| 1. |
- Gaines, Hans, et al.
(författare)
-
Six-week follow-up after HIV-1 exposure: a position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy
- 2016
-
Ingår i: Infectious Diseases. - : Informa UK Limited. - 2374-4235 .- 2374-4243. ; 48:2, s. 93-98
-
Forskningsöversikt (refereegranskat)abstract
- In 2014 the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy (RAV) conducted a review and analysis of the state of knowledge on the duration of follow-up after exposure to human immunodeficiency virus (HIV). Up until then a follow-up of 12 weeks after exposure had been recommended, but improved tests and new information on early diagnosis motivated a re-evaluation of the national recommendations by experts representing infectious diseases and microbiology, county medical officers, the RAV, the Public Health Agency, and other national authorities. Based on the current state of knowledge the Public Health Agency of Sweden and the RAV recommend, starting in April 2015, a follow-up period of 6 weeks after possible HIV-1 exposure, if HIV testing is performed using laboratory-based combination tests detecting both HIV antibody and antigen. If point-of-care rapid HIV tests are used, a follow-up period of 8 weeks is recommended, because currently available rapid tests have insufficient sensitivity for detection of HIV-1 antigen. A follow-up period of 12 weeks is recommended after a possible exposure for HIV-2, since presently used assays do not include HIV-2 antigens and only limited information is available on the development of HIV antibodies during early HIV-2 infection. If pre- or post-exposure prophylaxis is administered, the follow-up period is recommended to begin after completion of prophylaxis. Even if infection cannot be reliably excluded before the end of the recommended follow-up period, HIV testing should be performed at first contact for persons who seek such testing.
|
|
| 2. |
- Josephson, Filip, et al.
(författare)
-
Antiretroviral treatment of HIV infection: Swedish recommendations 2007.
- 2007
-
Ingår i: Scandinavian journal of infectious diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 39:6-7, s. 486-507
-
Tidskriftsartikel (refereegranskat)abstract
- On 3 previous occasions, in 2002, 2003 and 2005, the Swedish Medical Products Agency (Läkemedelsverket) and the Swedish Reference Group for Antiviral Therapy (RAV) have jointly published recommendations for the treatment of HIV infection. An expert group, under the guidance of RAV, has now revised the text again. Since the publication of the previous treatment recommendations, 1 new drug for the treatment of HIV has been approved - the protease inhibitor (PI) darunavir (Prezista). Furthermore, 3 new drugs have become available: the integrase inhibitor raltegravir (MK-0518), the CCR5-inhibitor maraviroc (Celsentri), both of which have novel mechanisms of action, and the non-nucleoside reverse transcriptase inhibitor (NNRTI) etravirine (TMC-125). The new guidelines differ from the previous ones in several respects. The most important of these are that abacavir is now preferred to tenofovir and zidovudine, as a first line drug in treatment-naïve patients, and that initiation of antiretroviral treatment is now recommended before the CD4 cell count falls below 250/microl, rather than 200/microl. Furthermore, recommendations on the treatment of HIV infection in children have been added to the document. As in the case of the previous publication, recommendations are evidence-graded in accordance with the Oxford Centre for Evidence Based Medicine, 2001 (see http://www.cebm.net/levels_of_evidence.asp#levels).
|
|
| 3. |
- Navér, Lars, et al.
(författare)
-
Prophylaxis and treatment of HIV-1 infection in pregnancy: Swedish recommendations 2013.
- 2014
-
Ingår i: Scandinavian journal of infectious diseases. - : Informa UK Limited. - 1651-1980 .- 0036-5548. ; 46:6, s. 401-11
-
Tidskriftsartikel (refereegranskat)abstract
- Prophylaxis and treatment with antiretroviral drugs and elective caesarean section delivery have resulted in very low mother-to-child transmission of HIV during recent years. Updated general treatment guidelines and increasing knowledge about mother-to-child transmission have necessitated regular revisions of the recommendations for the prophylaxis and treatment of HIV-1 infection in pregnancy. The Swedish Reference Group for Antiviral Therapy (RAV) updated the recommendations from 2010 at an expert meeting on 11 September 2013. The most important revisions are the following: (1) ongoing efficient treatment at confirmed pregnancy may, with a few exceptions, be continued; (2) if treatment is initiated during pregnancy, the recommended first-line therapy is essentially the same as for non-pregnant women; (3) raltegravir may be added to achieve rapid reduction in HIV RNA; (4) vaginal delivery is recommended if at > 34 gestational weeks and HIV RNA is < 50 copies/ml and no obstetric contraindications exist; (5) if HIV RNA is < 50 copies/ml and delivery is at > 34 gestational weeks, intravenous zidovudine is not recommended regardless of the delivery mode; (6) if HIV RNA is > 50 copies/ml close to delivery, it is recommended that the mother should undergo a planned caesarean section, intravenous zidovudine, and oral nevirapine, and the infant should receive single-dose nevirapine at 48-72 h of age and post-exposure prophylaxis with 2 drugs; (7) if delivery is preterm at < 34 gestational weeks, a caesarean section delivery should if possible be performed, with intravenous zidovudine and oral nevirapine given to the mother, and single-dose nevirapine given to the infant at 48-72 h of age, as well as post-exposure prophylaxis with 2 additional drugs.
|
|
| 4. |
- Svedhem Johansson, Veronica
(författare)
-
Kinetics of HIV-1 drug resistance mutations in vivo
- 2006
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Antiretroviral therapy (ARV) exert a selective pressure on HIV-1 and may select viral drug resistant strains which have competitive advantage in the presence of the drug. Knowledge about the appearance and disappearance of these mutations is important when choosing ARV. The aim of this thesis was to study the kinetics of drug induced resistance mutations and the relevance of the mutational patterns in minor and major viral populations at ARV cessation, change and failure in a clinical setting. Paper 1. To study the kinetics if HIV-1 RNA and drug-induced mutations after cessation of ARV therapy in 26 patients. After cessation of ARV a phase of varying length with undetectable virus was followed by a rapid viral increase before a plateau, corresponding to pretreatment levels, was reached. A significant larger number of primary protease inhibitor (PI) associated mutations reverted to wild-type, as compared with primary reverse transcriptase inhibitor (RTI) associated mutations, suggesting that they may cause a more impaired viral fitness. During the phase of rapid viral increase mutated and wild-type virus replicated equally good, indicating that mutated stains still may replicate efficiently. Paper 2. To study the reappearance of drug resistance mutations detected earlier at a new virological failure during second or third line antiretroviral therapy. Genotypic resistance testing was carried out in 66 patients before change of therapy and at the next treatment failure. The majority of primary and secondary resistance mutations persisted at new failures with modified treatment in both the RT and the PI genes. The results suggest that clinical cross-resistance may develop via common pathways within all categories of drugs in heavily treated patients. Paper 3. To describe the pattern of resistance mutations in Pl-naive HIV-1 infected patients experiencing their first treatment failure on nelfinavir(NFV) containing therapy. 172 patient were studied. Virus from base-line was sequenced in 29 patients, the V82A mutation was found in four patients without any epidemiological connections. Treatment-naïve patients in Sweden may thus harbour PI-resistant virus and resistance testing should be considered before treatment. 43 patients failed treatment. A diverse pattern of primary PI mutations was seen: 461 (n= 7), 30N (n= 6), 90M (n= 5) and 82A (n= 4). The finding of 461 was unexpected and is associated with a higher degree of PI cross-resistance than the common 30N. Paper 4. To investigate the kinetics of M1841/V in the minor HIV-1 populations. Sixteen HIV-1 infected patients with treatment failure on 3TC and/or doI containing regimens were analysed by direct sequencing and selective PCR (SPCR). In five samples, SPCR detected mutated virus, at low proportions, when direct sequencing showed a wild-type sequence. The good correlation between direct sequencing and SPCR is in line with that M184V mutants rapidly become dominating during 3TC failure, although a few patients may harbour 3TC resistant virus in minor populations only. Eleven patients with treatment failure on ddI containing treatment exhibited wild-type virus by both methods suggesting M184V does not cause any clinical significant decrease in sensitivity to ddI in vivo.
|
|
