“COVID-19 in People Living With HIV - Contagionlive.com” plus 1 more
“COVID-19 in People Living With HIV - Contagionlive.com” plus 1 more |
| COVID-19 in People Living With HIV - Contagionlive.com Posted: 27 Apr 2020 06:03 AM PDT  José Mirό, MD, PhD, from the University of Barcelona and colleagues of the COVID-19 in HIV Collaborative, reported what they characterize as the first single-center experience of COVID-19 in patients with HIV-1, in The Lancet HIV. "This pandemic is a challenge affecting everyone," Mirό and colleagues asserted. "By generating information such as we present here, the management and prognosis of patients co-infected with HIV and SARS-CoV-2 might be improved." The 5 patients with the co-infections were among 543 consecutive patients admitted to a hospital in Barcelona with COVID-19 as of March 9th. They ranged in age from 29 to 49 years; 2 of the 5 had an underlying illness (hypothyroidism and asthma, respectively). Four of the patients were on ART, 2 patients with a protease-inhibitor and 2 with integrase-inhibitor. One patient was ART-naïve and was described as having very advanced late presentation. The 4 patients on ART had CD4 cell counts >445 cells/μl (range 445-1140), while the ART-naive patient had CD4 count of 13 The 2 patients on protease-inhibitor ART were admitted with upper respiratory tract infection. The 2 patients on an integrase-inhibitor and the ART-naïve patient were admitted with viral pneumonia; with 1 of these patients on ART and the ART-naïve patient admitted to intensive care. The patient on ART, and with hypothyroidism, admitted to the ICU was the only patient to require invasive mechanical ventilation. Mirό and colleagues advise that patients with advanced, late presentation of HIV will require differential diagnosis and initial antimicrobial treatment to address pulmonary opportunistic infections such as pneumocystis jiroveci, which was detected in their ART-naive patient. The treatment of COVID-19 varied between patients, but could include interferon-beta-1b, hydroxychloroquine, antibiotics, corticosteroids and/or tocilizumab. The ART regimen for each patient was either maintained as or converted to a protease-inhibitor for the duration of hospitalization, and changed back to their original treatment on discharge from the hospital. "...we were making a transitional change in their regimen on the basis of the fact that HIV protease inhibitors might have activity against the coronavirus protease," Mirό and colleagues explained. All patients except the patient requiring mechanical ventilation had recovered and were discharged at the time of the report, within a range of 1-4 days, and 12 days for the patient who had been ART-naïve, followed by periods of supervised "home-hospitalization". Mirό and colleagues acknowledge that a possible benefit of the protease inhibitor ART in COVID-19 is hypothetical, and that one trial in China found that lopinavir-boosted ritonavir was ineffective as a monotherapy against severe pneumonia associated with COVID-19. They also note data from Janssen Pharmaceuticals indicate that darunavir was ineffective against SARS-CoV-2 due to low affinity to coronavirus protease. "Therefore, investigation of the efficacy of this treatment in patients with COVID-19 in combined therapy in earlier stages of the disease is needed," they said. Mirό and colleagues are awaiting results with remdesivir, which they characterize as the most active in-vitro and in-vivo antiviral drugs against coronavirus to date. In addition to hoping that it will be found effective, they point out that remdesivir does not appear to have pharmacokinetic interactions with ART medications. To stay informed on the latest in infectious disease news and developments, please sign up for our weekly newsletter. |
| Influenza Vaccination Reduces Unnecessary Antibiotic Prescriptions - PrecisionVaccinations Posted: 27 Apr 2020 05:28 AM PDT  A new study led by researchers from the US Centers for Disease Control and Prevention (CDC) found that influenza vaccinations helped avert about 4 percent (1 in 25) of antibiotic prescriptions among outpatients diagnosed with an Acute Respiratory Illness (ARI). ARI commonly causes outpatient visits and accounts for about 41 percent of antibiotics used in the USA, said these researchers. This data indicates an annual flu shot may reduce unnecessary antibiotic use and mitigate the risks of antibiotic resistance. Published on April 23, 2020, this 5-year study, among 37,487 ARI outpatients, 9,659 (26%) were found influenza-positive. Overall, 36 percent of ARI and 26 percent of influenza-positive patients were prescribed antibiotics. The leading ARI syndromes were viral upper respiratory tract infection (47%), pharyngitis (18%), and allergy or asthma (11%). After adjusting for potential confounders, the overall Vaccine Effectiveness (VE) against lab-confirmed influenza was 35 percent. Based on the VE and vaccination coverage, the researchers estimate that vaccination prevented 5.6 percent of all ARI syndromes, and 3.8 percent of antibiotic prescriptions among ARI outpatients. The authors of the study published in Clinical Infectious Diseases said the findings are consistent with previous research that suggests antibiotics are overprescribed for ARI syndromes for which they are not indicated. The CDC says 'everyone 6 months of age and older should get a flu vaccine every season with rare exceptions'. Vaccination is particularly important for people who are at high risk of serious complications from influenza. Sponsored Links: Flu vaccination offers several important benefits. It can reduce flu illnesses, doctors' visits, and missed work and school due to flu, as well as prevent flu-related hospitalizations. Flu vaccines also have been shown to be life-saving in children. In fact, a 2017 study showed that flu vaccination can significantly reduce a child's risk of dying from influenza. Different flu vaccines are approved for use in different groups of people. There are flu shots approved for use in children as young as 6 months of age and flu shots approved for use in adults 65 years and older. Furthermore, influenza vaccinations also are recommended for use in pregnant women and people with certain chronic health conditions, says the CDC. These researchers did not disclose industry-related conflicts of interest. Flu shot news published by Precision Vaccinations. |
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