina estimated frequencies/proportions, performed bivariate and multivariate analysis to determine factors associated with VL non-suppression using p<0.05 as significant level. Results: Records of 831 registered patients were analyzed using Epi-info 7. During the period, 751 (90.4%) achieved viral suppression, 426 (51.3%) had CD4 counts of ≥500 and 477 (57.4%) were on HAART for ≥5 years. Majority, 793 (95.4%) were on first-line and 809 (97.4%) in the non-advanced stage (WHO stages 1 and 2). The independent predictors of viral non-suppression included being on the second line HAART [Adjusted OR (AOR) 6.5; 95% CI 3.02-13.89], being employed [AOR 0.26; 95% CI 0.15-0.44] and baseline CD4 count less than 500 [AOR 0.35; 95% CI 0.21-0.61]. Conclusions: Our study demonstrated a good viral suppression among PLHIV on HAART. Low baseline CD4 counts and being on second-line HAART are predictive of viral non-suppression while being unemployed seems to be protective against viral non-suppression.

scholarly journals Evaluation of Autoclaving CAT: A Infectious Substance Packaging during the Ebola Crisis in the United States

2020 ◽  
Vol 41 (S1) ◽  
pp. s443-s444
Author(s):  
Edward Krisiunas ◽  
Gina Vallone-Hood ◽  
Alan Woodard ◽  
Neil Norrell
Keyword(s):  
United States ◽  
New York ◽  
Color Change ◽  
Treatment Options ◽  
Hold Time ◽  
Biological Indicators ◽  
The United States ◽  
Additional Treatment ◽  
Patient Treatment ◽  
Future Health

Background: During the 2014 US Ebola crisis, an unprecedented amount of biohazardous waste was generated during patient care; healthcare facilities were overwhelmed by large volumes of waste. Few facilities had on-site waste treatment; therefore, waste was packaged and sent off site for incineration and disposal in Port Arthur, Texas, at a significant cost. Shipping this waste off site required the use of the US Department of Transportation (USDOT) Hazardous Materials (HMR 49 CFR) category A triple packaging for infectious substances. The most common treatment method for biohazardous waste in the United States is via commercial autoclaves. Because Category A waste packaging had not been tested to ensure effective treatment, we conducted autoclave efficacy studies to evaluate the various types of Category A packaging containing surrogate Ebola waste. If successful, this would potentially provide additional treatment options in the United States. Methods: Testing was conducted at commercial locations in 3 states: New York, Pennsylvania, and Florida. Various types of Category A packaging were obtained (Fig. 1). Waste loads were comprised of Ebola patient treatment material and included personal protective equipment, sharps containers, suction canisters, drapes, and associated items. Configured packaging was placed into autoclave bins to be processed. Each package tested included a biological indicator, a class 5 integrator. Where possible, thermocouples were added to record the thermoprofile of the waste. Initially, a modified cycle was tested (a prevacuum cycle followed by exposure to steam at 138°C for 60 minutes) and a postvacuum cycle. Cycle times were adjusted based upon initial results. Results: The initial New York autoclave was tested from a cold start (no vessel preheating) resulting in a failure to obtain efficacy (Fig. 1). Successful results were no growth in recovered biological indicators, acceptable color change in integrators, and reaching and holding temperatures >121°C for 30 minutes. After making modifications to treatment cycles, which included preheating of vessels, multiple prevacuum steps and a hold time of 60 minutes, successful results were achieved in testing conducted at the treatment plants in Pennsylvania and Florida. Conclusions: Commercial autoclaves can be effective in treating Category A biohazardous waste. Each autoclave considered for treatment requires a validation process using the types of packaging containing the waste, biological indicators, integrators, and thermocouples to present a complete assessment of the treatment process.Funding: Three companies provided support for this study: Approved Storage & Waste Hauling, Daniels International, and ProMed Solutions.Disclosures: Edward Krisiunas reports contracted research for Future Health Care Systems, Daniels Sharpsmart, and ProMed Solutions.

Treatment patterns and economic burden of illness in patients with advanced bladder cancer receiving second-line therapy.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 320-320 ◽  
Author(s):  
Sumati Rao ◽  
Kyna McCullough Gooden ◽  
Pamela Landsman-Blumberg ◽  
Binglin Yue ◽  
Maria L. Lankford ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Real World ◽  
Burden Of Illness ◽  
Treatment Options ◽  
Objective Response ◽  
Medical Costs ◽  
Treatment Patterns ◽  
Additional Treatment ◽  
Second Line ◽  
Outpatient Services

320 Background: Second-line chemotherapies (SLCT) for bladder cancer (BC) are high in toxicity and yield low objective response rates resulting in low overall survival (OS). BC in general is an expensive malignancy to treat, but real-world SLCT treatment patterns and the associated burden of illness are absent from the published literature. The objective of this study was to describe chemotherapy regimens and evaluate the clinical and economic burdens of advanced BC in the second-line setting. Methods: Patients aged ≥18 years with newly diagnosed stage 3 or 4 BC (4/2011–9/2014) were identified from the Truven Health MarketScan Databases. Patients were continuously enrolled in health benefits 12 months before advanced diagnosis date through death, end of enrollment, or end of study period (12/2014) with no pre-diagnosis evidence of other primary cancers, HIV, or pregnancy. SLCT regimens, time on therapy, OS, and BC-specific resource use and costs were computed using the Kaplan-Meier sampling average method with bootstrap and reported from SLCT initiation to the end of available follow-up. Results: A total of 475 patients with advanced BC received SLCT (Table). Their median age was 64.0 years, 76% were male, and median duration of SLCT was 56 days. The median OS was 7.8 months from SLCT initiation and 15.8 months from the date of advanced diagnosis. Mean per-patient BC-specific medical costs from SLCT initiation were $54,226 (95% CI, $41,878–$63,055), of which 44% was attributable to chemotherapy and related services. Inpatient stays (35%) and other outpatient services (33%) were the other major contributors to medical costs. Conclusions: This is the first known study evaluating real-world advanced BC treatment patterns and costs in a nation-wide cohort of SLCT recipients.Immunotherapeutic agents recently approved and in development provide oncologists with additional treatment options for these patients. [Table: see text]

Antiretroviral Treatment-Associated Labia Majora Lipohypertrophy: A Rare Case and Plastic Surgical Treatment Options

2017 ◽  
Vol 2 (1) ◽  
pp. 43
Author(s):  
Akmal Hisham ◽  
Devananthan Ilenghoven ◽  
Wan Syazli Wan Ahmad Kamal ◽  
Salina Ibrahim ◽  
Shah Jumaat Mohd Yussof
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Daily Living ◽  
Treatment Options ◽  
Hiv Positive ◽  
Highly Active ◽  
Labia Majora ◽  
The Face ◽  
Central Fat

The emergence of highly active antiretroviral therapy (HAART) has revolutionized the prognosis of HIV-infected patients. However, the extended use of HAART is associated with a disfiguring complication termed lipodystrophy, a disorder of body fat maldistribution causing peripheral fat loss (lipoatrophy) and central fat accumulation (lipohypertrophy). Lipoatrophy commonly affects the face, legs, buttocks and arm, whilst lipohypertrophy frequently favours the abdomen, breast and dorsocervical region. To our knowledge, we present only the second documented case in the literature of a labia majora lipohypertrophy in a HIV-positive patient receiving long-term HAART. The severity of labial abnormality caused significant physical and functional morbidities. Labiaplasty with dermolipectomy of the labia majora and excisional lipectomy of the mons pubis was successfully performed. At a 6-month follow-up, patient had no recurrence with resolution of symptoms and resumption of normal activities of daily living (ADL).

An Effective Patient Treatment Plan Recommendation with Predicted Treatment Time Using Hadoop

2017 ◽  
Vol 5 (8) ◽  
pp. 155-158
Author(s):  
A. Haripriya ◽  
A.P. Siva Kumar
Keyword(s):  
Treatment Time ◽  
Treatment Plan ◽  
Patient Treatment

Conventional versus Mindfulness-based Interventions for Anxiety and Worry: A Review and Recommendations

2020 ◽  
Vol 16 (1) ◽  
pp. 60-67
Author(s):  
Deah Jo Abbott ◽  
Caleb Wayne Lack
Keyword(s):  
Treatment Options ◽  
Additional Treatment ◽  
Third Wave ◽  
Stage Model ◽  
Pharmacological Treatments ◽  
The Past ◽  
Behavioral Therapies ◽  
Cognitive Behavioral Therapies ◽  
Specific Disorders ◽  
Psychiatric Problems

Anxiety disorders are among the most prevalent and most functionally impairing psychiatric problems experienced by the population. Both pharmacological and psychological evidencebased treatments exist for a number of specific disorders, but may fail to fully relieve symptoms, pointing to the need for additional treatment options. Often considered to be part of the “third wave” of cognitive-behavioral therapies, treatments incorporating mindfulness have emerged in the past two decades as increasingly popular with clinicians and frequently sought out by consumers. The present article reviews the extant literature regarding the efficacy and effectiveness of mindfulnessbased treatments for anxiety, worry, and related problems. Although they have not attained the solid empirical status of CBT or certain pharmacological treatments, the extant research shows mindfulness- based interventions appear to be a promising and useful treatment for people suffering from anxiety and worry. Further work should be done, levels 3-5 of the NIH stage model to determine whether or not they should be further implemented.

scholarly journals Patient profiles as an aim to optimize selection in the second line setting: the role of aflibercept

2021 ◽  
Author(s):  
B. González Astorga ◽  
F. Salvà Ballabrera ◽  
E. Aranda Aguilar ◽  
E. Élez Fernández ◽  
P. García-Alfonso ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Therapeutic Option ◽  
Scientific Evidence ◽  
Treatment Options ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Effective Therapeutic Option ◽  
Line Setting ◽  
First Line Treatment

AbstractColorectal cancer is the second leading cause of cancer-related death worldwide. For metastatic colorectal cancer (mCRC) patients, it is recommended, as first-line treatment, chemotherapy (CT) based on doublet cytotoxic combinations of fluorouracil, leucovorin, and irinotecan (FOLFIRI) and fluorouracil, leucovorin, and oxaliplatin (FOLFOX). In addition to CT, biological (targeted agents) are indicated in the first-line treatment, unless contraindicated. In this context, most of mCRC patients are likely to progress and to change from first line to second line treatment when they develop resistance to first-line treatment options. It is in this second line setting where Aflibercept offers an alternative and effective therapeutic option, thought its specific mechanism of action for different patient’s profile: RAS mutant, RAS wild-type (wt), BRAF mutant, potentially resectable and elderly patients. In this paper, a panel of experienced oncologists specialized in the management of mCRC experts have reviewed and selected scientific evidence focused on Aflibercept as an alternative treatment.

scholarly journals Use of monoclonal antibody therapy for nosocomial SARS-CoV-2 infection in patients at high risk for severe COVID-19: experience from a tertiary-care hospital in Germany

Infection ◽  
2021 ◽  
Author(s):  
Johanna Koehler ◽  
Barbara Ritzer ◽  
Simon Weidlich ◽  
Friedemann Gebhardt ◽  
Chlodwig Kirchhoff ◽  
...  
Keyword(s):  
High Risk ◽  
Tertiary Care Hospital ◽  
Severe Disease ◽  
Treatment Options ◽  
Tertiary Care ◽  
Antibody Therapy ◽  
Additional Treatment ◽  
Care Hospital ◽  
Cross Sectional ◽  
Asymptomatic Patients

AbstractAdditional treatment options for coronavirus disease (COVID-19) are urgently needed, particularly for populations at high risk of severe disease. This cross-sectional, retrospective study characterized the outcomes of 43 patients with nosocomial severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with and without treatment using monoclonal SARS-CoV-2 spike antibodies (bamlanivimab or casirivimab/imdevimab). Our results indicate that treatment with monoclonal antibodies results in a significant decrease in disease progression and mortality when used for asymptomatic patients with early SARS-CoV-2 infection.

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