IHP news 473: infectious diseases & NTDs

By on June 8, 2018

Lancet HIV – Community-level changes in condom use and uptake of HIV pre-exposure prophylaxis by gay and bisexual men in Melbourne and Sydney, Australia: results of repeated behavioural surveillance in 2013–17


A study assesses the behavioural changes in the use of condoms by gay and bisexual men with the introduction of pre-exposure prophylaxis (PrEP) for HIV prevention in Australia.”

They aren’t very good…

For coverage of this new study, see The GuardianRapid rise in anti-HIV PrEP pills linked to drop in condom use.

Lancet (Editorial) – Dolutegravir for HIV: a lesson in pregnancy safety research


Editorial related to a study published on 4 June in the Lancet Global Health, which concluded: “Adverse birth outcomes were similar among pregnant women who initiated dolutegravir-based and efavirenz-based ART. Dolutegravir-based ART can be safely initiated in pregnancy.

“…The Botswana study highlights the importance of pregnancy safety research. Systematic birth surveillance—both of livebirths and stillbirths, with sufficient power and appropriate comparator groups—needs to be put in place before a new drug is rolled out. The global medical community also needs a better approach to test drug safety profiles in pregnant women, for treatment of HIV and beyond.”

Lancet Global Health – In-utero ART exposure and the need for pharmacovigilance

L Mofenson; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30272-9/fulltext

In 2016, the PROMISE trial demonstrated the remarkable efficacy of antiretroviral treatment (ART) during pregnancy and breastfeeding to reduce perinatal and postnatal transmission in Africa—from 37% in the absence of treatment to 1·1% at age 18 months—and to provide clinical benefit to the mother.  ART use by pregnant women living with HIV has resulted in a paradigm shift in the paediatric HIV epidemic in the past 20 years, with a striking 80% decrease in new infant infections, down from 590 000 in 1998 to 120 000 in 2016. … … However, although the benefits of treatment are clear, the crucial need for pharmacovigilance to assess for potential adverse effects of new agents, particularly on pregnancy outcome, birth defects, and exposed infants, has been relatively neglected.”

“…In The Lancet Global Health, Rebecca Zash and colleagues report preliminary results from a carefully conceived and well conducted birth surveillance programme in Botswana that was designed to fill a major gap in the evaluation of safety of antiretroviral drugs in pregnancy…” This is the related Comment.

“…This recent finding illustrates the importance of having a pharmacovigilance system in place as new drugs are introduced into the adult population to enable evaluation of potential effects of drug exposure prior to recognition of pregnancy in women of childbearing age. The Tsepamo study provides a model of a such a programme; in Uganda and Malawi, similar programmes have been put into place through funding from the US President’s Emergency Plan for AIDS Relief. The study by Zash and colleagues reminds us that although ART has great benefits, including prevention of perinatal transmission and saving mothers’ lives, surveillance systems to enable early detection of signals of potential adverse effects are needed to assess safety of new drugs in pregnancy and women of childbearing age.”

Lancet World Report –Resolution on snakebite envenoming adopted at the WHA


Experts say that this will bring snakebite envenoming, which affects an estimated hundreds of thousands every year, to the international agenda. Talha Burki reports.”

NYT – Nipah Virus, Rare and Dangerous, Spreads in India


“The infection, an emerging threat, has killed virtually all of its victims so far in India.” The picture so far (as of 4 June).

And a few quick links:

The ConversationKenya must wake up to the threat of an outbreak of Rift Valley fever

The GuardianThe US has an HIV epidemic – and its victims are gay black men

If white men were being infected at the horrifying rate that African-Americans are, it would be front-page news.” “There is an epidemic of HIV/Aids in the United States, and the reason you may not have heard about it is because of who it harms: black men who have sex with other men.”


Guardian – Antibiotic apocalypse: EU scraps plans to tackle drug pollution, despite fears of rising resistance


The EU has scrapped plans for a clampdown on pharmaceutical pollution that contributes to the spread of deadly superbugs. Plans to monitor farm and pharmaceutical companies, to add environmental standards to EU medical product rules and to oblige environmental risk assessments for drugs used by humans have all been discarded, leaked documents seen by the Guardian reveal….”

Cidrap – WHO aims to build health worker knowledge of antimicrobial stewardship


The World Health Organization, following up on its 3-year-old action plan to fight antimicrobial resistance (AMR), yesterday released guidance to help ensure that health workers have the knowledge and skills they need for that effort. The guidance is a 28-page document titled WHO Competence Framework for Health Workers’ Education and Training on Antimicrobial Resistance. It is intended mainly for education and training institutions, accreditation and licensing bodies, and authorities that make health policy….”

Reuters – Scientists map genetic codes of 3,000 dangerous bacteria


Scientists seeking new ways to fight drug-resistant superbugs have mapped the genomes of more than 3,000 bacteria, including samples of a bug taken from Alexander Fleming’s nose and a dysentery-causing strain from a World War One soldier….”

CIDRAP – Report: US pigs consume nearly as many antibiotics as people do


“A report today from the Natural Resources Defense Council (NRDC) is taking the US pork industry to task for irresponsible use of medically important antibiotics, saying the amount of antibiotics used in pigs is nearly the same as that used to treat humans. The report estimates that 27.1% of all medically important antibiotics sold in the United States are for pig production, while a roughly equivalent amount—27.6%—is sold for use in human medicine. The report suggests that the heavy use of antibiotics in pigs is primarily for disease prevention, a practice the NRDC says is unnecessary. … … The report also points out that US pork producers use more antibiotics than do pork producers in other developed nations. Using a methodology that enables comparison between countries with pork industries of different sizes, NRDC calculated that US producers use twice the antibiotics per kilogram of pig as are used in the United Kingdom, and more than seven times the amount used in Denmark and the Netherlands….”

PS: No idea how much antibiotics the US “Pig-in-chief” uses on a daily basis, but I guess that botoxed orange skin also needs a fair bit of maintaining.  

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