In this study, 2499 HIV-seronegative men or transgender women who were at high risk for HIV acquisition were enrolled in a trial of daily emtricitabine plus tenofovir versus placebo. Those receiving ...the antiretroviral medication had a 44% reduction in HIV incidence.
A total of 2.7 million new infections with the human immunodeficiency virus (HIV) were diagnosed worldwide in 2008, according to the Joint United Nations Program on HIV/AIDS (UNAIDS). Combination antiretroviral therapy for patients with HIV infection restores health and may decrease the transmission of the virus to uninfected partners.
1
Therapy also decreases mother-to-child transmission.
2
Postexposure chemoprophylaxis is recommended after occupational or nonoccupational exposure to HIV-infected fluids.
3
The use of such chemoprophylaxis requires that people recognize when they might have been exposed to HIV and that they start therapy within 72 hours. Both challenges are substantial limitations to the use of . . .
Malaria remains a global health burden. Elimination of the hypnozoite is required in patients infected with
P. vivax
to prevent relapse. In this report, the safety of a single dose of tafenoquine was ...similar to that of a 14-day course of primaquine in patients with normal G6PD activity.
Drug concentrations associated with protection from HIV-1 acquisition have not been determined. We evaluated drug concentrations among men who have sex with men in a substudy of the iPrEx trial (1). ...In this randomized placebo-controlled trial, daily oral doses of emtricitabine/tenofovir disoproxil fumarate were used as pre-exposure prophylaxis (PrEP) in men who have sex with men. Drug was detected less frequently in blood plasma and in viable cryopreserved peripheral blood mononuclear cells (PBMCs) in HIV-infected cases at the visit when HIV was first discovered compared with controls at the matched time point of the study (8% versus 44%; P < 0.001) and in the 90 days before that visit (11% versus 51%; P < 0.001). An intracellular concentration of the active form of tenofovir, tenofovir-diphosphate (TFV-DP), of 16 fmol per million PBMCs was associated with a 90% reduction in HIV acquisition relative to the placebo arm. Directly observed dosing in a separate study, the STRAND trial, yielded TFV-DP concentrations that, when analyzed according to the iPrEx model, corresponded to an HIV-1 risk reduction of 76% for two doses per week, 96% for four doses per week, and 99% for seven doses per week. Prophylactic benefits were observed over a range of doses and drug concentrations, suggesting ways to optimize PrEP regimens for this population.
Stunting, anemia, and soil-transmitted helminth (STH) infections are major health concerns for children in extremely poor regions of the world, especially rural and periurban ones. This study aimed ...to determine the prevalence of these three cooccurring conditions in preschool-age children in an extremely poor district on the outskirts of Iquitos, in the Peruvian Amazon, to inform public health actions. Malnutrition was assessed by standard World Health Organization-recommended metrics; anemia, by hemoglobin levels; and STH, by the Kato-Katz technique. Logistic regression analyses were performed to identify the risk factors for our three outcomes of interest. A total of 572 children aged 6-59 months were recruited in March 2019. We found a 31.3% stunting, 47.2% anemia, and 34.1% STH prevalence. Stunting and anemia figures exceeded both regional and national estimates for 2019. Having more children was a risk factor for stunting, whereas married mothers were associated with a lower risk. Risk factors for anemia included younger age and the male sex, whereas those for STH, older age, incomplete vaccination, and a lower socioeconomic status. Mothers’ employment outside the home was also associated with a lower STH risk. This recent evidence highlights the need for prompt and integrated clinical attention and public health actions to address both short- and long-term health consequences in this vulnerable child age group. The integration of a monitoring and evaluation framework is important to effectively manage these conditions, optimize resources and accountability, and show their impact.
El retraso en el crecimiento, la anemia y la infección por helmintos transmitidos por el contacto con el suelo (STH) son los principales problemas de salud de la infancia en las regiones del mundo caracterizadas por la extrema pobreza, especialmente en las zonas rurales y periurbanas. Este estudio se llevó a cabo para determinar la prevalencia de estas tres condiciones concurrentes en niños de edad preescolar en un distrito de extrema pobreza en las afueras de Iquitos, en la Amazonía peruana, con el fin último de informar la acción de salud pública. La malnutrición se evaluó mediante las mediciones estándar recomendadas por la Organización Mundial de la Salud (OMS), la anemia mediante los niveles de hemoglobina y la STH mediante la técnica de Kato-Katz. Se realizaron análisis de regresión logística para identificar los factores de riesgo de los tres resultados de interés. Un total de 572 niños de entre 6 y 59 meses fueron reclutados en marzo de 2019. Se determinó que la prevalencia de retraso en el crecimiento era del 31,3%, la anemia del 47,2% y el STH del 34,1%. Las cifras de retraso en el crecimiento y anemia superaron las estimaciones regionales y nacionales para 2019. Tener más hijos fue un factor de riesgo para el retraso del crecimiento, mientras que el hecho de que la madre estuviera casada se asoció con un riesgo menor. Los factores de riesgo para la anemia fueron la edad más joven y el sexo masculino, mientras que los factores de riesgo para el STH fueron la edad más avanzada, las vacunas incompletas y el nivel socioeconómico más bajo. El empleo de las madres fuera del hogar también se asoció a un menor riesgo de STH. Estos datos recientes ponen de manifiesto la necesidad de una atención clínica y una acción de salud pública rápidas e integradas para abordar las consecuencias sanitarias a corto y largo plazo en este grupo de edad infantil vulnerable. La integración de un marco de seguimiento y evaluación sería importante para una gestión eficaz, la optimización de los recursos y la rendición de cuentas, y para demostrar el impacto.
Desnutrição, anemia e infecção por helmintos transmitidos pelo solo (HTS) são as principais preocupações da saúde infantil em regiões do mundo caracterizadas pela extrema pobreza, especialmente em áreas rurais e periurbanas. Realizou-se este estudo para determinar a prevalência dessas três condições coocorrentes em crianças em idade pré-escolar num distrito de extrema pobreza nos arredores de Iquitos, na Amazônia peruana, com a visão final de informar a ação da saúde pública. A desnutrição foi avaliada utilizando métricas padrão recomendadas pela Organização Mundial da Saúde (OMS); a anemia, utilizando níveis de hemoglobina e a HTS, utilizando a técnica Kato-Katz. Realizaram-se análises de regressão logística para identificar fatores de risco para os três desfechos de interesse. Em março de 2019, foram recrutadas 572 crianças de 6 a 59 meses. A prevalência de desnutrição foi determinada em 31,3%, anemia em 47,2% e HTS em 34,1%. Os números de desnutrição e anemia superaram as estimativas regionais e nacionais para 2019. Ter mais filhos foi um fator de risco para a desnutrição, enquanto a mãe ser casada foi associado a um menor risco. Os fatores de risco para anemia foram idade mais jovem e sexo masculino, enquanto os fatores de risco para HTS foram idade mais avançada, vacinação incompleta e menor nível socioeconômico. O emprego das mães fora de casa também foi associado a um menor risco de HTS. Esta evidência recente destaca a necessidade de atenção clínica rápida e integrada e ações da saúde pública para enfrentar as consequências a curto e longo prazo para a saúde nessa faixa etária infantil vulnerável. A integração de um quadro de monitoramento e avaliação seria importante para uma gestão eficaz, otimização de recursos e prestação de contas, e para demonstrar impacto.
The World Health Organization recommends deworming to reduce soil‐transmitted helminth (STH)‐attributable morbidity in women of reproductive age, including pregnant and lactating women, to reduce ...blood loss, iron deficiency anaemia and nutrient malabsorption. This study assessed the impact of maternal postpartum deworming with albendazole approximately 1 day after delivery on infant milk intake among a subset of 216 randomly selected mother–infant pairs recruited into a large trial in Peru. Infant milk intake was measured using the deuterium‐oxide method at 1‐ and 6‐month postpartum. Maternal STH infection was measured at 6‐month postpartum. At 1‐month postpartum, mean intake was 756 ± 16 and 774 ± 18 mL day−1 in the albendazole and placebo groups, respectively (mean difference: −18 mL day−1; 95% CI: −65, 30). At 6‐month postpartum, mean intake was 903 ± 16 and 908 ± 18 mL day−1 in the albendazole and placebo groups, respectively (mean difference: −5 mL day−1; 95% CI: −52, 43). There was no statistically significant difference in milk intake between groups at either time point. At 6‐month postpartum, mothers infected with Trichuris trichiura had infants with higher milk intakes (adjusted mean difference: 70 mL day−1; 95% CI: 20, 120) compared with uninfected mothers. However, there was no statistically significant difference in infant milk intake between mothers who had moderate‐and‐heavy intensity infection compared with the comparison group (mothers with no and light intensity infection). A lower prevalence and intensity of infection, and inclusion of uninfected mothers in both arms of the trial, resulting in effect dilution, may explain the null findings.
Appropriate health and nutrition interventions to prevent long-term adverse effects in children are necessary before two years of age. One such intervention may include population-based deworming, ...recommended as of 12 months of age by the World Health Organization in soil-transmitted helminth (STH)-endemic areas; however, the benefit of deworming has been understudied in early preschool-age children.
A randomized, double-blind, placebo-controlled trial was conducted to determine the effect of deworming (500 mg single-dose crushed mebendazole tablet) on growth in one-year-old children in Iquitos, Peru. Children were enrolled during their routine 12-month growth and development clinic visit and followed up at their 18 and 24-month visits. Children were randomly allocated to: Group 1: deworming at 12 months and placebo at 18 months; Group 2: placebo at 12 months and deworming at 18 months; Group 3: deworming at both 12 and 18 months; or Group 4: placebo at both 12 and 18 months (i.e. control group). The primary outcome was weight gain at the 24-month visit. An intention-to-treat approach was used. A total of 1760 children were enrolled between September 2011 and June 2012. Follow-up of 1563 children (88.8%) was completed by July 2013. STH infection was of low prevalence and predominantly light intensity in the study population. All groups gained between 1.93 and 2.05 kg on average over 12 months; the average difference in weight gain (kg) compared to placebo was: 0.05 (95% CI: -0.05, 0.17) in Group 1; -0.07 (95%CI: -0.17, 0.04) in Group 2; and 0.04 (95%CI: -0.06, 0.14) in Group 3. There was no statistically significant difference in weight gain in any of the deworming intervention groups compared to the control group.
Overall, with one year of follow-up, no effect of deworming on growth could be detected in this population of preschool-age children. Low baseline STH prevalence and intensity and/or access to deworming drugs outside of the trial may have diluted the potential effect of the intervention. Additional research is required to overcome these challenges and to contribute to strengthening the evidence base on deworming.
ClinicalTrials.gov (NCT01314937).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Strongyloidiasis is a disease of great public health significance, caused by the parasitic nematodes Strongyloides stercoralis, Strongyloides fuelleborni, and Strongyloides fuelleborni subsp. kellyi. ...This systematic review and meta-analysis aimed to assess the prevalence of Strongyloides stercoralis infection in Peru. The review was based on a literature search in PubMed, SciELO and Google Scholar using the key words or root words "strongyl*" AND "Peru" on 15 July 2020. Eligible studies were published from 1 January 1981 to 15 July 2020 and written in English, Spanish, Italian, or French. We included 21 papers in the analysis. Studies were heterogeneous in terms of study population and diagnostic methods (e.g. Baermann technique, agar, Dancescu or charcoal cultures, serology, string capsule). Prevalence of S. stercoralis ranged from 0.3 to 45%. The pooled proportion of Strongyloides in the general population was 7.34% (95% CI 4.97 to 10.13%). Half the studies were designed to detect parasites in general. In studies designed to detect S. stercoralis, the most widely used diagnostic method was the Baermann technique. Prevalence of S. stercoralis in Peru was high but varied by geographic area, techniques for stool examination, and participant characteristics.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Nutritional interventions targeting the critical growth and development period before two years of age can have the greatest impact on health trajectories over the life course. Compelling evidence ...has demonstrated that interventions investing in maternal health in the first 1000 days of life are beneficial for both mothers and their children. One such potential intervention is deworming integrated into maternal postpartum care in areas where soil-transmitted helminth (STH) infections are endemic.
From February to August 2014, 1010 mother-infant pairs were recruited into a trial aimed at assessing the effectiveness of maternal postpartum deworming on infant and maternal health outcomes. Following delivery, mothers were randomly assigned to receive either single-dose 400 mg albendazole or placebo. Participants were followed-up at 1 and 6 months postpartum. There was no statistically significant difference in mean weight gain between infants in the experimental and control groups (mean difference: -0.02; 95% CI: -0.1, 0.08) at 6 months of age. Further, deworming had no effect on measured infant morbidity indicators. However, ad hoc analyses restricted to mothers who tested positive for STHs at baseline suggest that infants of mothers in the experimental group had greater mean length gain in cm (mean difference: 0.8; 95% CI: 0.1, 1.4) and length-for-age z-score (mean difference: 0.5; 95% CI: 0.2, 0.8) at 6 months of age.
In a study population composed of both STH-infected and uninfected mothers, maternal postpartum deworming was insufficient to impact infant growth and morbidity indicators up to 6 months postpartum. Among STH-infected mothers, however, important improvements in infant length gain and length-for-age were observed. The benefits of maternal postpartum deworming should be further investigated in study populations having higher overall prevalences and intensities of STH infections and, in particular, where whipworm and hookworm infections are of public health concern.
ClinicalTrials.gov (NCT01748929).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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