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Rilpivirine (Edurant, Eviplera) for HIV-infections: Overview

Rilpivirine has been approved in Germany since November 2011 as a single agent (trade name: Edurant) and in a fixed combination with emtricitabine and tenofovir (trade name: Eviplera) for treatment of HIV type 1 infection in some adults.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 31, 2014

Rilpivirine (Edurant, Eviplera) for HIV-infections: Initial treatment: Rilpivirine in combination with other agents

The agent efavirenz in combination with two other agents is the common initial treatment for patients with HIV. Emtricitabine and tenofovir are two possible agents for this treatment.In early 2012, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) assessed the benefit of rilpivirine (trade name: Edurant) in combination with two other agents compared to efavirenz in combination with two other agents. 815 patients were included in the studies. About three quarters of them received the combination of emtricitabine and tenofovir, about one quarter received zidovudine and lamivudine. Only a few patients were given abacavir and lamivudine.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 30, 2014

Rilpivirine (Edurant, Eviplera) for HIV-infections: Initial treatment: Rilpivirine in fixed combination with emtricitabine/tenofovir

The agent efavirenz in combination with two other agents is the common initial treatment for patients with HIV. Emtricitabine and tenofovir are two possible agents for this treatment.In early 2012, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) assessed the benefit of rilpivirine in combination with emtricitabine/tenofovir (trade name: Eviplera) in comparison to efavirenz in combination with emtricitabine/tenofovir. The assessment was based on three studies.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 30, 2014

Dolutegravir (Tivicay) for HIV infection: Dolutegravir for additional treatment in adults with HIV infection

In the spring of 2014 the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) assessed which advantages and disadvantages dolutegravir has compared with previous standard therapies in people who have already had medical treatment for HIV. One study was available to IQWiG for the purpose of this assessment. This study involved adults with HIV who had already had HIV therapy and were resistant to at least two HIV drugs.Participants in the study were divided into two groups. One group used dolutegravir, and the other was given the drug raltegravir. Both groups also received two additional drugs to treat HIV which were selected based on individual needs. A total of 724 people participated in this study and all data was analyzed after 48 weeks.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 15, 2014

Dolutegravir (Tivicay) for HIV infection: Dolutegravir for first treatment in adults with HIV infection

In the spring of 2014 the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) assessed which advantages and disadvantages dolutegravir has compared with previous standard therapies in people who are having initial treatment for HIV. The assessment was based on two relevant studies comparing dolutegravir with efavirenz. One study compared two groups who took both dolutegravir and a fixed combination of either abacavir / lamivudin or tenofovir / emtricitabin. In the other study, one group used dolutegravir with the fixed combination of abacavir / lamivudin, while the other group was given the fixed combination of efavirenz / tenofovir / emtricitabin.The first study included 103 people in its analysis, and the second study involved 844 participants. The study data were analyzed after 96 weeks.The following results apply to people who have not yet taken any other medication to treat HIV.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 15, 2014

Dolutegravir / abacavir / lamivudine fixed combination (Triumeq) for HIV: Dolutegravir / abacavir / lamivudine for initial treatment in adults with HIV infection

In 2014 the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) assessed which advantages and disadvantages dolutegravir / abacavir / lamivudine has compared with previous standard therapies in people who are having initial treatment for HIV. A study looking at efavirenz provided results which were used for a comparison of the two drugs. The patient group that was treated using efavirenz also received the fixed combination tenofovir / emtricitabine.A total of 844 people participated in the study, with one half of them receiving dolutegravir / abacavir / lamivudine and the other half efavirenz / tenofovir / emtricitabine. All data was analyzed after 20 months.The following results apply to people who have not yet taken any other medication to treat HIV.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 2, 2015

Nonoxynol‐9 for preventing vaginal acquisition of HIV infection by women from men

The spermicide nonoxynol‐9 does not prevent women becoming infected with sexually transmitted infections, and when used very frequently has been shown to cause open genital sores (which may theoretically increase the chance of acquiring sexually transmitted HIV infection).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Prevention of diarrhoea in children with HIV infection or who were born to an HIV‐infected mother

Diarrhoea is a common cause of illness in children, especially in low and middle‐income countries where it accounts for nearly 2.5 million deaths per year. Infants and children with HIV infection or maternal exposure through birth or breastfeeding to HIV infection may be more vulnerable to diarrhoea due to weakened immune systems, nutritional deficiencies or from having other infections. This review evaluated three interventions to assess whether they can prevent death or illness from diarrhoea in infants and children with HIV infection or exposure: vitamin A, zinc and cotrimoxazole. Vitamin A and zinc may correct micronutrient deficiencies that are prevalent in children with HIV infection or exposure, as well as prevent other infections. Cotrimoxazole is an antibiotic that helps prevent opportunistic infections in immunocompromised hosts, and may also prevent other infections. This review found nine studies that addressed these interventions in infants or children with HIV infection.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Using condoms consistently reduces sexual transmission of HIV infection

Sexual intercourse and contact with contaminated blood products (e.g., intravenous drug use) account for the majority of HIV infections. The wearing of condoms during sexual intercourse has been promoted to reduce the infection and spread of sexually transmitted infections (STIs) such as HIV. The review of studies found that condoms, when used consistently, substantially reduced HIV infection but did not totally eliminate the risk of infection.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

The majority of children with HIV infection live in low‐income countries without access to antiretroviral drugs.

One study fulfilled the inclusion criteria for this review. This was a well‐conducted trial of good methodological quality. It shows a significant reduction in mortality in children between the ages of 1 and 15 years, taking cotrimoxazole in comparison to placebo. Using cotrimoxazole in HIV‐infected children waiting for antiretroviral treatment, or not yet requiring it, may increase survival and reduce the number of days spent in hospital.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Vaginal disinfection for preventing mother‐to‐child transmission of HIV infection

Mother‐to‐child transmission (MTCT) of HIV is the primary way that children become infected with HIV. More than 2000 children worldwide are infected in this way every day. Researchers theorized that disinfecting the vaginal area of HIV‐infected pregnant women would make it less likely that their babies would be born with HIV. The primary objective of this review of clinical and randomised studies is to estimate the effect of vaginal disinfection during labour on the risk of mother‐to‐child transmission of HIV infection in HIV infected women. The secondary objectives are to determine the effect of vaginal disinfection on infant and maternal mortality and morbidity, and to describe its side effects to the mother and the new baby.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Vitamin A supplementation for reducing the risk of mother‐to‐child transmission of HIV infection

Mother‐to‐child transmission (MTCT) of HIV is the primary way that children become infected with HIV. More than 1000 children worldwide are infected in this way every day. Researchers theorized that giving vitamin A supplements to HIV‐infected pregnant or breastfeeding women might make it less likely that their children would be infected with HIV. The primary objective of this review of randomised studies is to estimate the effect of vitaminA supplementation during pregnancy and/or breastfeeding on the risk of mother‐to‐child transmission of HIV infection. The secondary objectives are to estimate the effect of vitamin A supplementation on infant and maternal mortality and morbidity, and to describe any side effects for the mother and the new baby.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

The use of the telephone to improve the health of people with HIV infection

The aim of this review was to assess the effectiveness of using the telephone to deliver interventions to improve the health of PLHIV compared to standard care. A comprehensive search of various scientific databases and other resources found 11 relevant studies. All of the studies were performed in the United States, and so the results may not apply to other countries, particularly developing countries. Some studies were aimed at any HIV positive person in the area in which the study was carried out, and others focused on specific groups of people, such as young substance using PLHIV, or older PLHIV. There were a lot of differences in the types of telephone interventions used in each study. There was some evidence that telephone interventions can improve medication adherence, reduce risky sexual behaviour, and reduce symptoms of depression in PLHIV. However, there were also a number of studies that suggested that telephone interventions were no more effective than usual care alone. We need more studies conducted in different settings to assess the effectiveness of telephone interventions for improving the health of PLHIV.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Abstinence‐only programs for preventing HIV infection in high‐income countries (as defined by the World Bank)

Abstinence‐only programs are widespread and well‐funded, particularly in the United States and countries supported by the US President's Emergency Plan for AIDS Relief. On the premise that sexual abstinence is the best and only way to prevent HIV, abstinence‐only interventions aim to prevent, stop, or decrease sexual activity. These programs differ from abstinence‐plus designs: abstinence‐plus programs promote safer‐sex strategies (e.g., condom use) along with sexual abstinence, but abstinence‐only programs do not, and instead often highlight the limitations of condom use. An up‐to‐date review suggests that abstinence‐only programs do not affect HIV risk in low‐income countries; this review examined the evidence in high‐income countries.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Population‐based interventions for reducing HIV infection

Community‐ or population‐based sexually transmitted infection control does not appear to be an effective HIV prevention strategy in most settings. In the early 1990s, improved STI treatment services were shown to reduce HIV incidence in northern Tanzania, in an environment characterised by an emerging HIV epidemic, where STI treatment services were poor and where STIs were highly prevalent. Subsequent trials, however, failed to confirm these findings and also failed to show a substantial benefit for community‐wide presumptive treatment for STIs. This is likely due to the endemic nature of HIV and relatively low incidence of STIs in these populations. There are, however, other good reasons as to why STI treatment services should be strengthened and the available evidence suggests that when an intervention is applied and accepted in a community, it can improve the quality of services provided. The trial in Masaka District, Uganda showed an increase in the use of condoms, a marker for less risky sexual behaviours, although a newer study by Gregson conducted in Zimbabwe suggested no effect. With the last three trials having shown disappointing results with respect to HIV prevention, it is unlikely that further community trials will be conducted, let alone yield different results. Future trials of biomedical interventions that involve individual randomisation, however, may represent an opportunity to reexamine presumptive treatment of STIs. Such trials should also aim to measure a range of factors that include health‐seeking behaviour and quality of treatment, as well as HIV, STI and other biological endpoints.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Interventions for the prevention and management of oral thrush associated with HIV infection in adults and children

Oral candidiasis (thrush) associated with human immunodeficiency virus (HIV) infection occurs commonly and recurs frequently, often presenting as an initial manifestation of the disease. Interventions aimed at preventing and treating HIV‐associated oral thrush form an integral component of maintaining the quality of life for affected individuals. This review evaluated the effects of interventions in preventing or treating oral thrush in children and adults with HIV infection. Thirty three trials (n=3445) were included. Twenty two trials investigated treatment and eleven trials investigate prevention. There was no difference with regard to clinical cure between fluconazole compared to ketoconazole, itraconazole, clotrimazole and posaconazole. Fluconazole, gentian violet and ketoconazole were superior to nystatin. Compared to placebo and no treatment, fluconazole was effective in preventing clinical episodes from occurring. Continuous fluconazole was better than intermittent treatment. Insufficient evidence was found to come to any conclusion about the effectiveness of clotrimazole, nystatin, amphotericin B, itraconazole, ketoconazole or chlorhexidine with regard to OC prophylaxis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Antihelminthics in helminth endemic areas: effects on HIV infection

This Cochrane Review summarizes trials that evaluated the benefits and potential risks of providing deworming drugs (antihelminthics) to people infected with human immunodeficiency virus (HIV). After we searched for relevant trials up to 29 September 2015 we included eight trials that enrolled 1612 participants.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Therapy for treating HIV infection in pregnant women who require treatment for their own health

Pregnant human immunodeficiency virus‐infected (HIV)‐infected women often need treatment with antiretroviral therapy (ART) for their own health. Mother‐to‐child transmission (MTCT) is the most common way that children worldwide become HIV infected. Treatment of HIV‐infected pregnant women with ART decreases the risk of HIV MTCT. It is possible to decrease the risk of MTCT to 1‐2% with the use of antiretroviral medications, caesarean section before labour begins, and avoiding breastfeeding. When women who require HIV treatment for the benefit of their own health become pregnant, we need to know the most effective therapy, the impact of the drug on the MTCT of HIV, and what the potential complications of the therapy might be for both the mother and her unborn child.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Antiretrovirals for reducing the risk of mother‐to‐child transmission of HIV infection

At the end of 2009, 2.5 million children under the age of 15 years were estimated to be living with HIV/AIDS (WHO 2011). The majority of these children acquired their infections as a result of mother‐to‐child transmission during pregnancy, labor, or breastfeeding. Antiretroviral drugs administered to the HIV‐infected mother and/or to her child during pregnancy, labor, or breastfeeding can reduce mother‐to‐child transmission of HIV. The objective of this review is to determine whether a regimen of antiretroviral drugs leads to a significant reduction in HIV transmission during pregnancy and labor without serious side‐effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

A daily low dose of cotrimoxazole for preventing opportunistic infections in adults with HIV

Cotrimoxazole helps to prevent infections in adults who are HIV‐infected but may increase resistance to the drug and more trials are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

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