Effect the pre-exposure prophylactic of hydroxychloroquine on severe COVID-19 disease: a randomized controlled trial

Background. In vitro studies have shown some effects for Hydroxychloroquine (HCQ) against SARS-CoV-2 virus. Despite effective vaccination program, relatively large proportion of population remains unvaccinated. So, there still remains a need for other prophylactic measures. The present study aims to evaluate whether HCQ can prevent severe COVID-19 outcomes among health-care workers. Materials and methods. In this randomized, double blind placebo-controlled clinical trial 334 healthcare workers aged 18–65 years old were included of whom 278 individuals completed the study. Participants were randomly assigned to the HCQ group (800 mg at day one, followed by 400 mg weekly for the next 7 weeks); or the placebo group. Participants were followed three weeks after the last dose of drug or placebo (10 weeks from the first dose of drug or placebo). The primary outcome was hospitalization or death from COVID-19. Results. Of 148 people who received HCQ, none were hospitalized or died from COIVD-19, while of 130 people who received the placebo, 2 (1.5%) were hospitalized for COIVD-19 (p-value: 0.26). And, 22 (14.9%) people in the HCQ group and 15 (11.6%) people in the placebo group contracted COVID-19 (p-value: 0.99). Adverse reactions were reported by 5 (3.4%) of participants in the HCQ group and 5 (3.9%) of participants in the placebo group (p-value: 0.99). Conclusion. We found that HCQ has no significant prevention effect on the incidence of mild COVID-19. However, the low rate of hospitalization (the primary outcome) in this trial like most of the other clinical trials with HCQ would have required increasing the sample size considerably to be able to comment on the effectiveness of HCQ in prevention of severe forms including death rate. This justifies systematic reviews to include similar studies to further investigate the issue

HIV and risk behaviors among visitors of inmates at the Great Tehran Prison, Iran, 2018.

ObjectivesThe objective of the present study was to determine the prevalence of HIV and risk behaviors among the inmates' visitors at the Great Tehran Prison in 2018.This population is more likely to be infected with HIV due to their relationship with inmates. However, they have not been prioritized to the other populations in comparison to inmates who are usually prioritized over others.MethodUsing a convenient sampling method, we recruited inmates' visitorsat the Great Tehran Prison in 2018. An anonymous questionnaire collected information on the participant's demographic characteristics, relationship withinmate, imprisonment history, drug-related risk behaviors, and HIV-related risk behaviors.Rapid HIV blood test detected HIV positive people. To examine the association between risk behaviors and HIV infection, we used a multivariate logistic regression model to calculate the adjusted Odds Ratio (OR)(adjusted Odds ratio of 23.140, 95% CI OD: 1.994-268.5).Results1131 visitors were asked to participate in the study; out of which 1120 consented (99%).Out of the 1120 participants, 55.2% were female, and the majority (72.4%) aged older than 35 years. Of those who had a sexual partner, 50% did not usea condom in the last 6 months. Overall, HIV prevalence was 0.4% in the inmate visitors, but it was significantly higher among those with a history of drug injection(p=0.003).ConclusionOur findings indicated that overall the HIV prevalence is low amonginmates' visitors; Subgroups with a history of injection have high HIV prevalence which needs to beprioritized for HIV screening and treatment

Comparison of safety and effectiveness of antiretroviral therapy regimens among pregnant women living with HIV at preconception or during pregnancy: a systematic review and network meta-analysis of randomized trials.

BACKGROUND: Mother-to-child transmission is the primary cause of HIV cases among children. Antiretroviral therapy (ART) plays a critical role in preventing mother-to-child transmission and reducing HIV progression, morbidity, and mortality among mothers. However, after more than two decades of ART during pregnancy, the comparative effectiveness and safety of ART medications during pregnancy are unclear, and existing evidence is contradictory. This study aimed to assess the effectiveness and safety of different ART regimens among pregnant women living with HIV at preconception or during pregnancy. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science. We included randomized trials that enrolled pregnant women living with HIV and randomized them to receive ART for at least four weeks. Pairs of reviewers independently completed screening for eligible studies, extracted data, and assessed the risk of bias using the Cochrane risk of bias tool. Our outcomes of interest included low birth weight, stillbirth, preterm birth, mother-to-child transmission of HIV, neonatal death, and congenital anomalies. Network meta-analysis was performed using a random-effects frequentist model, and the certainty of evidence was evaluated using the GRADE approach. RESULTS: We found 14 eligible randomized trials enrolling 9,561 pregnant women. The median duration of ART uptake ranged from 6.0 to 17.4 weeks. No treatment was statistically better than a placebo in reducing the rate of neonatal mortality, stillbirth, congenital defects, preterm birth, or low birth weight deliveries. Compared to placebo, zidovudine (ZDV)/lamivudine (3TC) and ZDV monotherapy likely reduce mother-to-child transmission (odds ratio (OR): 0.13; 95% CI: 0.05 to 0.31, high-certainty; and OR: 0.50; 95% CI: 0.33 to 0.74, moderate-certainty). Moderate-certainty evidence suggested that ZDV/3TC was associated with decreased odds of stillbirth (OR: 0.47; 95% CI: 0.09 to 2.60). CONCLUSIONS: Our analysis provides high- to moderate-certainty evidence that ZDV/3TC and ZDV are more effective in reducing the odds of mother-to-child transmission, with ZDV/3TC also demonstrating decreased odds of stillbirth. Notably, our findings suggest an elevated odds of stillbirth and preterm birth associated with all other ART regimens

Active Health Service Provision Scale up for HIV and Tuberculosis in 16 Prisons, Iran

Background: In most countries, the prevalence of HIV and tuberculosis (TB) among prisoners are higher than those in the general population. Nevertheless, the prison setting presents not only challenges, but also opportunities for the prevention and treatment of TB and HIV. Therefore, this program was designed to scale up a previously piloted guideline to screen and diagnose people living with HIV (PLWH) and those with TB diseases and then provide them actively needed health services. Methods: Since the beginning of March 2015 the program for active health service provision (AHSP) for TB and HIV was started. This guideline was based on a model that provide diagnostic, treatment and follow-up services actively including all aspects of HIV/TB diagnosis, treatment and care services. Also major HIV/TB-related topics are described in it. In order to carry out the scaling up of the implementation of the guideline, following steps were taken: Formation of the Steering Committee, establishing required structures and holding workshops to train staff. Results: The mean number of HIV tests done before the intervention, was 163.9 per season in 16 prisons, while this figure was 1106.5 per season after the intervention. The mean number of patients receiving antiretroviral therapy (ART) increased after the intervention. The numbers are, respectively, 10.8, and 16.4 person per season, before and after the intervention. Conclusion: The changes of target variables before and after the program within 16 prisons in 13 provinces in Iran show the efficiency of AHSP. Since the prevalence of HIV and TB among prisoners are high and HIV infection, itself, is the greatest risk factor for developing TB, prisons as well as challenges are opportunities for the prevention and treatment of TB and HIV. Actively health services provided in prisons show positive results and suggest an efficient way of dealing with these infections

Prevalence of sexually transmitted infections and associated risk behaviors in prisoners: A systematic review

Abstract Background and Aims Sexually transmitted infections (STIs) are one of the major health concerns globally. Generally, prisoners are at higher risks for STIs due to risk factors including; drug‐use, high‐risk sexual behaviors, densely populated prisons, and poor living conditions. Therefore, we aimed to conduct a systematic review to evaluate the existing data on STI prevalence, and its associated risk factors among prisoners. Methods We conducted a systematic search of the literature using the keywords in Scopus, PubMed, Web of Science, and Google Scholar online databases. We selected all the relevant original studies in English through title/abstract and full‐text screening process.‎ Results Based on the inclusion and exclusion criteria, we selected and reviewed 32 studies out of 96 identified papers. The most important STI‐associated risk factors among prisoners were drug use, low educational levels, and unsafe sex. The prevalence of STIs was heterogenous in selected studies and was reported as follows; Human Immunodeficiency Virus (HIV) (0%−14.5%), hepatitis B viruses (HBV) (0.04%−27.23%), hepatitis C viruses (HCV) (0.17%−49.7%), Syphilis (0.2%−22.1%), Chlamydia Trachomatis (CT) (1.02%−6.7%), Gonorrhea (0.6%−7.8%), and herpes simplex virus‐2 (HSV‐2) 22.4%. Conclusion This systematic review indicates that the prevalence of STIs (HIV, HBV, HCV, Syphilis, Chlamydia Trachomatis, Gonorrhea, and HSV‐2) among prisoners appears to be higher than the general population, with drug abuse, low educational levels, and unsafe sex as major risk factors

SARS-CoV-2 and Stroke Characteristics: A Report From the Multinational COVID-19 Stroke Study Group

International audienceBackground and Purpose: Stroke is reported as a consequence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in several reports. However, data are sparse regarding the details of these patients in a multinational and large scale. Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke, intracranial hemorrhage, and cerebral venous or sinus thrombosis among SARS-CoV-2–infected patients. We further investigated the risk of large vessel occlusion, stroke severity as measured by the National Institutes of Health Stroke Scale, and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with acute ischemic stroke. In addition, we explored the neuroimaging findings, features of patients who were asymptomatic for SARS-CoV-2 infection at stroke onset, and the impact of geographic regions and countries’ health expenditure on outcomes. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least 1 eligible stroke patient. Of 432 patients included, 323 (74.8%) had acute ischemic stroke, 91 (21.1%) intracranial hemorrhage, and 18 (4.2%) cerebral venous or sinus thrombosis. A total of 183 (42.4%) patients were women, 104 (24.1%) patients were <55 years of age, and 105 (24.4%) patients had no identifiable vascular risk factors. Among acute ischemic stroke patients, 44.5% (126 of 283 patients) had large vessel occlusion; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median National Institutes of Health Stroke Scale (8 [3–17] versus 11 [5–17]; P =0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; P <0.001) in countries with middle-to-high health expenditure when compared with countries with lower health expenditure. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144 (37.8%) were asymptomatic at the time of admission for SARS-CoV-2 infection. Conclusions: We observed a considerably higher rate of large vessel occlusions, a much lower rate of small vessel occlusion and lacunar infarction, and a considerable number of young stroke when compared with the population studies before the pandemic. The rate of mechanical thrombectomy was significantly lower in countries with lower health expenditures