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Beekmann SE, Henderson DK. Occupational Exposures among Healthcare Workers: New Methods for Prevention and Recommended Postexposure Prophylaxis for HIV and Hepatitis B and C. Curr Treat Options Infect Dis 2015; 7:28-38. [DOI: 10.1007/s40506-014-0036-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yu W, Wang L, Han N, Zhang X, Mahapatra T, Mahapatra S, Babu GR, Tang W, Detels R, Zhao J. Pre-exposure prophylaxis of HIV: A right way to go or a long way to go? Artif Cells Nanomed Biotechnol 2014; 44:201-8. [PMID: 25078629 DOI: 10.3109/21691401.2014.934458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Antiretroviral drugs are being tried as candidates for the pre-exposure prophylaxis (PrEP) against HIV for a considerable period, due to their potential for immediate inhibition of viral replication. Discrepancies in the findings called for a critical review of the relevant efforts and their outcomes. A systematic literature search identified 143 eligible articles of which only 5 reported complete findings while another 11 were still on-going. Observed moderate efficacy and good safety profile seemed to identify PrEP as a promising step for minimizing the spread of HIV to relatively unaffected population and controlling the epidemic among high risk population groups. But the duration of this efficacy was found to depend heavily on the availability, adherence and other related issues like cost, political commitment, ethical consideration etc. To prevent potential cultural and behavioral modifications, proper pre-administration counseling also seemed critical for the success of PrEP as a cost-effective intervention with adequate coverage.
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Affiliation(s)
- Wenya Yu
- a Shijiazhuang Center for Disease Control and Prevention , Shijia Zhuang , China
| | - Lu Wang
- b National Center for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention , Beijing , China
| | - Na Han
- c Institute of Clinical Molecular Biology, Peking University People's Hospital , Beijing China
| | - Xiayan Zhang
- b National Center for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention , Beijing , China
| | - Tanmay Mahapatra
- d Mission Arogya Health and Information Technology Research Foundation , Kolkata , India
| | - Sanchita Mahapatra
- d Mission Arogya Health and Information Technology Research Foundation , Kolkata , India
| | - Giridhar R Babu
- e Public Health Foundation of India, Indian Institutes of Public Health , Hyderabad, Bengaluru Campus, Bengaluru , India
| | - Weiming Tang
- f University of North Carolina , Project-China, Guangzhou , China
| | - Roger Detels
- g Department of Epidemiology , Fielding School of Public Health, University of California , Los Angeles , CA , USA
| | - Jinkou Zhao
- h Impact Results and Evaluation Department, The Global Fund to Fight AIDS , Tuberculosis and Malaria, Geneva , Switzerland
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Mutua G, Sanders E, Mugo P, Anzala O, Haberer JE, Bangsberg D, Barin B, Rooney JF, Mark D, Chetty P, Fast P, Priddy FH. Safety and adherence to intermittent pre-exposure prophylaxis (PrEP) for HIV-1 in African men who have sex with men and female sex workers. PLoS One 2012; 7:e33103. [PMID: 22511916 PMCID: PMC3325227 DOI: 10.1371/journal.pone.0033103] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 02/03/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about safety of and adherence to intermittent HIV PrEP regimens, which may be more feasible than daily dosing in some settings. We present safety and adherence data from the first trial of an intermittent PrEP regimen among Kenyan men who have sex with men (MSM) and female sex workers (FSW). METHODS/PRINCIPAL FINDINGS MSM and FSW were randomized to daily oral FTC/TDF or placebo, or intermittent (Monday, Friday and within 2 hours after sex, not to exceed one dose per day) oral FTC/TDF or placebo in a 2:1:2:1 ratio; volunteers were followed monthly for 4 months. Adherence was assessed with the medication event monitoring system (MEMS). Sexual activity data were collected via daily text message (SMS) queries and timeline followback interviews with a one-month recall period. Sixty-seven men and 5 women were randomized into the study. Safety was similar among all groups. Median MEMS adherence rates were 83% [IQR: 63-92] for daily dosing and 55% [IQR:28-78] for fixed intermittent dosing (p = 0.003), while adherence to any post-coital doses was 26% [IQR:14-50]. SMS response rates were low, which may have impaired measurement of post-coital dosing adherence. Acceptability of PrEP was high, regardless of dosing regimen. CONCLUSIONS/SIGNIFICANCE Adherence to intermittent dosing regimens, fixed doses, and in particular coitally-dependent doses, may be more difficult than adherence to daily dosing. However, intermittent dosing may still be appropriate for PrEP if intracellular drug levels, which correlate with prevention of HIV acquisition, can be attained with less than daily dosing and if barriers to adherence can be addressed. Additional drug level data, qualitative data on adherence barriers, and better methods to measure sexual activity are necessary to determine whether adherence to post-coital PrEP could be comparable to more standard regimens. TRIAL REGISTRATION ClinicalTrials.gov NCT00971230.
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Affiliation(s)
- Gaudensia Mutua
- Kenya AIDS Vaccine Initiative, University of Nairobi, Nairobi, Kenya
| | - Eduard Sanders
- Kenya Medical Research Institute, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Headington, United Kingdom
| | - Peter Mugo
- Kenya Medical Research Institute, Kilifi, Kenya
| | - Omu Anzala
- Kenya AIDS Vaccine Initiative, University of Nairobi, Nairobi, Kenya
| | - Jessica E. Haberer
- Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, United States of America
| | - David Bangsberg
- Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, United States of America
| | - Burc Barin
- The EMMES Corporation, Rockville, Maryland, United States of America
| | | | - David Mark
- International AIDS Vaccine Initiative, New York, New York, United States of America
| | - Paramesh Chetty
- International AIDS Vaccine Initiative, Johannesburg, South Africa
| | - Patricia Fast
- International AIDS Vaccine Initiative, New York, New York, United States of America
| | - Frances H. Priddy
- International AIDS Vaccine Initiative, New York, New York, United States of America
- * E-mail:
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Abstract
Numerous HIV prevention options have been tested, with limited success. Microbicides have been the focus of research specifically targeted to prevent new infections among women. After decades of research using non-HIV-specific microbicides, we now have proof of concept for antiretroviral-based microbicides. Issues of drug resistance, frequency of HIV testing and adherence to treatment remain to be explored. Drugs used for HIV treatment and with good safety profiles have been shown to provide protection to men who have sex with men. Ethical issues surrounding cost, access, future design of HIV prevention trials and composition of the prevention package offered to trial participants remain. The role of advocacy and market research will be crucial to ensure effective interventions are accessed and supported. There is renewed hope in the HIV prevention field with collective efforts needed to ensure we get the new prevention tools and options into the hands of men and women at risk of HIV infection. The purpose of this paper is to provide a review of existing research and identify issues for future enquiry.
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Affiliation(s)
- Gita Ramjee
- HIV Prevention Research Unit, Medical Research Council, Durban, South Africa and Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Pethö B. An intrinsic way of multiclassification of endogenous psychoses. A follow-through investigation/Budapest 2000/based upon Leonhard's classification. Psychiatr Neurol Med Psychol Beih 2011; 27:669-80. [PMID: 3101085 DOI: 10.1089/aid.2010.0206] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Denton PW, Krisko JF, Powell DA, Mathias M, Kwak YT, Martinez-Torres F, Zou W, Payne DA, Estes JD, Garcia JV. Systemic administration of antiretrovirals prior to exposure prevents rectal and intravenous HIV-1 transmission in humanized BLT mice. PLoS One 2010; 5:e8829. [PMID: 20098623 DOI: 10.1371/journal.pone.0008829] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 12/23/2009] [Indexed: 01/04/2023] Open
Abstract
Successful antiretroviral pre-exposure prophylaxis (PrEP) for mucosal and intravenous HIV-1 transmission could reduce new infections among targeted high-risk populations including discordant couples, injection drug users, high-risk women and men who have sex with men. Targeted antiretroviral PrEP could be particularly effective at slowing the spread of HIV-1 if a single antiretroviral combination were found to be broadly protective across multiple routes of transmission. Therefore, we designed our in vivo preclinical study to systematically investigate whether rectal and intravenous HIV-1 transmission can be blocked by antiretrovirals administered systemically prior to HIV-1 exposure. We performed these studies using a highly relevant in vivo model of mucosal HIV-1 transmission, humanized Bone marrow/Liver/Thymus mice (BLT). BLT mice are susceptible to HIV-1 infection via three major physiological routes of viral transmission: vaginal, rectal and intravenous. Our results show that BLT mice given systemic antiretroviral PrEP are efficiently protected from HIV-1 infection regardless of the route of exposure. Specifically, systemic antiretroviral PrEP with emtricitabine and tenofovir disoproxil fumarate prevented both rectal (Chi square = 8.6, df = 1, p = 0.003) and intravenous (Chi square = 13, df = 1, p = 0.0003) HIV-1 transmission. Our results indicate that antiretroviral PrEP has the potential to be broadly effective at preventing new rectal or intravenous HIV transmissions in targeted high risk individuals. These in vivo preclinical findings provide strong experimental evidence supporting the potential clinical implementation of antiretroviral based pre-exposure prophylactic measures to prevent the spread of HIV/AIDS.
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Salvato MS, Yin CC, Yagita H, Maeda T, Okumura K, Tikhonov I, Pauza CD. Attenuated disease in SIV-infected macaques treated with a monoclonal antibody against FasL. Clin Dev Immunol 2007; 2007:93462. [PMID: 18317535 DOI: 10.1155/2007/93462] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 10/31/2007] [Indexed: 11/18/2022]
Abstract
Acute SIVmac infection in macaques is accompanied by high levels of plasma viremia that decline with the appearance of viral immunity and is a model for acute HIV disease in man. Despite specific immune responses, the virus establishes a chronic, persistent infection. The destruction of CD4+
and CD4- lymphocyte subsets in macaques
contributes to viral persistence and suggests the
importance of mechanisms for depleting both infected
and uninfected (bystander) cells. Bystander cell killing
can occur when FasL binds the Fas receptor on activated lymphocytes,
which include T and B cell subpopulations that are responding to the
infection. Destruction of specific immune cells could be an important
mechanism for blunting viral immunity and establishing persistent infection
with chronic disease. We inhibited the Fas pathway in vivo with a monoclonal
antibody against FasL (RNOK203). Here we show that treatment with anti-FasL
reduced cell death in circulating T and B cells, increased CTL and antibody
responses to viral proteins, and lowered the setpoint viremia. By blocking
FasL during only the first few weeks after infection, we attenuated SIVmac
disease and increased the life span for infected and treated macaques.
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Hiransuthikul N, Hiransuthikul P, Kanasuk Y. Human immunodeficiency virus postexposure prophylaxis for occupational exposure in a medical school hospital in Thailand. J Hosp Infect 2007; 67:344-9. [PMID: 18023920 DOI: 10.1016/j.jhin.2007.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 09/28/2007] [Indexed: 10/22/2022]
Abstract
This is a retrospective review of occupational exposure to human immunodeficiency virus (HIV) and subsequent postexposure prophylaxis (PEP) among healthcare workers (HCWs) in King Chulalongkorn Memorial Hospital (KCMH), Bangkok, Thailand. From January 2002 to December 2004, data were collected from incident reports, the hospital's infectious diseases unit and the emergency department. There were 315 reported episodes of occupational exposure among 306 HCWs. Nurses (34.0%) were the HCWs most frequently exposed and percutaneous injury (91.4%) was the most common type of exposure. One-third of the source patients tested were infected with HIV. PEP was initiated following 200 (63.5%) of the 315 exposures and was started within 24h in >95% of cases. The most commonly prescribed PEP regimen was zidovudine, lamivudine and nelfinavir. Fifty-six percent of HCWs given PEP completed a four-week course but the remainder discontinued PEP prematurely due to side-effects, or after negative results from the source, or following informed risk reassessment or from their own accord. No exposed HCW acquired HIV during the study period. Appropriate counselling and careful risk assessment are important in achieving effective HIV PEP among HCWs.
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Affiliation(s)
- N Hiransuthikul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Abstract
The use of antiretroviral therapy as post-exposure prophylaxis against human immunodeficiency virus (HIV) is now routine following high-risk exposure to the HIV virus. This article summarizes the management of health care workers and others exposed to HIV in an occupational setting, and the evidence behind it.
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Affiliation(s)
- Elizabeth Hamlyn
- Department of Sexual Health and HIV, Kings College Hospital, London SE5 9RS, UK.
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Abstract
Increasing numbers of international, national and state/provincial health organizations in the developed and developing world recommend postexposure prophylaxis (PEP) following potential sexual exposure to HIV. The evidence for these policies is extrapolated from occupational healthcare worker, perinatal prophylaxis and animal studies. There is no direct evidence of PEP efficacy after sexual exposures. Studies addressing potential increases in risk behavior, toxicities and cost–effectiveness are encouraging. Considerations for offering PEP include the timing and characteristics of the exposure and the HIV status of the source and exposed individuals. PEP includes 28 days of a combination antiretroviral drug regimen containing two or more drugs and associated laboratory testing, counseling and referrals. PEP service delivery challenges include ensuring adequate access to services, optimizing PEP adherence and facilitating follow-up HIV testing and counseling. Men who have sex with men, sexual assault survivors, children and adolescents, and individuals in resource-limited settings present unique needs and challenges.
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Affiliation(s)
- Prasanna Jagannathan
- University of California, San Francisco, California, Department of General Internal Medicine, San Francisco General Hospital Ward 13, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Raphael Landovitz
- University of California, Los Angeles, Center for Clinical AIDS Research and Education, David Geffen School of Medicine, 9 911 W Pico Blvd., Suite 980 Los Angeles, CA 90035, USA
| | - Michelle E Roland
- University of California. San Francisco, Positive Health Program, Ward 84, San Francisco General Hospital, 995 Potrero Avenue, San Francisco, CA 94110, USA
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Emau P, Jiang Y, Agy MB, Tian B, Bekele G, Tsai CC. Post-exposure prophylaxis for SIV revisited: animal model for HIV prevention. AIDS Res Ther 2006; 3:29. [PMID: 17132170 PMCID: PMC1687192 DOI: 10.1186/1742-6405-3-29] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 11/28/2006] [Indexed: 12/23/2022] Open
Abstract
Background A 4-week, uninterrupted treatment with 9-(2-phosphonyl-methoxypropyly)adenine (PMPA, commonly called tenofovir) completely prevents simian immunodeficiency virus (SIVmne) infection in cynomolgus macaques if treatment begins within 24 hours after SIVmne inoculation, but is less effective if treatment is delayed or duration of treatment is shortened. Critical factors for efficacy include timing and duration of treatment, potency of antiretroviral drug and a contribution from antiviral immune responses. Therefore, we evaluated the impact of one or more treatment interruptions plus SIVmne re-exposures on efficacy of PMPA treatment to prevent SIVmne infection in cynomolgus macaques. We also evaluated whether macaques with pre-existing SIV immune responses show increased efficacy of treatment. Eight PMPA-treated, virus-negative and seronegative macaques, and five PMPA-treated, virus-negative but weakly or strongly seropositive macaques were re-inoculated with SIVmne and treated with PMPA starting 24 hr post inoculation. Thereafter, they received either a 5-week treatment involving one interruption plus one SIVmne challenge or a 10-week treatment involving six interruptions plus six SIVmne challenges early during treatment. Parameters measured were plasma SIV RNA, SIV-antibody response, CD4+ T lymphocyte subsets and in vivo CD8+ cell-suppression of virus infection. Results All seronegative macaques developed persistent antibody response beginning 4 to 8 weeks after stopping PMPA-treatment in absence of viremia in a majority of macaques and coinciding with onset of intermittent viremia in other macaques. In contrast, all weakly or strongly seropositive macaques showed immediate increase in titers (> 1600) of SIV antibodies, even before the end of PMPA-treatment, and in absence of detectable viremia. However, in vivo CD8+ -cell depletion revealed CD8 cell-suppression of viremia and persistence of virus in the macaques as long as 2 years after PMPA-treatment, even in aviremic macaques. Unlike untreated macaques, a treated macaque controlled viral replication and blocked CD4+ T cell depletion when challenged with a heterologus chimeric SIV/HIV-1 virus called SHIV89.6P. Conclusion A single interruption plus one SIVmne challenge was as sufficient as six interruptions plus six SIVmne challenges in reducing efficacy of PMPA, but results in long-term persistence of virus infection suppressed by CD8+ cells. Efficacy of PMPA treatment was highest in macaques with pre-existing SIV immune responses.
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Affiliation(s)
- Peter Emau
- Washington National Primate Research Center, University of Washington, Box 357330 Health Sciences Building, Seattle, Washington 98195, USA
| | - Yonghou Jiang
- Washington National Primate Research Center, University of Washington, Box 357330 Health Sciences Building, Seattle, Washington 98195, USA
| | - Michael B Agy
- Washington National Primate Research Center, University of Washington, Box 357330 Health Sciences Building, Seattle, Washington 98195, USA
| | - Baoping Tian
- Washington National Primate Research Center, University of Washington, Box 357330 Health Sciences Building, Seattle, Washington 98195, USA
| | - Girma Bekele
- Washington National Primate Research Center, University of Washington, Box 357330 Health Sciences Building, Seattle, Washington 98195, USA
| | - Che-Chung Tsai
- Washington National Primate Research Center, University of Washington, Box 357330 Health Sciences Building, Seattle, Washington 98195, USA
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Johnson JA, Rompay KKAV, Delwart E, Heneine W. A rapid and sensitive real-time PCR assay for the K65R drug resistance mutation in SIV reverse transcriptase. AIDS Res Hum Retroviruses 2006; 22:912-6. [PMID: 16989618 DOI: 10.1089/aid.2006.22.912] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Macaques infected with simian immunodeficiency virus (SIV) provide a suitable model for assessing the efficacy of antiretroviral (ARV) drug interventions and drug resistance selection associated with treatment. Resistance to the HIV reverse transcriptase inhibitor tenofovir continues to be examined in different treatment strategies in the macaque model. Evaluations of treatment interventions and drug resistance are hampered by the limited sensitivity of conventional population sequencing and the substantial effort involved in testing various tissue compartments in which viruses may reside. Therefore, a sensitive assay that permits simple and rapid testing for drug-resistant viruses would benefit appraisals of ARV treatments using in vivo models. To have this capability, we developed a real-time PCR-based assay for the detection of the SIV K65R reverse transcriptase mutation, a key marker for reduced susceptibility to tenofovir. Evaluations of SIV sequences yielded an assay detection limit mean of 0.4% mutant virus (range = 0.1-2%) in a wild-type background. In testing longitudinal plasma specimens from four SIV-infected macaques that received an active daily regimen of 30 mg/kg of tenofovir subcutaneously, the assay was able to detect K65R-positive viruses in all animals within 1-7 weeks after treatment began. The emerging mutants were initially present at frequencies estimated between 0.4% and 3%, below the detection capability of population sequencing. We propose the SIV K65R real-time PCR assay provides improved sensitivity and simplicity in studying tenofovir resistance in macaque models.
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Affiliation(s)
- Jeffrey A Johnson
- National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30303, USA.
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Roland ME, Neilands TB, Krone MR, Katz MH, Franses K, Grant RM, Busch MP, Hecht FM, Shacklett BL, Kahn JO, Bamberger JD, Coates TJ, Chesney MA, Martin JN. Seroconversion following nonoccupational postexposure prophylaxis against HIV. Clin Infect Dis 2005; 41:1507-13. [PMID: 16231265 DOI: 10.1086/497268] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2005] [Accepted: 07/06/2005] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The efficacy of antiretroviral postexposure prophylaxis (PEP) against infection with human immunodeficiency virus (HIV) following occupational exposures has prompted the use of PEP after nonoccupational exposures. There are, however, important differences between occupational and nonoccupational exposures, and the effectiveness of PEP following nonoccupational exposure is unknown. We sought to describe the occurrence and circumstances of HIV seroconversion following nonoccupational PEP. METHODS HIV uninfected individuals reporting potential sexual or injection drug use exposures to HIV in the preceding 72 h received a 28-day regimen of antiretroviral therapy and counseling in a nonrandomized trial. The level of HIV antibody was measured 12 weeks after PEP initiation. RESULTS Of 877 exposed subjects, 702 were evaluable 12 weeks after exposure. Seroconversion was detected in 7 subjects (1%; 95% confidence interval, 0.4%-2%). Three seroconverters reported having no exposures after PEP initiation and, thus, probably represent evidence of chemoprophylactic failure. In the other 4 subjects, additional exposures to HIV after PEP initiation or detection of HIV RNA in plasma specimens obtained at baseline precluded determination of the source of seroconversion. No exposure source was available to assess genetic concordance with the seroconverter's virus. CONCLUSIONS As for occupational exposure, PEP is not completely effective in preventing HIV infection following nonoccupational exposure. Therefore, primary prevention remains essential. In contrast to the occupational setting, the potential source of exposure is rarely available for testing in the nonoccupational setting, and exposures are often not isolated. Thus, it is often impossible to determine whether seroconversion resulted from failure of PEP or from other exposures, posing difficulties for future comparative studies seeking to evaluate the effectiveness of PEP.
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Affiliation(s)
- Michelle E Roland
- Positive Health Program at San Francisco General Hospital, California, USA.
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Abstract
The Brown University AIDS Program and the Rhode Island Department of Health joined with health care practitioners, researchers, and representatives of community-based health, social service, and advocacy organizations to create comprehensive guidelines on nonoccupational HIV postexposure prophylaxis for the state of Rhode Island. These guidelines offer health care practitioners detailed advice on the evaluation and management of blood or body fluid exposures outside the health care setting, e.g., through sexual assault, consensual sex, injecting-drug use, or needlestick injuries. In these circumstances, HIV postexposure prophylaxis serves those for whom primary prevention measures have failed or were impractical or impossible. The guidelines represent the end product of coordination among private and public, academic and nonacademic, clinician and layperson groups committed to decreasing the incidence of HIV infections in the state of Rhode Island. The guidelines serve as both a resource for health care practitioners and a means of educating them on this method of HIV prevention.
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Affiliation(s)
- Roland C Merchant
- Division of Infectious Diseases, Section of Emergency Medicine, Brown Medical School, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA.
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Zhang ZQ, Schleif WA, Casimiro DR, Handt L, Chen M, Davies ME, Liang X, Fu TM, Tang A, Wilson KA, McElhaugh M, Carella A, Tan C, Connolly B, Hill S, Klein H, Emini EA, Shiver JW. The impact of early immune destruction on the kinetics of postacute viral replication in rhesus monkey infected with the simian-human immunodeficiency virus 89.6P. Virology 2004; 320:75-84. [PMID: 15003864 DOI: 10.1016/j.virol.2003.11.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2003] [Revised: 10/31/2003] [Accepted: 11/03/2003] [Indexed: 10/26/2022]
Abstract
Set-point viral load is positively correlated with the extent of initial viral replication in pathogenic simian-human immunodeficiency virus (SHIV) infection. To elucidate the mechanisms underlying the correlation, we conducted a systematic investigation in rhesus monkeys infected with the highly pathogenic SHIV 89.6P. This model is widely used in the preclinical evaluation of AIDS vaccine candidates and a thorough understanding of the model's biology is important to the proper interpretation of these evaluations. We found that the levels of peak viremia were positively correlated not only with the levels of set-point viremia but, importantly, with the extent of initial overall immune destruction as indicated by the degree of CD4+ T cell depletion and lymph node germinal center (GC) formation. The extent of initial overall immune destruction was inversely correlated with subsequent development and maintenance of virus-specific cellular and humoral immune responses. Thus, these data suggest that the extent of early immune damage determines the development and durability of virus-specific immunity, thereby playing a critical role in establishing the levels of set-point viral replication in SHIV infection. Vaccines that limit both the initial viral replication and the extent of early immune damage will therefore mediate long-term virus replication control and mitigation of long-term immune destruction in this model of immunodeficiency virus infection.
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Affiliation(s)
- Zhi-Qiang Zhang
- Department of Viral Vaccine Research, Merck Research Laboratories, West Point, PA 19486, USA.
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De Clercq E. Clinical potential of the acyclic nucleoside phosphonates cidofovir, adefovir, and tenofovir in treatment of DNA virus and retrovirus infections. Clin Microbiol Rev 2004; 16:569-96. [PMID: 14557287 PMCID: PMC207110 DOI: 10.1128/cmr.16.4.569-596.2003] [Citation(s) in RCA: 253] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The acyclic nucleoside phosphonates HPMPC (cidofovir), PMEA (adefovir), and PMPA (tenofovir) have proved to be effective in vitro (cell culture systems) and in vivo (animal models and clinical studies) against a wide variety of DNA virus and retrovirus infections: cidofovir against herpesvirus (herpes simplex virus types 1 and 2 varicella-zoster virus, cytomegalovirus [CMV], Epstein-Barr virus, and human herpesviruses 6, 7, and 8), polyomavirus, papillomavirus, adenovirus, and poxvirus (variola virus, cowpox virus, vaccinia virus, molluscum contagiosum virus, and orf virus) infections; adefovir against herpesvirus, hepadnavirus (human hepatitis B virus), and retrovirus (human immunodeficiency virus types 1 [HIV-1] and 2 [HIV-2], simian immunodeficiency virus, and feline immunodeficiency virus) infections; and tenofovir against both hepadnavirus and retrovirus infections. Cidofovir (Vistide) has been officially approved for the treatment of CMV retinitis in AIDS patients, tenofovir disoproxil fumarate (Viread) has been approved for the treatment of HIV infections (i.e., AIDS), and adefovir dipivoxil (Hepsera) has been approved for the treatment of chronic hepatitis B. Nephrotoxicity is the dose-limiting side effect for cidofovir (Vistide) when used intravenously (5 mg/kg); no toxic side effects have been described for adefovir dipivoxil and tenofovir disoproxil fumarate, at the approved doses (Hepsera at 10 mg orally daily and Viread at 300 mg orally daily).
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Affiliation(s)
- Erik De Clercq
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium.
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Holý A, Votruba I, Tloušťová E, Masojídková M. Synthesis and Cytostatic Activity of N-[2-(Phosphonomethoxy)alkyl] Derivatives of N6-Substituted Adenines, 2,6-Diaminopurines and Related Compounds. ACTA ACUST UNITED AC 2001. [DOI: 10.1135/cccc20011545] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
N6-Substituted adenine and 2,6-diaminopurine derivatives of 9-[2-(phosphonomethoxy)- ethyl] (PME), 9-[(R)-2-(phosphonomethoxy)propyl] [(R)-PMP] and enantiomeric (S)-PMP series were synthesized by reactions of primary or secondary amines with 6-chloro-9-{[2-(diisopropoxyphosphoryl)methoxy]alkyl}purines (26-28) or 2-amino-6-chloro-9-{[2-(diisopropoxy- phosphoryl)methoxy]alkyl}purines (29-31) followed by treatment of the diester intermediates32with bromo(trimethyl)silane and hydrolysis. Diesters32were also obtained by reaction ofN6-substituted purines with synthons23-25bearing diisopropoxyphosphoryl group. Alkylation of 2-amino-6-chloropurine (9) with diethyl [2-(2-chloroethoxy)ethyl]phosphonate (148) gave the diester149which was analogously converted toN6-substituted 2,6-diamino- 9-[2-(2-phosphonoethoxy)ethyl]purines151-153. Alkylation ofN6-substituted 2,6-diaminopurines with (R)-[(trityloxy)methyl]oxirane (155) followed by reaction of thus-obtained intermediates156with dimethylformamide dimethylacetal and condensation with diisopropyl [(tosyloxy)methyl]phosphonate (158) followed by deprotection of the intermediates159gaveN6-substituted 2,6-diamino-9-[(S)-3-hydroxy-2-(phosphonomethoxy)propyl]purines160-163. The highest cytostatic activityin vitrowas exhibited by the followingN6-derivatives of 2,6-diamino-9-[2-(phosphonomethoxy)ethyl]purine (PMEDAP): 2,2,2-trifluoroethyl (53), allyl (54), [(2-dimethylamino)ethyl] (68), cyclopropyl (75) and dimethyl (91). In CCRF-CEM cells, the cyclopropyl derivative75is deaminated to the guanine derivative PMEG (3) which is then converted to its diphosphate.
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