Tenofovir DF Plus Lamivudine or Emtricitabine for Nonoccupational Postexposure Prophylaxis (NPEP) in a Boston Community Health Center

Mayer, Kenneth H.; Mimiaga, Matthew J.; Cohen, Daniel E.; Grasso, Chris; Bill, Ronn; VanDerwarker, Rodney; Fisher, Alvan

doi:10.1097/qai.0b013e318162afcb

Cited by 64 publications

(56 citation statements)

References 16 publications

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“…The impressive strides that have been made recently in the effort to prevent HIV through pre-exposure prophylaxis (PrEP) [26,27], post-exposure prophylaxis (PEP) [28,29], and treatment as prevention [30,31] will be useless if there is not uptake by those most at risk. Real world effectiveness of biomedical prevention methods will be greatly served if we are able to understand and promote resilience factors that contribute to uptake and adherence.…”

Section: Incorporating a Resilience Framework Into Research Among Gaymentioning

confidence: 99%

Resilience as a Research Framework and as a Cornerstone of Prevention Research for Gay and Bisexual Men: Theory and Evidence

et al. 2013

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This commentary presents the content and results of a recent symposium held to discuss how resiliencies among gay and bisexual men, and other men who have sex with men, could inform HIV prevention interventions. We outline the argument for including resiliencies in prevention work and present a critique of the deficitbased approached to public health research as it applies to this line of inquiry. The commentary makes the case that HIV prevention work would be more efficacious if it were designed to incorporate naturally occurring resiliencies that manifest among gay male communities rather than primarily using interventions that address vulnerabilities among men who continue to reside in high risk contexts. The commentary concludes by listing a set of resiliency variables and constructs proposed at the meeting that could be tested in theoretically-based investigations to raise resiliencies among gay and bisexual men thereby lowering HIV risks in this population.Keywords Resilience Á MSM health Á Gay and bisexual men Á TheoryIn the summer of 2011, The Fenway Institute of Boston and the University of Pittsburgh Center for Lesbian, Gay, Bisexual and Transgender (LGBT) Health Research convened a meeting of many of the thought leaders in the field of Gay and Bisexual men's health to discuss how resilience among gay and bisexual men, and other men who have sex with men (henceforth referred to simply as gay and bisexual men), could inform HIV prevention interventions. The idea behind the meeting was to outline ways in which resiliencies could be used to move the field forward towards the abatement or elimination of health disparities within this population. The primary goals of this meeting were to raise interest in the study of resilience as a way to improve health outcomes among gay and bisexual men, to learn from community-based programs that were already using resilience-based approaches in their work, and to begin conceptualizing how researchers could adapt and use a resilience-based framework in their study of HIV and other health disparities in gay and bisexual men. We also critically reviewed deficit-based approach to health, focusing on assumptions underlying these methods.Relative to the field of prevention research, communitybased organizations for gay and bisexual men have better recognized that focusing on strengths, resilience, and other protective factors can bring about positive individual and community-level results. However, few community programs have had the resources to test or evaluate their work. To begin to bridge this divide, the meeting organizers brought together leaders in research as well as key informants from resilience-based community programs including Manifest Love, the Harlem United Community AIDS Center (www.harlemunited.org), Easton Mountain (www. eastonmountain.com), Life Lube (www.lifelube.org), and others who have already been using strength-based approaches to promote health among gay and bisexual men. After a day of sharing methods, challenges, questions and results f...

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Section: Incorporating a Resilience Framework Into Research Among Gaymentioning

confidence: 99%

Resilience as a Research Framework and as a Cornerstone of Prevention Research for Gay and Bisexual Men: Theory and Evidence

et al. 2013

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“…Geralmente, todos esses efeitos são de intensidade leve a moderada e autolimitados, como observado no caso relatado, devendo ser recomendado apenas o uso de medicamentos sintomáticos, quando necessário. Ainda assim, a taxa de descontinuação dos antirretrovirais devido a eventos adversos nos estudos de PEP tem variado de 11,7 a 21% [6][7][8] . As alterações laboratoriais são geralmente discretas, transitórias e pouco frequentes 3 .…”

Section: Discussionunclassified

“…Nesses casos, convém que o médico do trabalho consulte um especialista quanto à necessidade de substituição do TDF. Embora dois estudos de tolerabilidade da PEP contendo TDF não tenham demonstrado aumento dos níveis de creatinina nos indivíduos expostos 6,7 , há relato de insuficiência renal aguda e síndrome de Fanconi em uma pessoa previamente hígida após 16 dias do início da PEP contendo TDF e um inibidor de protease potencializado com RTV 12 . Deve-se considerar também o risco de exacerbação aguda grave da hepatite após término da profilaxia com TDF e 3TC quando o trabalhador exposto tiver infecção pelo vírus da hepatite B. Entretanto, o início da PEP não deve ser retardado se o status sorológico do trabalhador não for conhecido.…”

Section: Discussionunclassified

Efeitos adversos da profilaxia antirretroviral após exposição ocupacional ao HIV

Alverca¹,

Quixabeiro²,

Martins³

2018

Rev. Bras. Med. Trab.

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RELATO DE CASORESUMO | A exposição ocupacional a material biológico com risco de transmissão do vírus da imunodeficiência humana (HIV) constitui uma emergência médica. A profilaxia pós-exposição (PEP) deve ser iniciada precocemente e mantida por 28 dias. Desde julho de 2015, o Ministério da Saúde passou a recomendar o uso combinado de três drogas antirretrovirais para a PEP, menos tóxicas e melhor toleradas do que as usadas anteriormente. Apesar disso, quase metade dos expostos em uso da PEP apresenta efeitos adversos. Geralmente, eles são leves e autolimitados. Os mais comuns são alterações gastrointestinais, astenia, cefaleia e tontura. Entretanto, eventos mais graves já foram observados e a taxa de interrupção da profilaxia permanece elevada. Em 2017, o Ministério da Saúde modificou o esquema de primeira linha da PEP, substituindo o terceiro antirretroviral. Esse artigo relata um caso de toxicidade associada ao uso da PEP após exposição ocupacional a material biológico contaminado pelo HIV, traz a revisão dos potenciais efeitos adversos das drogas antirretrovirais que compõem o esquema profilático preconizado pelo Ministério da Saúde e discute a conduta do médico do trabalho diante dessas complicações. Palavras-chave | exposição ocupacional; profilaxia pós-exposição; efeitos colaterais e reações adversas relacionados a medicamentos; antirretrovirais.ABSTRACT | Occupational exposure to biological materials involving risk of human immunodeficiency virus (HIV) transmission is a medical emergency. Post-exposure prophylaxis (PEP) should be started early and administered for 28 days. Since July 2015, the Brazilian Ministry of Health recommends the combined use of three antiretroviral drugs for PEP, which are less toxic and better tolerated than the ones previously used. Nevertheless, almost half of the exposed individuals under PEP exhibit adverse effects, which are usually mild and self-limited. The most frequent adverse events are gastrointestinal disorders, asthenia, headache and dizziness. However, more severe events have been reported, and the rate of non-completion of prophylaxis remains high. In 2017, the Brazilian Ministry of Health modified the first-line PEP regimen involving replacement of the third antiretroviral drug. The present article reports a case of toxicity associated with PEP following an occupational accident involving exposure to HIV infected biological material. In addition, we review the potential adverse effects of antiretroviral drugs included in the prophylactic regimens recommended by the Brazilian Ministry of Health and discuss measures occupational physicians should adopt vis-à-vis these complications.

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“…9 No seroconversions were reported in this study, and tenofovir is now widely used in postexposure prophylaxis regimens.…”

Section: Antiretroviral Medication For Preventing Hiv Infection In Nomentioning

confidence: 98%

“…Efavirenz is not usually used because of the neuropsychiatric adverse effects that are common during the first two to four weeks of therapy. 9 Commonly used two-drug regimens include tenofovir plus emtricitabine, which can be given together as a once daily combination pill with few adverse effects ( Table 2). 9 If a third drug is added, protease inhibitors, such as lopinavir, atazanavir or darunavir, all boosted with ritonavir, are commonly used.…”

Section: When Should Postexposure Prophylaxis Start?mentioning

confidence: 99%

Antiretroviral medication for preventing HIV infection in nonoccupational settings

Bogoch

Scully

Zachary

2012

CMAJ

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Tenofovir DF Plus Lamivudine or Emtricitabine for Nonoccupational Postexposure Prophylaxis (NPEP) in a Boston Community Health Center

Cited by 64 publications

References 16 publications

Resilience as a Research Framework and as a Cornerstone of Prevention Research for Gay and Bisexual Men: Theory and Evidence

Resilience as a Research Framework and as a Cornerstone of Prevention Research for Gay and Bisexual Men: Theory and Evidence

Efeitos adversos da profilaxia antirretroviral após exposição ocupacional ao HIV

Antiretroviral medication for preventing HIV infection in nonoccupational settings

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