59 research outputs found
Restrictions for reimbursement of interferon-free direct-acting antiviral drugs for HCV infection in Europe
To access publisher's full text version of this article click on the hyperlink belowAll-oral direct-acting antiviral drugs (DAAs) for hepatitis C virus, which have response rates of 95% or more, represent a major clinical advance. However, the high list price of DAAs has led many governments to restrict their reimbursement. We reviewed the availability of, and national criteria for, interferon-free DAA reimbursement among countries in the European Union and European Economic Area, and Switzerland. Reimbursement documentation was reviewed between Nov 18, 2016, and Aug 1, 2017. Primary outcomes were fibrosis stage, drug or alcohol use, prescriber type, and HIV co-infection restrictions. Among the 35 European countries and jurisdictions included, the most commonly reimbursed DAA was ombitasvir, paritaprevir, and ritonavir, with dasabuvir, and with or without ribavirin (33 [94%] countries and jurisdictions). 16 (46%) countries and jurisdictions required patients to have fibrosis at stage F2 or higher, 29 (83%) had no listed restrictions based on drug or alcohol use, 33 (94%) required a specialist prescriber, and 34 (97%) had no additional restrictions for people co-infected with HIV and hepatitis C virus. These findings have implications for meeting WHO targets, with evidence of some countries not following the 2016 hepatitis C virus treatment guidelines by the European Association for the Study of Liver.UNSW (Sydney, Australia)
CanHepC Trainee Program (Canada)
National Health and Medical Research Council
Australian Government Department of Healt
Infections in Infants during the First 12 Months of Life: Role of Placental Malaria and Environmental Factors
Background: The association between placental malaria (PM) and first peripheral parasitaemias in early infancy was assessed in Tori Bossito, a rural area of Benin with a careful attention on transmission factors at an individual level. Methodology: Statistical analysis was performed on 550 infants followed weekly from birth to 12 months. Malaria transmission was assessed by anopheles human landing catches every 6 weeks in 36 sampling houses and season defined by rainfall. Each child was located by GPS and assigned to the closest anopheles sampling house. Data were analysed by survival Cox models, stratified on the possession of insecticide-treated mosquito nets (ITNs) at enrolment. Principal Findings: Among infants sleeping in a house with an ITN, PM was found to be highly associated to first malaria infections, after adjusting on season, number of anopheles, antenatal care (ANC) visits and maternal severe anaemia. Infants born from a malaria infected placenta had a 2.13 fold increased risk to present a first malaria infection than those born from a non infected placenta ([1.24-3.67], p<0.01) when sleeping in a house with an ITN. The risk to present a first malaria infection was increased by 3.2 to 6.5, according to the level of anopheles exposure (moderate or high levels, compared to the absence of anopheles). Conclusions: First malaria infections in early childhood can be attributed simultaneously to both PM and high levels of exposure to infected anopheles. Protective measures as Intermittent Preventive Treatment during pregnancy (IPTp) and ITNs, targeted on both mothers and infants should be reinforced, as well as the research on new drugs and insecticides. In parallel, investigations on placental malaria have to be strengthened to better understand the mechanisms involved, and thus to protect adequately the infants high risk group
Staying hepatitis C negative: a systematic review and meta-analysis of cure and reinfection in people who inject drugs
To access publisher's full text version of this article click on the hyperlink belowBACKGROUND AND AIMS:
Direct-acting antivirals (DAAs) are highly effective in treating hepatitis C. However, there is concern that cure rates may be lower, and reinfection rates higher, among people who inject drugs. We conducted a systematic review of treatment outcomes achieved with DAAs in people who inject drugs (PWID).
METHODS:
A search strategy was used to identify studies that reported sustained viral response (SVR), treatment discontinuation, adherence or reinfection in recent PWID and/or opioid substitution therapy (OST) recipients. Study quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis of proportions was used to estimate pooled SVR and treatment discontinuation rates. The pooled relative risk of achieving SVR and pooled reinfection rate were calculated using generalized mixed effects linear models.
RESULTS:
The search identified 8075 references; 26 were eligible for inclusion. The pooled SVR for recent PWID was 88% (95% CI, 83%-92%) and 91% (95% CI 88%-95%) for OST recipients. The relative risk of achieving SVR for recent PWID compared to non-recent PWID was 0.99 (95% CI, 0.94-1.06). The pooled treatment discontinuation was 2% (95% CI, 1%-4%) for both recent PWID and OST recipients. Amongst recent PWID, the pooled incidence of reinfection was 1.94 per 100 person years (95% CI, 0.87-4.32). In OST recipients, the incidence of reinfection was 0.55 per 100 person years (95% CI, 0.17-1.76).
CONCLUSIONS:
Treatment outcomes were similar in recent PWID compared to non-PWID treated with DAAs. People who report recent injecting or OST recipients should not be excluded from hepatitis C treatment.National Health and Medical Research Council of Australi
Immunisation of migrants in EU/EEA countries: Policies and practices
In recent years various EU/EEA countries have experienced an influx of migrants from low and middle-income countries. In 2018, the âVaccine European New Integrated Collaboration Effort (VENICE)â survey group conducted a survey among 30 EU/EEA countries to investigate immunisation policies and practices targeting irregular migrants, refugees and asylum seekers (later called âmigrantsâ in this report). Twenty-nine countries participated in the survey. Twenty-eight countries reported having national policies targeting children/adolescent and adult migrants, however vaccinations offered to adult migrants are limited to specific conditions in seven countries. All the vaccinations included in the National Immunisation Programme (NIP) are offered to children/adolescents in 27/28 countries and to adults in 13/28 countries. In the 15 countries offering only certain vaccinations to adults, priority is given to diphtheria-tetanus, measles-mumps-rubella and polio vaccinations. Information about the vaccines given to child/adolescent migrants is recorded in 22 countries and to adult migrants in 19 countries with a large variation in recording methods found across countries. Individual and aggregated data are reportedly not shared with other centres/institutions in 13 and 15 countries, respectively. Twenty countries reported not collecting data on vaccination uptake among migrants; only three countries have these data at the national level. Procedures to guarantee migrantsâ access to vaccinations at the community level are available in 13 countries. In conclusion, although diversified, strategies for migrant vaccination are in place in all countries except for one, and the strategies are generally in line with international recommendations. Efforts are needed to strengthen partnerships and implement initiatives across countries of origin, transit and destination to develop and better share documentation in order to guarantee a completion of vaccination series and to avoid unnecessary re-vaccination. Development of migrant-friendly strategies to facilitate migrants' access to vaccination and collection of vaccination uptake data among migrants is needed to meet existing gaps
Acute risk for hepatitis E virus infection among HIV-1-positive pregnant women in central Africa
<p>Abstract</p> <p>Background</p> <p>Hepatitis E virus (HEV), an enterically transmitted pathogen, is highly endemic in several African countries. Pregnant women are at particularly high risk for acute or severe hepatitis E. In Gabon, a central African country, the prevalence of antibodies to HEV among pregnant women is 14.1%. Recent studies have demonstrated unusual patterns of hepatitis E (chronic hepatitis, cirrhosis) among immunodeficient patients.</p> <p>Findings</p> <p>We investigated the prevalence of antibodies to HEV among pregnant women infected with HIV-1 or HTLV-1 in Gabon. Of 243 samples collected, 183 were positive for HIV-1 and 60 for HTLV-1; 16 women (6.6%) had IgG antibodies to HEV. The seroprevalence was higher among HIV-1-infected women (7.1%) than HTLV-1-infected women (5.0%). Moreover, the HIV-1 viral load was significantly increased (<it>p</it> †0.02) among women with past-HEV exposure (1.3E+05 <it>vs</it> 5.7E+04 copies per ml), whereas no difference was found in HTLV-1 proviral load (9.0E+01 <it>vs</it> 1.1E+03 copies per ml).</p> <p>Conclusions</p> <p>These data provide evidence that HIV-1-infected women are at risk for acute or severe infection if they are exposed to HEV during pregnancy, with an increased viral load.</p
OstĂ©otomie dâavancĂ©e maxillo-mandibulaire ou orthĂšse dâavancĂ©e mandibulaire dans le traitement des syndromes dâapnĂ©es obstructives du sommeil modĂ©rĂ©s Ă sĂ©vĂšres : comparaison dâefficacitĂ© et recherche de critĂšres prĂ©dictifs dâefficacitĂ©
Introduction. La pression positive continue, traitement de référence du
syndrome dâapnĂ©es-hypopnĂ©es obstructives du sommeil (SAHOS), prĂ©sente un taux Ă©levĂ©
dâintolĂ©rance. Les deux alternatives thĂ©rapeutiques reconnues sont lâorthĂšse dâavancĂ©e
mandibulaire (OAM) et la chirurgie dâavancĂ©e maxillo-mandibulaire (AMM). Patients et
méthode. Cette étude rétrospective a comparé entre janvier 2005 et septembre 2012
lâefficacitĂ© de ces deux traitements chez des patients atteints de SAHOS modĂ©rĂ© Ă sĂ©vĂšre,
et a recherchĂ© des critĂšres prĂ©dictifs dâefficacitĂ©. LâefficacitĂ© Ă©tait dĂ©finie par un
index dâapnĂ©es-hypopnĂ©es (IAH) infĂ©rieur Ă 15/h et diminuĂ© de plus de 50 %. La diffĂ©rence
dâefficacitĂ© a Ă©tĂ© Ă©tudiĂ©e par rĂ©gression logistique ajustĂ©e sur le score de propension Ă
ĂȘtre traitĂ© par AMM plutĂŽt quâOAM. RĂ©sultats. LâĂ©tude a inclus 198 patients :
37 ont été traités par AMM et 161 par OAM. Le traitement par AMM était significativement
plus efficace avec un rapport de cotes (odd-ratio) Ă 3,22; IC95 % 1,31Î7,82 (p = 0,011). Les
facteurs prĂ©dictifs dâefficacitĂ© identifiĂ©s Ă©taient un Ăąge jeune et un IAH de dĂ©part
faible. Il nâa pas Ă©tĂ© retrouvĂ© dâinteraction significative entre le traitement et les
caractĂ©ristiques morphologiques du patient. Conclusion. La chirurgie dâAMM
apparaĂźt ĂȘtre un traitement significativement plus efficace que lâOAM chez les patients
atteints de SAHOS modéré à sévÚre. Aucune caractéristique morphologique ne semble
favoriser la réussite du traitement par OAM comparativement au traitement par AMM
Pression arterielle du babouin (Papio hamadryas) et expositions repetees aux accelerations +Gz soutenues et de haut niveau
SIGLECNRS-CDST / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc
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