The objectives of these guidelines are to provide recommendations outlining a public health approach to managing people presenting with advanced HIV disease, and to provide guidance on the timing of initiation of antiretroviral ...e-to-highlight medbox">therapy (ART) for all people living with HIV.
WHO recommends that a package of screening, prophylaxis, rapid ART initiation and intensified adherence interventions be offered to everyone living with HIV presenting with advanced disease.
WHO strongly recommends that rapid ART initiation should be offered to people living with HIV following confirmed diagnosis and clinical assessment. Rapid initiation of ART is defined as within seven days of HIV diagnosis. WHO further strongly recommends ART initiation on the same day as HIV diagnosis based on the person’s willingness and readiness to start ART immediately, unless there are clinical reasons to delay treatment.
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HIV treatment
Policy brief
July 2017
WHO/HIV/2017.18
ince the introduction of multidrug therapy (MDT), there has been significant progress in reducing the prevalence of leprosy and the occurrence of new cases. Global strategies have evolved with progress in reducing the ...ight medbox">disease burden. Encouraged by the decrease in the number of cases on treatment, the World Health Assembly passed a resolution calling on Member States to accelerate efforts towards global elimination of leprosy as a public health problem by 2000.
Most countries reached the milestone by 2010. The global strategies for 2006–2015 focused on sustaining high-quality leprosy services and early diagnosis. Reduction in the disease burden was measured in terms of grade-2 disability (G2D) or visible deformities in new cases. Since 2016, the strategies have included reduction of stigmatization of people with leprosy.
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Chagas disease affects 8-10 million people worldwide, mainly in Latin America. The current therapy for Chagas disease is limited to nifurtimox and ...benznidazole, which are effective in treating only the acute phase of the disease but with severe side effects. Therefore, there is an unmet need for new drugs and for the exploration of innovative approaches which may lead to the discovery of new effective and safe drugs for its treatment.
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Chromoblastomycosis (CMB) is a chronic fungal infection of the skin and the subcutaneous tissue caused by a transcutaneous traumatic inoculation of a specific group of dematiaceous fungi occurring mainly in tropical and subtropical zones worldwide. If not diagnosed at early stages, patients with CBM... require long term therapy with systemic antifungals, sometimes associated with physical methods. Unlike other neglected endemic mycoses, comparative clinical trials have not been performed for this disease. Nowadays, therapy is based on a few open trials and on expert opinion. Itraconazole either as monotherapy or associated with other drugs, or with physical methods, is widely used. Recently, photodynamic therapy has been successfully employed in combination with antifungals in patients presenting with CBM. In the present revision the most used therapeutic options against CBM are reviewed as well as the several factors that may have impact on the patient's outcome.
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This study was aimed to ascertain the clinical profile and management of patients with ischemic heart disease (IHD) and/or peripheral artery disease (PAD). In this observational and cross-sectional ...study developed in 80 hospitals throughout Spain, consecutive adults with stable IHD and/or PAD were included. A total of 1089 patients were analyzed, of whom 65.3% had only IHD, 17.8% PAD and 16.9% both. A total of 80.6% were taking only one antiplatelet agent, and 18.2% were on dual antiplatelet therapy (mainly aspirin/clopidogrel). Almost all patients were taking ≥1 lipid lowering drug, mainly moderate-to-high intensity statins. IHD patients took ezetimibe more commonly than PAD (43.9% vs. 12.9%; p < 0.001). There were more patients with IHD that achieved blood pressure targets compared to PAD (<140/90 mmHg: 67.9% vs. 43.0%; p < 0.001; <130/80 mmHg: 34.1% vs. 15.7%; p < 0.001), LDL-cholesterol (<70 mg/dL: 53.1% vs. 41.5%; p = 0.033; <55 mg/dL: 26.5% vs. 16.0%; p = 0.025), and diabetes (HbA1c < 7%, with SGLT2i/GLP1-RA: 21.7% vs. 8.8%; p = 0.032). Modifications of antihypertensive agents and lipid-lowering therapy were performed in 69.0% and 82.3% of patients, respectively, without significant differences between groups. The use of SGLT2i/GLP1-RA was low. In conclusion, cardiovascular risk factors control remains poor among patients with IHD, PAD, or both. A higher use of combined therapy is warranted.
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INTRODUCTION: Lower extremity peripheral artery disease (PAD) is increasing in prevalence in low- and middle-income countries creating a large health care burden. Clinical management may require substantial resources but little consideration has bee...n given to which treatments are appropriate for less advantaged countries.
EVIDENCE ACQUISITION: The aim of this review was to systematically appraise published data on the costs and effectiveness of PAD treatments used commonly in high-income countries, and for an international consensus panel to review that information and propose a hierarchy of treatments relevant to low- and middle-income countries.
EVIDENCE SYNTHESIS: Pharmacotherapy for intermittent claudication was found to be expensive and improve walking distance by a modest amount. Exercise and endovascular therapies were more effective and exercise the most cost-effective. For critical limb ischemia, bypass surgery and endovascular therapy, which are both resource intensive, resulted in similar rates of amputation-free survival. Substantial reductions in cardiovascular events occurred with use of low cost drugs (statins, ACE inhibitors, anti-platelets) and smoking cessation.
CONCLUSIONS: The panel concluded that, in low- and middle-income countries, cardiovascular prevention is a top priority, whereas a lower priority should be given to pharmacotherapy for leg symptoms and revascularisation, except in countries with established vascular units.
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Cardiovascular disease is a major cause of disability and premature death throughout the world, and contributes substantially to the escalating costs of health care. The underlying pathology is atherosclerosis, which develops over many years and is ...usually advanced by the time symptoms occur, generally in middle age. Acute coronary and cerebrovascular events frequently occur suddenly, and are often fatal before medical care can be given. Modification of risk factors has been shown to reduce mortality and morbidity in people with diagnosed or undiagnosed cardiovascular disease.
This publication provides guidance on reducing disability and premature deaths from coronary heart disease, cerebrovascular disease and peripheral vascular disease in people at high risk, who have not yet experienced a cardiovascular event. People with established cardiovascular disease are at very high risk of recurrent events and are not the subject of these guidelines. They have been addressed in previous WHO guidelines.
Several forms of therapy can prevent coronary, cerebral and peripheral vascular events. Decisions about whether to initiate specific preventive action, and with what degree of intensity, should be guided by estimation of the risk of any such vascular event. The risk prediction charts that accompany these guidelinesb allow treatment to be targeted accord-
ing to simple predictions of absolute cardiovascular risk.
Recommendations are made for management of major cardiovascular risk factors through changes in lifestyle and prophylactic drug therapies. The guidelines provide a framework for the development of national guidance on prevention of cardiovascular disease that takes into account the particular political, economic, social and medical circumstances.
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Cardiovascular disease (CVD) is the leading cause of global deaths, with the majority occurring in low- and middle-income countries (LMIC). The primary and secondary prevention of CVD is suboptimal throughout the world, but the evidence-practice gap...s are much more pronounced in LMIC. Barriers at the patient, health-care provider, and health system level prevent the implementation of optimal primary and secondary prevention. Identification of the particular barriers that exist in resource-constrained settings is necessary to inform effective strategies to reduce the identified evidence-practice gaps. Furthermore, targeting modifiable factors that contribute most significantly to the global burden of CVD, including tobacco use, hypertension, and secondary prevention for CVD will lead to the biggest gains in mortality reduction. We review a select number of novel, resource-efficient strategies to reduce premature mortality from CVD, including: (1) effective measures for tobacco control; (2) implementation of simplified screening and management algorithms for those with or at risk of CVD, (3) increasing the availability and affordability of simplified and cost-effective treatment regimens including combination CVD preventive drug therapy, and (4) simplified delivery of health care through task-sharing (non-physician health workers) and optimizing self-management (treatment supporters). Developing and deploying systems of care that address barriers related to the above, will lead to substantial reductions in CVD and related mortality.
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The document by the American Thoracic Society provides an overview of Chronic Obstructive Pulmonary Disease (COPD), explaining its causes, such as smoking and environmental factors, symptoms like breathlessness and chronic cough, and diagnostic meth...ods including spirometry. It discusses treatment strategies, emphasizing smoking cessation, medication use, oxygen therapy, and pulmonary rehabilitation. The document also highlights that while COPD is a lifelong condition, effective management can improve symptoms and quality of life.
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The guidelines are aimed at clinical professionals directly involved with and responsible for the care of adults with HIV infection, and at community advocates responsible for promoting the best interests and care of HIV-positive adults. They should be read in conjunction with other published BHIVA ...guidelines.
The 2016 interim update to the 2015 BHIVA antiretroviral guidelines has been published online to include tenofovir-alafenamide/emtricitabine as a preferred NRTI backbone for first-line therapy. Changes were based on new data and the consensus opinion of the writing committee. All changes to the guideline are highlighted and include updates to the chronic kidney disease and bone disease sections of special populations and some small changes to managing virological failure.
The 2019 interim statement provides updated advice on treatment with two-drug regimens
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The NICE guideline NG114 provides recommendations on antimicrobial therapy for acute exacerbations of chronic obstructive pulmonary disease (COPD), aiming to optimize antibiotic use and minimize the... development of antibiotic resistance.
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This clinical job aid addresses the importance of maternal health and antiretroviral therapy adherence, as well as care and testing for the HIV-exposed infant until the infant’s final HIV diagnosis after the end of breastfeeding.
CDC’s Core Elements of Hospital Antibiotic Stewardship Programs suggests that pharmacists review antibiotic therapy that is unnecessarily duplicative, including the use of agents with overlapping spectra. The combination of two agents with anaerob...ic activity is unnecessary in most cases. Exceptions may include Clostridioides difficile infection, necrotizing fasciitis, and certain biliary infections.
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Asbestos, the most frequent cause of occupational cancer, continues to be consumed ona massive scale, with millions of people exposed on a daily basis. This review explains why we havefailed in curtailing the silent epidemic of asbestos-related disease...an> and why the numbers of asbestosvictims are likely to remain high. Emerging and developed countries have to be reminded that asbestosexposure has yet to become a problem of the past. The worldwide spread of asbestos, followed by thesurge of asbestos-related cancers, resembles the lung cancer epidemic caused by smoking andstimulated by manufacturers.
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It is estimated that prior to the war there were more than 250 000 people (1% of total population) living with HIV in Ukraine, of whom around 130 000 were receiving antiretroviral therapy.
As the displacement of people from Ukraine escalates, it ...is imperative that countries across Europe receiving these displaced people are prepared to ensure high standards of HIV prevention, treatment and care.
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n response to the outbreak, the Africa Centres for Disease Control and Prevention (Africa CDC) has been supporting African Union Member States in responding to the COVID-19 pandemic through a variety of interventions such as non-pharmaceutical inter...ventions, quarantine, testing, isolation, contact tracing, and clinical management. The Test to Treat guideline aims to increase continental testing efforts and reduce COVID-19 transmission in Africa and put-up response measures to control the impact of the virus, both to limit spread and to reduce substantially the risks of severe health outcomes related to COVID-19 infection. These countermeasures include highly effective vaccines and boosters, rapid testing options for monitoring exposure, and effective therapeutic options for both pre-exposure prevention and treatment of mild-to-moderate disease, oxygen therapy for moderate-severe disease, all of which can potentially be updated efficiently as new variants emerge that may affect the effectiveness of the available tools.
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