Dolutegravir (DTG) is widely recommended within three-drug regimens. However, similar efficacy and tolerability have also been achieved with DTG within two-drug regimens in clinical trials. This study evaluated the real-world effectiveness and discontinuations in people living with HIV-1 (PLHIV) switching to DTG with lamivudine (3TC) or rilpivirine (RPV). MethodsThis was a one-arm meta-analysis utilizing data from a systematic literature review. Data from real-world evidence studies of DTG + RPV and DTG + 3TC were extracted, pooled and analysed. The primary outcome was the proportion of patients with viral failure (VF; ≥ 50 copies/mL in two consecutive measurements and/or ≥ 1000 copies/mL in a single measurement) at week 48 (W48) and week 96 (W96). Other outcomes included virological suppression (VS; < 50 copies/mL) and discontinuations (W48 and W96). Estimates were calculated for VF, VS as per snapshot (VSS) and on treatment analysis (VSOT), and discontinuations. ResultsPooled mean estimates of VF for DTG + 3TC and DTG + RPV were 0.8% [95% confidence interval (CI): 0.4-1.3] and 0.6% (95% CI: 0.0-1.6), respectively, at W48. VSS rate at W48 was 85.0% (95% CI: 82.3-87.5) for DTG + 3TC regimen and 92.4% (95% CI: 85.0-97.7) in the DTG + RPV regimen. The DTG + 3TC and DTG + RPV regimens led to discontinuations in 13.6% (95% CI: 11.1-16.2) and 7.2% (95% CI: 2.1-14.4) of patients, respectively, at W48. Similar results were observed at W96. ConclusionsTreatment with DTG + 3TC or DTG + RPV in clinical practice provides a low rate of VF and a high rate of VS when initiated in virologically suppressed PLHIV with diverse backgrounds.

SUMMARY:Third branchial cleft cysts (BCCs) are rare entities that represent abnormal persistence of the branchial apparatus. On CT examination, these cysts appear as homogeneous low-attenuation masses with well-circumscribed margins; on MR imaging, they demonstrate variable signal intensity on T1-weighted images and are hyperintense relative to muscle on T2-weighted images. Definitive treatment is surgical excision. We present a case of a third BCC and describe its diagnosis and treatment. Most cases of third branchial cleft cysts (BCCs) are diagnosed in childhood and show a marked preference for the left side (97%).1 Prenatal diagnosis is uncommon. Here, we present an example of this rare anomaly that was diagnosed prenatally. The embryologic development and radiologic evaluation of third BCCs are discussed. Case ReportA female neonate was delivered by planned cesarean delivery at 34 weeks' gestation on the basis of the presence of a neck mass resolved by prenatal ultrasonography, consistent in location with a type 3 BCC. At delivery, physical examination revealed no tracheal abnormalities, fistulas, or neck masses, but intraoral examination showed fullness of the posterior oropharynx on the left side. MR imaging examination demonstrated a large cystic structure in the retropharyngeal space, extending from the nasopharynx through the thoracic inlet (Fig 1). On direct laryngoscopy, palpation of the neck produced clear fluid from an opening at the inferior aspect of the left pyriform sinus, and a left type 3 BCC was diagnosed. Cauterization of this opening was performed; however, postoperatively the mass failed to resolve. On day of life (DOL) #22, intraoperative sonography-guided drainage of the cyst was performed for decompression and produced straw-colored fluid and air. Definitive resection was completed on DOL #36. The surgical procedure included a left thyroid lobectomy and excision of a 3 ϫ 3-cm cystic mass adherent to the left thyroid lobe with a tract entering the pyriform sinus. Pathologic evaluation was consistent with a BCC (Fig 2). DiscussionMost cystic lesions in infants and children are congenital or developmental in origin and reflect aberrancies in embryogenesis. The differential diagnosis most commonly includes thyroglossal duct (TGD) cysts, lymphatic malformations (LMs), and BCCs. The appropriate radiologic evaluation for these masses depends on their location, extent, and presumed consistency (cystic vs solid). To determine consistency, ultrasonography offers many advantages: it does not require sedation, does not expose the patient to radiation, and can determine easy establishment of whether the lesion is solid or cystic. CT scanning and MR imaging are preferred when the lesion is extensive or when it crosses multiple anatomic spaces. 2 A TGD cyst usually presents as a palpable, nontender midline neck mass that elevates with swallowing or protrusion of the tongue. Ultrasonography is the imaging technique of choice for these lesions, which will have a variable appearance (anechoic, homogeneou...

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A systematic search was conducted using PubMed, Embase, and Cochrane for real-world studies (January 2014 to February 2019) following PRISMA guidelines. Cross-references were checked to identify studies post 2009, with ongoing status. Results: Of 2,838 screened articles, 42 met the inclusion criteria. Observed adherence ranged between 69%-98% in the US, 57%-96% in European, 62%-93% in African, 79%-80% in Latin and 66%-98% in Asian population. Most of the studies indicated a positive correlation between adherence and VS, consistent across all geographies, irrespective of adherence-thresholds (90-95%) and treatment class. Across all ARTs, the odds of detectable viral load (.400 copies/ml) for different adherence levels range as follows: 95-99%: 1.5 (1.2-1.9); 90-94%: 2.0 (1.5-2.8); ,90%: 4.1 (3.1-5.4). The impact of adherence also varies as per the treatment class. For unboosted-PIs, patients with adherence $95% were 1.6 times and 7.7 times more likely to achieve viral-suppression than those with adherence between 75%-95% and ,75% respectively. For INSTIs, patients with adherence $95% were 1.1 times and 4 times more likely to achieve viral-suppression than those with adherence between 75%-95% and ,75% respectively. Main determinants of non-adherence were alcohol/ substance use (p,0.005) apart from gender, age, comorbidities and polypharmacy. Naïve patients seemed to be more adherent than the experienced patients. Conclusions: Adherence levels of 90-95% seem to maximise the possibility of achieving sustained viral suppression with clinically significant improvements. Interventions to improve adherence in HIV patients with alcohol/substance use are deemed desirable.

BACKGROUND Lesions of a cystic nature have long been described in relation to the bones of the face. Over the course of the last four hundred years, such entities have been identified and studied in great detail; the evolution of systems of classification, the knowledge regarding the true nature of such phenomena, and the different ways of treating such maladies of the face have all undergone vast transformation since the 19th century. The introduction and development of anaesthetics, both general and regional, helped broaden the types of approaches to cysts of the orofacial region. Therapies of a conservative nature could be studied in greater detail with a larger population of patients, with the long term outcomes of such procedures yielding a significant amount of data, which in turn helped contrast such forms of management against more extensive and often radical procedures. Controversy has long surrounded the treatment of Dentigerous Cysts. Older techniques that had fallen out of favour amongst practicing surgeons returned decades later as serious contenders for becoming the treatment of choice for this particular pathology, the Partsch I technique being a prime example. The employment of the scientific method, conscientious effort towards ethics, and diligent recording of findings - whether prior to the surgical procedure or in the immediate and late post operative periods - all aided in the provision of a pool of knowledge that was made available to students and practitioners alike, providing clarity in the midst of opposing theories, guiding them in the selection of an appropriate treatment in response to cysts. Revolutions in medical imaging technology helped refine this process and will continue to serve the surgeon greatly in the pursuit of a treatment modality that is tailored to the needs of the patient and the demands of the lesion. Dentigerous cysts are anomalies that have been frequently encountered by practitioners, and the treatment for the same has long been discussed. The purpose of this paper was to review the existing evidence in relation to the management of Dentigerous Cysts, and to highlight in particular the efficacy of decompression amongst paediatric patients. We conducted a narrative review of literature using electronic databases such as Pubmed, Scopus, and Google Scholar involving studies with data on the modes of management of Dentigerous Cysts. The list of included studies was reviewed to find more significant articles for relevant evidence. KEY WORDS Dentigerous Cyst, Enucleation, Marsupialization