Since the beginning of the COVID-19 pandemic, therapeutic options for treating COVID-19 have been investigated at different stages of clinical manifestations. Considering the particular impact of ...COVID-19 in the Americas, this document aims to present recommendations for the pharmacological treatment of COVID-19 specific to this population.
Fifteen experts, members of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API) make up the panel responsible for developing this guideline. Questions were formulated regarding prophylaxis and treatment of COVID-19 in outpatient and inpatient settings. The outcomes considered in decision-making were mortality, hospitalisation, need for mechanical ventilation, symptomatic COVID-19 episodes, and adverse events. In addition, a systematic review of randomised controlled trials was conducted. The quality of evidence assessment and guideline development process followed the GRADE system.
Nine technologies were evaluated, and ten recommendations were made, including the use of tixagevimab + cilgavimab in the prophylaxis of COVID-19, tixagevimab + cilgavimab, molnupiravir, nirmatrelvir + ritonavir, and remdesivir in the treatment of outpatients, and remdesivir, baricitinib, and tocilizumab in the treatment of hospitalised patients with severe COVID-19. The use of hydroxychloroquine or chloroquine and ivermectin was discouraged.
This guideline provides recommendations for treating patients in the Americas following the principles of evidence-based medicine. The recommendations present a set of drugs that have proven effective in the prophylaxis and treatment of COVID-19, emphasising the strong recommendation for the use of nirmatrelvir/ritonavir in outpatients as the lack of benefit from the use of hydroxychloroquine and ivermectin.
•There is poor documentation of antiretroviral use in Latin America•Early antiretroviral therapy (ART) initiation has improved in the region•ART and genotypification availability are unequally ...distributed in the region•Efavirenz remains the first option for initiating ART; Zidovudine use has decreased•Use of new antiretroviral drugs like integrase inhibitors as a third drug is delayed
To document antiretroviral use in Latin America during the last decade.
We collected indicators from 79 HIV health care centres in 14 Latin American Spanish-speaking countries for 2013–2017. Indicators were analysed by age, sex and other characteristics and weighted by the estimated people under care (PUC) population in each country.
We gathered information on 116 299 PUC. One-third belonged to centres reporting a shortage of at least one antiretroviral therapy (ART) drug for >30 days during 2017. At end 2017, 95.1% of PUC were receiving ART. During 2013–2017, 45 329 people living with HIV were admitted to 39 centres. ART initiated during the first year after admission increased from 76.7% in 2013 to 83.8% in 2017. In 35 centres across the study period, 71.7% of PUC started ART with tenofovir disoproxil fumarate and lamivudine, and zidovudine use decreased. The third most common ART drug, EFV, reached 64.8%. Raltegravir and other alternatives increased annually to almost 10% of total use in 2017.
Initial ART in Latin America is not based on the most recent scientific evidence and recommendations; use of drugs with higher efficacy and safety profiles and guarantee of ART availability continues to be a public health challenge.
Background Since the beginning of the COVID-19 pandemic, therapeutic options for treating COVID-19 have been investigated at different stages of clinical manifestations. Considering the particular ...impact of COVID-19 in the Americas, this document aims to present recommendations for the pharmacological treatment of COVID-19 specific to this population. Methods Fifteen experts, members of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API) make up the panel responsible for developing this guideline. Questions were formulated regarding prophylaxis and treatment of COVID-19 in outpatient and inpatient settings. The outcomes considered in decision-making were mortality, hospitalisation, need for mechanical ventilation, symptomatic COVID-19 episodes, and adverse events. In addition, a systematic review of randomised controlled trials was conducted. The quality of evidence assessment and guideline development process followed the GRADE system. Results Nine technologies were evaluated, and ten recommendations were made, including the use of tixagevimab + cilgavimab in the prophylaxis of COVID-19, tixagevimab + cilgavimab, molnupiravir, nirmatrelvir + ritonavir, and remdesivir in the treatment of outpatients, and remdesivir, baricitinib, and tocilizumab in the treatment of hospitalised patients with severe COVID-19. The use of hydroxychloroquine or chloroquine and ivermectin was discouraged. Conclusion This guideline provides recommendations for treating patients in the Americas following the principles of evidence-based medicine. The recommendations present a set of drugs that have proven effective in the prophylaxis and treatment of COVID-19, emphasising the strong recommendation for the use of nirmatrelvir/ritonavir in outpatients as the lack of benefit from the use of hydroxychloroquine and ivermectin. Keywords: COVID-19, SARS-CoV-2, Therapy, Guidelines, Treatment
COVID-19 has caused more than 767 million cases and 6.94 million deaths up to June 2023 (https://covid19.who.int/), and these numbers could be significantly higher, potentially even three to four ...times the excess mortality associated with this disease 6–10. ...early during this pandemic (2020) 11–14, multiple studies began to recognize and understand that chronic consequences may occur in a significant proportion of patients 15,16, leading to various manifestations and affecting different systems and organs after the acute phase of the illness 17. According to this study, once the symptoms of prolonged COVID are established, they tend to remain stable and without much variation over time, the same can be said of those people who do not develop the condition immediately 37. According to the WHO, 10–20% of people infected by SARS-CoV-2 may go on to develop its symptoms (https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition). ...studies assessing the trajectories of the evolution of post-COVID-19 conditions in the long term are widely needed 43. Female sex, younger age, belonging to a an African-American, mixed ethnicity or another ethnic minority group, socioeconomic deprivation, smoking, high body mass index and the presence of a wide range of comorbidities were associated with increased risk of symptoms included in the WHO definition of long COVID-19, and they are statistically associated with SARS-CoV-2 infection reported 12 weeks or more after infection 48.
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