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New guidelines for the prevention of imported malaria in France. Med Mal Infect 2019; 50:113-126. [PMID: 31472994 DOI: 10.1016/j.medmal.2019.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/03/2019] [Indexed: 01/07/2023]
Abstract
Prevention of malaria is based on personal vector-control measures (PVCMs) to avoid mosquito bites at night and chemoprophylaxis if justified by the risk of contracting the disease. The most effective PVCM is the use of insecticide-treated mosquito nets. The decision to prescribe chemoprophylaxis, mainly to prevent Plasmodium falciparum infection, depends on the benefit-risk ratio. Overall, the risk of contracting malaria is 1,000-fold lower during a stay in the tropical regions of Asia or the Americas than in sub-Saharan Africa. For "conventional" stays (less than one month with nights spent in urban areas) in low-risk settings in tropical Asia and America, the risk of being infected with Plasmodium parasites (≤1/100,000) is equivalent or lower than that of experiencing serious adverse effects caused by chemoprophylaxis. Preventive medication is therefore no longer recommended. By contrast, in other settings and particularly in sub-Saharan Africa, chemoprophylaxis is the most effective measure against malaria. However, it is worth noting that no single preventive measure provides full protection. Regardless of the level of risk or chemoprophylaxis-related indication, protection against mosquito bites and rapid management of febrile illness after returning from an endemic area are also critical to prevent malaria. Finally, migrants of sub-Saharan origin visiting friends and relatives in their country of origin form a high-risk group who should be recommended chemoprophylaxis in the same way as any other travelers-with a preference for the least expensive molecules (doxycycline).
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Pistone T, Ouattara E, Gabillard D, Lele N, Duvignaud A, Cordel H, Malvy D, Bouchaud O, Abgrall S. Travel-related health events and their risk factors in HIV-infected sub-Saharan migrants living in France and visiting their native country: The ANRS VIHVO cohort study. Travel Med Infect Dis 2019; 29:40-47. [PMID: 30951905 DOI: 10.1016/j.tmaid.2019.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/20/2019] [Accepted: 03/28/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Literature on health events in HIV-infected travellers is scarce, particularly in sub-Saharan African (SSA) migrants. METHODS We investigated health events in HIV-infected SSA migrants living in France during and after travel to their native country. All had a pre-travel plasma viral load (pVL) below 200 copies/mL and were on stable combined antiretroviral therapy (cART). Logistic regression models were used to assess the risk factors for at least one adverse health event or febrile event. RESULTS Among 264 HIV migrants, pre-travel median CD4 count was 439/mm3 and 27 migrants (6%) experienced a low-level viremia between 50 and 200 copies/mL. One hundred (38%) experienced at least one event (13 experienced two events). The most common events were gastrointestinal, including diarrhoea (n = 29, 26%), respiratory events (n = 20, 18%), and malaria (n = 17, 15%; 1 death). In multivariable analysis, a pre-travel low-level viremia and a lack of pre-travel medical advice significantly increased the risk for any event (OR 4.31, 95% CI, 1.41-13.1; and OR 3.62, 95% CI, 1.38-9.47; respectively). A lack of pre-travel advice significantly increased the risk for febrile event. CONCLUSIONS Early and tailored counselling on pre-travel medical advice regarding diarrhoea and vector-borne diseases prophylactic measures in HIV-infected SSA migrants should be emphasised before travel to Africa.
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Affiliation(s)
- Thierry Pistone
- CHU Bordeaux, Department for Infectious and Tropical Diseases, 33000, Bordeaux, France; Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Eric Ouattara
- CHU Bordeaux, Department for Infectious and Tropical Diseases, 33000, Bordeaux, France; Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Delphine Gabillard
- Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Nathalie Lele
- AP-HP, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, 93000, Bobigny, France; Université Paris 13, Bobigny, France.
| | - Alexandre Duvignaud
- CHU Bordeaux, Department for Infectious and Tropical Diseases, 33000, Bordeaux, France; Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Hugues Cordel
- AP-HP, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, 93000, Bobigny, France; Université Paris 13, Bobigny, France.
| | - Denis Malvy
- CHU Bordeaux, Department for Infectious and Tropical Diseases, 33000, Bordeaux, France; Inserm U1219, Infectious Diseases in Lower Income Countries (IDLIC), Université de Bordeaux, 146 rue Léo-Saignat, 33076, Bordeaux cedex, France.
| | - Olivier Bouchaud
- AP-HP, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, 93000, Bobigny, France; Université Paris 13, Bobigny, France.
| | - Sophie Abgrall
- AP-HP, Hôpital Antoine Béclère, Clamart, France; Inserm U1018, Centre de recherche en Epidémiologie et Santé des Populations (CESP), Le Kremlin-Bicêtre Cedex, Université Paris Sud University, Paris Saclay University, France.
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Zautner AE, Herchenröder O, Moussi AE, Schwarz NG, Wiemer DF, Groß U, Frickmann H. Pharmaceutical interactions between antiretroviral and antimalarial drugs used in chemoprophylaxis. Acta Trop 2018; 179:25-35. [PMID: 29273442 DOI: 10.1016/j.actatropica.2017.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/08/2017] [Accepted: 12/17/2017] [Indexed: 10/18/2022]
Abstract
Human immunodeficiency virus (HIV) is the causative agent of the Acquired Immunodeficiency Syndrome (AIDS). The pandemic is believed to have originated within the Northern Congo basin covering large parts of the Democratic Republic of Congo, the Republic of Congo, the Central African Republic, Cameroon and Gabon. Although over decades, HIV-1 has spread throughout the World leaving no country unaffected, sub-Saharan Africa remains the region with more than 80% of all infected individuals. The HIV-2 epidemic has largely remained restricted to West Africa along the Upper Guinean forests. Co-incident with these regions of highest HIV distribution is a part of the malaria belt and therefore, co-infections are common. In this review we carve out the consequences of HIV transmission prevention and synchronous malaria prophylaxis during occupational or leisure travelling activities within this World region. In particular, we elaborate on considering pre-existing drug resistances of both, the malaria parasites and the immunodeficiency viruses, when determining a combination for prophylactic and, if necessary, post-expositional measures with a focus on the compatibility of both medications.
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Seden K, Gibbons S, Marzolini C, Schapiro JM, Burger DM, Back DJ, Khoo SH. Development of an evidence evaluation and synthesis system for drug-drug interactions, and its application to a systematic review of HIV and malaria co-infection. PLoS One 2017; 12:e0173509. [PMID: 28334018 PMCID: PMC5363796 DOI: 10.1371/journal.pone.0173509] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/21/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In all settings, there are challenges associated with safely treating patients with multimorbidity and polypharmacy. The need to characterise, understand and limit harms resulting from medication use is therefore increasingly important. Drug-drug interactions (DDIs) are prevalent in patients taking antiretrovirals (ARVs) and if unmanaged, may pose considerable risk to treatment outcome. One of the biggest challenges in preventing DDIs is the substantial gap between theory and clinical practice. There are no robust methods published for formally assessing quality of evidence relating to DDIs, despite the diverse sources of information. We defined a transparent, structured process for developing evidence quality summaries in order to guide therapeutic decision making. This was applied to a systematic review of DDI data with considerable public health significance: HIV and malaria. METHODS AND FINDINGS This was a systematic review of DDI data between antiretrovirals and drugs used in prophylaxis and treatment of malaria. The data comprised all original research in humans that evaluated pharmacokinetic data and/or related adverse events when antiretroviral agents were combined with antimalarial agents, including healthy volunteers, patients with HIV and/or malaria, observational studies, and case reports. The data synthesis included 36 articles and conference presentations published via PubMed and conference websites/abstract books between 1987-August 2016. There is significant risk of DDIs between HIV protease inhibitors, or NNRTIs and artemesinin-containing antimalarial regimens. For many antiretrovirals, DDI studies with antimalarials were lacking, and the majority were of moderate to very low quality. Quality of evidence and strength of recommendation categories were defined and developed specifically for recommendations concerning DDIs. CONCLUSIONS There is significant potential for DDIs between antiretrovirals and antimalarials. The application of quality of evidence and strength of recommendation criteria to DDI data is feasible, and allows the assessment of DDIs to be robust, consistent, transparent and evidence-based.
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Affiliation(s)
- Kay Seden
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Sara Gibbons
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital of Basel, Basel, Switzerland
| | | | - David M. Burger
- Department of Pharmacy & Radboud Institute of Health Sciences (RIHS), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - David J. Back
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Saye H. Khoo
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
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Aung AK, Trubiano JA, Spelman DW. Travel risk assessment, advice and vaccinations in immunocompromised travellers (HIV, solid organ transplant and haematopoeitic stem cell transplant recipients): A review. Travel Med Infect Dis 2014; 13:31-47. [PMID: 25593039 DOI: 10.1016/j.tmaid.2014.12.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 12/19/2022]
Abstract
International travellers with immunocompromising conditions such as human immunodeficiency virus (HIV) infection, solid organ transplantation (SOT) and haematopoietic stem cell transplantation (HSCT) are at a significant risk of travel-related illnesses from both communicable and non-communicable diseases, depending on the intensity of underlying immune dysfunction, travel destinations and activities. In addition, the choice of travel vaccinations, timing and protective antibody responses are also highly dependent on the underlying conditions and thus pose significant challenges to the health-care providers who are involved in pre-travel risk assessment. This review article provides a framework of understanding and approach to aforementioned groups of immunocompromised travellers regarding pre-travel risk assessment and management; in particular travel vaccinations, infectious and non-infectious disease risks and provision of condition-specific advice; to reduce travel-related mortality and morbidity.
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Affiliation(s)
- A K Aung
- Department of General Medicine, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - J A Trubiano
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Microbiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - D W Spelman
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Microbiology, The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
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